RELEVANCE OF SERUM BILE-ACID PROFILE IN THE DIAGNOSIS OF INTRAHEPATICCHOLESTASIS OF PREGNANCY IN AN HIGH-INCIDENCE AREA - PORTUGAL

Objective(s): The present work was conducted to clarify the relevance of usual liver function tests, and define the most predictive serum bi le acid profile for diagnosis of intrahepatic cholestasis of pregnancy (ICP). Study design: This study comprised 20 healthy nonpregnant wome n and 77 pregnant women in the last trimester of pregnancy, from which 38 were normal pregnancies, and 39 suffered from ICP. Liver function tests were evaluated by routine laboratory techniques, conjugated bile acids were analysed by high-performance liquid chromatography, and un conjugated forms were measured by an enzymatic-fluorimetric assay. Res ults: During the third trimester in normal pregnancy, increased concen tration of conjugated species affected all primary bile acids, althoug h only significantly for glycocholic acid. Moreover, deoxycholic acid proportion decreased when compared with healthy nonpregnant women. Imp ortant ICP-induced changes in serum profiles of amidated bile acids we re observed, involving both a marked increase in cholic acid concentra tion and a shift towards a higher proportion of taurine-conjugated spe cies. Among routine liver tests, alanine aminotransferase and conjugat ed bilirubin were the most common indicators of ICP. Conclusion(s): In the early diagnosis and follow-up of ICP, the most predictive and acc urate markers (efficiency 100%) were: (i) TBA concentration in serum > 11.0 mu mol l(-1): (ii) cholic/chenodeoxycholic acid ratio >1.5 and ch olic acid percentage >42%: (iii) glycine/taurine bile acid ratio <1.0 or glycocholic acid concentration >2.0 mu mol l(-1). Accurate diagnosi s based on sensitive biochemical markers followed by appropriate treat ment may improve both pregnancy outcome and newborn prognosis. (C) 199 8 Elsevier Science Ireland Ltd.