Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy specific cholestatic disorder characterized by maternal pruritus in the third trimester, elevated liver enzymes and serum bile acids. The disease has been observed in almost all ethnic groups, but there is relevant geographical variation in the incidence. The prevelance of disease is 0.45% in our country. The etiology of ICP is not fully understood, but it is likely to result from genetic, hormonal and environmental causes. The most studied candidate genes are ABCB4 and ABCB11, which encode the bile acids transport proteins. Hormonal factors are high level of estrogen and progesterone and environmental factors are selenium deficiency, infections and seasonal variation. The diagnosis of ICP is based on the ruling out of other diseases with impaired liver function and pruritis. Maternal effects of ICP are mild; however there is a clear association between ICP and preterm labor, meconium aspiration, and sudden intrauterine fetal death. The eiology of the fetal complications is thought to related to an increased flux of bile acids into the fetal circulation. Elevated serum total bile acid concentration is the most sensitive marker for the diagnosis and monitoring of the disease. Lack of predictability of future wellbeing by normal cardiotocography, ultrasonography and normal fetal movements is a major limitation of the use of these modalities. There is no concensus about monitoring patients with ICP. Recent data showed that ursodeoxycolic acid is the most effective treatment, whereas there is as yet no treatment for improving the obstetrical outcome.