INTRAHEPATIC CHOLESTASIS - A PUZZLING DISORDER OF PREGNANCY

Intraheptic cholestasis of pregnancy is characterized by skin pruritus and a biochemical cholestasis of mild to moderate severity appearing during pregnancy (mainly in the third trimester) and disappearing afte r delivery. It recurs in 40-60% of future pregnancies. The intensity o f pruritus and the laboratory alterations (increased serum bile salts and transaminases in almost all patients, hyperbilirubinaemia in 20% o f patients) fluctuate during one pregnancy and also vary in subsequent affected pregnancies. This disease has no meaningful consequences for the mother; in contrast, it is associated with an increased risk of f oetal distress, causing premature deliveries and stillbirths. Cholesta sis of pregnancy has been recognized in most countries and ethnic grou ps but its prevalence is higher in Chile (14% of deliveries in 1975 an d approximately 4% in 1995) and in Sweden than in other countries. The cause is unknown. Sex hormones, mainly oestrogens and progesterone, a ppear to be involved in its pathogenesis. An interplay between a genet ic metabolic predisposition and some environmental factor(s) is appare ntly relevant. Clinical and experimental studies suggest that a margin al selenium deficiency could be a dietary pathogenic factor. Some drug s attenuate pruritus and improve maternal cholestasis, but not the foe tal prognosis. Ursodeoxycholic acid (UDCA) administration provides a s ignificant improvement in maternal pruritus and in the biochemical abn ormalities, with no adverse effects in the mother or child. Recent cli nical and experimental studies show that UDCA administration improves maternal disease and foetal prognosis without any detectable adverse e ffects.