Epidemiology, diagnosis, treatment, and consequences of intrahepatic cholestasis in pregnancy for mother and fetus: literature review

Inga Vasilevskytė1,2

1Vilnius University, Faculty of Medicine, Vilnius, Lithuania

2Vilnius University Hospital Santaros Klinikos, Department of Obstetrics and Gynecology, Vilnius, Lithuania


Introduction. Intrahepatic cholestasis (ICP) is a common disorder in the second half of pregnancy characterized by pruritus and elevated serum bile acids, and is associated with adverse fetal consequences such as preterm birth and intrauterine death. There are limited data on the pathogenesis of ICP and the mechanisms involved in adverse fetal outcomes, so treatment and diagnostic options are limited.

Aim. To review the possibilities of diagnosis and treatment of intrahepatic cholestasis in pregnancy.

Methods. The international database Pubmed was used to review the literature. A total of 50 articles were found, of which 40 articles were analyzed using the following inclusion criteria: publications in English, publications 5-10 years old, examining the diagnosis and treatment of ICP. Articles describing studies on animals, effects of mother and fetus were not included.

Results. Intrahepatic cholestasis is a common pregnancy disorder that resolves after delivery. The most sensitive and specific diagnostic test is bile acids detection. Determination of the level of autotaxin activity in the blood serum can be used as a reliable diagnostic tool for the future diagnosis of ICP. Ursodeoxycholic acid is still considered a first-line treatment for ICP, although its benefit to the fetus has not been established.

Conclusions. ICP is a common disorder in the second half of pregnancy. The first-choice test is to determine the concentration of bile acids in the blood serum. The most common treatment for INC is ursodeoxycholic acid, with additional medications given for the treatment of refractory disease.

Keywords: cholestasis, pregnancy, pruritus, bile.

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