The Determination of Bile Acids in Women Upon Suspicion of Intrahepatic Cholestasis of Pregnancy

Background: Bile acids are used in testing of women with suspicion of intrahepatic cholestasis of pregnancy, but the influence of their levels on diagnoses, week of delivery and response to treatment remains unclear. Methods: We retrospectively evaluated the serum levels of total bile acids in 217 singleton pregnant women measured by photometric enzymatic method from Dialab. Results: Medians of bile acids in serum of women with intrahepatic cholestasis of pregnancy increased compared to normal pregnancies (23.4 (19.5-28.2) versus 3.7 (3.0-4.2); P<0.0001). ROC analysis for bile acids showed AUC of 0.942 (95% CI, 0.902-0.969), P<0.0001, a sensitivity of 85,9% and a specificity of 94,9% for intrahepatic cholestasis of pregnancy. The statistically significant correlation between levels of bile acids and ALT, AST and ALP was proved. The difference in week of delivery between group with bile acid < 40µmol/L and > 40µmol/L was about 1 week (P=0.01). The dynamics of concentration of bile acids after treatment by hepatoprotectives was monitored as well. We observed mostly either decreased or unchanged concentration of bile acids, but in almost 24% of cases, there was a rapid and significant increase of bile acids concentration, despite the treatment.