Intrahepatic cholestasis of pregnancy (IHCP) is a disorder characterized by impaired bile flow that occurs in women during pregnancy. IHCP causes elevated levels of bile acids in the blood and may present with itching, especially on the palms and soles, and jaundice. The disorder typically occurs in the second or third trimester of pregnancy and is associated with hormonal changes, genetic predisposition, and other factors. Although IHCP may resolve after delivery, it carries a risk of complications for both mother and fetus, including premature birth and neonatal pathology.
History of the disease and interesting historical facts
Intrahepatic cholestasis of pregnancy was first described in 1941. For decades, the medical community has sought to understand the nature of this disease and its impact on pregnancy and newborns. Studies have shown that IHC occurs worldwide with variable frequency, with the first cases reported in women giving birth in the 19th century. The disease attracted the attention of scientists, and in the 1990s, the molecular mechanisms underlying the pathogenesis began to be actively studied, opening up new horizons for diagnosis and treatment. Today, there is evidence that IHC has a clear familial predisposition, as well as certain genetic markers that can help predict the occurrence of this condition.
Epidemiology
The epidemiology of IPC varies from 0.1% to 2% of all pregnancies, depending on the region and ethnic group. Aggravating factors for the occurrence of this condition are individual characteristics of women and the presence of previous liver diseases. In particular, women with a history of cholestasis have a 10-fold higher risk of recurrence during the next pregnancy. Current studies show that in countries with a high level of medicine, the incidence of IPC is estimated at 0.5-1.5%, while in countries with limited access to health services, this figure can reach 2% and higher.
Genetic predisposition to this disease
Genetic predisposition to IPCB has been highlighted in several studies. It has been established that the involved genes associated with bile acid transport may have mutations that contribute to the development of cholestasis. In particular, the ABCB11 and ABCB4 genes responsible for the production of transporters play a key role in the metabolism of bile acids. The interaction of these genetic factors may increase the likelihood of developing the disease in women with a predisposition, which is the basis for further study of the genetics of IPCB.
Risk factors for the development of this disease
There are several risk factors associated with the development of HPCB:
- History of cholestasis in previous pregnancies. Women who have had cholestasis in the past have a high risk of recurrence.
- Family history. Having a case of the disease in your immediate family increases your chances of developing ICP.
- Ethnicity: Some ethnic groups, such as Scandinavian peoples, have a higher risk.
- Maternal age: Older women, especially those over 35, have an increased risk of developing the disease.
- Presence of underlying liver disease. Chronic diseases such as viral hepatitis may be triggers for HPLC.
Diagnosis of this disease
Diagnosis of VPHB requires a comprehensive approach, since the manifestations of the disease may be similar to other conditions. The main symptoms are:
- Itching that often gets worse at night.
- Jaundice, which is characterized by darkening of urine and discoloration of feces.
- General weakness and fatigue.
Laboratory tests include determination of bile acid levels in the blood and evaluation of liver function through biochemical analysis. Often, methods such as ultrasound of the liver are used to exclude other causes of cholestasis. The differential diagnosis may include hepatitis as well as other liver diseases, which requires a complete medical history and examination.
Treatment
Treatment of VPHB should be comprehensive and individualized. The main measures are usually aimed at relieving symptoms and preventing complications:
- General treatment: A special diet, limited physical activity and strict monitoring of health are recommended.
- Pharmacological treatment: Drugs such as ursodeoxycholic acid are used to reduce bile acid levels.
- Surgical treatment. In rare cases, when conservative measures are not effective, surgical interventions may be required.
- Other treatments: Some women benefit from plasmapheresis to reduce levels of toxic substances in the blood.
List of medications used to treat this disease
Several main classes of drugs are used to treat CPBP:
- Ursodeoxycholic acid (UDCA)
- Rifampicin
- Antihistamines to relieve itching (eg, cetirizine)
- Steroids in rare cases to reduce inflammation
- Vitamins and minerals to support overall health
Disease monitoring
Monitoring of patients with IPHB includes monitoring of liver function and bile acid levels. The prognosis for most women with IPHB is good; the disease usually resolves after delivery. However, it is important to consider possible complications, such as early delivery and prematurity. Regular examinations allow early detection of changes and prevention of potential risks to mother and child.
Age-related features of the disease
The manifestations of VPHB vary depending on the woman's age. In young pregnant women, the disease is usually less severe, unlike older women, who are more likely to experience complications. At the same time, young women may experience a sharp exacerbation of the disease if they have a history of predisposition, which requires special monitoring of the condition. Constant monitoring is usually recommended from the early stages of pregnancy.
Questions and Answers
- What are the main symptoms of HPS? The main symptoms include itching, jaundice, general weakness and discolored stools.
- How does HPV affect pregnancy? The disease can lead to premature birth and increased risks to the fetus, including the birth of a premature baby.
- Can HPV be prevented? Unfortunately, precise methods of prevention have not yet been developed, but monitoring the health status of those in the risk group can help.
- How is the diagnosis carried out? Diagnosis is based on laboratory tests, ultrasound examination and analysis of symptoms.
- What treatment is recommended for VPHB? Treatment may include ursodeoxycholic acid, as well as supportive care based on individual symptoms.
Advice from Dr. Oleg Korzhikov
Dr. Oleg Korzhikov emphasizes the importance of early detection of HPCB to minimize risks for both mother and child. “If you have itching that is uncontrollably bothering you, you need to see a doctor and get examined. Don’t wait until the condition worsens. These symptoms may be signs of cholestasis, and the sooner you get help, the better the outcome will be for you and your baby.” Monitor your health, especially during pregnancy, and don’t ignore changes in your well-being.
