Bile Acid Determination after Standardized Glucose Load in Pregnant Women

Abstract

Objective Intrahepatic cholestasis of pregnancy (ICP) is a rare liver disorder, usually manifesting in the third trimester and associated with increased perinatal morbidity and mortality. The hallmark laboratory abnormality in ICP is elevated fasting serum bile acids; however, there are limited data on whether a nonfasting state affects a pregnant woman's total bile acids. This study assesses fasting and nonfasting bile acid levels in 10 healthy pregnant women after a standardized glucose load to provide insight into the effects of a glucose load on bile acid profiles. Study Design Pilot prospective cohort analysis of serum bile acids in pregnant women. A total of 10 healthy pregnant women from 28 to 32 weeks' gestation were recruited for the study before undergoing a glucose tolerance test. Total serum bile acids were collected for each subject in the overnight fasting state, and 1 and 3 hours after the 100-g glucose load. Results There was a statistically significant difference between fasting versus 3-hour values. There was no statistically significant difference between fasting versus 1-hour and 1-hour versus 3-hour values. Conclusion There is a difference between fasting and nonfasting total serum bile acids after a 100-g glucose load in healthy pregnant women.

Management of Intrahepatic Cholestasis of Pregnancy: Recommendations of the Working Group on Obstetrics and Prenatal Medicine – Section on Maternal Disorders

“…However, postprandial assaying is possible. Numerous studies show that the postprandial elevation in bile acid levels is only minor 105 , 106 . If postprandial levels ≥ 100 µmol/L are reached in some cases (without UDCA administration – depending on the type of assay [see above]), follow-up testing can also measure the fasting level for differential diagnostic consideration.…”

“…Postprandiale Bestimmungen sind jedoch möglich. Eine Vielzahl an Untersuchungen belegt, dass die postprandiale Erhöhung der Gallensäurenkonzentration nur gering ausgeprägt ist 105 , 106 . Sollten in Einzelfällen postprandiale Werte ≥ 100 µmol/l erreicht werden (ohne UDCA-Einnahme – je nach Testverfahren [s.…”

Schwangerschaftscholestase

“…Es gibt Labore, die nüchtern gewonnene Proben erwarten. Eine Vielzahl an Untersuchungen belegt jedoch, dass die postprandiale Erhöhung der GS-Konzentration nur gering ausfällt [ 54 , 55 ]. In den meisten Studien wurden keine Nüchternblutwerte bestimmt.…”