What should my bile acid level be

Treatment of ICP should ideally decrease maternal bile acid levels to prolong the pregnancy and reduce both fetal risk and maternal symptoms. Systemic treatment with antihistamines, epomediol, silymarin, phenobarbital, or activated charcoal have had only limited success. Although the exact mechanism of action in ICP is still not fully understood, there is evidence that it corrects the maternal serum bile acid profile, 4 decreases the passage of maternal bile acids to the fetoplacental unit, and improves the function of the bile acid transport system across the trophoblast, 22 thus representing a valuable contribution to fetal well-being and outcome.

With the exception of 1 patient who experienced transient, mild diarrhea, ursodeoxycholic acid was tolerated without adverse effects in all our patients.

In conclusion, pruritus in pregnancy, particularly in the last trimester, must never be neglected, and its workup should always include laboratory assessment of total serum bile acid levels to exclude or confirm ICP.

Because ICP may be associated with severe fetal risks, including premature birth, intrapartal fetal distress, and stillbirth, early diagnosis, close obstetric surveillance, and prompt treatment with ursodeoxycholic acid are essential.

Dermatologists have an important role in detecting and treating ICP and therefore need to be familiar with its diagnostic criteria and therapeutic options.

Correspondence: Christina M. Author Contributions: Study concept and design : Ambros-Rudolph. Analysis and interpretation of data : Ambros-Rudolph, Glatz, and Trauner. Drafting of the manuscript : Ambros-Rudolph.

Statistical analysis : Ambros-Rudolph. Administrative, technical, and material support : Glatz. Arch Dermatol. Coronavirus Resource Center. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Save Preferences. Privacy Policy Terms of Use. Twitter Facebook. This Issue. Citations View Metrics.

June Christina M. Clinical characteristics and therapy. View Large Download. Laboratory findings. Obstetric characteristics. Back to top Article Information. The specific dermatoses of pregnancy revisited and reclassified: results of a retrospective two-center study on pregnant patients. Carter J Serum bile acids in normal pregnancy. Kreek MJ Female sex steroids and cholestasis. Reyes H The spectrum of liver and gastrointestinal disease seen in cholestasis of pregnancy.

Intrahepatic cholestasis of pregnancy as an indicator of liver and biliary diseases: a population-based study. Selenium, zinc and copper plasma levels in intrahepatic cholestasis of pregnancy, in normal pregnancies and in healthy individuals in Chile.

Is a leaky gut involved in the pathogenesis of intrahepatic cholestasis of pregnancy? Intrahepatic cholestasis of pregnancy: a retrospective case-control study of perinatal outcome. Shornick JK Dermatoses of pregnancy. Kroumpouzos G Intrahepatic cholestasis of pregnancy: what's new.

Correction of maternal serum bile acid profile during ursodeoxycholic acid therapy in cholestasis of pregnancy. Obstetric cholestasis with elevated gamma glutamyl transpeptidase: incidence, presentation and treatment.

Ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy: a year experience. Total bile acids are metabolized in the liver and can serve as a marker for normal liver function. Increases in serum bile acids are seen in patients with acute hepatitis, chronic hepatitis, liver sclerosis, and liver cancer. Serum total bile acid testing is generally not suitable for differentiation among the various types of liver diseases.

Total bile acid concentration is increased after meals; samples should be collected under fasting conditions. Clin Chim Acta. Shima T, Tada H, Morimoto M, et al: Serum total bile acid level as a sensitive indicator of hepatic histological improvement in chronic hepatitis C patients responding to interferon treatment.

J Gastroenterol Hepatol. Lebovics E, Seif F, Kim D, et al: Pruritus in chronic hepatitis C: Association with high serum bile acids, advanced pathology, and bile duct abnormalities. Dig Dis Sci. Serum bile acids compared with conventional tests and histology. NEJM June 20; Total serum bile acids or serum bile acid profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy.

This testing can be performed at any point in the day and, based on recent recommendations, does not require fasting. There are a number of different bile acid tests, depending on the laboratory, and these all can be used for diagnosis.

Fractionated bile acid tests can be used to diagnose at a lower level, as these tests measure only select bile acids. Bile acid results in the United States can take anywhere between 36 hours days for results to return, as these are specialized tests that are only performed in a few laboratories in the country. Normal bile acids do not rule out an eventual diagnosis of cholestasis.

Itching is often related to a chemical known as lysophosphatidic acid and not directly to the elevation of the bile acids.

Studies have shown that itching can occur even a few weeks prior to an elevation in blood bile acid levels. If you continue to have itching, you should be retested as long as your symptoms persist.

Bile acid levels should also be followed in pregnancy even after diagnosis. Prior studies have shown a greater risk for pregnancy complications with higher bile acid levels. Complications such as preterm labor, respiratory issues after birth, and meconium staining of the amniotic fluid occur at greater rates with bile acids over A recent analysis of a large number of cholestasis pregnancies also found that most pregnancy complications occur with bile acids over , and bile acids over this level require a more aggressive management plan.

There is no consensus for how often bile acids should be measured, but it is recommended that they be followed, especially near the end of pregnancy, so that delivery timing can be planned. Please visit the Diagnostic Testing page for additional information on the different types of bile acid tests and their reference ranges.

A normal liver function panel does not rule out the disorder as bile acid testing still needs to be performed.