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Hépato-Gastro & Oncologie Digestive

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Intrahepatic cholestasis of pregnancy Volume 22, issue 3, Mars 2015

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Author
Professeur honoraire à l’Université Paris 7, 1422, route des Mauvares, 13840 Rognes, France
* Tirés à part

Intrahepatic cholestasis of pregnancy occurs mostly during the 2nd or 3rd trimester. It presents essentially with pruritus, sometimes severe, rarely with jaundice associated with pruritus. Its prevalence in France is of the order of 1 per 100 pregnancies, slightly more during twin pregnancies. Liver biochemical tests show an increase in serum transaminases and bile acid concentrations. Clinical and biochemical abnormalities disappear rapidly and completely after delivery. The disease is probably caused by a genetic susceptibility to estrogens and progesterone, whose concentration in blood increases considerably during pregnancy, and which are known cholestatic agents in experimental animals. Such a susceptibility is explained by mutations or polymorphisms of genes encoding transport proteins of hepatocytes implicated in bile secretion, mainly ABCB4, ATP8B1 and ABCB11. Environmental factors play a role in some cases. Besides discomfort caused by pruritus, maternal prognosis is usually good. Severity is due to the occurrence of fetal complications, such as prematurity (sometimes induced by the obstetrical team) and its pulmonary consequences, and more rarely intrauterine fetal death. Treatment with ursodeoxycholic acid improves pruritus, decreases the frequency of fetal complications, without side effects for the mother or baby. In severe forms, systematic delivery at 37-38 weeks of gestation, or even before, may be necessary.