Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels

Brouwers, Laura; Koster, Maria P. H.; Page-Christiaens, G. C. M. L.; Kemperman, Hans; Boon, Janine; Evers, Inge M.; Bogte, Auke; Oudijk, Martijn A.

doi:10.1016/j.ajog.2014.07.026

Cited by 211 publications

(241 citation statements)

References 25 publications

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“…Despite the absence of fetal or neonatal deaths, significantly higher incidence of complications was observed in mothers diagnosed with ICP compared to the rest of the population. The increase in complications noted in the study correlate well with the findings of similar studies [2] [3] [15]- [17]. Postpartum hemorrhage and placental abruption showed the greatest increase in those with ICP, with roughly a 10 fold increase over those who had pruritus in the absence of ICP [18].…”

Section: Discussionsupporting

confidence: 87%

“…Postpartum hemorrhage and placental abruption showed the greatest increase in those with ICP, with roughly a 10 fold increase over those who had pruritus in the absence of ICP [18]. The Increase in bleeding manifestations such as PPH is well recognized [15] [19] and is thought to occur as a result of subclinical steatorrhea associated with ICP resulting in reduced absorption of vitamin K [20] [21]. Fetal distress, another complication known to be associated with ICP was twice more common among mothers with ICP in our study.…”

Section: Discussionmentioning

confidence: 95%

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Presence of Obstetrics Cholestasis in Mothers Presenting with Pruritus in Pregnancy: In a Low Resource South Asian Setting

Dodampahala¹,

Pieris²,

Chandrasena³

et al. 2016

ARSci

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Obstetric cholestasis (also referred to as intrahepatic cholestasis of pregnancy-ICP) is a pruritic form of reversible cholestasis that is associated with significant fetal risks. There is a paucity of research regarding pregnancy outcomes of the mothers with obstetric cholestasis in the South Asian setting. Hence, the objective of this study was to determine the prevalence of obstetric cholestasis among mothers presenting with pruritus during pregnancy and to describe the characteristics and outcomes for those diagnosed with ICP in comparison with those with pruritus in the absence of ICP. Methods: All mothers presenting with pruritus to De Soyza Maternity hospital in Colombo Sri Lanka, between 1st January 2011 to 1st January 2014, were recruited for the study. A standard set of biochemical tests were used for diagnosis of ICP. An interviewer administered questionnaire and patient records were used for data collection. Presentation, characteristics and pregnancy outcomes were assessed and compared for mothers with ICP against those with pruri-

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 95%

Presence of Obstetrics Cholestasis in Mothers Presenting with Pruritus in Pregnancy: In a Low Resource South Asian Setting

Dodampahala¹,

Pieris²,

Chandrasena³

et al. 2016

ARSci

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“…Our findings are also supported by clinical data suggesting that “physiologic cholestasis” is caused by immature posttranslational glycosylation modifications of NTCP 30, 31. Under physiological conditions, the fetus presents a low serum BA pool (0.1 mM) that increases postnatally (1‐2 mM).…”

Section: Discussionsupporting

confidence: 84%

Age‐dependent glycosylation of the sodium taurocholate cotransporter polypeptide: From fetal to adult human livers

Sargiacomo

El-Kehdy

Pourcher

et al. 2018

Hepatology Communications

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Sodium taurocholate cotransporter polypeptide (NTCP), mainly expressed on the sinusoidal membrane of hepatocytes, is one of the major transporters responsible for liver bile acid (BA) re‐uptake. NTCP transports conjugated BA from the blood into hepatocytes and is crucial for correct enterohepatic circulation. Studies have shown that insufficient hepatic clearance of BA correlates with elevated serum BA in infants younger than 1 year of age. In the current study, we investigated human NTCP messenger RNA and protein expression by using reverse‐transcription quantitative polymerase chain reaction and immunoblotting in isolated and cryopreserved human hepatocytes from two different age groups, below and above 1 year of age. Here, we show that NTCP messenger RNA expression is not modulated whereas NTCP protein posttranslational glycosylation is modulated in an age‐dependent manner. These results were confirmed by quantification analysis of NTCP 55‐kDa N‐glycosylated bands, which showed significantly less total NTCP protein in donors below 1 year of age compared to donors older than 1 year. NTCP tissue localization was also analyzed by means of immunofluorescence. This revealed that NTCP cellular localization in fetal samples was mainly perinuclear, suggesting that NTCP is not glycosylated, while its postnatal localization on the plasma membrane is age dependent compared to multidrug resistant protein 2, which is apical starting in fetal life. Conclusion: After birth, the NTCP age‐dependent maturation process requires approximately 1 year to complete NTCP glycosylation in human hepatocytes. Therefore, NTCP late posttranslational glycosylation appears to be important for correct NTCP membrane localization, which might explain physiologic cholestasis in neonatal life and might play a central role for HBV infection after birth. (Hepatology Communications 2018;2:693‐702)

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“…Higher bile acid levels (>40 mmol/L) correlate with higher rates of fetal complications, including preterm delivery, meconium-stained liquor, and even perinatal death. 29, Maternal outcome is good, with symptoms rapidly subsiding after delivery and complete recovery. However, a recent large population based study showed a higher risk of hepatobiliary cancer, autoimmune diseases, and cardiovascular diseases in women with ICP.…”

Section: Correct Answers: a B And Cmentioning

confidence: 98%

Hepatobiliary Quiz Answers—17 (2016)

Rathi

Dhiman

2016

Journal of Clinical and Experimental Hepatology

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Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels

Cited by 211 publications

References 25 publications

Presence of Obstetrics Cholestasis in Mothers Presenting with Pruritus in Pregnancy: In a Low Resource South Asian Setting

Presence of Obstetrics Cholestasis in Mothers Presenting with Pruritus in Pregnancy: In a Low Resource South Asian Setting

Age‐dependent glycosylation of the sodium taurocholate cotransporter polypeptide: From fetal to adult human livers

Hepatobiliary Quiz Answers—17 (2016)

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