scholarly journals Intrahepatic Cholestasis of Pregnancy: Natural History and Current Management

2021 ◽  
Author(s):  
Rebecca Roediger ◽  
Jaquelyn Fleckenstein
Keyword(s):  
Adverse Effects ◽  
Intrahepatic Cholestasis ◽  
Elevated Serum ◽  
Reproductive Hormones ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Current Management ◽  
Immune Mediated ◽  
Increased Risk ◽  
Fetal Complications ◽  
Cholestasis Of Pregnancy

AbstractIntrahepatic cholestasis of pregnancy (ICP) is a common disorder in the second half of pregnancy characterized by pruritus and elevated serum bile acids (BAs) with spontaneous resolution after delivery. ICP carries a risk of adverse effects on the fetus which correlates with the degree of BA elevation. ICP occurs in genetically susceptible women as the reproductive hormones increase during pregnancy. Ursodeoxycholic acid is still considered the first-line treatment for ICP though it is of unproven benefit in preventing adverse effects on the fetus. Fetal complications, such as stillbirth, increase with gestational age, so preterm delivery is generally performed in cases of severe ICP, defined as BA levels above 40 μmol/L. ICP may recur in future pregnancies and is associated with an increased risk for future hepatobiliary, immune mediated, and cardiovascular diseases. Children born of mothers with ICP have normal development but may have a risk for subsequent metabolic disease.

Fetal complications due to intrahepatic cholestasis of pregnancy

2015 ◽  
Vol 43 (2) ◽  
Author(s):  
Patrik Šimják ◽  
Antonín Pařízek ◽  
Libor Vítek ◽  
Andrej Černý ◽  
Karolína Adamcová ◽  
...  
Keyword(s):  
Intrahepatic Cholestasis ◽  
Current Knowledge ◽  
Elevated Serum ◽  
Liver Function Tests ◽  
Liver Disorder ◽  
Intrauterine Fetal Death ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Management Options ◽  
Fetal Complications ◽  
Cholestasis Of Pregnancy

AbstractIntrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder of pregnancy. Diagnosis is based on the clinical picture, particularly the presence of pruritus with a deterioration of liver function tests, and typically elevated serum levels of total bile acids. ICP manifests in the second half of pregnancy, predominantly during the third trimester. Symptoms of the disease resolve spontaneously after delivery. Etiology is still not fully understood. Genetic defects in specific transport proteins, elevated levels of sex hormones, and various environmental factors are thought to play a role in the development of this disorder. Although practically benign for the pregnant woman, ICP represents a serious threat to the fetus. It increases the risk of preterm delivery, meconium excretion into the amniotic fluid, respiratory distress syndrome, and sudden intrauterine fetal death. Identifying fetuses at risk of ICP complications remains challenging. The ideal obstetrical management of ICP needs to be definitively determined. The aim of this review is to summarize the current knowledge on fetal complications of ICP and describe management options for their prevention.

scholarly journals The relationship of bile acid with biochemical tests in the diagnosis of intrahepatic cholestasis of pregnancy

2021 ◽  
Vol 38 (4) ◽  
pp. 485-489
Author(s):  
Cuma TAŞIN ◽  
Revan Sabri ÇİFTÇİ
Keyword(s):  
Bile Acid ◽  
Preterm Delivery ◽  
Sensitivity And Specificity ◽  
Intrahepatic Cholestasis ◽  
Control Group ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Biochemical Tests ◽  
Increased Risk ◽  
Fetal Complications ◽  
Cholestasis Of Pregnancy

Intrahepatic pregnancy cholestasis (ICP) is associated with increased fetal complications. It is linked to an increased risk. Early diagnosis of this disease reduces these fetal complications. In this study, it was aimed to determine the sensitivity and specificity of biochemical tests according to cut off values. The values of 14 patients with bile acid ≥40 μmol / L diagnosed with intrahepatic cholestasis of pregnancy and 40 patients with bile acid <40 μmol / L were compared retrospectively with 60 control patients. In ICP patients, the ALT and AST values in patients with group 1 with bile acid ≥40 μmol / L and group 2 with bile acid <40 μmol / L were significantly higher than the control group (p = 0.0001 for both markers). Groups 1 and 2 with ICP patients have high sensitivity and specificity compared to the cut off value of ALT and AST. In our study, it was found that increased the risk of preterm delivery in ICP patients. Especially in cases where bile acid was ≥ 40 μmol / L, complications such as preterm delivery and low birth weight increased in proportion to the increase in bile acid. In the ICP patients, AST and especially ALT values increased in proportion to the increase in bile acid.

Intrahepatic cholestasis of pregnancy and cancer, immune-mediated and cardiovascular diseases: A population-based cohort study

2015 ◽  
Vol 63 (2) ◽  
pp. 456-461 ◽  
Author(s):  
Elisabeth A. Wikström Shemer ◽  
Olof Stephansson ◽  
Marcus Thuresson ◽  
Malin Thorsell ◽  
Jonas F. Ludvigsson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiovascular Diseases ◽  
Intrahepatic Cholestasis ◽  
Population Based ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Immune Mediated ◽  
Cholestasis Of Pregnancy

Association of ABCB4 and ABCB11 nucleotide variants with intrahepatic cholestasis of pregnancy

2019 ◽  
Vol 88 (4) ◽  
pp. 209-217
Author(s):  
Milena Gruszczyńska-Losy ◽  
Adrianna Mostowska ◽  
Łukasz Adamczak ◽  
Paweł Jagodziński ◽  
Ewa Wender-Ożegowska ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Intrahepatic Cholestasis ◽  
Clinical Symptoms ◽  
Melting Curve ◽  
Liver Disorder ◽  
Melting Curve Analysis ◽  
Control Group ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Increased Risk ◽  
Cholestasis Of Pregnancy

Background: Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder during gestation. The exact pathogenesis of ICP is multifactorial and still unclear. Therefore, our study aimed to check whether the selected ABCB4and ABCB11nucleotide variants are associated with an increased risk of ICP. Methods:ICP was diagnosed based on clinical symptoms characteristic of this disease and confirmed by increase in serum bile acids and transaminases, spontaneous resolution of clinical symptoms and normalization of laboratory tests after delivery. The total of 86 pregnant women meeting the criteria were included into the study. Healthy pregnant women with uncomplicated pregnancy served as control group (n=310). Sixcommon nucleotide variants in theABCB11and ABCB4genes were genotypedwith the use of high-resolution melting curve analysis. Conclusion:Our study did not show any significant association of analysed ABCB4and ABCB11nucleotide variants with the increased risk of intrahepatic cholestasis of pregnancy.

scholarly journals Intrahepatic cholestasis of pregnancy

2021 ◽  
Vol 16 (S3) ◽  
pp. 50-55
Author(s):  
Ana Maria SCUTELNICU ◽  
◽  
Brînduşa Ana CIMPOCA-RAPTIS ◽  
Anca Marina CIOBANU ◽  
Nicolae GICĂ ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Intrahepatic Cholestasis ◽  
Perinatal Outcomes ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Fetal Asphyxia ◽  
Increased Risk ◽  
Adverse Perinatal Outcomes ◽  
Adverse Pregnancy ◽  
Cholestasis Of Pregnancy ◽  
Meconium Stained Amniotic Fluid

Intrahepatic cholestasis of pregnancy is the most common liver disease during pregnancy. The main features are maternal pruritus, in the absence of a rash, and raised serum bile acids. Intrahepatic cholestasis of pregnancy is associated with an increased risk of adverse perinatal outcomes, including preterm birth, meconium-stained amniotic fluid, fetal asphyxia with neonatal unit admission or even stillbirth. The main treatment option is ursodeoxycholic acid. We review the etiology, diagnosis, adverse pregnancy outcomes, focusing especially on management of this intriguing condition.

scholarly journals Influence of severity of total bile acids and mode of delivery on the perinatal outcomes in intrahepatic cholestasis of pregnancy

2021 ◽  
Author(s):  
Chengcai Kong ◽  
Fenglin Mei ◽  
Pingping Xue ◽  
Jingyun Cao ◽  
Yong Li ◽  
...  
Keyword(s):  
Bile Acids ◽  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Intrahepatic Cholestasis ◽  
Mode Of Delivery ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Fetal Outcomes ◽  
Increased Risk ◽  
Total Bile Acids ◽  
Cholestasis Of Pregnancy

Abstract To assess the associations between mode of delivery and pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy (ICP) based on the severity of maternal hypercholanemia. A hospital-based retrospective cohort study was performed between January 1, 2015, and December 31, 2019. Among the 177 women with mild total bile acids, 123 (69.5%) had a vaginal delivery and 54 (30.5%) underwent a cesarean delivery, of which 42 (23.7%) were planned and 12 (6.8%) were unplanned. Among the 50 severe ICP women, 13 (26.0%) had a vaginal delivery and 37 (74.0%) underwent a cesarean delivery, of which 26 (52.0%) were planned and 11 (22.0%) were unplanned. Severe ICP was associated with an increased risk of preterm delivery (P < 0.001), low birthweight (P=0.001), and neonatal intensive care unit admission (P < 0.001). Women with severe ICP (aOR, 5.017; 95% CI 1.848–13.622), planned cesarean delivery (aOR, 5.444; 95%CI 1.723–17.203), or unplanned cesarean delivery (aOR, 5.792; 95%CI 1.384–24.236) had increased risks of adverse fetal outcomes compared to controls. Both planned and unplanned cesarean delivery are associated with a higher incidence of adverse fetal outcomes and severe ICP than vaginal delivery.

The Role of Melatonin, IL-8 and IL-10 in Intrahepatic Cholestasis of Pregnancy

2020 ◽  
Author(s):  
Samettin Çelik ◽  
Huri Guve ◽  
Canan Çalışkan ◽  
Sebahattin Çelik
Keyword(s):  
Intrahepatic Cholestasis ◽  
Inflammatory Cytokine ◽  
Elevated Serum ◽  
Interleukin 10 ◽  
Interleukin 8 ◽  
Controlled Study ◽  
Control Group ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Cholestasis Of Pregnancy

Abstract Introduction Intrahepatic cholestasis of pregnancy is a pregnancy-specific liver disease that usually emerges during the third trimester of pregnancy. It is characterized by itching and elevated serum total bile acid levels, and it may lead to severe fetal complications. This study aimed to investigate the role of interleukin-8, a pro-inflammatory cytokine; interleukin-10, an anti-inflammatory cytokine; and melatonin in intrahepatic cholestasis of pregnancy. Materials and Methods This prospective, case-controlled study was conducted with 51 women with intrahepatic cholestasis of pregnancy (40 mild and 11 severe cases) and 43 healthy pregnant women. Serum interleukin-8, interleukin-10, and melatonin levels were evaluated. Results Melatonin and interleukin -10 were significantly lower in subjects with intrahepatic cholestasis of pregnancy (p=0.001; p=0.001, respectively p<0.05). Interleukin-8 levels were found to be significantly higher in the cholestasis group than control group (p=0.001, p<0.05). Conclusions Because interleukin-8, interleukin-10, and melatonin were found to be significantly correlated with intrahepatic cholestasis of pregnancy, we believe this finding could shed light on the etiology of the disease.

scholarly journals Intrahepatic Cholestasis in Pregnancy: Review of the Literature

2020 ◽  
Vol 9 (5) ◽  
pp. 1361
Author(s):  
Joanna Piechota ◽  
Wojciech Jelski
Keyword(s):  
Intrahepatic Cholestasis ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Serum Levels ◽  
Premature Delivery ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Perinatal Complications ◽  
Hepatic Disorder ◽  
Increased Risk ◽  
Cholestasis Of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is the most common hepatic disorder related to pregnancy in women. It usually develops within the third trimester of pregnancy and presents with pruritus as well as elevated levels of bile acid and/or alanine aminotransferase. Clinical signs quickly resolve after delivery; however, there is a high risk of the disorder recurring in subsequent pregnancies. ICP is associated with an increased risk of perinatal complications (premature birth, respiratory disorders, even stillbirth). Elevated levels of gestational hormones and genetic predispositions are important factors for the development of ICP; among the latter, mutations in hepatobiliary transport proteins (multidrug resistance protein 3-MDR3, bile salt export pump- BSEP) play a major role. Clinical and biochemical symptoms of ICP include pruritus and increased levels of total bile acids (TBA). Serum levels of TBA should be monitored in ICP patients throughout the pregnancy as concentrations above 40 μmol/L, which define that severe ICP isassociated with an increased risk of fetal complications. Therapeutic management is aimed at reducing the clinical symptoms, normalizing maternal biochemistry and preventing complications to the fetus. Pharmacological treatment of intrahepatic cholestasis of pregnancy consists of the administration of ursodeoxycholic acid to lower the levels of TBA and possibly reduce pruritus. If the treatment fails, premature delivery should be considered.

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