NEW INSIGHT IN THE PATHOGENESIS OF INTRAHEPATIC CHOLESTASIS OF PREGNANCY: BILE ACID PROFlLES ASSESSED BY CAPILLARY ELETROPHORESIS IS THE USEFUL TOOL IN THE DlFFERENTlAL DIAGNOSIS.

TRIPODI V.,; LUCANGIOLI S.,; SOOKIAN S.,; MESQUIDA M.,; DI SCALA M.,; MASRIAN E.,; FRANCHI P.,; CARDUCCI C.,; CASTAÑO G.

BOSTON, USA

Jornada; 55TH ANNUAL MEETING OF AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES; 2004

AMERICAN ASSOCIATION FOR THE STUDY OF THE LIVER DISEASES

Intrahepatic cholestasis of pregnancy (lCP) is characterized b´ Iht presence of pruritus and biochemical cholestasis, including raiSt( serum bile acids (SBA) and, usually, elevated aminotransfera_ levels. Asymptomatic hypercholanemia (AH), defined as the p_ ence of total SBA levels above the cutoff value, has been recenlh described in healthy pregnant women. Aim: to describe clinic_ and biochemical findings and the outcome of the newboms!i patients with ICP and controls. Patients atldMetllOds: 18 patiel1!l with ICP, and 28 healthy pregnant women were studied in tbr thirdtrimester of their pregnancies. Complete medical, obstetria: and perinatal data were recorded. A complete individual profileá SBA, including free and conjugated (taurine and glycine) ursodt­oxicholic, cholic, lithocholic (LCA), deoxycholic and chenodeoXT. cholic acids was performed by capilJary electrophoresis. A cut-ije value of 10 p.M for total SBA was previously determined in healtbt non-pregnant women. The control group was divided in norm¡). cholanemia and AH. Liver function tests were performed usinr autoanalyzer. Newbom data were registered: weight at birth, Ap- !gar score and gestational age (evaluated by. the Capurro melhoál . Results were expressed as mean :t SD. One-way ANVA ,,;11 post-hoc tests or non-parametrical tests were used for compari­sons. Reslllts: Compared with the control group, ICP patienb showed higher values of aminotransferases (p<O.Ol), alkalil´i! phosphatases (p<O.OOl), total SBA (36 :t 26 vs. 15 :t 11 ¡.lM; p< 0.01), free SBA (15 :t 19 vs. 2 :t 4 p.M; pO.001) and LCA (pO.OO5 Newborns of ICP patients showed lower weight and gestalioni age (p<O.OI), without differences in Apgar scores. Twelve oul el 18 patients with ICP preserited elevated aminotransferases. No differences in clinical features, SBA profiles and outcome of nel<­borns were found between normal and elevated aminolrans­feraseslCP patients. Thirteen out of twenty eight normal pregnanl women (46%) showed AH; levels of total SBA (23:t11 vs. 7:t2 ¡tt-t p<O.OOO) and conjugated SBA (21 :tl0 vs. 6:t3 p.M, p<O.OOl) welt higher Ihan normocholanemia ones, without differences in any other clinical or biochemical parameter. The comparison betwet1l ICP and AH patients revealed no significant difference in loUI SBA levels. Nevertheless, higher values of aminotransferaStl (p<0.05) and free SBA (p<O.O1) were found in ICP patienls, and their newborns showed lower weight and gestational agt (p<O.Ol). Conclllsiotls: 1) Free SBA and LCA, but not total 5__were useful parameters in the diagnosis of ICP and AH. 2) A hl_proportion of healthy pregnant women presented AH, wilho_impact in the newbom outcomes. 4) A shift towards hydrophobiC SBA was observed in ICP.The follo            ´¡ng authors have indicated they have no relationshiff to disclose:Valeria Tripodi, Silvia Lucangioli, Silvia C Sookoian, Maree:Mesquida, Mirta di Scala, Edmond Masrian, Paula Franchi, el)"Carducci, Gustavo Castano