In Search of an Accurate Evaluation of Intrahepatic Cholestasis of Pregnancy

Abstract

Until now, biochemical parameter for diagnosis of intrahepatic cholestasis of pregnancy (ICP) mostly used is the rise of total serum bile acids (TSBA) above the upper normal limit of 11 μM. However, differential diagnosis is very difficult since overlapped values calculated on bile acids determinations, are observed in different conditions of pregnancy including the benign condition of pruritus gravidarum. The aim of this work was to determine the better markers in ICP for a precise diagnosis together with parameters associated with severity of symptoms and treatment evaluation. Serum bile acid profiles were evaluated using capillary electrophoresis in 38 healthy pregnant women and 32 ICP patients and it was calculated the sensitivity, specificity, accuracy, predictive values and the relationships of certain individual bile acids in pregnant women in order to replace TSBA determinations. The evaluation of the results shows that LCA and UDCA/LCA ratio provided information for a more complete and accurate diagnosis and evaluation of ICP than calculation of solely TSBA levels in pregnant women.

The biochemical diagnosis of intrahepatic cholestasis of pregnancy

“…A group of asymptomatic pregnant women with high levels of total TSBA and normal LFT has been classified as asymptomatic hypercholanemia of pregnancy (AHP). 3 While Castano et al reported normal pregnancy outcomes with AHP in Argentinian women, Feng and He reported 141 asymptomatic women with elevated TSBA in Si Chuan, China in which there was a high rate of adverse fetal outcomes, including meconium-stained amniotic fluid in 20%, fetal distress in 6.4%, and stillbirth in 3.5%. 4,5 Several investigators have assessed bile acid profiles on electrophoresis seeking better biochemical markers for ICP.…”

The Serum microRNA Profile of Intrahepatic Cholestasis of Pregnancy: Identification of Novel Noninvasive Biomarkers

“…No specific diagnostic biomarker, other than the TBA marker, is currently available. However, serum TBA could not be used to distinguish the ICP patients with low pruritus from normal pregnant women [7], and even more, normal serum TBA concentrations have been observed in some cases with ICP [8]. So, new diagnostic and prognostic ICP biomarkers are urgently required.…”

Intrahepatic Cholestasis of Pregnancy

“…Normal values for cholic acid are ≤3μmol/L, deoxycholic acid ≤7.3 μmol/L and chenodeoxycholic acid ≤9.9 μmol/L.) It has been suggested in the literature that elevated lithocholic acid levels are more highly correlated with severity of symptoms in ICP, and that an increased lithocholic acid/ursodeoxycholic acid (UDCA) ratio provides a more accurate diagnosis of ICP (Martinefski, Contin, Lucangioloi, DiCarlo, & Tripodi, ). Women with ICP often have elevated aminotransferase levels, with up to a 15‐fold increase (Kondrackiene & Kupcinskas, ).…”

“…Th e course is benign, but can be distressing as it can cause intense itching, particularly at night, although improvement is seen with Women present, usually in the third trimester of pregnancy, reporting intense itching, beginning on the palms of the hands and soles of the feet Photo © W. Tolenaars / thinkstockphotos.com ≤7.3 μmol/L and chenodeoxycholic acid ≤9.9 μmol/L.) It has been suggested in the literature that elevated lithocholic acid levels are more highly correlated with severity of symptoms in ICP, and that an increased lithocholic acid/ursodeoxycholic acid (UDCA) ratio provides a more accurate diagnosis of ICP (Martinefski, Contin, Lucangioloi, DiCarlo, & Tripodi, 2012). Women with ICP oft en have elevated aminotransferase levels, with up to a 15-fold increase (Kondrackiene & Kupcinskas, 2008).…”