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. 2023 Jan 12;12(2):616.
doi: 10.3390/jcm12020616.

Severe Intrahepatic Cholestasis of Pregnancy-Potential Mechanism by Which Fetuses Are Protected from the Hazardous Effect of Bile Acids

Gal Hershkovitz  1 , Yael Raz  1 , Ilana Goldinger  2 , Ariel Many  3 , Liran Hiersch  1 , Rimon Eli  1
Affiliations

Severe Intrahepatic Cholestasis of Pregnancy-Potential Mechanism by Which Fetuses Are Protected from the Hazardous Effect of Bile Acids

Gal Hershkovitz et al. J Clin Med. .

Abstract

Intrahepatic cholestasis of pregnancy (ICP) is characterized by elevated total bile acids (TBA). Although elevated maternal TBA is a major risk factors for fetal morbidity and mortality, it is unclear why some fetuses are more prone to the hazardous effect of bile acids (BA) over the others. It is unclear whether fetuses are protected by placental BA uptake, or it is the fetal BA metabolism that reduces fetal BA as compared to maternal levels. Therefore, we aimed to compared TBA levels in the umbilical vein and artery to maternal TBA in women with ICP. The study included 18 women who had TBA > 40 μmol/L and their 23 fetuses. We found that the TBA level in umbilical vein was significantly lower compared to maternal TBA level. The TBA levels in umbilical vein and umbilical artery were similar. No fetus had a serious neonatal complication. Importantly, since TBA level remains low even though maternal TBA level is high the fetuses are protected from the hazardous effects of maternal BA. Our findings suggest that there is no effective metabolism of BA in the fetus and the main decrease in TBA in the fetus is related to placental BA uptake.

Keywords: intrahepatic cholestasis of pregnancy; placenta; total bile acid; ursodeoxycholic acid.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The total bile acids levels in maternal serum delivery, umbilical vein, and umbilical artery. The TBA level in maternal serum at delivery (black) compared to TBA levels in umbilical vein (gray, 23 samples) and umbilical artery (dotted, 19 samples). TBA—total bile acids in μmol/L.
Figure 2
Figure 2
The correlations between maternal and fetal TBA levels. Graphic diagrams which show the correlations between maternal and fetal TBA levels. (A) A positive correlation between TBA levels in umbilical artery and vein (r = 0.78, p < 0.0001), (B) A positive correlation between TBA levels in maternal serum at delivery and umbilical vein (r = 0.52, p = 0.01), TBA—total bile acids in μmol/L.
See this image and copyright information in PMC

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