Asymptomatic intrahepatic cholestasis of pregnancy

Abstract

Background and Aim: Pruritus is a varying symptom of cholestatic liver diseases. Previous studies suggested that latent intrahepatic cholestasis of pregnancy (ICP) affects a subset of pregnant women. The aim of this study was to assess the characteristics of asymptomatic ICP and its course following treatment. Methods: We used total serum bile acids (BAs) as a laboratory marker of ICP. Patients were evaluated for history and clinical data, pregnancy outcome and laboratory biochemical parameters at baseline and 1 and 2 weeks after treatment with ursodeoxycholic acid (500 mg to 2 g per day). Results: Among 97 pregnant women with laboratory-confirmed ICP, 70 (72.2%) had pruritus, while 27 (27.8%) did not. Among symptomatic and asymptomatic ICP patients, there was no significant difference in clinical and demographic parameters, pre-treatment biochemical parameters or pregnancy outcome. The rate of decrease of liver transaminases was significantly higher in symptomatic than in asymptomatic ICP patients (p <0.001). By comparison, the therapy-associated changes of BAs levels were not significantly different in the two groups. Conclusions: The lack of significant differences in clinical pattern, pregnancy outcome, and laboratory signs of liver damage suggests that asymptomatic ICP is not associated with pruritus. Since asymptomatic ICP and classical ICP carry the same risk to the fetus, it seems appropriate to perform BAs laboratory screening in pregnant women to detect subclinical ICP. *Correspondence to: Arkadiy Sheptulin, Professor, Chair of Internal Diseases Propedeutics, First Moscow State Medical I. M. Sechenov-University, Pogodinskaya Street, 1, Bld. 1, 119435, Moscow, Russian Federation, E-mail: arkalshep@gmail.com