Intrahepatic cholestasis of pregnancy: the usefulness of serum bile acid profile for diagnosis and treatment

LUCANGIOLI S; TRIPODI V

Cholestasis

InTech - Open Access Publisher.

Año: 2012; p. 3 - 16

Intrahepatic cholestasis of pregnancy (ICP), also called obstetric cholestasis, is a reversible form of cholestasis that develops in the third trimester of pregnancy and spontaneously disappears after parturition. Although obstetric cholestasis causes extreme discomfort in the mother, the most important effects are that it carries risks for the fetus such as premature birth, fetal distress, low weight for gestational age and intrauterine death. The most efficient medical management that can improve maternal condition and may prevent the perinatal complications for ICP patients without adverse effects is ursodeoxycholic acid (UDCA) administration during pregnancy. Thus, as soon as obstetric cholestasis is diagnosed, the mother should be considered a high-risk patient and UDCA treatment together with close maternal-fetal control are mainly indicated. Usually, diagnosis of ICP is based on pruritus with mild or moderate elevated levels of amino transferases but the biochemical parameter most commonly used in the diagnosis of ICP and follow-up after treatment, is the raised levels of total serum bile acids (TSBA) . However, it is often difficult to accomplish an accurate diagnosis by solely performing routine laboratory tests because they can be also altered in some other conditions of pregnants. In fact, the existence of subclinical cholestasis during pregnancy may also compromise the identification of the disease. Moreover, pruritus in pregnancy is a common symptom but it could be the only evidence in ICP, therefore it is necessary to discriminate women with ICP disease from those with benign condition of pruritus gravidarum. Furthermore, a subgroup of asymptomatic pregnant women with high levels of TSBA, and normal liver function tests but not showing pruritus symptom has recently been classified as asymptomatic hypercholanaemic pregnants (AHP). A precise diagnosis of ICP and its follow up should be taken into account in the discrimination between patients with ICP and others with benign processes during pregnancy. It should be also important to evaluate the possibility to score the degree of severity of ICP condition and to check the effectiveness of UDCA treatment in this patients. Several authors have demonstrated the usefulness of serum bile acid profiles in the discrimination power for hepatobiliary diseases instead of solely performing TSBA determination. Over the last few years, the increasing interest in the study of bile acid profiles in different diseases has led to improvements in the analytical methodology to determine serum bile acid patterns. Although chromatographic methods with mass spectrometric detection represent the methods of choice for bile acid measurements in biofluids, their usefulness is rather constrained because of the complex instrumentation required in routine analysis. Capillary electrophoresis, with its relevant features of performance such as simplicity, very high resolution in a short time of analysis and low cost of operation, has become an alternative methodology in the analysis of serum bile acid profiles. This chapter presents the main characteristics of bile acids, advances in analytical technology that allows to unequivocally analyze the complete profile of serum bile acids and different points of view on how this profile could be interpreted in the diagnosis and control of ICP that enables the physician to make the correct interpretation management of the disease.