Liver Function in Hepatosis of Pregnancy and Pre‐Eclampsia: With Special Reference to Modified Bromsulphthalein Tests

Ylöstalo, Pekka

doi:10.3109/00016347009155063

Cited by 20 publications

(5 citation statements)

References 91 publications

(131 reference statements)

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“…In the maternal plasma, the direct fraction of bilirubin is elevated (1), and the concentration of total bile acids rises from 10-to 100-fold above the levels found in normal pregnancy (2). The excretion of administered bromsulphalein into the bile is reduced and so is the capacity of the liver to take up this substance (3). Recently, Sj6vall and Sjdvall (4) have shown that, as a result of cholestasis, the levels of several neutral steroid sulfates, mostly metabolites of progesterone,1 are high in maternal plasma in this condition.…”

Section: Introductionmentioning

confidence: 97%

Effect of Maternal Intrahepatic Cholestasis on Fetal Steroid Metabolism

Laatikainen¹,

Peltonen²,

Nylander³

1974

J. Clin. Invest.

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A B S T R A C T Estriol, estriol sulfate, progesterone, and 17 neutral steroid sulfates, including estriol precursors and progesterone metabolites, were determined in 27 cord plasma samples collected after pregnancies complicated by intrahepatic cholestasis of the mother. The levels of these steroids were compared with those in the cord plasma of 42 healthy controls.In the cord plasma, the steroid profile after pregnancies complicated by maternal intrahepatic cholestasis differed greatly from that seen after uncomplicated pregnancy. Two main differences were found. In the disulfate fraction, the concentrations of two pregnanediol isomers, 5a-pregnane-3a,20a-diol and 5P-pregnane3a,20a-diol, were high after cholestasis. Other investigators have shown that, as a result of cholestasis, these pregnanediol sulfates circulate in greatly elevated amounts in the maternal plasma. Our results indicate that in cholestasis these steroids cross the placenta into the fetal compartment, where they circulate in elevated amounts as disulfates. Secondly, the concentrations of several steroid sulfates known to be synthesized by the fetus were significantly lower in the cholestasis group than in the healthy controls. This was especially true of 16a-hydroxydehydroepiandrosterone sulfate and 16a-hydroxypregnenolone sulfate. These results suggest that, in pregnancies complicated by maternal intrahepatic cholestasis, impairment of fetal steroid synthesis, and especially of 16a-hydroxylation, occurs in the fetal compartment.Thus, the changes in maternal steroid metabolism caused by cholestasis are reflected in the steroid profile of the fetoplacental circulation. Furthermore, maternal intrahepatic cholestasis may result in the production of some substance which crosses the placenta and affects fetal steroid metabolism.

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Section: Introductionmentioning

confidence: 97%

Effect of Maternal Intrahepatic Cholestasis on Fetal Steroid Metabolism

Laatikainen¹,

Peltonen²,

Nylander³

1974

J. Clin. Invest.

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“…2 The biliary excretion of bromosulfophthaduring normal pregnancy have not been clearly estab-lein decreases during pregnancy. 3,4 Some authors have lished, mainly because most studies do not include stated that there is a subclinical physiological cholestamatched controls. We therefore measured the serum val-sis during pregnancy.…”

mentioning

confidence: 99%

Liver function tests in normal pregnancy: A prospective study of 103 pregnant women and 103 matched controls

Bacq¹,

Zarka²,

Bréchot³

et al. 1996

Hepatology

224

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Except for increased serum alkaline phosphatase (AP) effects on metabolic, synthetic, and excretory hepatic levels, the changes in liver function test (LFT) values functions. 2 The biliary excretion of bromosulfophthaduring normal pregnancy have not been clearly estab-lein decreases during pregnancy. 3,4 Some authors have lished, mainly because most studies do not include stated that there is a subclinical physiological cholestamatched controls. We therefore measured the serum val-sis during pregnancy. 5 The increase in plasma volume ues of routine liver tests including 5 -nucleotidase and that occurs during pregnancy leads to hemodilution 6,7 total bile acids in 103 healthy pregnant women (first tri-and decreases the serum protein concentrations. Semester, n Å 34; second trimester, n Å 36; third trimester, rum alkaline phosphatase levels increase in late pregn Å 33) and in 103 age-matched controls not receiving nancy because of both a production of the placental oral contraception. Fasting blood samples were taken.isoenzyme and an increase in the bone isoenzyme. [8][9][10] Because of hemodilution, serum albumin levels were significantly lower during all trimesters. As expected, AP It is therefore not surprising that changes in liver funcactivity was significantly higher in the third trimester. tion tests (LFTs) occur during pregnancy. NevertheSerum aspartate transaminase (AST) activity and total less, except for increased alkaline phosphatase levels, bile acid (TBA) concentrations did not differ between which have been clearly demonstrated, the changes in pregnant and nonpregnant women. Serum alanine the other LFT values have not been clearly established, transaminase (ALT) activity was slightly higher in the and a recent review in this field has shown that there second-trimester pregnant women than in controls (6.8 are some discordances in the literature. 11 The identifi-{ 4.5 vs. 8.2 { 5.8, P Å .04), although all values remained cation of these physiological changes is important for within normal limits. In pregnant women, total and free the diagnosis of liver diseases during pregnancy.bilirubin concentrations were significantly lower durThus, the aim of this study was to evaluate the ing all three trimesters, as was conjugated bilirubin during the second and third trimesters. Serum g-glutamyl changes in serum levels of routine LFTs, i.e., alkaline transpeptidase (GGT) activity was significantly lower in phosphatase (AP), alanine transaminase (ALT), asparthe second and third trimesters. Serum 5 -nucleotidase tate transaminase (AST), g-glutamyltranspeptidase activity was slightly but significantly higher in the sec-(GGT), total and conjugated bilirubin, 5 -nucleotidase, ond and third trimesters. The knowledge of these results and total bile acids (TBA) during normal pregnancy is useful for the interpretation of LFT values and the compared with a control group of nonpregnant women. hemodilution. The pregnant woman experiences physiological PATIENTS AND METHODSchanges to support fetal growth and development. Dur...

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“…Earlier studies have indicated a high incidence of cholecystopathia in CP (12,17,25). Even normal pregnancy has been considered cholestatic (24,27) and a female preponderance of gallbladder has lead to the suggestion that female gonadal steroidal hormones interfere with bile formation leading to ''lithogenic bile". The phosphoglyceride, lecithin, participates in the dissolving of cholesterol in bile.…”

mentioning

confidence: 99%

Studies in Cholestasis of Pregnancy

Samsioe¹,

Svendsen²,

Johnson³

et al. 1975

Acta Obstet Gynecol Scand

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Women from an earlier series of cholestasis of pregnancy (CP) were called for a retrospective study to consider presence of gallstones in the gallbladder (evaluated by cholecystography), liver function tests, serum lipids and lipoproteins and the relative fatty acid composition of serum lecithin (as determined by GLC). The attendance in the retrospective study was 60%. Estimated on the total series (assuming that none of the non-responders would have a positive X-ray), the incidence of gallbladder disease was 23.7%. Among women with previous cholestasis of pregnancy and with a positive X-ray finding no characteristic changes in liver function tests or serum lipids were revealed. The women with positive X-ray had, however, a lower alpha-lipoprotein cholesterol than women with negative X-ray. A characteristic finding among women with positive X-ray was furthermore the low relative content of palmitic acid (16:0) in serum lecithin. Also women with negative X-ray had a lower relative content of palmitic acid than controls. It is suggested that the low palmitic acid content is expressive of an influence on liver lecithin synthesis pathways and that the serum lecithin fatty acid composition reflects similar changes in bile lecithin. The "basic defect" in CP influencing liver lecithin synthesis might be the primary cause for disturbed cholesterol solubility in bile and of the frequent occurrence of gallstones in CP.

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Liver Function in Hepatosis of Pregnancy and Pre‐Eclampsia: With Special Reference to Modified Bromsulphthalein Tests

Cited by 20 publications

References 91 publications

Effect of Maternal Intrahepatic Cholestasis on Fetal Steroid Metabolism

Effect of Maternal Intrahepatic Cholestasis on Fetal Steroid Metabolism

Liver function tests in normal pregnancy: A prospective study of 103 pregnant women and 103 matched controls

Studies in Cholestasis of Pregnancy

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