Intrahepatic cholestasis of pregnancy: A French prospective study

Abstract

The prevalence of ICP varies greatly according to country. The aim of this prospective study was to analyze the charac-The prevalence is high in Scandinavian countries (1%-teristics of intrahepatic cholestasis of pregnancy (ICP) in a 1.5%), 3,4 in Bolivia (9.2%), 5 and in Chile, with a prevalence French population. From 1989 to 1995 we studied 50 consecof between 11.8% and 27.6% according to ethnic origin. 6 In utive pregnant women with ICP (41 single, 7 twin, and 2Santiago the prevalence of ICP was recently evaluated at 4%. 7 triplet pregnancies) referred for hepatologic consultation. All In contrast, the prevalence is reported to be low in the United patients suffered from pruritus and/or jaundice associated States, 8 Canada, 9 and Switzerland. 10 In France the prevalence with elevated fasting serum levels of total bile acids (mean has been assessed to be 0.2% to 0.5% 11,12 and ICP has not 49 mmol/L, range 7-290). No patients had concomitant liver often been studied. disease and all recovered normal liver function after delivery.The aim of this prospective study was to analyze characterOverall prematurity rate was 60%: 100% in multiple pregnanistics of ICP in France. rently treated with cholestyramine), after decrease in dose ofSigns of pre-eclampsia, fever, and urinary or endocervical infection progesterone in 1 patient, and spontaneously in 2 patients.were exclusion criteria. In cases of recurrent ICP the first occurrence During the same period, the percentage of pregnant women during the period under study was taken into account for the dewithout ICP who had been treated with progesterone during scription of characteristics. pregnancy was statistically lower than the percentage of patients treated with progesterone before the onset of pruritus Methods in our group of patients with ICP (36% vs. 64%, P õ .01, Biological Tests. Fasting blood samples were taken and serum TBA odds ratio 3.16, 95% CI:1.29-7.80). These results suggest that and total bilirubin and conjugated bilirubin concentrations, and orally administered progesterone might be an exogenous fac-serum ALT, alkaline phosphatase (AP), and g-glutamyl transpeptitor which triggers ICP in predisposed women. (HEPATOLOGY dase (GGT) activity, were measured at least twice, for each patient. 1997;26:358-364.)In fact, this was usually once or twice a week until delivery. Serum aspartate aminotransferase (AST) and 5 nucleotidase activity was measured in 19 and 44 patients, respectively. Prothrombin time, Intrahepatic cholestasis of pregnancy (ICP) is a liver discreatininemia, and uricemia were also regularly monitored. For each ease unique to pregnancy, which occurs in the second or patient, the most abnormal values, i.e., the highest values for LFTs, third trimesters and disappears spontaneously after delivery. uricemia, creatininemia, and the lowest values for prothrombin timeThe occurrence of ICP carries a risk for the fetus and pruritus were retained for the calculation of the biological characteristics. is a very uncomfortable symptom for the mother. ...

Inhibition of Na+-Taurocholate Co-transporting Polypeptide-mediated Bile Acid Transport by Cholestatic Sulfated Progesterone Metabolites

“…A subgroup of women with a history of ICP who take the oral contraceptive pill or exogenous estrogens develop pruritus and hepatic impairment (4). In addition, administration of oral micronized natural progesterone for prophylaxis of preterm labor causes increased rates of ICP (12). Moreover, there is experimental evidence demonstrating that cholestatic reproductive hormone metabolites can influence the major and minor bile acid uptake transporters, the sodium-dependent Na ϩ -taurocholate co-transporting polypeptide (NTCP), and the Na ϩ -independent organic anion transporting proteins (13,14), respectively, as well as the major canalicular bile salt export pump (BSEP) (14 -16).…”

Insuficiência Hepática Aguda da Gravidez Experiência Clínica com Sete Casos

“…Sua causa é ainda desconhecida, mas os resultados de estudos clíni-cos e epidemiológicos sugerem fatores genéticos, hormonais e exógenos 3,4,10,11,21 . Dentre estes, a hiperestrogenemia parece ser um dos fatores mais importantes para o aparecimento da CIHG em mulheres predispostas 3,22 .…”

“…Tal evolução também foi verificada em nossa casuística, em que estes casos (2 e 4) apresentaram evolução materna mais favorável e de rápido restabelecimento. Todavia, a CIHG é acompanhada de alto risco de prematuridade na gravidez e óbito fetal 21,24 . De fato, um de nossos três casos de CIHG cursou com parto prematuro de 27 semanas e óbito fetal.…”

Liver diseases unique to pregnancy

“…In contrast, ICP may have serious conseJūratė Kondrackienė, Limas Kupčinskas quences for the fetus. Clinical studies show that the disease is a strong risk factor for premature deliveries in 19 to 60% (26), stillbirths in 1 to 2 % (27), and fetal distress in 22 to 33% of cases (28). The cause is unknown.…”