BJOG. 2022 Apr 4. doi: 10.1111/1471-0528.17174. Online ahead of print.
ABSTRACT
OBJECTIVE: To establish pregnancy-specific reference ranges for fasting and postprandial total serum bile acids (TSBA) concentrations.
DESIGN: Cross-sectional study.
SETTING: Tertiary care university hospital.
POPULATION: Healthy pregnant women at term admitted to the Obstetrics Department over one year. Exclusion criteria were an established diagnosis of intrahepatic cholestasis of pregnancy (ICP) or any co-existing condition of increased risk for ICP.
METHODS AND MAIN OUTCOME MEASURES: Both fasting (8-14 hours of fasting) and postprandial (2 hours after meal) TSBA concentrations were measured in 612 women (528 fasting and 377 postprandial samples) by automated enzymatic-spectrophotometric assay.
RESULTS: Reference intervals of 4.4-14.1 μmol/L for fasting TSBA, and 4.7-20.2 μmol/L for postprandial TSBA were established. The postprandial values were significantly higher than the fasting measurements, with a median increase of 1.0 μmol/L (p< 0.0001). A correlation between fasting TSBA concentrations and postprandial concentrations was found, as well as with fetal gender, parity, and assisted reproductive technologies. A seasonal pattern was noticed for both fasting and postprandial TSBA, with the highest values in the winter season (p < 0.01 and 0.02, respectively).
CONCLUSIONS: Normal pregnancy is associated with mild hypercholanaemia, therefore a higher threshold should be considered for the diagnosis of ICP. We suggest using the upper reference limit observed in our healthy pregnant population (14 μmol/L for fasting and 20 μmol/L for postprandial TSBA). As the fasting measurement is more specific for the diagnosis, and the postprandial is essential for severity assessment, it is recommended to measure both values, rather than use random samplings.
PMID:35373886 | DOI:10.1111/1471-0528.17174
