Severe intrahepatic cholestasis of pregnancy is a risk factor for preeclampsia in singleton and twin pregnancies

Raz, Yael; Lavie, Anat; Vered, Yaffa; Goldiner, Ilana; Skornick-Rapaport, Avital; Asher, Ysca Landsberg; Maslovitz, Sharon; Levin, Ishai; Lessing, Joseph B.; Kuperminc, Michael; Rimon, Ephraim

doi:10.1016/j.ajog.2015.05.011

Cited by 69 publications

(78 citation statements)

References 40 publications

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“…Interestingly, patients with bile acid levels less than 20 did not develop preeclampsia in this study [12]. As seen in our case, normalization of bile acid levels and liver function tests typically occurs within one to three weeks of treatment with ursodeoxycholic acid [12]. Despite normalization of these laboratory values, the development of preeclampsia remains a subsequent event later in pregnancy, perhaps suggesting that the initial elevation in bile acids may act to promote the development of hypertensive disorders of pregnancy [12].…”

Section: Discussionmentioning

confidence: 88%

“…Specifically, Wikström Shemer et al have demonstrated an increased incidence of preeclampsia among pregnancies affected by ICP, with adjusted odds ratio 2.62 [11]. Additionally, a recent retrospective cohort study of 78 patients with ICP has revealed that severe ICP (total bile acid level greater than 40 micromol/L) is noted as a significant risk factor for preeclampsia in both singleton and twin pregnancies [12]. Interestingly, patients with bile acid levels less than 20 did not develop preeclampsia in this study [12].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, a recent retrospective cohort study of 78 patients with ICP has revealed that severe ICP (total bile acid level greater than 40 micromol/L) is noted as a significant risk factor for preeclampsia in both singleton and twin pregnancies [12]. Interestingly, patients with bile acid levels less than 20 did not develop preeclampsia in this study [12]. As seen in our case, normalization of bile acid levels and liver function tests typically occurs within one to three weeks of treatment with ursodeoxycholic acid [12].…”

Section: Discussionmentioning

confidence: 99%

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Intrahepatic Cholestasis of Pregnancy with Severe Elevation of Bile Acids in the Setting of Acute Hepatitis C Infection

Lawlor

Critchfield

2016

Case Reports in Obstetrics and Gynecology

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Intrahepatic cholestasis of pregnancy (ICP) is a complication of pregnancy resulting in elevation of serum bile acid levels. ICP is often associated with underlying liver disease, including hepatitis C. Bile acids in relationship to the acute infection of hepatitis C virus have not yet been delineated in the literature. A 26-year-old gravida 4 para 2103 with dichorionic, diamniotic twin gestation and history of intravenous drug abuse developed ICP in the setting of acute hepatitis C infection. In addition to clinical symptoms of pruritus and right upper quadrant pain, she developed severe elevation in bile acids, 239 micromol/L, and transaminitis aspartate aminotransferase 1033 U/L, and alanine aminotransferase 448 U/L. She received ursodeoxycholic acid and antenatal testing was performed. Patient delivered vaginally at 33-week gestation following preterm rupture of membranes. Neonates were admitted to NICU and had uncomplicated neonatal courses. In the setting of ICP with significant transaminitis and severe elevation of bile acids, consideration of acute viral hepatitis is important, especially considering the worsening opioid epidemic and concurrent increase in intravenous drug use in the United States. Further study is needed regarding the acute form of HCV infection and its effect on ICP and associated bile acids.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intrahepatic Cholestasis of Pregnancy with Severe Elevation of Bile Acids in the Setting of Acute Hepatitis C Infection

Lawlor

Critchfield

2016

Case Reports in Obstetrics and Gynecology

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“…Birkaç çalışmada, GİK ve preeklampsi arasındaki ilişki bildirilmiştir. 66 Doğumdan sonra biyokimyasal testlerin normale dönmesinin ardından KOK kullanımı kontrendike değildir. 61 …”

Section: Maternal Sonuçlarunclassified

Gestational Intrahepatic Cholestasis: Etiology, Maternal Outcome, Fetal Outcome and Management

Abide¹,

Vural²

2017

Turkiye Klinikleri J Health Sci

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“…While pregnant, women can have jaundice, steatorrhea [10] and increased risk of preeclampsia [16]. Enhanced blood coagulation has been noted through increases in mean platelet volume [17] along with significant increases in factor VIII, von Willebrand factor and fibrinogen levels [18].…”

Section: Risk Factors and Effects Of Icpmentioning

confidence: 99%

Immunological basis in the pathogenesis of intrahepatic cholestasis of pregnancy

Larson

Kovilam

Agrawal

2015

Expert Review of Clinical Immunology

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Summary Intrahepatic cholestasis of pregnancy poses a great risk to both maternal and fetal health. Despite extensive research, much of the pathogenesis of this disorder is unknown. The increase in bile acids observed in patients with intrahepatic cholestasis of pregnancy has been noted to cause a change in the immune system from the normally mediated TH2 response to one that is more oriented towards TH1. In this literature review, we have critically reviewed the current literature regarding the changes in the immune system and the potential effects of immunological changes in the management of the patient. The current treatment, ursodeoxycholic acid, is also discussed along with potential combination therapies and future directions for research.

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Severe intrahepatic cholestasis of pregnancy is a risk factor for preeclampsia in singleton and twin pregnancies

Cited by 69 publications

References 40 publications

Intrahepatic Cholestasis of Pregnancy with Severe Elevation of Bile Acids in the Setting of Acute Hepatitis C Infection

Intrahepatic Cholestasis of Pregnancy with Severe Elevation of Bile Acids in the Setting of Acute Hepatitis C Infection

Gestational Intrahepatic Cholestasis: Etiology, Maternal Outcome, Fetal Outcome and Management

Immunological basis in the pathogenesis of intrahepatic cholestasis of pregnancy

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