Materiały źródłowe

• #1 Cholestasis of pregnancy – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cholestasis-of-pregnancy/symptoms-causes/syc-20363257

  Intrahepatic cholestasis of pregnancy, commonly known as cholestasis of pregnancy, is a liver condition that can occur in late pregnancy. […] The exact cause of cholestasis of pregnancy is unclear. Cholestasis is reduced or stopped bile flow. Bile is the digestive fluid made in the liver that helps break down fats. Instead of leaving the liver for the small intestine, bile builds up in the liver. As a result, bile acids eventually enter the bloodstream. High levels of bile acids appear to cause the symptoms and complications of cholestasis of pregnancy. […] Pregnancy hormones, genetics and the environment may all play a role. […] Hormones. Pregnancy hormones rise the closer you get to your due date. This may slow the flow of bile. […] Genes. Sometimes, the condition runs in families. Certain gene changes have been identified that may be linked to cholestasis of pregnancy. […] Environment. Although the exact environmental factors aren’t clear, risk varies by geographic location and season.

• #2 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551503/

  Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder in the late second and early third trimester of pregnancy. […] The etiology of intrahepatic cholestasis of pregnancy (ICP) is poorly understood and is thought to be complicated and multifactorial. Genetic susceptibility, hormonal, and environmental factors have been proposed as possible mechanisms. […] There appears to be a relation between cholestatic properties of reproductive hormones in genetically susceptible women and ICP. […] Recent studies have shown evidence of mutations in genes (ABCB4) encoding hepatobiliary canalicular translocator proteins called multidrug resistance 3 (MDR3) and pedigrees with the mode of inheritance being a sex-limited, dominant pattern. […] The role of reproductive hormones in developing ICP has also appeared in multiple studies. Many studies showed an association of high levels of estrogen conditions such as multitone pregnancy, ovarian hyperstimulation effect, and late second-trimester presentation of ICP.

• #3 Intrahepatic cholestasis of pregnancy – UpToDate

  https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy/print

  Intrahepatic cholestasis of pregnancy (ICP) is characterized by pruritus and an elevation in serum bile acid concentrations, typically developing in the late second and/or third trimester and rapidly resolving after delivery. […] The etiology of ICP is not completely understood but likely involves a combination of genetic susceptibility, hormonal factors, and environmental factors.

• #4 Cholestasis of Pregnancy: Symptoms and TreatmentCircleBumpCheckedFilledMedicalBookmarkBookmarkTickBookmarkAddCheckBoxCheckBoxFilled

  https://www.thebump.com/a/cholestasis-of-pregnancy

  Experiencing intensely itchy palms and feet? It may be a sign of a prenatal liver condition called cholestasis of pregnancy. […] While it’s extremely rare (the occurrence rate is between 0.3 and 0.5 percent among the general population), according to the Society of Maternal-Fetal Medicine (SMFM), cholestasis is still the most common pregnancy-specific liver condition. […] So why does cholestasis happen during pregnancy? “We think that the high estrogen and progesterone state alters the way the liver processes bile acids,” says G. Thomas Ruiz, MD, an ob-gyn and lead provider at MemorialCare Orange Coast Medical Center in Fountain Valley, California. […] Estrogen levels are at record highs during pregnancy and then drop rapidly after delivery, explains Erlich, when cholestasis of pregnancy symptoms mostly resolve. This strengthens the argument that pregnancy hormone fluctuations play the biggest role in contributing to cholestasis of pregnancy.

• #5 Cholestasis Of Pregnancy: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17901-cholestasis-of-pregnancy

  Cholestasis of pregnancy is a liver disease that can develop late in pregnancy. Cholestasis of pregnancy is a condition that causes bile to build up in your gallbladder, liver and bloodstream. Cholestasis of pregnancy is a liver condition that causes severe itching late in pregnancy. ICP temporarily lowers liver function in some pregnant women. Increased levels of estrogen and progesterone during pregnancy affect your liver’s ability to transport bile. Cholestasis of pregnancy typically develops in the third trimester (around week 28 of pregnancy) when pregnancy hormone levels are at their highest. In some cases, it’s genetic, meaning you’re at higher risk if your biological parents have cholestasis. […] Cholestasis of pregnancy may cause complications. You may have problems absorbing vitamin K, which increases the risk of hemorrhage (heavy internal bleeding). It’s also associated with preeclampsia and gestational diabetes. […] You’re at higher risk for developing cholestasis of pregnancy if you have a family member with the condition.

• #6 Intrahepatic cholestasis of pregnancy – Wikipedia

  https://en.wikipedia.org/wiki/Intrahepatic_cholestasis_of_pregnancy

  Intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis, cholestasis of pregnancy, jaundice of pregnancy, and prurigo gravidarum, is a medical condition in which cholestasis occurs during pregnancy. […] The causes of intrahepatic cholestasis of pregnancy are still not fully understood, but are thought to be caused through a combination of genetic, hormonal, and environmental factors. […] ICP commonly occurs in the third trimester at the time when hormone levels are at their highest. […] Twin and triplet pregnancies, which are associated with higher hormone levels, show a higher incidence of ICP. […] Older high-dose estrogen oral contraceptive pills could cause features of ICP. […] Clustering of cases of ICP in families, geographic variation in rates of ICP, and recurrence of ICP in 45-70% of subsequent pregnancies all suggest a genetic component to the disease.

• #7 Intrahepatic cholestasis of pregnancy – Wikipedia

  https://en.wikipedia.org/wiki/Intrahepatic_cholestasis_of_pregnancy

  Genetic mutations in the hepatocellular transport protein ABCB4 (MDR3), which controls secretion of phosphatidylcholine into bile, have been found in cases of ICP. […] Genetic mutations affecting hepatic bile salt transport molecules have also been found in patients with progressive familial intrahepatic cholestasis. […] High levels of estrogen glucuronides have been shown to inhibit the bile salt export pump (BSEP) ABCB11, and high levels of progesterone to inhibit the ABCB4 (MDR3) phospholipid transporter. […] Consequently, both genetic mutations in hepatocyte proteins involved in bile secretion together with inhibition of those proteins by high levels of hormone metabolites in pregnancy may have roles in the pathogenesis of ICP. […] A number of features of ICP suggest that environmental factors also have a role in the disease: It has been reported that the incidence of ICP is higher in winter than summer. […] Low serum selenium levels have been linked to ICP, although the role of selenium in bile secretion is not known.

• #8 Causes — ICP Support

  https://www.icpsupport.org/causes

  ICP is a complex condition caused through a combination of: […] hormones […] genetics […] environment. […] In ICP the levels of estrogen and progesterone are not higher than normal, but the level of some progesterone breakdown products (called sulfated metabolites) is higher in women with ICP. […] Some researchers think that it is these substances that affect the liver’s ability to cope with bile acids, leading to cholestasis. […] Women with ICP have also reported developing cholestasis following the use of oral contraceptives, and we know that progesterone preparations used to prevent preterm labour may also increase the risk of developing ICP. […] ICP is more common in certain populations, including women of South American, Indian and Pakistani origin, and it can also run in families.

• #9 Cholestasis of Pregnancy: Causes, Symptoms & Treatment

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/cholestasis-of-pregnancy/?sw_cache=rebuild

  Pregnancy hormones affect liver function, resulting in slowing or stopping the flow of bile. The gallbladder holds bile that is produced in the liver, which is necessary for the breakdown of fats in digestion. When the bile flow in the liver itself is stopped or slowed down, this causes a build up of bile acids in the liver which can spill into the bloodstream. ICP is diagnosed when the total bile acids (TBA) or serum bile acids are measured at 10 micromol/L and above. Studies initially showed that this increase in bile acids was due to estrogen only, but recent research has found that progesterone may contribute just as much to this backup. […] 1 to 2 pregnancies in 1,000 are affected by cholestasis. The following women have a higher risk of getting cholestasis during pregnancy: Women carrying multiples, Women who have previous liver damage, Women whose mother or sisters had Cholestasis or ICP.

• #9 Cholestasis of Pregnancy: Causes, Symptoms & Treatment

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/cholestasis-of-pregnancy/?sw_cache=rebuild

  Cholestasis of Pregnancy: Causes, Symptoms & Treatment […] Some women experience a very severe itching in late pregnancy. The most common cause of this is cholestasis, a common liver disease that only happens in pregnancy. Intrahepatic Cholestasis of Pregnancy (ICP) is a condition in which the normal flow of bile is affected by the increased amounts of pregnancy hormones. Cholestasis in pregnancy is more common in the last trimester of pregnancy when hormones are at their peak, but it usually goes away within a few days after delivery. According to Cincinnati Children’s Hospital Medical Center, Cholestasis occurs in about 1 out of 1,000 pregnancies but is more common in Swedish and Chilean ethnic groups. Cholestasis is sometimes referred to as extrahepatic cholestasis which occurs outside the liver, intrahepatic cholestasis which occurs inside the liver, or obstetric cholestasis.

• #9 Cholestasis of Pregnancy: Causes, Symptoms & Treatment

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/cholestasis-of-pregnancy/?sw_cache=rebuild

  A diagnosis of cholestasis can be made by doing a complete medical history, physical examination, and blood tests that evaluate liver function, bile acids, and bilirubin. The Society for Maternal-Fetal Medicine concurs that cholestasis of pregnancy should be diagnosed when the total bile acids (TBA) or serum bile acids are measured at 10 micromol/L and above. […] Cholestasis may increase the risks for fetal distress, preterm birth, or stillbirth. A developing baby relies on the mother’s liver to remove bile acids from the blood; therefore, the elevated levels of maternal bile cause stress on the baby’s liver. Women with cholestasis should be monitored closely and serious consideration should be given to inducing labor once the baby’s lungs have reached maturity. […] The treatment goals for cholestasis of pregnancy are to relieve itching. Make sure you speak with your healthcare provider before taking any medications or supplements. Some treatment options include: Topical anti-itch medications or medication with corticosteroids, Medication to decrease the concentration of bile acids such as ursodeoxycholic acid, Cold baths and ice water slow down the flow of blood in the body by decreasing the temperature, Dexamethasone is a steroid that increases the maturity of the baby’s lungs, Vitamin K supplements administered to the mother before delivery and again once the baby is born to prevent intracranial hemorrhaging, Dandelion Root and Milk Thistle are natural substances that are beneficial to the liver (talk to your healthcare provider before taking these), Bi-weekly non-stress tests which involve fetal heart monitoring and contraction recordings, Regular blood tests monitoring both bile serum levels and liver function.

• #10 Intrahepatic cholestasis of pregnancy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2678574/

  Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder characterized by maternal pruritus in the third trimester, raised serum bile acids and increased rates of adverse fetal outcomes. The etiology of ICP is complex and not fully understood, but it is likely to result from the cholestatic effects of reproductive hormones and their metabolites in genetically susceptible women. Equally unclear are the mechanisms by which the fetal complications occur. […] The etiology of ICP is complex and not fully understood. Evidence from ICP pedigrees suggests that there is a genetic component to the disease, and the relative risk for parous sisters of affected women is 12. […] Several studies provide evidence that reproductive hormones play a role in the etiology of ICP. The disease is more common in multiple than singleton pregnancies, and the symptoms may recur in a subgroup of affected women when taking the combined oral contraceptive pill. […] The etiology of the fetal complications associated with ICP is poorly understood, but is thought to relate to an increased flux of bile acids into the fetal circulation, as indicated by elevated levels in amniotic fluid, cord serum and meconium.

• #11 Intrahepatic Cholestasis of Pregnancy

  https://mobile.fpnotebook.com/Derm/OB/IntrhptcChlstsOfPrgncy.htm

  Reversible pregnancy-specific cholestasis associated with Pruritus, increased serum bile acids and liver enzymes […] Related to increased serum Estrogen levels […] Genetic Predisposition may affect bile salt transport and excretion […] Mutations have been identified in gene on p23 region of Chromosome 2 […] History of Intrahepatic Cholestasis of Pregnancy in prior pregnancies (recurs in 40 to 60% of patients) […] Serum bile acid levels 40 umol/L are associated with higher fetal mortality […] Findings most consistent with Intrahepatic Cholestasis of Pregnancy […] Bile canaliculi widened with non-inflammatory centrilobular cholestasis […] Normal hepatic parenchyma […] Bile plugs in the hepatocytes […] Bilirubin is toxic to fetal cardiac cells, and causes Vasoconstriction of chorionic veins […] Fetal adverse effects increase with degree of bile acid accumulation.

• #12 Intrahepatic cholestasis of pregnancy: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/intrahepatic-cholestasis-of-pregnancy/

  The largest genetic contributor is the ABCB4 gene; variants in this gene have been found in up to 25 percent of women with intrahepatic cholestasis of pregnancy. […] Even with these variants, enough protein is still available in most cases to move an adequate amount of phospholipids out of liver cells to bind to bile acids. The added stress on the liver during pregnancy, however, contributes to the buildup of bile acids. Toxic levels of bile acids can impair liver function, including the regulation of bile flow.

• #13 Causes — ICP Support

  https://www.icpsupport.org/causes

  In ICP, scientists have shown that rare changes in the code of two genes can be found in women with the disease. […] These two genes, ABCB4 (changes in about 20% of women) and ABCB11 (about 5% of women), have rare mutations that are believed to be causative – making sense, as both genes are involved in making the genes that transport bile. […] Environmental factors are thought to play a role in the development of the condition because ICP is more common in the winter months in some countries. […] Some theories include that the cause of ICP could be linked to: […] Sunlight and vitamin D levels, as research studies have shown that supplementation with vitamin D can improve cholestasis in animals […] Diet, as people often have a tendency to eat fattier foods in the winter […] Low levels of the element selenium.

• #14 Intrahepatic cholestasis of pregnancy: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/intrahepatic-cholestasis-of-pregnancy/

  Intrahepatic cholestasis of pregnancy is a complex disorder. It is believed to be caused by a combination of genetic, hormonal, and environmental factors. Risk factors for developing intrahepatic cholestasis of pregnancy include underlying liver disease and a form of diabetes called gestational diabetes that occurs during pregnancy. Being pregnant with more than one baby or having a history of intrahepatic cholestasis of pregnancy also increases the risk of developing this condition. Sometimes, more than one person in a family has this condition. […] Variants in several different genes are believed to increase the risk of developing intrahepatic cholestasis of pregnancy. Many of these genes provide instructions for making proteins that help with the production (synthesis) or transportation of bile acids.

• #15 Intrahepatic Cholestasis of Pregnancy

  https://liverfoundation.org/liver-diseases/complications-of-liver-disease/intrahepatic-cholestasis-of-pregnancy-icp/

  Intrahepatic Cholestasis of Pregnancy (ICP) is a liver disorder which occurs during pregnancy. […] This condition affects the normal flow of bile. Bile acids are chemicals in the bile of the liver that help with digestion. With ICP the bile flow begins to slow down and the bile acids build up in the blood. […] Intrahepatic Cholestasis of Pregnancy is a condition in which the normal flow of bile is affected by the increased amounts of pregnancy hormones. Cholestasis is more common in the last trimester of pregnancy when hormones are at their peak. […] Overall, 1 to 2 pregnancies in 1,000 is affected by ICP in the USA with Latina populations at 5.6%. Risk is increased in women carrying multiples, women who have had IVF treatment and those who have had previous liver damage or issues. […] ICP has been shown to extend in families. Mothers and sisters are at higher risk of developing the condition, proving that there is a definite genetic predisposition although additional research is needed to explain all cases of the condition in reference to genes.

• #16 Itching and intrahepatic cholestasis of pregnancy – NHS

  https://www.nhs.uk/pregnancy/related-conditions/complications/itching-and-intrahepatic-cholestasis/

  Intrahepatic cholestasis of pregnancy (ICP) is a potentially serious liver disorder that can develop in pregnancy. […] In ICP, the bile acids do not flow properly and build up in your body instead. […] ICP seems to run in families, but it can happen even if there is no family history. […] It is more common in women of south Asian origin, affecting around 1 in 70 to 80 pregnancies. […] If you have had ICP in a previous pregnancy, you have a high chance of developing it again in another pregnancy. […] Some studies have found that babies whose mothers have ICP have a higher chance of being born prematurely or stillborn. […] Because of the link with stillbirth, you may be offered induction of labour. […] ICP is diagnosed by excluding other causes of the itch. […] A medicine called ursodeoxycholic acid (UDCA) can be prescribed to try to relieve itching. […] But recent evidence suggests it may not be effective in reducing bile acids and easing itching. […] Most experts on ICP only prescribe vitamin K if the mother-to-be reports pale poo, has a known blood clotting problem, or has very severe ICP from early in pregnancy.

• #17

  https://www.bhrhospitals.nhs.uk/obstetric-cholestasis-/

  Intrahepatic Cholestatis of Pregnancy (ICP) also known as obstetric cholestasis is a liver disorder that can develop during pregnancy. […] Research shows that ICP is likely to be due to a combination of hormones during pregnancy and genetic factors. ICP also seems to run in families (although it can happen even if theres no family history). […] If you have had ICP in a previous pregnancy, you have a high chance (up to 90%) of developing it again.

• #18 Intrahepatic Cholestasis of Pregnancy

  https://liverfoundation.org/liver-diseases/complications-of-liver-disease/intrahepatic-cholestasis-of-pregnancy-icp/

  Pregnancy hormones estrogen and progesterone have an effect on the livers ability to transport certain chemicals, including bile acids. The flow of bile acids is significantly reduced and leads to the bile acids building up in the blood that causes the symptoms. […] There are more women diagnosed with Intrahepatic Cholestasis of Pregnancy (ICP) during the winter months. Although the reason for this is not clear, it suggests that there is an environmental trigger for the condition, such as a reduced exposure to sunlight or a change in diet.

• #19 Pregnancy Intrahepatic Cholestasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551503/

  High circulating estrogen levels may induce cholestasis in genetically predisposed women in ICP. […] Environmental and seasonal factors have also correlated with ICP. ICP is noted to be more prevalent in women with a low level of selenium and vitamin D. […] Chronic underlying liver disease correlates with ICP; however, it is not yet clear whether chronic liver diseases contribute to developing ICP or are revealed by pregnancy.

• #20 Cholestasis of Pregnancy: Causes, Symptoms, & Treatment | Zaya

  https://zayacare.com/blog/cholestasis-of-pregnancy/

  Cholestasis of pregnancy has many interrelated causes that lead to a buildup of bile acids in the bloodstream. […] Doctors don’t fully understand the exact cause of this disorder. There seems to be a mix of factors that lead to its development: […] Women with a minor mutation in a gene called MDR3 have a higher risk for cholestasis of pregnancy. […] There appears to be some link between pesticide exposure, diets high in rapeseed oil, and dietary deficiencies in selenium and the development of cholestasis of pregnancy. […] The female hormones estrogen and progesterone begin to peak in the third trimester of pregnancy. This coincides with the time of onset of cholestasis of pregnancy.

• #21 Intrahepatic Cholestasis of Pregnancy: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1562288-overview

  Changes induced by these genetic mutations lead to an increased sensitivity to estrogen. Estrogen has a known role in causing cholestasis, and, thus, cholestasis can arise from estrogen-containing OCPs. All steroids, estrogen, progesterone, and corticosteroids are increased during pregnancy 1,000-fold at term compared with the nonpregnant state. […] Environmental factors are also thought to contribute to the development of ICP. Many patients have more mild recurrence in subsequent pregnancies, which suggests that environmental factors play a role in the development and severity of ICP. […] Some investigators have noted the association of hepatitis C with ICP. They observed that patients with hepatitis C have an increased risk for ICP, and likewise women with ICP are at increased risk for acquiring hepatitis C.

• #22

  https://journals.lww.com/md-journal/fulltext/2023/01060/factors_associated_with_intrahepatic_cholestasis.16.aspx

  This study showed that HDP was independently associated with ICP (OR=14.911), consistent with the literature. […] This study showed that gestational diabetes could lead to an increased incidence of ICP, and gestational diabetes was independently associated with ICP (OR=3.146). […] A certain correlation between the incidence of ICP and abnormal lipid metabolism in the body has been observed. […] Hepatitis virus infection is closely correlated with the occurrence of ICP. […] In conclusion, family history of ICP, multiple pregnancies, BMI at delivery, number of births, combined HDP, gestational diabetes, hyperlipidemia, and hepatitis virus infection are independently associated with ICP.

• #22

  https://journals.lww.com/md-journal/fulltext/2023/01060/factors_associated_with_intrahepatic_cholestasis.16.aspx

  The present retrospective study aimed to investigate the clinical characteristics and outcomes of ICP from 2015 to 2016 in the Yangtze River area (China), which includes Changsha City. […] The findings indicate that ICP is closely related to BMI at delivery, the number of births, HDP, gestational diabetes, hyperlipidemia, and hepatitis virus infection. […] The incidence of ICP has obvious differences among different regions and races and in relation to dietary habits. Its pathogenesis is relatively complex. […] The results showed that a family history of ICP had an impact on the occurrence of ICP. […] The present study showed that twin pregnancy was associated with the occurrence of ICP, which may be because women pregnant with twins had higher estrogen levels and aggravated abnormal lipid metabolism than single pregnancies, thus increasing the possibility of cholestasis.

• #23 Considerations After an Intrahepatic Cholestasis of Pregnancy – ICP Care

  https://icpcare.org/healthcare-provider/considerations-after-intrahepatic-cholestasis-pregnancy/

  Intrahepatic Cholestasis of Pregnancy (ICP) is thought to be caused by a combination of genetic, environmental and hormonal factors. […] Genes such as ABCB4 which control for bile acid transport in the liver have been identified in cases that occur in families and this gene is probably responsible for about 15% of ICP pregnancies. […] Intrahepatic Cholestasis of Pregnancy may also develop due to an underlying liver condition. […] Patients who have previously been diagnosed with Hepatitis C are at increased risk of developing Intrahepatic Cholestasis of Pregnancy (ICP). […] There is a higher risk of Intrahepatic Cholestasis of Pregnancy in patients with autoimmune hepatitis, alpha-1 antitrypsin deficiency, benign recurrent intrahepatic cholestasis (BRIC) and progressive familial intrahepatic cholestasis (PFIC).

• #24 Intrahepatic cholestasis of pregnancy (ICP): View Causes, Symptoms and Treatments | 1mg

  https://www.1mg.com/diseases/intrahepatic-cholestasis-of-pregnancy-icp-1036?srsltid=AfmBOoqZULi2ZrAlo90Ld3LBV0Huizp2KA2xT7q5NMy1QgpkDlCqLCKZ

  Cholestasis of pregnancy (CP), also known as intrahepatic cholestasis of pregnancy (ICP), is a liver disorder that occurs during pregnancy. […] The exact cause of cholestasis of pregnancy is unclear, but genetics may play a significant role. […] Several factors likely play a role in the development of ICP: […] Genetic predisposition: In some cases, intrahepatic cholestasis of pregnancy (ICP) seems to have a hereditary component. […] Hormonal influence: Pregnancy hormones like estrogen and progesterone impact gallbladder function, potentially slowing or halting bile flow. […] History of hepatitis C infection: Hepatitis C infection has been linked to an increased risk of developing ICP. […] Cholelithiasis (gallstones): The presence of gallstones can interfere with the normal flow of bile, potentially leading to cholestasis and increasing the risk of ICP.

• #24 Intrahepatic cholestasis of pregnancy (ICP): View Causes, Symptoms and Treatments | 1mg

  https://www.1mg.com/diseases/intrahepatic-cholestasis-of-pregnancy-icp-1036?srsltid=AfmBOoqZULi2ZrAlo90Ld3LBV0Huizp2KA2xT7q5NMy1QgpkDlCqLCKZ

  Multiple Pregnancies (twins or More): Women carrying multiple fetuses (twins, triplets, etc.) are at an increased risk of developing ICP compared to those with a singleton pregnancy. […] Environmental component: Winter months see more ICP diagnoses. […] Assisted reproduction: Women who conceive with assisted reproduction techniques have a higher risk of developing ICP compared to those who conceive spontaneously. […] Maternal age: Some studies suggest that older maternal age might be a risk factor for developing ICP.

• #25 Cholestasis of Pregnancy: Symptoms and TreatmentCircleBumpCheckedFilledMedicalBookmarkBookmarkTickBookmarkAddCheckBoxCheckBoxFilled

  https://www.thebump.com/a/cholestasis-of-pregnancy

  Although cholestasis has an overall low occurrence rate, some research has suggested a number of factors that may contribute in part to a woman’s risk of developing the liver condition: Family history of biliary disease, Hepatitis C, Cholestasis of pregnancy during previous pregnancies, Multiple gestation pregnancy, such as twins or triplets, Maternal age greater of 35+. […] While itchy palms and feet may be a nuisance for pregnant moms, the consequences of cholestasis can be more severe for baby. Although overall a very rare condition, with a cholestasis diagnosis there’s an increased rate of stillbirth, says Ruiz. […] The Mayo Clinic notes other possible risks to baby, including preterm birth and potential lung problems from breathing in the meconium that can pass into the amniotic fluid of a mom with cholestasis.

• #26 Obstetric cholestasis (liver disorder in pregnancy) – Buckinghamshire Healthcare NHS Trust – Birth Choices Website

  https://www.buckshealthcare.nhs.uk/birthchoices/pifs/obstetric-cholestasis-liver-disorder-in-pregnancy/

  Obstetric cholestasis (OC) is a liver problem that can happen during pregnancy and may cause your body to make more bile acids. […] We do not know what causes OC, but it is thought that hormones, genetics and environmental factors may be involved. […] There is a high chance that OC may happen again in a future pregnancy: 45 to 90 in every 100 women (45-90%) who have had OC will develop it again in future pregnancies.

• #27 Cholestasis of Pregnancy: Diagnosis, Symptoms, Treatment, More

  https://www.healthline.com/health/pregnancy/cholestasis-pregnancy

  If youve ever had cholestasis with a previous pregnancy, youre at risk for developing it again with a future pregnancy. In fact, some estimate that between 60 and 70 percent of women will experience it again if they get pregnant. […] The likelihood of a recurrence during a future pregnancy could rise as high as 90 percent for women whove had a severe case of cholestasis during pregnancy.

• #28 Intrahepatic Cholestasis of Pregnancy: Even Today a Puzzling Disease of Pregnancy | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/publications/e-wgn/e-wgn-expert-point-of-view-articles-collection/intrahepatic-cholestasis-of-pregnancy-even-today-a-puzzling-disease-of-pregnancy

  Intrahepatic cholestasis of pregnancy (ICP) is a cholestatic liver disease unique to pregnancy with a variable worldwide prevalence ranging approximately between 0.3 and 5.6% of pregnancies. […] The cause of ICP is unknown, but genetic, hormonal, and environmental factors are likely involved. […] The cause of ICP is currently unknown, but genetic, hormonal, and environmental factors are involved, as suggested by the higher prevalence seen in certain ethnic groups (Swedish, Chilean, and Araucanian Indians); an increased incidence in late pregnancy and multiple pregnancies with precipitation by exogenous progestogens; and the possible association with low selenium levels. […] Genetic influences play a role, with a strong family tendency (between 10-16% of mothers, sisters, or daughters of previous ICP patients had had liver dysfunction during pregnancy) and the more recent discovery of some specific gene mutations in some ICP cases. […] Seasonal variations of the disease have been attributed to dietary factors related with high maternal levels of copper and low levels of selenium and zinc. […] Recently our group from Chile has also shown an increased intestinal permeability in ICP patients during and after pregnancy.

• #29 Cholestasis of Pregnancy

  http://healthlibrary.gradyhealth.org/Library/Wellness/Dental/90,P02440

  Cholestasis of pregnancy is a liver problem. It slows or stops the normal flow of bile from the gallbladder. […] Healthcare providers don’t know what causes cholestasis of pregnancy. They do know that this happens: […] The hormones your body releases during pregnancy change the way the gallbladder works. This may cause bile to slow or stop flowing. […] Bile builds up in the liver and spills into the bloodstream.

• #30 Intrahepatic cholestasis of pregnancy: A past and present riddle | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-intrahepatic-cholestasis-pregnancy-a-past-S1665268119320125

  Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific disorder that occurs mainly in the third trimester of pregnancy and is characterized by pruritus and elevated bile acid levels. […] The pathogenesis of the disease is unknown but likely involves a genetic hypersensitivity to estrogen or estrogen metabolites. […] Mutations or polymorphisms of some hepatobiliary transport proteins may contribute to disease pathogenesis or severity. […] Despite intense research in the field, the cause of ICP remains unknown although its pathogenesis appears to be related to the effects of sex hormones in the liver of genetically predisposed women. […] Several lines of evidence suggest that estrogens are involved in the pathogenesis of ICP. […] The disease appears in the third trimester when the estrogen production reaches its maximum.

• #31 Causes — ICP Support

  https://www.icpsupport.org/causes

  Some women are diagnosed with ICP following a course of penicillin-based antibiotics. […] Although the exact nature of the link between infection, antibiotics and ICP is not clear, research has identified a common genetic change in both women with ICP and women with drug- (antibiotic-) induced cholestasis. […] It has always been suggested that the most likely cause of stillbirth comes from bile acids, and the most recent research from Ovadia (2019) has identified the level at which bile acids become a problem for the unborn baby in ICP. […] In ICP the transport of bile acids across the liver doesn’t happen as efficiently as it should. […] The bile acids accumulate in the liver and eventually leak back into the blood, causing raised levels in the blood. […] Because the bile acids are quite toxic it is important to try to reduce the levels.

• #32 Cholestasis of pregnancy: Causes, symptoms, and treatment – Flo

  https://flo.health/pregnancy/pregnancy-health/pains-and-discomforts/cholestasis-of-pregnancy

  Cholestasis of pregnancy can also carry risks for your baby. It can lead to lung problems from breathing in a dark, sticky substance called meconium. […] In addition, cholestasis of pregnancy can also lead to preterm birth or stillbirth. […] Essentially, it’s because your baby mostly relies on your liver to remove bile acids from its blood while their own liver is still developing. […] A high level of bile acids can impact your baby. It’s thought this can increase the chance of a fatal fetal arrhythmia (an abnormal fetal heartbeat). […] There are no known ways to prevent cholestasis of pregnancy from developing.

• #32 Cholestasis of pregnancy: Causes, symptoms, and treatment – Flo

  https://flo.health/pregnancy/pregnancy-health/pains-and-discomforts/cholestasis-of-pregnancy

  ICP is the most common liver disease in pregnancy, but the condition itself is pretty rare. It only affects around 0.2% to 2% of pregnancies. […] While scientists haven’t quite pinned down the answer to that just yet, it’s likely to involve a combination of genetic susceptibility, hormonal factors, and environmental factors. […] It’s thought that the high levels of estrogen during pregnancy might affect the way the liver processes bile acids, which could lead people with certain combinations of genes to develop ICP. […] You also have a greater risk of cholestasis of pregnancy if you have a history of liver damage or gallstones, or have had cholestasis in a previous pregnancy. […] Cholestasis of pregnancy can increase the risk of complications in your pregnancy, such as gestational diabetes (high blood sugar) and preeclampsia (high blood pressure).

• #33 Bile Acids in Intrahepatic Cholestasis of Pregnancy

  https://www.mdpi.com/2075-4418/12/11/2746

  The accumulation of BAs in the maternal and fetal liver observed in ICP may lead to oxidative stress and hepatocyte apoptosis, significantly affecting the course of pregnancy. […] An altered BA profile is observed in women with ICP. CA remains the major BA and its concentration is significantly higher than that of CDCA, resulting in an increase in the CA/CDCA ratio and a decrease in the percentage of CDCA in the total pool of BAs. […] The level of total serum BAs is currently considered to be the most sensitive and specific biochemical marker used in the diagnosis and monitoring of ICP.

• #33 Bile Acids in Intrahepatic Cholestasis of Pregnancy

  https://www.mdpi.com/2075-4418/12/11/2746

  Intrahepatic cholestasis of pregnancy (ICP) is the most common, reversible, and closely related to pregnancy condition characterized by elevated levels of bile acids (BAs) in blood serum and an increased risk of adverse perinatal outcomes. […] The etiology of ICP is complex and not fully explained. It is believed that the development of ICP is the result of many factors, such as: genetic predisposition, hormonal factors, environmental factors and nutritional deficiencies, and the influence of chronic diseases on the predisposition to developing cholestasis. […] The disease occurs at different rates; the average incidence of ICP remains at the level of 0.2–15.6%, but shows large ethnic, geographic, and seasonal variation. […] The main complications related to this disease are presented in Figure 1. They include, but are not limited to, neonatal respiratory distress syndrome (associated with the presence of BA in the lungs), meconium-stained amniotic fluid, preterm birth, and an increased risk of stillbirth.

• #34 Cholestasis of Pregnancy: Symptoms, Causes & Treatment

  https://www.whattoexpect.com/pregnancy/your-health/cholestasis

  Cholestasis is a liver disorder that most often occurs late in pregnancy, typically during the third trimester. It’s also known as intrahepatic cholestasis (ICP) or obstetric cholestasis. […] Cholestasis occurs in just one to two pregnancies in 1,000, but the incidence can vary worldwide for unknown reasons. It’s more common in people of Hispanic and Scandinavian background. […] Possible causes of cholestasis include: Hormonal changes: Increased estrogen levels during pregnancy (especially in the third trimester) can slow the flow of bile. […] Cholestasis is also more common in women carrying multiples and in those who have had previous liver damage. And if you’ve had cholestasis in a previous pregnancy, you’re also at a greater risk of having the condition in subsequent ones. […] In cases when maternal bile acids are higher, cholestasis can increase baby’s risk of a low birth weight, a slightly lower Apgar score, lung immaturity and preterm delivery which is why early diagnosis and treatment are so important. […] The good news is that the condition is very treatable if it’s caught early, and all the symptoms of cholestasis usually disappear on their own within 48 hours after birth.

• #35 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content?ContentTypeID=90&ContentID=P02440

  Cholestasis of pregnancy is a liver problem. It slows or stops the normal flow of bile from the gallbladder. […] Healthcare providers don’t know what causes cholestasis of pregnancy. They do know that this happens: The hormones your body releases during pregnancy change the way the gallbladder works. This may cause bile to slow or stop flowing. Bile builds up in the liver and spills into the bloodstream. […] There is a serious risk of complications in your developing baby if you have cholestasis of pregnancy. The complications include: Fetal distress. This means your developing baby is not doing well. For example, the baby may not be getting enough oxygen. Preterm birth. You may be at greater risk for giving birth too early. Meconium in amniotic fluid. This means your baby has a bowel movement before birth. This may cause very serious breathing problems. Breathing (respiratory) problems. Your baby may have breathing problems as a newborn. […] Cholestasis of pregnancy can also lead to vitamin K deficiency. This will need to be treated before you give birth, because it can cause you to bleed too much.

• #36 Intrahepatic cholestasis of pregnancy – British Liver Trust

  https://britishlivertrust.org.uk/information-and-support/liver-conditions/intrahepatic-cholestasis-pregnancy/

  Intrahepatic cholestasis of pregnancy is a liver condition that happens in about 1 in every 150 pregnancies. […] Most people will not have any other symptoms of ICP. In rare cases you can develop jaundice. This is a yellow colour to your eyes or skin. Or notice that your poo is a very pale, putty colour. […] To diagnose ICP, health professionals such as doctors or midwives will ask you a number of questions and examine you. If they think you might have ICP you will need some blood tests. […] If you have ICP you will have raised levels of bile acids in your blood. However, other liver conditions can also cause the bile acid level to be raised. […] Doctors can only be sure that you have ICP if your itching and bile acids go back to normal after your baby is born. […] People with ICP have an increased risk of a condition called pre-eclampsia.

• #37 Intrahepatic cholestasis of pregnancy – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/800

  Intrahepatic cholestasis of pregnancy (ICP) is characterized by maternal pruritus (itch) and liver dysfunction, with raised total serum bile acid concentrations, in the absence of other contributing liver disorders and restricted to pregnancy. […] The condition is caused by a combination of hormonal, genetic, and environmental factors. […] Maternal complications include an increased risk of gestational diabetes and preeclampsia, in addition to impaired glucose tolerance and dyslipidemia; fetal complications include preterm birth, meconium-staining of the amniotic fluid, neonatal unit admission, and, in pregnant women with bile acid concentrations of 100 micromol/L, intrauterine fetal death (stillbirth).

• #38 Intrahepatic cholestasis of pregnancy (ICP) | CUH

  https://www.cuh.nhs.uk/patient-information/intrahepatic-cholestasis-of-pregnancy-icp/

  ICP is a condition that affects your liver during pregnancy. It causes a build-up of bile acids in your body. […] The development of ICP may be influenced by a complex interplay of hormones, genetic factors and the environment. It is more common in certain populations, including Indian Pakistani and South American people. In some cases, a genetic origin can be identified. […] There is approximately 80% chance of ICP recurring in future pregnancies.

• #39 Intrahepatic Cholestasis of Pregnancy (ICP) | Tommy’sCloseleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowCloseReconfirm cookies choice

  https://www.tommys.org/pregnancy-information/pregnancy-complications/obstetric-cholestasis

  Intrahepatic cholestasis of pregnancy (ICP), sometimes called obstetric cholestasis, is a condition affecting your liver in pregnancy. […] The causes of ICP are not fully understood but it is possibly due to a combination of hormonal, genetic and environmental factors. It sometimes runs in families. […] Having ICP increases your chance of having it again in future pregnancies. […] There is some evidence that people with ICP may be slightly more likely to have liver problems in the future, or other conditions including psoriasis, thyroid disease, heart disease and Crohn’s disease. But extra screening or follow-up is not recommended.

• #40 Intrahepatic cholestasis of pregnancy and associated causes of death: a cohort study with follow-up of 27–46 years | BMC Women’s Health | Full Text

  https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-018-0606-0

  The main finding was that women with a history of ICP do not have an increased overall mortality. There were more deaths from gastrointestinal diseases in the ICP group than in the control group. […] Despite the rather small number of deaths, statistically significant differences were found. The findings may be considered clinically relevant. Increased risk of hepatobiliary diseases has been reported among women who experience ICP. The increased occurrence of hepatobiliary diseases may be reflected in the increase of deaths from gastrointestinal diseases among the ICP group. […] Women with a history of ICP do not have an increased overall mortality. However, gastrointestinal diseases are overrepresented in the underlying causes of death among women with a history of ICP.

• #41 What is cholestasis of pregnancy?

  https://www.babycenter.com/pregnancy/your-body/cholestasis-of-pregnancy_20000158

  Cholestasis of pregnancy is a potentially serious liver condition that causes sudden, severe itching. It happens when bile starts building up in the liver. […] The exact cause of cholestasis of pregnancy is unknown, but hormonal and genetic factors likely play a role. High levels of progesterone and estrogen may slow the flow of bile from the liver, usually in the third trimester, when pregnancy hormones peak. Women with a family history of cholestasis are more likely to have the condition. […] Cholestasis in pregnancy increases the risk of several complications, including: Preterm birth, or delivery before week 37 of pregnancy; Respiratory distress syndrome (RDS), a condition when a baby doesn’t have enough surfactant for the lungs to inflate properly; it’s more common in preterm babies; Meconium aspiration, as cholestasis of pregnancy increases the risk of the passage of meconium (your baby’s first stool) from your baby’s intestines into the amniotic fluid, putting your baby at risk of inhaling meconium into their lungs; Stillbirth, or an unborn baby’s death after week 20 of pregnancy; Preeclampsia. […] The risks to your baby increase with higher levels of bile acids in your blood and the closer you are to your due date.

• #42 Intrahepatic cholestasis of pregnancy | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/intrahepatic-cholestasis-of-pregnancy/

  ICP is a condition that affects how your liver works when you are pregnant. It is sometimes called obstetric cholestasis. […] ICP causes a build-up of bile acids in your body. […] It is often not clear why it develops in one pregnancy and not another. […] Your chance of having a stillbirth depends on the level of bile acids found in your blood as well as any other pregnancy complications you may be experiencing. […] If your bile acid levels are 100 micromol/L or more (Severe ICP), your chance of having a stillbirth is higher than someone who doesn’t have ICP and is around 3%.

• #43 Intrahepatic cholestasis of pregnancy – Symptoms, Causes, Images, and Treatment Options

  https://www.epocrates.com/online/diseases/800/intrahepatic-cholestasis-of-pregnancy

  Intrahepatic cholestasis of pregnancy (ICP) is characterized by maternal pruritus (itch) and liver dysfunction, with raised total serum bile acid concentrations, in the absence of other contributing liver disorders and restricted to pregnancy. […] The condition is associated with an increased risk of adverse pregnancy outcomes for the newborn, including spontaneous preterm birth, meconium-stained amniotic fluid, neonatal unit admission, and, if the mother’s serum bile acid concentrations are elevated to a level of 100 micromol/L, stillbirth. Maternal complications include an increased risk of gestational diabetes and preeclampsia, in addition to impaired glucose tolerance and dyslipidemia. […] The risk of stillbirth is increased for pregnant women with total serum bile acid concentrations of 100 micromol/L, and so delivery should be offered to these women at 35 to 36 gestational weeks.

• #44 Pregnancy Spotlight: Understanding Cholestasis of Pregnancy

  https://www.abclawcenters.com/blog/pregnancy-spotlight-cholestasis-of-pregnancy/

  In pregnancies involving Cholestasis, there is an increased risk of stillbirth, as well of birth injuries. […] There is also an increase in the risk of the baby passing meconium while in the womb. Meconium, if inhaled during delivery, can damage the lungs and cause respiratory difficulty. […] With cholestasis, doctors will most likely recommend early induction in order to prevent the baby from suffering health complications or injuries.

• #45 Intrahepatic Cholestasis in Pregnancy: Increased Surveillance and the Role of Bile Acids in a Patient with History of Fetal Demise

  https://clinmedjournals.org/articles/ogcr/obstetrics-and-gynaecology-cases-reviews-ogcr-8-212.php?jid=ogcr

  Intrahepatic cholestasis of pregnancy (ICP) is a known risk for fetal demise and premature delivery. […] The causes of ICP are poorly understood, but are believed to be a combination of genetic, hormonal, and environmental factors. Mutations in phospholipid and bile salt export pumps found in the liver and placentas of ICP patients are believed to be factors. […] An increased amount of the smooth muscle relaxant estrogen during pregnancy is another known contributor to stasis and the buildup of bile acids. Increased progesterones conjugation in the hepatic export system leads to inflammation and could play an additional role. […] In ICP, the fetomaternal concentration gradient is reversed and is known to increase risk of fetal complications such as stillbirth, spontaneous preterm birth, and vasospasms leading to abnormal ECG findings.

• #46 Gebelik Kolestazı Nedir? Gebelik Kolestazı Tedavisi

  https://yeditepehastaneleri.com/en/health-guide/womens-health-and-obstetrics/pregnancy-cholestasis

  In gestational cholestasis, bile acids with increased levels in maternal blood are passed to the baby through the placenta. […] Increased bile acids accumulate in the baby’s lungs, heart muscle, intestine, and amniotic fluid. […] Therefore, early diagnosis and effective treatment of the disease are very important. […] National and international guidelines recommend that pregnant women diagnosed with gestational cholestasis be delivered 3 to 5 weeks earlier than the expected date of birth, depending on the severity of the disease. […] Pregnancy cholestasis is 60-70% likely to recur in the next pregnancy.

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