The biochemical diagnosis of intrahepatic cholestasis of pregnancy

Abstract

Background: Bile acid levels and liver function tests may be normal at presentation in women with intrahepatic cholestasis of pregnancy. The biochemical results of patients presenting with pruritus typical for intrahepatic cholestasis of pregnancy were reviewed.

Methods: A retrospective audit of women coded as having intrahepatic cholestasis of pregnancy over a three-year period.

Results: One hundred and ninety-three women (1.1% of the obstetric population) presented with pruritus typical of intrahepatic cholestasis of pregnancy. Forty (21%) of these women had normal biochemistry at presentation, half subsequently developing abnormal results. Women with a history of allergic reactions were more likely to develop intrahepatic cholestasis of pregnancy.

Conclusions: Normal biochemistry should not preclude a trial of ursodeoxycholic acid in women with distressing pruritus typical for intrahepatic cholestasis of pregnancy. Biochemical tests which are more sensitive and specific in the diagnosis of intrahepatic cholestasis of pregnancy would be valuable. Investigation of other populations with intrahepatic cholestasis of pregnancy regarding a possible association with atopy/allergy would be interesting.

Keywords: Intrahepatic cholestasis of pregnancy; liver function tests; total serum bile acids; ursodeoxycholic acid.

Figure 1.

TSBA and LFT in women with typical symptoms of ICP. k = mean gestation at presentation with symptoms for each group (weeks). ICP: intrahepatic cholestasis of pregnancy; LFT: liver function test; TSBA: total serum bile acid.