Bile Acids and Pregnancy

Serum Total Bile Acids Level As an Indicator for Intrahepatic Cholestasis of Pregnancy

Some women experience severe itching during late pregnancy. The most common cause of this is Cholestasis;a common liver disease that only happens during pregnancy. Cholestasis of pregnancy is a condition in which the normal flow of bile in the gallbladder is affected by the high amounts of hormones released during pregnancy. Cholestasis is more common in the last trimester of pregnancy when hormonal activity are at their peak, but usually subsides within a few days after delivery. Cholestasis of pregnancy is also referred to as intrahepatic cholestasis of pregnancy(ICP) or obstetric cholestasis.

What causes Cholestasis of pregnancy? Pregnancy hormones affect gallbladder function, resulting in slowing or stopping of the flow of bile. The gallbladder holds bile that is produced in the liver, which is necessary in the breakdown of fats in digestion. When the bile flow is stopped or slowed down, this causes a build up of bile acids in the liver which can spill into the bloodstream, and leads to significantly increased serum TBA levels as shown in Figure 9.

What causes Cholestasis of pregnancy? Pregnancy hormones affect gallbladder function, resulting in slowing or stopping of the flow of bile. The gallbladder holds bile that is produced in the liver, which is necessary in the breakdown of fats in digestion. When the bile flow is stopped or slowed down, this causes a build up of bile acids in the liver which can spill into the bloodstream, and leads to sigincreased serum TBA levels as shown in Figure 9.

 

What are the symptoms of Cholestasis of pregnancy?

  • Itching, particularly on the hands and feet (often is the only symptom noticed)
  • Dark-colored urine
  • Light-colored bowel movements
  • Fatigue or exhaustion
  • Loss of appetite
  • Depression
  • Less common symptoms include:
    • Jaundice (yellow coloring of skin, eyes,and mucous membranes)
    • Upper-Right Quadrant Pain
    • Nausea

Who is at risk for Cholestais of pregnancy?
1 to 2 pregnant women in 1000 are affected by Cholestasis inNorth America and European countries. It is more common in some South American countries, especially Chile and Bolivia, where up to 1 in 10 (or more) pregnant women develop this condition. In general, the following women have a higher risk of developing Cholestatis during pregnancy:

  • Women carrying multiples
  • Women having previous liver damage
  • Women whose mother or sisters had
  • Cholestasis

How is Cholestasis of pregnancy diagnosed?
A diagnosis of Cholestasis can be made by doing a complete medical history, physical examination, and blood tests that evaluate liver function, total bile acids, and bilirubin.

How will the baby be affected if the mother is diagnosed
with Cholestasis?
Cholestasis may increase the risks for fetal distress, preterm birth, or stillbirth. A developing baby relies on the mother’s liver to remove bile acids from the blood, therefore the elevated levels of maternal bile cause stress on the baby’s liver. Women with Cholestasis should be monitored closely and serious consideration should be given to inducing labor once the baby’s lungs have reached maturity.

What is the treatment for Cholestasis of Pregnancy?
The treatment goals for Cholestasis of Pregnancy are to relieveitching. Some treatment options include:

  • Topical anti-itch medications or medication with corticosteroids
  • Medication to decrease the concentration of bile acids such as ursodeoxycholic acid
  • Cold baths and ice water slows down the flow of blood in the body by decreasing it’s temperature.
  • Dexamethansone is a steriod that increases the maturity of the baby’s lungs.
  • Vitamin K supplements administered to the mother before delivery and again once the baby is born to prevent intracranial hemmorhaging.
  • Regular blood tests monitoring both serum TBA levels and liver functions.

Treatment for Cholestasis of Pregnancy needs to be determined by your physician who will take the following criteria into consideration:

  • Your pregnancy, overall health, and medical history
  •  The extent of the disease
  • Your tolerance of specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference