Enzymatic quantification of total serum bile acids as a monitoring strategy for women with intrahepatic cholestasis of pregnancy receiving ursodeoxycholic acid treatment: a cohort study

TY - JOUR

T1 - Enzymatic quantification of total serum bile acids as a monitoring strategy for women with intrahepatic cholestasis of pregnancy receiving ursodeoxycholic acid treatment

T2 - a cohort study

AU - Borges Manna, Luiza

AU - Ovadia, Caroline

AU - Lövgren-Sandblom, Anita

AU - Chambers, Jenny

AU - Begum, Shahina

AU - Seed, Paul

AU - Walker, Ian

AU - Chappell, Lucy C

AU - Marschall, Hanns-Ulrich

AU - Williamson, Catherine

N1 - This article is protected by copyright. All rights reserved.

PY - 2019/12/1

Y1 - 2019/12/1

N2 - OBJECTIVE: To evaluate enzymatic total serum bile acid quantification as a monitoring strategy for women with intrahepatic cholestasis of pregnancy (ICP) treated with ursodeoxycholic acid (UDCA).DESIGN: Cohort.SETTING: One UK university hospital.POPULATION: 29 ICP cases treated with UDCA.METHODS: Serial samples were collected prospectively throughout gestation. Total serum bile acids were measured enzymatically and individual bile acids by High-Performance Liquid Chromatography-Tandem Mass Spectrometry. Data were log-transformed and analysed with random effects generalised least square regression.MAIN OUTCOME MEASURES: The relationship between enzymatic total bile acid measurements and individual bile acid concentrations after UDCA treatment.RESULTS: In untreated women cholic acid was the principal bile acid (51%) and UDCA concentrations were <0.5%, whereas UDCA comprised 60% (IQR 43-69) of serum bile acids following treatment and cholic acid fell to <20%. Changes in the total bile acid measurement reflected similar alterations in the concentrations of the pathologically elevated bile acids, e.g. a two-fold increase in enzymatic total bile acids is accompanied by approximately a two-fold increase in cholic acid and chenodeoxycholic acid at most UDCA doses (p<0.001). Most of the effects of UDCA on cholic acid occur in the first week of treatment (60% relative reduction, p=0.025, 95% CI 0.2-0.9, from 10μmol/L (4.7-17.6) to 3.5μmol/L (1.4-7.5).CONCLUSION: UDCA becomes the main component of the bile acid measurement after treatment. Enzymatic total bile acid assays are good predictors of both cholic acid and chenodeoxycholic acid, the primary bile acids that are raised prior to treatment. This article is protected by copyright. All rights reserved.

AB - OBJECTIVE: To evaluate enzymatic total serum bile acid quantification as a monitoring strategy for women with intrahepatic cholestasis of pregnancy (ICP) treated with ursodeoxycholic acid (UDCA).DESIGN: Cohort.SETTING: One UK university hospital.POPULATION: 29 ICP cases treated with UDCA.METHODS: Serial samples were collected prospectively throughout gestation. Total serum bile acids were measured enzymatically and individual bile acids by High-Performance Liquid Chromatography-Tandem Mass Spectrometry. Data were log-transformed and analysed with random effects generalised least square regression.MAIN OUTCOME MEASURES: The relationship between enzymatic total bile acid measurements and individual bile acid concentrations after UDCA treatment.RESULTS: In untreated women cholic acid was the principal bile acid (51%) and UDCA concentrations were <0.5%, whereas UDCA comprised 60% (IQR 43-69) of serum bile acids following treatment and cholic acid fell to <20%. Changes in the total bile acid measurement reflected similar alterations in the concentrations of the pathologically elevated bile acids, e.g. a two-fold increase in enzymatic total bile acids is accompanied by approximately a two-fold increase in cholic acid and chenodeoxycholic acid at most UDCA doses (p<0.001). Most of the effects of UDCA on cholic acid occur in the first week of treatment (60% relative reduction, p=0.025, 95% CI 0.2-0.9, from 10μmol/L (4.7-17.6) to 3.5μmol/L (1.4-7.5).CONCLUSION: UDCA becomes the main component of the bile acid measurement after treatment. Enzymatic total bile acid assays are good predictors of both cholic acid and chenodeoxycholic acid, the primary bile acids that are raised prior to treatment. This article is protected by copyright. All rights reserved.

KW - Bile acid assay

KW - cholestasis

KW - pregnancy

KW - ursodeoxycholic acid

UR - http://www.scopus.com/inward/record.url?scp=85073950146&partnerID=8YFLogxK

U2 - 10.1111/1471-0528.15926

DO - 10.1111/1471-0528.15926

M3 - Article

C2 - 31483939

SN - 1470-0328

VL - 126

SP - 1633

EP - 1640

JO - BJOG

JF - BJOG

IS - 13

ER -