Intrahepatic cholestasis of pregnancy

Main Article Content

Titta Joutsiniemi Susanna Timonen

Abstract

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific disorder characterized by maternal pruritus and elevated liver enzymes. It usually begins in the third trimester of pregnancy and resolves spontaneously after delivery. ICP is considered benign for the pregnant woman, but it is associated with an increased risk for unexplained term stillbirth and preterm delivery.

Article Details

How to Cite
JOUTSINIEMI, Titta; TIMONEN, Susanna. Intrahepatic cholestasis of pregnancy. Medical Research Archives, [S.l.], v. 4, n. 5, sep. 2016. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/602>. Date accessed: 26 sep. 2023.
Keywords
intrahepatic cholestasis, pregnancy, treatment fetal surveillance and complications
Section
Review Articles

References

Al Inizi, S., R. Gupta & A. Gale (2006) Fetal tachyarrhythmia with atrial flutter in obstetric cholestasis. Int J Gynaecol Obstet, 93, 53-4.
Alsulyman, O. M., J. G. Ouzounian, M. Ames-Castro & T. M. Goodwin (1996) Intrahepatic cholestasis of pregnancy: perinatal outcome associated with expectant management. Am J Obstet Gynecol, 175, 957-60.
Ataalla, W. M., D. H. Ziada, R. Gaber, A. Ossman, S. Bayomy & B. R. Elemary (2016) The impact of total bile acid levels on fetal cardiac function in intrahepatic cholestasis of pregnancy using fetal echocardiography: a tissue Doppler imaging study. J Matern Fetal Neonatal Med, 29, 1445-50.
Bacq, Y. (1999) [Liver and pregnancy]. Pathol Biol (Paris), 47, 958-65.
Bacq, Y., L. Sentilhes, H. B. Reyes, A. Glantz, J. Kondrackiene, T. Binder, P. L. Nicastri, A. Locatelli, A. Floreani, I. Hernandez & V. Di Martino (2012) Efficacy of Ursodeoxycholic Acid in Treating Intrahepatic Cholestasis of Pregnancy: A Meta-analysis. Gastroenterology.
Barnes, S. K. & S. E. Ozanne (2011) Pathways linking the early environment to long-term health and lifespan. Prog Biophys Mol Biol, 106, 323-36.
Beckett, G. J. & J. D. Hayes (1993) Glutathione S-transferases: biomedical applications. Adv Clin Chem, 30, 281-380.
Berg, B., G. Helm, L. Petersohn & N. Tryding (1986) Cholestasis of pregnancy. Clinical and laboratory studies. Acta Obstet Gynecol Scand, 65, 107-13.
Bergasa, N. V. (1995) The pruritus of cholestasis. Semin Dermatol, 14, 302-12.
Binder, T., P. Salaj, T. Zima & L. Vítek (2006) Randomized prospective comparative study of ursodeoxycholic acid and S-adenosyl-L-methionine in the treatment of intrahepatic cholestasis of pregnancy. J Perinat Med, 34, 383-91.
Boelsterli, U. A., G. Rakhit & T. Balazs (1983) Modulation by S-adenosyl-L-methionine of hepatic Na+,K+-ATPase, membrane fluidity, and bile flow in rats with ethinyl estradiol-induced cholestasis. Hepatology, 3, 12-7.
Brites, D., C. M. Rodrigues, H. van-Zeller, A. Brito & R. Silva (1998) Relevance of serum bile acid profile in the diagnosis of intrahepatic cholestasis of pregnancy in an high incidence area: Portugal. Eur J Obstet Gynecol Reprod Biol, 80, 31-8.
Brouwers, L., M. P. Koster, G. C. Page-Christiaens, H. Kemperman, J. Boon, I. M. Evers, A. Bogte & M. A. Oudijk (2015) Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels. Am J Obstet Gynecol, 212, 100.e1-7.
Chappell, L. C., V. Gurung, P. T. Seed, J. Chambers, C. Williamson, J. G. Thornton & P. S. Consortium (2012) Ursodeoxycholic acid versus placebo, and early term delivery versus expectant management, in women with intrahepatic cholestasis of pregnancy: semifactorial randomised clinical trial. BMJ, 344, e3799.
Chen, J., K. N. Zhao & G. B. Liu (2013) Estrogen-induced cholestasis: pathogenesis and therapeuticimplications. Hepatogastroenterology, 60, 1289-96.
Clifton, V. L., M. A. Read, I. M. Leitch, A. L. Boura, P. J. Robinson & R. Smith (1994) Corticotropin-releasing hormone-induced vasodilatation in the human fetal placental circulation. J Clin Endocrinol Metab, 79, 666-9.
Costoya, A. L., E. A. Leontic, H. G. Rosenberg & M. A. Delgado (1980) Morphological study of placental terminal villi in intrahepatic cholestasis of pregnancy: histochemistry, light and electron microscopy. Placenta, 1, 361-8.
Dann, A. T., A. P. Kenyon, P. T. Seed, L. Poston, A. H. Shennan & R. M. Tribe (2004) Glutathione S-transferase and liver function in intrahepatic cholestasis of pregnancy and pruritus gravidarum. Hepatology, 40, 1406-14.
Dann, A. T., A. P. Kenyon, A. S. Wierzbicki, P. T. Seed, A. H. Shennan & R. M. Tribe (2006) Plasma lipid profiles of women with intrahepatic cholestasis of pregnancy. Obstet Gynecol, 107, 106-14.
Davies, M. H., R. C. da Silva, S. R. Jones, J. B. Weaver & E. Elias (1995) Fetal mortality associated with cholestasis of pregnancy and the potential benefit of therapy with ursodeoxycholic acid. Gut, 37, 580-4.
Diac, M., A. Kenyon, C. Nelson-Piercy, J. Girling, F. Cheng, R. M. Tribe, J. Goodman, A. Shennan & C. Williamson (2006) Dexamethasone in the treatment of obstetric cholestasis: a case series. J Obstet Gynaecol, 26, 110-4.
Diaferia, A., P. L. Nicastri, M. Tartagni, P. Loizzi, C. Iacovizzi & A. Di Leo (1996) Ursodeoxycholic acid therapy in pregnant women with cholestasis. Int J Gynaecol Obstet, 52, 133-40.
Dixon, P. H., C. A. Wadsworth, J. Chambers, J. Donnelly, S. Cooley, R. Buckley, R. Mannino, S. Jarvis, A. Syngelaki, V. Geenes, P. Paul, M. Sothinathan, R. Kubitz, F. Lammert, R. M. Tribe, C. L. Ch'ng, H. U. Marschall, A. Glantz, S. A. Khan, K. Nicolaides, J. Whittaker, M. Geary & C. Williamson (2014) A comprehensive analysis of common genetic variation around six candidate loci for intrahepatic cholestasis of pregnancy. Am J Gastroenterol, 109, 76-84.
Eloranta, M. L., T. Häkli, M. Hiltunen, S. Helisalmi, K. Punnonen & S. Heinonen (2003) Association of single nucleotide polymorphisms of the bile salt export pump gene with intrahepatic cholestasis of pregnancy. Scand J Gastroenterol, 38, 648-52.
Fagan, E. A. (1999) Intrahepatic cholestasis of pregnancy. Clin Liver Dis, 3, 603-32.
Fisk, N. M. & G. N. Storey (1988) Fetal outcome in obstetric cholestasis. Br J Obstet Gynaecol, 95, 1137-43.
Floreani, A., D. Paternoster, A. Melis & P. V. Grella (1996) S-adenosylmethionine versus ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy: preliminary results of a controlled trial. Eur J Obstet Gynecol Reprod Biol, 67, 109-13.
Frezza, M., G. Pozzato, L. Chiesa, G. Stramentinoli & C. di Padova (1984) Reversal of intrahepatic cholestasis of pregnancy in women after high dose S-adenosyl-L-methionine administration. Hepatology, 4, 274-8.
Geenes, V., J. Chambers, R. Khurana, E. W. Shemer, W. Sia, D. Mandair, E. Elias, H. U. Marschall, W. Hague & C. Williamson (2015) Rifampicin in the treatment of severe intrahepatic cholestasis of pregnancy. Eur J Obstet Gynecol Reprod Biol, 189, 59-63.
Geenes, V., L. C. Chappell, P. T. Seed, P. J. Steer, M. Knight & C. Williamson (2013) Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: A prospective population-based case-control study. Hepatology.
--- (2014a) Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Hepatology, 59, 1482-91.
Geenes, V., A. Lövgren-Sandblom, L. Benthin, D. Lawrance, J. Chambers, V. Gurung, J. Thornton, L. Chappell, E. Khan, P. Dixon, H. U. Marschall & C. Williamson (2014b) The reversed feto-maternal bile acid gradient in intrahepatic cholestasis of pregnancy is corrected by ursodeoxycholic acid. PLoS One, 9, e83828.
Geenes, V. & C. Williamson (2009) Intrahepatic cholestasis of pregnancy. World J Gastroenterol, 15, 2049-66.
Geenes, V. L., Y. H. Lim, N. Bowman, H. Tailor, P. H. Dixon, J. Chambers, L. Brown, J. Wyatt-Ashmead, K. Bhakoo & C. Williamson (2011) A placental phenotype for intrahepatic cholestasis of pregnancy. Placenta, 32, 1026-32.
Germain, A. M., S. Kato, J. A. Carvajal, G. J. Valenzuela, G. L. Valdes & J. C. Glasinovic (2003) Bile acids increase response and expression of human myometrial oxytocin receptor. Am J Obstet Gynecol, 189, 577-82.
Glantz, A., H. U. Marschall, F. Lammert & L. A. Mattsson (2005) Intrahepatic cholestasis of pregnancy: a randomized controlled trial comparing dexamethasone and ursodeoxycholic acid. Hepatology, 42, 1399-405.
Glantz, A., H. U. Marschall & L. A. Mattsson (2004) Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates. Hepatology, 40, 467-74.
Glantz, A., S. J. Reilly, L. Benthin, F. Lammert, L. A. Mattsson & H. U. Marschall (2008) Intrahepatic cholestasis of pregnancy: Amelioration of pruritus by UDCA is associated with decreased progesterone disulphates in urine. Hepatology, 47, 544-51.
Gonzalez, M. C., H. Reyes, M. Arrese, D. Figueroa, B. Lorca, M. Andresen, N. Segovia, C. Molina & S. Arce (1989) Intrahepatic cholestasis of pregnancy in twin pregnancies. J Hepatol, 9, 84-90.
Gorelik, J., A. I. Shevchuk, I. Diakonov, M. de Swiet, M. Lab, Y. Korchev & C. Williamson (2003) Dexamethasone and ursodeoxycholic acid protect against the arrhythmogenic effect of taurocholate in an in vitro study of rat cardiomyocytes. BJOG, 110, 467-74.
Grand'Maison, S., M. Durand & M. Mahone (2014) The effects of ursodeoxycholic acid treatment for intrahepatic cholestasis of pregnancy on maternal and fetal outcomes: a meta-analysis including non-randomized studies. J Obstet Gynaecol Can, 36, 632-41.
Gurung, V., P. Middleton, S. J. Milan, W. Hague & J. G. Thornton (2013) Interventions for treating cholestasis in pregnancy. Cochrane Database Syst Rev, 6, CD000493.
Gylling, H., S. Riikonen, K. Nikkilä, H. Savonius & T. A. Miettinen (1998) Oral guar gum treatment of intrahepatic cholestasis and pruritus in pregnant women: effects on serum cholestanol and other non-cholesterol sterols. Eur J Clin Invest, 28, 359-63.
Haas, D., H. Gan-Schreier, C. D. Langhans, T. Rohrer, G. Engelmann, M. Heverin, D. W. Russell, P. T. Clayton, G. F. Hoffmann & J. G. Okun (2012) Differential diagnosis in patients with suspected bile acid synthesis defects. World J Gastroenterol, 18, 1067-76.
Heikkinen, J., O. Mäentausta, P. Ylöstalo & O. Jänne (1982) Serum bile acid levels in intrahepatic cholestasis of pregnancy during treatment with phenobarbital or cholestyramine. Eur J Obstet Gynecol Reprod Biol, 14, 153-62.
Heinonen, S. & P. Kirkinen (1999) Pregnancy outcome with intrahepatic cholestasis. Obstet Gynecol, 94, 189-93.
Henderson, C. E., R. R. Shah, S. Gottimukkala, K. K. Ferreira, A. Hamaoui & R. Mercado (2014) Primum non nocere: how active management became modus operandi for intrahepatic cholestasis of pregnancy. Am J Obstet Gynecol, 211, 189-96.
Hirvioja, M. L., R. Tuimala & J. Vuori (1992) The treatment of intrahepatic cholestasis of pregnancy by dexamethasone. Br J Obstet Gynaecol, 99, 109-11.
Jacquemin, E. (2012) Progressive familial intrahepatic cholestasis. Clin Res Hepatol Gastroenterol, 36 Suppl 1, S26-35.
Jain, R., V. Suri, S. Chopra, Y. K. Chawla & K. K. Kohli (2013) Obstetric cholestasis: outcome with active management. J Obstet Gynaecol Res, 39, 953-9.
Joutsiniemi, T., R. Leino, S. Timonen, K. Pulkki & U. Ekblad (2008) Hepatocellular enzyme glutathione S-transferase alpha and intrahepatic cholestasis of pregnancy. Acta Obstet Gynecol Scand, 87, 1280-4.
Joutsiniemi, T., S. Timonen, R. Leino, P. Palo & U. Ekblad (2014) Ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy: a randomized controlled trial. Arch Gynecol Obstet, 289, 541-7.
Joutsiniemi, T., S. Timonen, M. Linden, P. Suvitie & U. Ekblad (2015) Intrahepatic cholestasis of pregnancy: observational study of the treatment with low-dose ursodeoxycholic acid. BMC Gastroenterol, 15, 92.
Kaaja, R. J., K. K. Kontula, A. Räihä & T. Laatikainen (1994) Treatment of cholestasis of pregnancy with peroral activated charcoal. A preliminary study. Scand J Gastroenterol, 29, 178-81.
Kafkasli, A., M. A. Belfort, G. Giannina, Y. P. Vedërnikov, D. L. Schaffner & E. J. Popek (1997) Histopathologic effects of meconium on human umbilical artery and vein: in vitro study. J Matern Fetal Med, 6, 356-61.
Kauppila, A., H. Korpela, U. M. Mäkilä & E. Yrjänheikki (1987) Low serum selenium concentration and glutathione peroxidase activity in intrahepatic cholestasis of pregnancy. Br Med J (Clin Res Ed), 294, 150-2.
Kenyon, A. P., C. N. Piercy, J. Girling, C. Williamson, R. M. Tribe & A. H. Shennan (2002) Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG, 109, 282-8.
Kirbas, A., E. Biberoglu, K. Daglar, C. İskender, S. Erkaya, H. Dede, D. Uygur & N. Danisman (2014) Neutrophil-to-lymphocyte ratio as a diagnostic marker of intrahepatic cholestasis of pregnancy. Eur J Obstet Gynecol Reprod Biol, 180, 12-5.
Kirwan, W. O., A. N. Smith, W. D. Mitchell, J. D. Falconer & M. A. Eastwood (1975) Bile acids and colonic motility in the rabbit and the human. Gut, 16, 894-902.
Knapen, M. F., A. M. van Altena, W. H. Peters, H. M. Merkus, J. B. Jansen & E. A. Steegers (1998) Liver function following pregnancy complicated by the HELLP syndrome. Br J Obstet Gynaecol, 105, 1208-10.
Koivurova, S., A. L. Hartikainen, M. Gissler, E. Hemminki, U. Sovio & M. R. Järvelin (2002) Neonatal outcome and congenital malformations in children born after in-vitro fertilization. Hum Reprod, 17, 1391-8.
Kondrackiene, J., U. Beuers & L. Kupcinskas (2005) Efficacy and safety of ursodeoxycholic acid versus cholestyramine in intrahepatic cholestasis of pregnancy. Gastroenterology, 129, 894-901.
Kremer, A. E., R. Bolier, P. H. Dixon, V. Geenes, J. Chambers, D. Tolenaars, C. Ris-Stalpers, B. M. Kaess, C. Rust, J. A. van der Post, C. Williamson, U. Beuers & R. P. Oude Elferink (2014) Autotaxin activity has a high accuracy to diagnose intrahepatic cholestasis of pregnancy. J Hepatol.
Kretowicz, E. & H. D. McIntyre (1994) Intrahepatic cholestasis of pregnancy, worsening after dexamethasone. Aust N Z J Obstet Gynaecol, 34, 211-3.
Krueger, K. J., B. J. Hoffman & W. M. Lee (1990) Hepatic infarction associated with eclampsia. Am J Gastroenterol, 85, 588-92.
Kumtepe, Y., B. Börekçi, H. Aksoy, K. Altinkaynak, M. Ingeç & O. Ozdiller (2002) Measurement of plasma glutathione S-transferase in hepatocellular damage in pre-eclampsia. J Int Med Res, 30, 483-7.
Laatikainen, T. (1978) Effect of cholestyramine and phenobarbital on pruritus and serum bile acid levels in cholestasis of pregnancy. Am J Obstet Gynecol, 132, 501-6.
Laatikainen, T. J. (1975) Fetal bile acid levels in pregnancies complicated by maternal intrahepatic cholestasis. Am J Obstet Gynecol, 122, 852-6.
Laifer, S. A., R. J. Stiller, D. S. Siddiqui, G. Dunston-Boone & J. C. Whetham (2001) Ursodeoxycholic acid for the treatment of intrahepatic cholestasis of pregnancy. J Matern Fetal Med, 10, 131-5.
Lammert, F., H. U. Marschall, A. Glantz & S. Matern (2000) Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. J Hepatol, 33, 1012-21.
Lazaridis, K. N., G. J. Gores & K. D. Lindor (2001) Ursodeoxycholic acid 'mechanisms of action and clinical use in hepatobiliary disorders'. J Hepatol, 35, 134-46.
Lee, R. H., T. M. Goodwin, J. Greenspoon & M. Incerpi (2006) The prevalence of intrahepatic cholestasis of pregnancy in a primarily Latina Los Angeles population. J Perinatol, 26, 527-32.
Lee, R. H., K. M. Kwok, S. Ingles, M. L. Wilson, P. Mullin, M. Incerpi, B. Pathak & T. M. Goodwin (2008) Pregnancy outcomes during an era of aggressive management for intrahepatic cholestasis of pregnancy. Am J Perinatol, 25, 341-5.
Leevy, C. B., B. Koneru & K. M. Klein (1997) Recurrent familial prolonged intrahepatic cholestasis of pregnancy associated with chronic liver disease. Gastroenterology, 113, 966-72.
Liu, X., M. B. Landon, Y. Chen & W. Cheng (2015) Perinatal outcomes with intrahepatic cholestasis of pregnancy in twin pregnancies. J Matern Fetal Neonatal Med, 1-6.
Liu, Y., F. Qiao, H. Liu & D. Liu (2006) Ursodeoxycholic acid in the treatment of intraheptic cholestasis of pregnancy. J Huazhong Univ Sci Technolog Med Sci, 26, 350-2.
Lunzer, M., P. Barnes, K. Byth & M. O'Halloran (1986) Serum bile acid concentrations during pregnancy and their relationship to obstetric cholestasis. Gastroenterology, 91, 825-9.
Mannervik, B., Y. C. Awasthi, P. G. Board, J. D. Hayes, C. Di Ilio, B. Ketterer, I. Listowsky, R. Morgenstern, M. Muramatsu & W. R. Pearson (1992) Nomenclature for human glutathione transferases. Biochem J, 282 ( Pt 1), 305-6.
Marschall, H. U., M. Wagner, G. Zollner, P. Fickert, U. Diczfalusy, J. Gumhold, D. Silbert, A. Fuchsbichler, L. Benthin, R. Grundström, U. Gustafsson, S. Sahlin, C. Einarsson & M. Trauner (2005) Complementary stimulation of hepatobiliary transport and detoxification systems by rifampicin and ursodeoxycholic acid in humans. Gastroenterology, 129, 476-85.
Marschall, H. U., E. Wikström Shemer, J. F. Ludvigsson & O. Stephansson (2013) Intrahepatic cholestasis of pregnancy and associated hepatobiliary disease: a population-based cohort study. Hepatology, 58, 1385-91.
Martineau, M., C. Raker, R. Powrie & C. Williamson (2014) Intrahepatic cholestasis of pregnancy is associated with an increased risk of gestational diabetes. Eur J Obstet Gynecol Reprod Biol.
Meng, L. J., H. Reyes, J. Palma, I. Hernandez, J. Ribalta & J. Sjövall (1997) Effects of ursodeoxycholic acid on conjugated bile acids and progesterone metabolites in serum and urine of patients with intrahepatic cholestasis of pregnancy. J Hepatol, 27, 1029-40.
Miragoli, M., G. Gaudesius & S. Rohr (2006) Electrotonic modulation of cardiac impulse conduction by myofibroblasts. Circ Res, 98, 801-10.
Mullally, B. A. & W. F. Hansen (2002) Intrahepatic cholestasis of pregnancy: review of the literature. Obstet Gynecol Surv, 57, 47-52.
Mushtaq, I., S. Logan, M. Morris, A. W. Johnson, A. M. Wade, D. Kelly & P. T. Clayton (1999) Screening of newborn infants for cholestatic hepatobiliary disease with tandem mass spectrometry. BMJ, 319, 471-7.
Müllenbach, R., K. J. Linton, S. Wiltshire, N. Weerasekera, J. Chambers, E. Elias, C. F. Higgins, D. G. Johnston, M. I. McCarthy & C. Williamson (2003) ABCB4 gene sequence variation in women with intrahepatic cholestasis of pregnancy. J Med Genet, 40, e70.
Nicastri, P. L., A. Diaferia, M. Tartagni, P. Loizzi & M. Fanelli (1998) A randomised placebo-controlled trial of ursodeoxycholic acid and S-adenosylmethionine in the treatment of intrahepatic cholestasis of pregnancy. Br J Obstet Gynaecol, 105, 1205-7.
Oelberg, D. G., S. A. Downey & M. M. Flynn (1990) Bile salt-induced intracellular Ca++ accumulation in type II pneumocytes. Lung, 168, 297-308.
Oztas, E., K. Erkenekli, S. Ozler, A. O. Ersoy, M. Kurt, D. Uygur & N. Danisman (2014) Can routine laboratory parameters predict adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy? J Perinat Med.
Oztekin, D., I. Aydal, O. Oztekin, S. Okcu, R. Borekci & S. Tinar (2009) Predicting fetal asphyxia in intrahepatic cholestasis of pregnancy. Arch Gynecol Obstet, 280, 975-9.
Painter, J. N., M. Savander, A. Ropponen, N. Nupponen, S. Riikonen, O. Ylikorkala, A. E. Lehesjoki & K. Aittomäki (2005) Sequence variation in the ATP8B1 gene and intrahepatic cholestasis of pregnancy. Eur J Hum Genet, 13, 435-9.
Palma, J., H. Reyes, J. Ribalta, I. Hernández, L. Sandoval, R. Almuna, J. Liepins, F. Lira, M. Sedano, O. Silva, D. Tohá & J. J. Silva (1997) Ursodeoxycholic acid in the treatment of cholestasis of pregnancy: a randomized, double-blind study controlled with placebo. J Hepatol, 27, 1022-8.
Papacleovoulou, G., S. Abu-Hayyeh, E. Nikolopoulou, O. Briz, B. M. Owen, V. Nikolova, C. Ovadia, X. Huang, M. Vaarasmaki, M. Baumann, E. Jansen, C. Albrecht, M. R. Jarvelin, J. J. Marin, A. S. Knisely & C. Williamson (2013) Maternal cholestasis during pregnancy programs metabolic disease in offspring. J Clin Invest, 123, 3172-81.
Patel, S., M. Pinheiro, J. C. Felix, N. Opper, J. G. Ouzounian & R. H. Lee (2014) A case-control review of placentas from patients with intrahepatic cholestasis of pregnancy. Fetal Pediatr Pathol, 33, 210-5.
Pathak, B., L. Sheibani & R. H. Lee (2010) Cholestasis of pregnancy. Obstet Gynecol Clin North Am, 37, 269-82.
Pauli-Magnus, C., T. Lang, Y. Meier, T. Zodan-Marin, D. Jung, C. Breymann, R. Zimmermann, S. Kenngott, U. Beuers, C. Reichel, R. Kerb, A. Penger, P. J. Meier & G. A. Kullak-Ublick (2004) Sequence analysis of bile salt export pump (ABCB11) and multidrug resistance p-glycoprotein 3 (ABCB4, MDR3) in patients with intrahepatic cholestasis of pregnancy. Pharmacogenetics, 14, 91-102.
Paumgartner, G. & U. Beuers (2002) Ursodeoxycholic acid in cholestatic liver disease: mechanisms of action and therapeutic use revisited. Hepatology, 36, 525-31.
Perez, M. J., R. I. Macias & J. J. Marin (2006) Maternal cholestasis induces placental oxidative stress and apoptosis. Protective effect of ursodeoxycholic acid. Placenta, 27, 34-41.
Puljic, A., E. Kim, J. Page, T. Esakoff, B. Shaffer, D. Y. LaCoursiere & A. B. Caughey (2015) The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy by gestational age. Am J Obstet Gynecol.
Reid, R., K. J. Ivey, R. H. Rencoret & B. Storey (1976) Fetal complications of obstetric cholestasis. Br Med J, 1, 870-2.
Reyes, H. (1997) Review: intrahepatic cholestasis. A puzzling disorder of pregnancy. J Gastroenterol Hepatol, 12, 211-6.
Reyes, H., M. E. Báez, M. C. González, I. Hernández, J. Palma, J. Ribalta, L. Sandoval & R. Zapata (2000) Selenium, zinc and copper plasma levels in intrahepatic cholestasis of pregnancy, in normal pregnancies and in healthy individuals, in Chile. J Hepatol, 32, 542-9.
Reyes, H., M. C. Gonzalez, J. Ribalta, H. Aburto, C. Matus, G. Schramm, R. Katz & E. Medina (1978) Prevalence of intrahepatic cholestasis of pregnancy in Chile. Ann Intern Med, 88, 487-93.
Reyes, H. & J. Sjövall (2000) Bile acids and progesterone metabolites in intrahepatic cholestasis of pregnancy. Ann Med, 32, 94-106.
Ribalta, J., H. Reyes, M. C. Gonzalez, J. Iglesias, M. Arrese, J. Poniachik, C. Molina & N. Segovia (1991) S-adenosyl-L-methionine in the treatment of patients with intrahepatic cholestasis of pregnancy: a randomized, double-blind, placebo-controlled study with negative results. Hepatology, 13, 1084-9.
Riikonen, S., H. Savonius, H. Gylling, K. Nikkilä, A. M. Tuomi & T. A. Miettinen (2000) Oral guar gum, a gel-forming dietary fiber relieves pruritus in intrahepatic cholestasis of pregnancy. Acta Obstet Gynecol Scand, 79, 260-4.
Rioseco, A. J., M. B. Ivankovic, A. Manzur, F. Hamed, S. R. Kato, J. T. Parer & A. M. Germain (1994) Intrahepatic cholestasis of pregnancy: a retrospective case-control study of perinatal outcome. Am J Obstet Gynecol, 170, 890-5.
Rodrigues, C. M., J. J. Marín & D. Brites (1999) Bile acid patterns in meconium are influenced by cholestasis of pregnancy and not altered by ursodeoxycholic acid treatment. Gut, 45, 446-52.
Roger, D., L. Vaillant, A. Fignon, F. Pierre, Y. Bacq, J. F. Brechot, M. C. Grangeponte & G. Lorette (1994) Specific pruritic diseases of pregnancy. A prospective study of 3192 pregnant women. Arch Dermatol, 130, 734-9.
Rolfes, D. B. & K. G. Ishak (1986) Liver disease in pregnancy. Histopathology, 10, 555-70.
Roncaglia, N., A. Arreghini, A. Locatelli, P. Bellini, C. Andreotti & A. Ghidini (2002) Obstetric cholestasis: outcome with active management. Eur J Obstet Gynecol Reprod Biol, 100, 167-70.
Roncaglia, N., A. Locatelli, A. Arreghini, F. Assi, I. Cameroni, J. C. Pezzullo & A. Ghidini (2004) A randomised controlled trial of ursodeoxycholic acid and S-adenosyl-l-methionine in the treatment of gestational cholestasis. BJOG, 111, 17-21.
Ropponen, A., R. Sund, S. Riikonen, O. Ylikorkala & K. Aittomäki (2006) Intrahepatic cholestasis of pregnancy as an indicator of liver and biliary diseases: a population-based study. Hepatology, 43, 723-8.
Sadler, L. C., M. Lane & R. North (1995) Severe fetal intracranial haemorrhage during treatment with cholestyramine for intrahepatic cholestasis of pregnancy. Br J Obstet Gynaecol, 102, 169-70.
Saleh, M. M. & K. R. Abdo (2007) Intrahepatic cholestasis of pregnancy: review of the literature and evaluation of current evidence. J Womens Health (Larchmt), 16, 833-41.
Samsioe, G., P. Svendsen, P. Johnson & A. Gustafson (1975) Studies in cholestasis of pregnancy. V. Gallbladder disease, liver function tests, serum lipids and fatty acid composition of serum lecithin in the non-pregnant state. Acta Obstet Gynecol Scand, 54, 417-23.
Savander, M., A. Ropponen, K. Avela, N. Weerasekera, B. Cormand, M. L. Hirvioja, S. Riikonen, O. Ylikorkala, A. E. Lehesjoki, C. Williamson & K. Aittomäki (2003) Genetic evidence of heterogeneity in intrahepatic cholestasis of pregnancy. Gut, 52, 1025-9.
Sentilhes, L., E. Verspyck, P. Pia & L. Marpeau (2006) Fetal death in a patient with intrahepatic cholestasis of pregnancy. Obstet Gynecol, 107, 458-60.
Sepúlveda, W. H., C. González, M. A. Cruz & M. I. Rudolph (1991) Vasoconstrictive effect of bile acids on isolated human placental chorionic veins. Eur J Obstet Gynecol Reprod Biol, 42, 211-5.
Serrano, M. A., D. Brites, M. G. Larena, M. J. Monte, M. P. Bravo, N. Oliveira & J. J. Marin (1998) Beneficial effect of ursodeoxycholic acid on alterations induced by cholestasis of pregnancy in bile acid transport across the human placenta. J Hepatol, 28, 829-39.
Shand, A. W., J. E. Dickinson & L. D'Orsogna (2008) Refractory fetal supraventricular tachycardia and obstetric cholestasis. Fetal Diagn Ther, 24, 277-81.
Simják, P., A. Pařízek, L. Vítek, A. Cerný, K. Adamcová, M. Koucký, M. Hill, M. Dušková & L. Stárka (2014) Fetal complications due to intrahepatic cholestasis of pregnancy. J Perinat Med.
Sjövall, J. & K. Sjövall (1970) Steroid sulphates in plasma from pregnant women with pruritus and elevated plasma bile acid levels. Ann Clin Res, 2, 321-37.
Steegers, E. A., T. P. Mulder, J. G. Bisseling, F. M. Delemarre & W. H. Peters (1995) Glutathione S-transferase alpha as marker for hepatocellular damage in pre-eclampsia and HELLP syndrome. Lancet, 345, 1571-2.
Strehlow, S. L., B. Pathak, T. M. Goodwin, B. M. Perez, M. Ebrahimi & R. H. Lee (2010) The mechanical PR interval in fetuses of women with intrahepatic cholestasis of pregnancy. Am J Obstet Gynecol, 203, 455.e1-5.
Suri, V., R. Jain, N. Aggarwal, Y. K. Chawla & K. K. Kohli (2012) Usefulness of fetal monitoring in intrahepatic cholestasis of pregnancy: a prospective study. Arch Gynecol Obstet, 286, 1419-24.
Tan, L. K. (2003) Obstetric cholestasis: current opinions and management. Ann Acad Med Singapore, 32, 294-8.
Turunen, K., K. Helander, K. J. Mattila & M. Sumanen (2013) Intrahepatic cholestasis of pregnancy is common among patients' first-degree relatives. Acta Obstet Gynecol Scand, 92, 1108-10.
Turunen, K., M. Sumanen, R. L. Haukilahti, P. Kirkinen & K. Mattila (2010) Good pregnancy outcome despite intrahepatic cholestasis. Scand J Prim Health Care, 28, 102-7.
Wang, C., X. Chen, S. F. Zhou & X. Li (2011) Impaired fetal adrenal function in intrahepatic cholestasis of pregnancy. Med Sci Monit, 17, CR265-71.
Wasmuth, H. E., A. Glantz, H. Keppeler, E. Simon, C. Bartz, W. Rath, L. A. Mattsson, H. U. Marschall & F. Lammert (2007) Intrahepatic cholestasis of pregnancy: the severe form is associated with common variants of the hepatobiliary phospholipid transporter ABCB4 gene. Gut, 56, 265-70.
Wikström Shemer, E., H. U. Marschall, J. F. Ludvigsson & O. Stephansson (2013) Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study. BJOG, 120, 717-23.
Wikström Shemer, E., M. Thorsell, E. Östlund, B. Blomgren & H. U. Marschall (2012) Stereological assessment of placental morphology in intrahepatic cholestasis of pregnancy. Placenta, 33, 914-8.
Wikström Shemer, E. A., O. Stephansson, M. Thuresson, M. Thorsell, J. F. Ludvigsson & H. U. Marschall (2015) Intrahepatic cholestasis of pregnancy and cancer, immune-mediated and cardiovascular diseases: A population-based cohort study. J Hepatol, 63, 456-61.
Williamson, C., J. Gorelik, B. M. Eaton, M. Lab, M. de Swiet & Y. Korchev (2001) The bile acid taurocholate impairs rat cardiomyocyte function: a proposed mechanism for intra-uterine fetal death in obstetric cholestasis. Clin Sci (Lond), 100, 363-9.
Williamson, C., L. M. Hems, D. G. Goulis, I. Walker, J. Chambers, O. Donaldson, M. Swiet & D. G. Johnston (2004) Clinical outcome in a series of cases of obstetric cholestasis identified via a patient support group. BJOG, 111, 676-81.
Wilson, B. R. & A. D. Haverkamp (1979) Cholestatic jaundice of pregnancy: new perspectives. Obstet Gynecol, 54, 650-2.
Wu, W. B., Y. Y. Xu, W. W. Cheng, Y. X. Wang, Y. Liu, D. Huang & H. J. Zhang (2015) Agonist of farnesoid X receptor protects against bile acid induced damage and oxidative stress in mouse placenta--a study on maternal cholestasis model. Placenta, 36, 545-51.
Zapata, R., L. Sandoval, J. Palma, I. Hernández, J. Ribalta, H. Reyes, M. Sedano, D. Tohá & J. J. Silva (2005) Ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy. A 12-year experience. Liver Int, 25, 548-54.
Zecca, E., S. Costa, V. Lauriola, G. Vento, P. Papacci & C. Romagnoli (2004) Bile acid pneumonia: a "new" form of neonatal respiratory distress syndrome? Pediatrics, 114, 269-72.
Zecca, E., D. De Luca, S. Baroni, G. Vento, E. Tiberi & C. Romagnoli (2008) Bile acid-induced lung injury in newborn infants: a bronchoalveolar lavage fluid study. Pediatrics, 121, e146-9.
Zecca, E., D. De Luca, M. Marras, A. Caruso, T. Bernardini & C. Romagnoli (2006) Intrahepatic cholestasis of pregnancy and neonatal respiratory distress syndrome. Pediatrics, 117, 1669-72.
Zhou, F., B. Gao, X. Wang & J. Li (2014a) [Meta-analysis of ursodeoxycholic acid and S-adenosylmethionine for improving the outcomes of intrahepatic cholestasis of pregnancy]. Zhonghua Gan Zang Bing Za Zhi, 22, 299-304.
Zhou, F., M. M. He, Z. F. Liu, L. Zhang, B. X. Gao & X. D. Wang (2013) Expression of corticotrophin-releasing hormone and its receptor in patients with intrahepatic cholestasis of pregnancy. Placenta, 34, 401-6.
Zhou, F., L. Zhang, M. M. He, Z. F. Liu, B. X. Gao & X. D. Wang (2014b) Corticotropin-releasing hormone expression in patients with intrahepatic cholestasis of pregnancy after ursodeoxycholic acid treatment: an initial experience. Curr Med Res Opin, 30, 1529-35.
Zimmermann, P., J. Koskinen, P. Vaalamo & T. Ranta (1991) Doppler umbilical artery velocimetry in pregnancies complicated by intrahepatic cholestasis. J Perinat Med, 19, 351-5.