Intrahepatic cholestasis of pregnanc

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... 

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. 

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

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. 

Reyes, H., Ribalta, J., Gonzalez, M.C., Segovia, N., and Oberhauser, E. (1981) Sulfobromophthalein clearance tests before and after ethinyl estradiol administration, in women and men with familial history of intrahepatic cholestasis of pregnancy. Gastroenterology, 81 (2), 226-231. 

Intrahepatic cholestasis of pregnancy is a syndrome of unknown etiology characterized by a 100-fold increase in maternal and fetal blood bile salt levels. Bile salts are produced in both the fetal and maternal liver. The fetus transfers the bile salts across the placenta for disposal. When the function of the maternal gallbladder is slowed, bile salts can accumulate in the liver and bloodstream, ultimately resulting in the classical pruritus symptom. It is believed that pregnancy-related hormones may slow bile salt excretion from the gallbladder. 

Elites D. Intrahepatic cholestasis of pregnancy changes in maternal-fetal bile acid balance and improvement by ursodeoxycholic acid. Ann Hepatol 2002 l(l) 20-8. Devlin TM, ed. Textbook of Biochemistry with Clinical Correlations, 5th ed. New York Wiley-Liss, 2002. 

Germain AM, Carvajal JA, Glasinovic JC, et al. Intrahepatic cholestasis of pregnancy an intriguing pregnancy specific disorder. J Soc Gynecol Investig 2002 9(1) 10-14. 

H14. Heikkinen, J., Serum bile acids in the early diagnosis of intrahepatic cholestasis of pregnancy. Obstet. Gynecol. 61, 581-587 (1983). 

H15. Heikkinen, J., Maentausta, O., Ylostalo, P., and Janne, O., Changes in serum bile acids during normal pregnancy, in patients with intrahepatic cholestasis of pregnancy and in pregnant women with itching. Br. J. Obstet. Gynaecol. 88, 240—245 (1981). 

H21. Holzbach, R. T., and Sanders, H. W., A unique response to synthetic oestrogen progestational hormone in a familial case of recurrent intrahepatic cholestasis of pregnancy. Oastroenterology 48, 822-826 (1965). 

Sun XM, Shao Y, Wang XL, Wu WZ. Expression and clinical significance of constitutive androstane receptor in placental syntrophoblast of intrahepatic cholestasis of pregnancy. Zsionghua Fu Chan Ke Za Zhi. 2011 46 338-41. 

Huinink and K. H. Brandt, Familial benign recurrent intrahepatic cholestasis Interrelation with intrahepatic cholestasis of pregnancy and from oral contraceptives, Gastroenterol., 71 202 (1976). 

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