Raised Serum Bile Acid Level Linked to IHP


VIENNA — An elevated serum bile acid level is a highly reliable indicator of intrahepatic cholestasis of pregnancy in a woman who presents with itching and excoriated skin lesions late in gestation, Christina M. Rudolph, M.D., reported at the annual meeting of the European Society for Dermatological Research.

The differential diagnosis of pruritic skin conditions during pregnancy has often been vexing because of extensive overlap in clinical presentation. But in her series of 75 patients who presented with pruritic skin changes to a specialized dermatology clinic for pregnant women, the lowest serum bile acid level among the 11 patients with intrahepatic cholestasis of pregnancy (ICP)—7.3 μmol/L—was markedly greater than the highest value among women with other pruritic conditions, said Dr. Rudolph of the University of Graz, Austria.

The distinction is clinically important because ICP, if untreated, is associated with increased risks of stillbirth and preterm delivery, she noted.

Other dermatologic diagnoses made in this cohort were atopy-related skin changes, specific dermatoses of pregnancy, psoriasis, pityriasis rosea, and drug reaction. The mean serum bile acid level in these women was 2.3 μmol/L, with a range of 0.4-4.5 μmol/L.

In contrast, the range of serum bile acid levels in women with ICP was 7.3-138 μmol/L, with a mean value of 37.4 μmol/L.