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

Professor Catherine Williamson, Dr Peter Dixon

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

Start date: 2018

End date: 2020

Intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis (OC), is the most common liver condition that occurs during pregnancy. It affects around 1 in 140 pregnancies in the UK. 

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, although results may initially come back as normal because itching often starts before elevated levels of bile acids can be detected. Itching during pregnancy occurs in around one in five women, and there is currently no way of finding out which of these women will go on to develop ICP.

We want to find a way of predicting early in pregnancy which women are most likely to develop ICP.

Urine is simple to test

So far, we have found that raised levels in blood of a family of molecules, called sulphated metabolites of progesterone (PMS), can predict the future onset of ICP. PMS are partly released into urine, and so we want to find out if PMS levels in urine also predict the risk of developing ICP later in pregnancy.

This is an attractive option, as urine is easier, quicker and cheaper to handle than blood, and simpler for a patient to provide.

We 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.

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This study is funded by Tommy's and NIHR Biomedical Research Centres. 

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