Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management

Lammert, Frank; Marschall, Hanns‐Ulrich; Glantz, Anna; Matern, Siegfried

doi:10.1016/s0168-8278(00)80139-7

Cited by 474 publications

(435 citation statements)

References 109 publications

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“…The reasons for the geographic and ethnic disparities in the prevalence of the disease include genetic and environmental factors, although the former are thought to be much more important. 17 In our patient population, nearly one in five pregnancies is associated with pruritus score >4 in the third trimester. This observation is consistent with literature reporting the prevalence of pruritus in pregnancy.…”

Section: Resultsmentioning

confidence: 75%

The prevalence of intrahepatic cholestasis of pregnancy in a primarily Latina Los Angeles population

et al. 2006

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Objective: To establish the prevalence of intrahepatic cholestasis of pregnancy (ICP) in a primarily Latina population in the United States.Study design: Over a period of 16 months, a convenience sample of subjects admitted to labor and delivery in the third trimester was enrolled. Each subject completed a questionnaire rating their severity of pruritus on a numeric scale of 1 to 10. Serum was analyzed via radioimmunoassay for total bile acid concentration. ICP was defined as pruritus score >4 and a total serum bile acid concentration of X20 mmol/l. Ethnicity was determined from hospital record demographic data.Results: All invited participants enrolled in the study. Three hundred and forty subjects were enrolled. Three hundred and sixteen subjects (93%) were identified as Latina. The serum bile acid concentration range for the entire study population was 1 to 580 mmol/l with a mean of 10.4±34.9 mmol/l. Twenty-four (7.1%) subjects had a serum bile acid concentration X20 mmol/l. A pruritus score >4 was found in 19.7% (67/ 340). Of the 24 subjects with a bile acid concentration X20 mmol/l, 19 also had a pruritus score >4. Thus, the prevalence of ICP in this population was 5.6% (19/340). In subjects with ICP, the mean serum bile acid concentration was 89.5±124.0 mmol/l. When controlling for confounders, women with ICP were associated with higher rates of chorioamnionitis (P ¼ 0.043) and their fetuses had higher rates of thick meconium (P ¼ 0.053). Conclusions:The overall prevalence of ICP in this population was 5.6%, 10 to 100 times higher than previously reported data from the United States. Larger studies of perinatal morbidity examining the diagnostic criteria of cholestasis need to be conducted.

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Section: Resultsmentioning

confidence: 75%

The prevalence of intrahepatic cholestasis of pregnancy in a primarily Latina Los Angeles population

et al. 2006

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“…This is inferred by declining rates of ICP in Chile over the past decade, as well seasonal variation, with a higher incidence in the winter than summer 30,44,45 . Seasonal variations in ICP may be due to seasonal differences in selenium and copper contents of diets.…”

Section: Pathogenesismentioning

confidence: 99%

“…ICP develops late in gestation, when hormone levels are at their highest, and resolves after delivery as hormone levels return to baseline values. Moreover, ICP occurs more frequently in twin pregnancies, in which hormone levels are higher 30,44 . Estrogens are known to induce cholestasis in experimental models of cholestasis 46 .…”

Section: Pathogenesismentioning

confidence: 99%

“…• Raised serum bile acid levels are the most sensitive indicator of ICP 30,48 . AST and ALT may be increased 2-10× ULN, although serum bilirubin elevations are rare 30,38 .…”

Section: Laboratory Evaluationmentioning

confidence: 99%

“…AST and ALT may be increased 2-10× ULN, although serum bilirubin elevations are rare 30,38 . Serum alkaline phosphatase levels are not reliable indicators of cholestasis in pregnancy because they are increased in normal pregnancies, caused by increased production by the placenta and bone.…”

Section: Laboratory Evaluationmentioning

confidence: 99%

See 2 more Smart Citations

The multiple facets of ABCB4 (MDR3) deficiency

Sundaram

Sokol²

2007

Curr Treat Options Gastro

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The Importance of Serum Bile Acid Level Analysis and Treatment With Ursodeoxycholic Acid in Intrahepatic Cholestasis of Pregnancy

Ambros-Rudolph

Glatz²,

Trauner³

et al. 2007

Arch Dermatol

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Background: Intrahepatic cholestasis of pregnancy (ICP) is a severely pruritic form of reversible cholestasis that is associated with significant fetal risks. Because precise diagnostic and therapeutic guidelines are lacking, we performed a retrospective investigation of dermatologic and biochemical features, treatment, and neonatal outcome in patients with ICP seen from 2000 through 2005 at a university-based dermatologic hospital in central Europe. Observations:The 13 observed cases of ICP (11 patients) represented 6% of all pregnancy-associated dermatoses at our department. Intrahepatic cholestasis of pregnancy started at a mean±SD of 30±4 weeks' gestation, with pruritus as the leading symptom, followed by secondary skin lesions in 11 cases (85%). Total serum bile acid levels were markedly elevated in all patients and correlated with impaired fetal prognosis. Only 10 cases (77%) had other liver function test result abnormalities. Fetal distress occurred in 3 pregnancies (23%). In the 10 cases treated with ursodeoxycholic acid, 3 (30%) involved preterm deliveries compared with a 100% preterm delivery rate in the cases not treated with ursodeoxycholic acid.Conclusions: Severe pruritus with or without skin changes in the second half of pregnancy should alert the physician to the possibility of ICP. Elevated total serum bile acid levels are the clue to diagnosis, which should be established as early as possible. Close obstetric surveillance and prompt treatment with ursodeoxycholic acid are warranted.

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Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management

Cited by 474 publications

References 109 publications

The prevalence of intrahepatic cholestasis of pregnancy in a primarily Latina Los Angeles population

The prevalence of intrahepatic cholestasis of pregnancy in a primarily Latina Los Angeles population

The multiple facets of ABCB4 (MDR3) deficiency

The Importance of Serum Bile Acid Level Analysis and Treatment With Ursodeoxycholic Acid in Intrahepatic Cholestasis of Pregnancy

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