Biochemical Parameters of the Intrahepatic Cholestasis of Pregnancy

Overview

Setting:
Department of Obstetrics and Gynecology, 2^nd Medical School Charles University and Teaching Hospital Motol, Prague, Department of Clinical Biochemistry, General Teaching Hospital and lst Medical School Charles University, Prague.

Aim of the study:
To asses the biochemical parameters of the intrahepatic cholestasis of pregnancy from the viewpoint of their importance for establishmnet of the diagnosis, seriousness and progress of the illness with special aspect of the possible compromise of the foetus. To asses if the examination of the serum levels of serotonin could contribute the objectification of the seriousness of the skin pruritus.

Methodology:
From January1999 till June 2005 at two Prague perinatology centres was the ICP diagnosed in 269 from 29 890 pregnant women. In 78 of them the manifestation of the signs of illness was appreciated as moderate or severe and they appeared before the finished 36^th gestational week. These women underwent the treatment. Of the biochemical parametres we monitored in these women the dynamic serum values of AST, ALT, ALP, GMT and bilirubin in 7 day intervals. The serum levels of bile acids were assessed at the beginning of the treatment and at the time of labour. We also assessed the serum levels of bile acids in cord blood immediately after the labour. In 22 women with ICP we monitored the serum levels of serotonin and ALP isomers. The control suite comprised 20 healthy pregnant women.

Results:
In severe cases the serum levels of AST and ALT reached even 50 multiple of regular values and bile acids values cross over 100 μmol/l. The serum levels of bilirubin, GMT and ALP were statistically significantly elevated compared with controls. The serum levels of serotonin did not differ from the levels of the controls. The incidence of severe cases did not reached even 5% of ICP, moderate cases occurred in 25%.

Conclusions:
For the precise assignment diagnosis and prognosis of the illness ICP with the aspect on the foetus condition is the examination of the serum levels of bile acids essential. All monitored biochemical parameters were positively influenced by the treatment with ursodeoxycholic acid. The exception represents the total value of ALP which persists high untill the labour. Serotonin and its serum levels are not applicable marker to the objectivization of the seriousness of the skin pruritus.

Key words:
intrahepatic cholestasis of pregnancy, liver enzymes, bile acids, serotonin, alkaline phosphatase