Fetal Outcomes in Pregnancies Complicated by Intrahepatic Cholestasis of Pregnancy in a Northern California Cohort

Rook, Michelle; Vargas, Juan; Caughey, Aaron B.; Bacchetti, Peter; Rosenthal, Philip; Bull, Laura N.

doi:10.1371/journal.pone.0028343

Cited by 114 publications

(114 citation statements)

References 23 publications

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“…75 It confers only a minimal risk of morbidity/mortality to the mother, but can significantly contribute to peri-natal morbidity. 75,76 The incidence of ICP varies with geographical region and is most common in South America and Chile in particular. 75 In India, there are only a few studies looking at the epidemiology and incidence is very low at $0.08%.…”

Section: Intrahepatic Cholestasis Of Pregnancy (Icp)mentioning

confidence: 99%

Pregnancy-Related Liver Disorders

Goel

Jamwal

Ramachandran

et al. 2014

Journal of Clinical and Experimental Hepatology

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Pregnancy-related liver disorders accounted for 8% of all maternal deaths at our center from 1999 to 2011. Of the three pregnancy-related liver disorders (acute fatty liver of pregnancy (AFLP), HELLP (Hemolysis, elevated liver enzymes, low platelets) syndrome and pre-eclamptic liver dysfunction, which can lead to adverse maternal and fetal outcome, AFLP is most typically under -diagnosed. Risk of maternal death can be minimised by timely recognition and early/aggressive multi-specialty management of these conditions. Urgent termination of pregnancy remains the cornerstone of therapy for some of these life threatening disorders, but recent advancements in our understanding help us in better overall management of these patients. This review focuses on various aspects of pregnancy-related liver disorders. ( J CLIN EXP HEPATOL 2014;4:151-162) A ny liver disorder can occur co-incidentally in pregnancy. Pregnancy can also occur in a patient with pre-existent chronic liver disorder/portal hypertension. In addition, liver dysfunction in pregnancy can also be secondary to pregnancy (i.e. pregnancy-related liver disorders). The 5 pregnancy-related liver disorders-acute fatty liver of pregnancy (AFLP), HELLP syndrome (hemolysis, elevated liver enzymes and low platelets), pre-eclamptic liver dysfunction, intrahepatic cholestasis of pregnancy (ICP) and hyperemesis gravidarum-occur in different gestational time periods.

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Section: Intrahepatic Cholestasis Of Pregnancy (Icp)mentioning

confidence: 99%

Pregnancy-Related Liver Disorders

Goel

Jamwal

Ramachandran

et al. 2014

Journal of Clinical and Experimental Hepatology

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“…ICP predominantly occurs in the late stages of pregnancy and spontaneously recovers after birth (3). Although ICP is a relatively mild disorder for the mother, it poses significant risks of complications to the fetus, including preterm delivery, respiratory stress, and prenatal mortality (1)(2)(3)(4). One of the characteristic clinical manifestations of ICP is markedly elevated levels of serum bile acids, indicating the disruption of bile acid homeostasis in ICP patients (5)(6)(7).…”

mentioning

confidence: 99%

Estrogen and Estrogen Receptor-α-Mediated Transrepression of Bile Salt Export Pump

Chen

Василенко

Song

et al. 2015

Molecular Endocrinology

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Among diseases unique to pregnancy, intrahepatic cholestasis of pregnancy is the most prevalent disorder with elevated serum bile acid levels. We have previously shown that estrogen 17β-estradiol (E2) transrepresses bile salt export pump (BSEP) through an interaction between estrogen receptor (ER)-α and farnesoid X receptor (FXR) and transrepression of BSEP by E2/ERα is an etiological contributing factor to intrahepatic cholestasis of pregnancy. Currently the mechanistic insights into such transrepression are not fully understood. In this study, the dynamics of coregulator recruitment to BSEP promoter after FXR activation and E2 treatment were established with quantitative chromatin immunoprecipitation assays. Coactivator peroxisome proliferator-activated receptor-γ coactivator-1 was predominantly recruited to the BSEP promoter upon FXR activation, and its recruitment was decreased by E2 treatment. Meanwhile, recruitment of nuclear receptor corepressor was markedly increased upon E2 treatment. Functional evaluation of ERα and ERβ chimeras revealed that domains AC of ERα are the determinants for ERα-specific transrepression on BSEP. Further studies with various truncated ERα proteins identified the domains in ERα responsible for ligand-dependent and ligand-independent transrepression. Truncated ERα-AD exhibited potent ligand-independent transrepressive activity, whereas ERα-CF was fully capable of transrepressing BSEP ligand dependently in vitro in Huh 7 cells and in vivo in mice. Both ERα-AD and ERα-CF proteins were associated with FXR in the coimmunoprecipitation assays. In conclusion, E2 repressed BSEP expression through diminishing peroxisome proliferator-activated receptor-γ coactivator-1 recruitment with a concurrent increase in nuclear receptor corepressor recruitment to the BSEP promoter. Domains AD and CF in ERα mediated ligand-independent and ligand-dependent transrepression on BSEP, respectively, through interacting with FXR.

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“…ICP is associated with increased risk of preterm delivery, meconium passage, intrapartum fetal distress and stillbirth [27,28]. Due to the high rates of stillbirth and neonatal complications early delivery is recommended for these pregnants [29].…”

Section: Discussionmentioning

confidence: 99%

Elevated red blood cell distribution width is associated with intrahepatic cholestasis of pregnancy

Yılmaz¹,

Türkmen²,

Dağlar³

et al. 2017

Ginekol Pol

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Objectives: Intrahepatic cholestasis of pregnancy is the most common pregnancy specific liver disease and related with adverse maternal and perinatal outcome. Red blood cell distribution width, an anisocytosis marker in a complete blood count, has been used as an inflammation marker in various diseases. However the association of red blood cell distribution width with intrahepatic cholestasis of pregnancy is unknown. We aimed to evaluate the relationship between red blood cell distribution width and intrahepatic cholestasis of pregnancy. Material and methods:Ninety pregnant women with intrahepatic cholestasis of pregnancy and ninety healthy pregnant women were included in the study. Their clinical and laboratory characteristics including red blood cell distribution width, liver function tests, fasting and postprandial bile acid concentrations were analyzed.Results: Serum red blood cell distribution width cell levels were significantly higher in pregnants with intrahepatic cholestasis of pregnancy than healthy pregnants. We also demonstrated that red blood cell distribution Width levels were higher in severe disease than mild disease and was significantly correlated with fasting and postprandial bile acid concentration in intrahepatic cholestasis of pregnancy group. Conclusions:Our study showed that red blood cell distribution width, an easy and inexpensive marker; were associated with intrahepatic cholestasis of pregnancy and can be used as a diagnostic and prognostic marker in intrahepatic cholestasis of pregnancy.

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Fetal Outcomes in Pregnancies Complicated by Intrahepatic Cholestasis of Pregnancy in a Northern California Cohort

Cited by 114 publications

References 23 publications

Pregnancy-Related Liver Disorders

Pregnancy-Related Liver Disorders

Estrogen and Estrogen Receptor-α-Mediated Transrepression of Bile Salt Export Pump

Elevated red blood cell distribution width is associated with intrahepatic cholestasis of pregnancy

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