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

Professor Catherine Williamson, Dr Peter Dixon

Scientists are investigating whether certain metabolites in urine can be used to identify the risk of developing ICP later on in pregnancy.

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 is caused by a raised level of bile acids in the liver, which then leak into the woman’s bloodstream. It is characterised by itching skin, which is often more noticeable on the palms of the hands and soles of the feet. 

ICP can increase the risks for the baby, with higher chances of premature birth and stillbirth. 

Women who develop itching during pregnancy are diagnosed with ICP following the detection of raised bile acids in their blood. This itching often comes before the levels of elevated bile acid are discovered. 

However, itching during pregnancy occurs in 20% of women, and there is currently no way of finding out which women will go on to develop ICP. 

We have previously identified that raised levels of sulphated metabolites of progesterone (PMS) in the blood can predict the future onset of ICP. This is because PMS are elevated during the first trimester prior to the onset of the disease, and it is known that they are partly excreted in the urine. 

We want to find out if testing for PMS in the urine can be used to predict the risk of developing ICP later on in pregnancy. We also want to identify a way to assess the response to treatment. Currently the treatment for ICP is the drug UDCA. This will allow the clinician to alter drug doses for affected women appropriately. 

We will use stored samples of urine from women with ICP to measure concentrations of PMS. We will also be testing to see if these urine samples can be used to detect how well the women is responding to treatment for ICP.

Funding

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

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