Serum bile acid concentrations during pregnancy and their relationship to obstetric cholestasis

Lunzer, Michael; Barnes, P. R. H.; Byth, Karen; O'Halloran, Mary

doi:10.1016/0016-5085(86)90682-7

Cited by 91 publications

(30 citation statements)

References 13 publications

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“…13 Elevated liver enzymes and bile acids are recognised as consistent findings in cholestasis of pregnancy. 17,18 The most common tests used to establish the diagnosis of OC in the maternity units sharing in the survey were measurements of bile acids and liver enzymes, followed by measurement of serum bilirubin (Table 3). There was no agreement on the use of any other investigation for the diagnosis, which indicates that the concept of diagnosis by exclusion to rule out other liver conditions 6,10,12 has yet to be accepted or considered in the majority of UK maternity units.…”

Section: Discussionmentioning

confidence: 99%

Short communication: Consensus on the management of obstetric cholestasis: National UK survey

Saleh¹,

Abdo²

2006

BJOG

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An anonymous questionnaire was sent to the lead consultant obstetricians and the midwives in charge of the antenatal clinics of all maternity units in UK to determine their current views on the diagnosis and management of obstetric cholestasis (OC). The response rate was 60%. Management policies were broadly similar and consistent with those recommended in the current literature. However, the survey highlighted areas for improvement. Based on the findings of this survey, a consensus view of the management of OC in UK is achievable.

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Section: Discussionmentioning

confidence: 99%

Short communication: Consensus on the management of obstetric cholestasis: National UK survey

Saleh¹,

Abdo²

2006

BJOG

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“…Laatikainen and Hesso (13) similarly found no statistical significant correlation between total bile acid levels and levels of serum aminotransferase, alkaline phosphatase and total bilirubin indicating that total bile acid levels give additional information on the disturbance of liver function. Conversely Lunzer et a1 (14) assessed changes in 'conventional' biochemical liver function tests and found elevated cholyglycine levels (CG) correlated with serum transaminase and serum cholesterol concentrations, while other liver functions correlated poorly with serum CG levels.…”

Section: Discussionmentioning

confidence: 99%

Liver Function in Normal Pregnancy

Carter

1990

Aust NZ J Obst Gynaeco

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Liver function tests were measured in a longitudinal study of 64 women throughout normal pregnancy. Standard liver function tests and postprandial levels of cholesterol, triglycerides, protein and albumin were measured at each visit. Serum alkaline phosphatase, cholesterol and triglyceride levels increased significantly throughout pregnancy (p less than 0.001) while serum transaminases and bilirubin remained within the normal range. Total protein and albumin levels decreased significantly (p less than 0.001).

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“…Morphological the third trimester of the pregnancy in women who abnormalities in the canaliculi were found in animals were healthy before and after the pregnancy. 6 Besides with impaired biliary function. In summary, these reskin pruritus, subclinical fat malabsorption, and mildly sults indicate that maternal cholestasis may profoundly abnormal results of routine biochemical liver tests, delbut transiently impair the normal liver maturation.…”

Section: Cholate Was Not Modified This Alteration Was Not Selec-mentioning

confidence: 99%

Reversible impairment of neonatal hepatobiliary function by maternal cholestasis

et al. 1996

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importance of the implications derived from these findThe effect of total blockage of maternal biliary excreings both in the nutrition and management of human tion during the last third of the pregnancy on the matuneonates demands further evaluation of the hepatobiliration of hepatobiliary function was investigated in neoary function of babies born after alterations of fetal-manatal rats. Extrahepatic obstruction of the common bile ternal bile acid homeostasis, such as in maternal obstetduct on day 14 of pregnancy induced a marked enhanceric cholestasis. (HEPATOLOGY 1996;23:1208-1217.) ment in serum bilirubin-mainly conjugated bilirubinand bile acid concentrations as compared with shamoperated pregnant rats. Excretion of bile acids by the Normal fetal development requires efficient transfer kidney was significantly increased, whereas fecal elimi-across the placenta. Nutrients are supplied by the nation of these compounds was almost abolished. Most mother while certain potentially toxic compounds cross of the cholestatic mothers (CMs) (77%) were able to carry the placenta, mainly in the fetus-to-mother direction. pregnancy to term and lactation until weaning (21 days Among the latter are bile acids. Both in humans and after birth). The body and liver weights of their offspring experimental animals, the onset of bile acid biosynthewere lower than for offspring of control healthy mothers sis precedes the development of efficient mechanisms in all postnatal periods considered. Serum bile acid concentrations were higher in the fetuses and neonates of involved in enterohepatic circulation.1 Hepatic insuffiCMs. This difference was evident up to 1 week after ciency with respect to bile acid secretion is found in weaning and disappeared in young adult animals (8 both premature and full-term infants.2 This is accomweeks old). When the bile secretion rate was investi-panied by a marked immaturity of small intestinal gated in these animals at 4 or 8 weeks of age, no signifi-transport of bile acids. [3][4][5] Because the accumulation of cant difference was found as far as nonstimulated bile bile acids within the fetus can seriously challenge the flow and bile acid output was concerned. However, the viability of pregnancy, such compounds must be transbiliary response to stepwise sodium taurocholate (TC) ferred to the mother, whose liver is able to excrete them intravenous infusion showed that 4-week-old neonates into bile. Therefore, fetal-maternal bile acid homeostaof CMs had impaired bile acid secretion. Moreover, the sis requires both functional placental transfer and normaximal secretion rate (SR max ) for TC was significantly reduced (030%), whereas the choleretic ability of tauro-mal maternal hepatobiliary function. cholate was not modified. This alteration was not selec-Obstetric cholestasis is a pathological situation chartive for bile acids. The SR max for bromosulfophthalein acterized by a 10-to 100-fold increase in postprandial (BSP) was also significantly lowered (040%). These dys-bile acid concentrations in the m...

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Serum bile acid concentrations during pregnancy and their relationship to obstetric cholestasis

Cited by 91 publications

References 13 publications

Short communication: Consensus on the management of obstetric cholestasis: National UK survey

Short communication: Consensus on the management of obstetric cholestasis: National UK survey

Liver Function in Normal Pregnancy

Reversible impairment of neonatal hepatobiliary function by maternal cholestasis

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