Pregnancy cholestasis

There is very little evidence relating to the role of ROMs in cholestatic liver disease. Serum selenium and glutathione peroxidase activity are decreased in humans with intrahepatic cholestasis of pregnancy (Kauppila et al., 1987). Low levels of vitamin E have been reported in patients with primary biliary cirrhosis, and in children with Alagille s syndrome or biliary atresia (Knight et al., 1986 Jeffrey etal., 1987 Lemonnier etal., 1987 Babin etal., 1988 Kaplan et al., 1988 Sokol etal., 1989). Serum levels of Mn-SOD are increased in patients with all stages of primary biliary cirrhosis compared with patients with other forms of chronic liver disease, although whether this causes or results from the disease process is unclear (Ono etal., 1991). 

Kauppila, A., Korpela, H., Makila, U-M. and Yrjanheikki, E. (1987). Low serum selenium concentration and glutathione peroxidase activity in intrahepatic cholestasis of pregnancy. Br. Med. J. 294, 150-152. 

Jacquemin E, Cresteil D, Manouvrier S, Boute O, Hadchouel M. Heterozygous non-sense mutation of the MDR3 gene in familial intrahepatic cholestasis of pregnancy. Lancet 1999 353(9148) 210-211. 

Dixon PH, Weerasekera N, Linton KJ, Donaldson O, Chambers J, Egginton E et al. Heterozygous MDR3 missense mutation associated with intrahepatic cholestasis of pregnancy evidence for a defect in protein trafficking. Hum Mol Genet 2000 9(8) 1209-1217. 

Back P, Siovall J, Siovall (1974) Monohydroxy bile acids in plasma in intrahepatic cholestasis of pregnancy. Identification by computerized gas chromatography-mass spectrometry. Med Biol 52 31-38... 

Jaundice as a result of oral contraceptive treatment has been repeatedly described. Whereas in the Swedish population figures between 1 100 and 1 4000 were published when the early high-dose formulations were still in use (213), the overall incidence was estimated in 1979 at about 1 10 000 (9), and the current incidence is certainly further reduced. When such hepatic symptoms occur, they usually do so within the first month of medication (214), and jaundice may be accompanied by anorexia, malaise, and pruritus. Very few cases arise after the third month of medication and those reported are regarded by some as unlikely to be due to oral contraceptives. Microscopic examination of the liver shows intrahepatic cholestasis. When medication is stopped, symptoms usually disappear rapidly and the reaction does not seem to leave any sequelae (215). Genetic components seem to be important for the development of the reaction women who have experienced jaundice or severe pruritus in late pregnancy seem to be especially susceptible to jaundice or gallbladder disease when using... 

Meier PJ, Kullak-Ublick G. Sequence analysis of bile salt export pump (ABCB11) and multidrug resistance P-glycoprotein 3 (ABCB4, MDR3) in patients with intrahepatic cholestasis of pregnancy. Pharmacogenetics 2004 14 91-102. 

The findings of this study suggest that women who are already jaundiced at the initiation of HRT are most at risk of increased bilirubin levels and cholestasis. In view of this it would seem sensible that, as well as assessing bilirubin levels prior to treatment, women who want to take HRT should also be assessed for any history (including family history) of jaundice. This will include specific defects in bilirubin excretion, such as intrahepatic cholestasis of pregnancy or familial conjugated hyper-bilirubinaemia, which may worsen cholestasis. 

Pregnancy-related cholestasis - category 2 advantages outweigh the... 

The FFPRHC have advised that the lUD method can be advocated in pregnancy-related cholestasis. Both Cu and LNG lUDs can be used [4, 30]. There is concern that a history of COC-related cholestasis may predict subsequent cholestasis with the LNG-IUD however, as the device has a local effect the risk of side-effects is thought to be minimal, and there are no trial data to support or contradict this concern [30]. However, because of the theoretical risk it would be advisable to monitor LFTs after the insertion of a LNG-IUD. 

Kreek MJ, Sleisenger MH, Jeffries GH (1967) Recurrent cholestatic jaundice of pregnancy with demonstrated oestrogen sensitivity. Am J Med 43 79-203. Weden M, Glaumann H, Einarsson K (1992) Protracted cholestasis probably induced by oral contraceptive. J Intern Med 231 561-565. 

Elevation of serum copper is found in cholestasis, obstructive jaundice, primary biliary cholangitis, malignant tumours, kwashiorkor, exocrine pancreatic insufficiency, during the last trimenon of pregnancy and after administration of oestrogens. A decrease in serum copper is typical of Wilson s disease. In some rare cases, it is caused by familial benign hypocupraemia and nutritional deficiency in neonates. 

Further intrahepatic forms of obstruction include recurrent intrahepatic cholestasis and recurrent cholestasis in pregnancy, (s. tab. 12.4)... 

Diagnosis and therapy of intrahepatic cholestasis of pregnancy (review). Zschr. Gastroenterol. 2004 42 623 - 628... 

Reyes, H. Review Intrahepatic cholestasis. A puzzling disorder of pregnancy. J. Gastroenterol. Hepatol. 1997 12 211-216... 

Confluent liver cell necrosis, possibly developing into bridging necroses (32) or multilobular (< 3% of cases) or even massive necroses in B, B/D and C hepatitis, as well as in E hepatitis during pregnancy collapse of the lattice fibre network. Formation of passive septa, cholestasis, accumulation of ceroid and siderin in macrophages and stellate cells. 

The clinical and biological effects and safety of urso-deoxychohc acid in intrahepatic cholestasis of pregnancy have been reported in 19 patients, 14 of whom had clinical improvement, with reduction or disappearance of pruritus, and 11 of whom had an improvement in biochemical hver function tests (13). The only birth defect reported was pyloric stenosis in a boy whose mother had taken ursodeoxychohc acid for 10 days at 34 weeks gestation. 

Berkane N, Cocheton JJ, Brehier D, Merviel P, Wolf C, Lefevre G, Uzan S. Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy. A retrospective study of 19 cases. Acta Obstet Gynecol Scand 2000 79(ll) 941-6. 

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