Can markers in urine predict the onset of intrahepatic cholestasis of pregnancy?

Dr Caroline Ovadia, Prof Catherine Williamson, Dr Peter Dixon, Prof Hanns-Ulrich Marschall

Scientists are investigating whether certain chemicals in urine can be used to identify women who are at risk of developing intrahepatic cholestasis later on in pregnancy.

Start date: 2018

End date: 2020

Why do we need this research?

Intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis, is the most common liver condition that occurs during pregnancy. It affects around 1 in 140 pregnancies in the UK and can sometimes lead to problems for the baby, such as premature birth.

ICP happens when chemicals made by the liver – bile acids – leak into a woman’s bloodstream. Women who itch in pregnancy are usually offered a blood test to see whether they have raised levels of bile acids in their blood. However, around one in five women have itchy skin during pregnancy, and there is currently no way to tell for certain whether these women will go on to develop ICP or not.

We need to find a better way to predict early in pregnancy which women are most likely to develop ICP, so that treatment can start as soon as possible.

What’s happening in this project?

Our scientists are studying a family of molecules called sulphated metabolites of progesterone (PMS). So far, they have found that raised levels of PMS in the blood could predict the future onset of ICP. PMS can be released into urine, and so the team want to find out if PMS levels in urine also predict the risk of developing ICP later in pregnancy. This would make a test much easier, as urine is easier, quicker and cheaper for scientists to work with than blood, and simpler for a patient to provide.

The team also want to see whether PMS levels in urine can be used to see how well a woman is responding to treatment with a drug called ursodeoxycholic acid (UDCA). It is currently very difficult to monitor how well a patient is responding, so if our test works, this could allow drug doses to be altered as required for women with ICP.

So far, the team have recruited 290 women to their study, who donated urine samples at various points during and after pregnancy. Some of these women later went on to develop ICP and others had an uncomplicated pregnancy. The team plan to measure the amounts of PMS in the samples, comparing the urine samples from women who developed ICP with samples from women who didn’t.

What difference will this project make?

By measuring the levels of PMS in urine, our researchers hope to find out whether a urine test could predict early which women are at most risk of developing ICP later in pregnancy. It could also provide an easy way to tell if medicines to treat ICP are working. This work will help doctors to treat ICP effectively, helping to protect the health of both mother and baby.

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