The role of metabolic disorders in the pathogenesis of intrahepatic cholestasis of pregnancy

Abstract

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder which typically commences in the late second or third trimester and resolves within 48 hours after delivery. It is characterized by mild to severe pruritus, without any specific dermatologic features, elevated liver enzymes and increased serum bile acids (BA). The etiology of ICP is still not completely explicit. Pathogenesis includes a combination of hormonal and environmental factors superimposing on a genetic predisposition. During recent years increasingly ICP is recognized to be associated with an abnormal metabolic profile, including glucose intolerance and dyslipidemia, although it is considered to be secondary to maternal aberrant BA homeostasis. This article reviews the recent literature data and current concepts for ICP, with emphasis on a possibility of metabolic disorders being primary causative factors in ICP pathogenesis.

Differentiated timing of induction for women with intrahepatic cholestasis of pregnancy—A historical cohort study

“…This correlation could be the result of observational bias as closer observation of women who develop one disease may lead to a higher chance of detecting another disease in these women; however, we find it more plausible that there is a shared etiology linking these diseases. Previous studies have suggested a common metabolic syndrome, which has also been linked with obesity, artificial reproduction treatment, gestational diabetes, preeclampsia, and age, all of which are associated with ICP in our study as well 15,16 …”

“…Previous studies have suggested a common metabolic syndrome, which has also been linked with obesity, artificial reproduction treatment, gestational diabetes, preeclampsia, and age, all of which are associated with ICP in our study as well. 15,16 Because of the reported increased risks of fetal demise, various guidelines advocate active management by intense surveillance in pregnancy and early delivery. From this study-and the results of the Swedish study in particular-we confirm that mild ICP with no concurrent preeclampsia or diabetes implies a low risk of stillbirth and asphyxia; perhaps lower than in the general pregnant population.…”

Intrahepatic cholestasis of pregnancy: Is fetoplacental doppler ultrasound useful in the diagnosis and follow-up?

“…In Doppler average comparisons conducted according to gestation weeks, it was observed that there was no correlation. In the literature, there are publications asserting that meconium causes acute umbilical vein construction and decrease in umbilical flow [18]. And yet, we could not establish any value in this regard with Doppler data we obtained.…”

Analysis of Flavonoids Bioactivity for Cholestatic Liver Disease: Systematic Literature Search and Experimental Approaches

“…In contrast, other studies reported contradictory values suggesting a wide metabolic disparity between species, rodent strain, and time of damage exposure [38,39]. In addition, it has been established that intrahepatic cholestasis of pregnancy (ICP) and PBC are associated with impaired metabolic profile, including glucose intolerance and dyslipidemia [33,34]. Our analysis showed few data on metabolic parameters for BDL (Table 3).…”

“…Despite Sprague Dawley was developed from Wistar strain, data show that Wistar strain is prone for metabolic impairments [32]. This should be relevant in taking into account the metabolic component of cholestasis [33,34].…”