Bile acids in pregnancy and cholestasis gravidarum.

Before we talk about bile acids in pregnancy, it is important to explain what bile acids are.

Bile acids are components found in bile, which is the substance that is produced in the last part of the intestine to facilitate the digestion of food and the absorption of fats. Usually the values in a healthy person should be less than 10 μmol/L.

These bile acids are in fact used in the intestine to complete the digestion and for the correct absorption of fats and, at the end of this process, are then reabsorbed by the liver and reused for the next digestion.

Therefore, the task of the liver is precisely to reabsorb most of the bile acids at the end of digestion and not allow them to remain in the bloodstream. If the values of bile acids in the blood were high, this would show an incorrect functioning of the liver.

While high bile acids in normal life could be a symptom of diseases such as cirrhosis or hepatitis, in the case of high bile acids in pregnancy these are caused by hormones typical of pregnancy that cause a blockage in the outflow of bile resulting in cholestasis gravidarum.

Cholestasis gravidarum symptoms

It should be noted that cholestasis in pregnancy usually occurs in the last three months even if it is not excluded that it can occur even in the first two trimesters. The most common symptom is itching; it usually occurs on the palms of the hands and feet, but without any rash.

Less common symptoms instead can be:

It is not necessary for all symptoms to occur, often in fact, the only symptom present is that of itching.

High bile acids in pregnancy consequences

The consequences of high bile acids are not very worrying for the mother, but more so for the baby.

For the pregnant woman, it usually does not involve anything serious, apart from increasing the chances of bleeding, in fact, as we have expressed before, the time of blood clotting will be much higher due to the malabsorption of vitamin K.

As for the fetus instead, the presence of bile acids in pregnancy could be dangerous and endanger its life.

If cholestasis gravidarum is not treated you may face consequences such as:

• Premature birth;
• Amniotic fluid tinged with meconium;
• Abnormal fetal heart rhythm;
• Neonatal respiratory distress syndrome.

To avoid and control all these possible complications, in most cases the newborn is taken to the intensive care unit.

Between the 34th and 40th week of pregnancy, in a few cases there is endouterine death due to deprivation of oxygen to the brain of the fetus.

Cholestasis gravidarum therapy

To avoid problems and consequences for the mother and the fetus, once recognized the cholestasis gravidarum, also called hepatosis gravidarum, the doctor will immediately prescribe the therapy that usually consists in the oral administration of ursodeoxycholic acid, which is a hydrophilic bile acid, non-toxic and well tolerated, which can improve the bile flow and will also eliminate the symptoms of cholestasis gravidarum.

Despite the therapy the fetus is not out of danger, for this reason, the mother and the fetus must be constantly monitored and in most cases it is advisable to schedule the delivery a few weeks before the term.

Cholestasis gravidarum is not a very well known disease in pregnancy, also because it is found in only 1% of pregnant women.

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