COLESTASIS INTRAHEPÁTICA DEL EMBARAZO: CONCEPTOS ACTUALES

Gerardo Cruz

Submitted October 21, 2024

Published 2026-03-02

Artículos de Investigación

Vol. 25 No. 1 (2012): Revista Médico Científica

INTRAHEPATIC CHOLESTASIS OF PREGNANCY: CURRENT CONCEPTS

Gerardo Cruz⁺⁻

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Published: 2026-03-02

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Abstract

Intrahepatic cholestasis of pregnancy is a pathology which is characterized by pruritus and elevated serum bile acid levels. Its frequency varies according to geographic areas and ethnic groups, reaching low levels in countries like the United States and high levels in scandinavian and Latin American countries. It has been shown that fetuses from mothers with this diagnosis are at higher risk of developing serious complications like premature births and stillbirths. Currently management is based on the use of ursodeoxycholic acid to relieve symptoms and normalize the biochemical alterations, together with the recommendation of ending the current pregnancy at 37 weeks to prevent fetal complications.

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References

Geenes V, Williamson C. Intrahepatic Cholestasis of Pregnancy. World J Gastroenterol. 2009; 15(17): 2049-66.
Pusl T, Beuers U. Intrahepatic Cholestasis of Pregnancy. Orphanet Journal of Rare Diseases. 2007, 2:26.
Eileen J. Liver Disease in Pregnancy. Hepatology. 2008; 47(3): 1068-76.
Guntapalli S, Steingrub J. Hepatic disease and pregnancy: An overview of diagnosis and management. Crit Care Med. 2005; 33(10):332-39.
Lee R, Goodwin T, Greenspoon J, Incerpi M. The prevalence of intrahepatic cholestasis of pregnancy in a primarily latina los angeles population. Journal of Perinatology. 2006; 26(9):527-32.
Lee NM, Brady CW. Liver disease in pregnancy. World J Gastroenterol. 2009; 15(8): 897-906.
Müllenbach R, Linton KJ, Wiltshire S, Weerasekera N, Chambers J, Elias E, Higgins CF, Johnston DG, Mcarthy MI, C Williamson C. ABCB4 gene sequence variation in women with intrahepatic cholestasis of pregnancy. J Med Genet. 2003; 40(5): 1-5.
Zollner G, Trauner M. Mechanisms of Cholestasis. Clin Liver Dis. 2008;12(1):1-26.
Lausman A, Al-Yaseen E, Sam D, Nitsch R, Barret J, Wee-Shian C. Intrahepatic Cholestasis of Pregnancy in Women with a Multiple Pregnancy: An Analysis of Risks and Pregnancy Outcomes. J Obstet Gynaecol Can. 2008;30(11):1008-13.
Kondrackiene J, Kupcinskas L. Intrahepatic cholestasis of pregnancy –current achievements and unsolved problems. World J Gastroenterol. 2008; 14(38): 5781-88.
Arrese M, Reyes H. Intrahepatic cholestasis of pregnancy: A past and present riddle. Annals of Hepatology 2006; 5(3): 202-05.
Medina-Lomelí JM, Jáuregui-Meléndrez RA, Medina-Castro N, Medina-Castro D. Colestasis intrahepática del embarazo: una revisión. Ginecol Obstet Mex. 2012;80(4):285-94.
Locatelli A, Roncaglia N, Arreghini A, Bellini P, Vergani P, Ghidini A. Hepatitis C virus infection is associated with a higher incidence of cholestasis of pregnancy. Br J Obstet Gynaecol. 1999;106(5):498-500.
Ambros-Rudolph C, Glatz M, Trauner M, Kerl H, Müllegger R. The Importance of Serum Bile Acid Level Analysis and Treatment with Ursodeoxycholic Acid in Intrahepatic Cholestasis of Pregnancy. Arch Dermatol. 2007;143(6):757-62.
Arrese M. Cholestasis during pregnancy: Rare hepatic diseases unmasked by pregnancy. Ann Hepatol. 2006; 5(3): 216-18.
Obstetric Cholestasis. Royal College of Obstetricians and Gynaecologists Guidelines (RCOG). 2006;43:1-12.
Dann A, Kenyon A, Wierzbicki A, Seed P, Shennan A, Tribe R. Plasma Lipid Profile of Women with Intrahepatic Cholestasis of Pregnancy. Obstet Gynecol. 2006;107(1):107-14.
Bacq Y, Sapey T, Brechot MC, Pierre F, Fignon A, Dubois F. Intrahepatic Cholestasis of Pregnancy: A French Prospective Study. Hepatology. 1997; 26(2):358-64.
Zecca E, De Luca D, Marras M, Caruso A, Bernardini T, Romagnoli C. Intrahepatic Cholestasis of Pregnancy and Neonatal Respiratory Distress Syndrome. Pediatrics. 2006;117(5):1669-72
Turunen K, Sumanen M, Haukilahti RL, Kirkinen P, Mattila K. Good pregnancy outcome despite intrahepatic cholestasis. Scand J Prim Health. 2010;28(2):102-7.
Davies MH, da Silva RC, Jones SR, Weaver JB, Elias E. Fetal mortality associated with cholestasis of pregnancy and the potential benefit of therapy with ursodeoxycholic acid. Gut. 1995;37(4):580-84.
Sepúlveda WH, González C, Cruz MA, Rudolph MI. Vasoconstrictive effects of bile acids on isolated human placental chorionic veins. Eur J Obstet Gynecol Reprod Biol. 1991;42(3):211-15.
Kondrackiene J, Beuers U, Zalinkevicius R, Tauschel HD, Gintautas V, Kupcinskas L. Predictors of preterm delivery in patients with intrahepatic cholestasis of pregnancy. World J Gastroenterol. 2007;13(46):6226-30.
Glantz A, Marschall H, Mattson L. Intrahepatic Cholestasis of Pregnancy: Relationships Between Bile Acid Levels and Fetal Complication Rates. Hepatology. 2004;40(2):467-74.
Joshi D, James A, Quaglia A, Westbrook R, Heneghan M. Liver disease in pregnancy. Lancet. 2010;375(9714):595-605.
Paumgartner G, Beuers U. Mechanisms of action and therapeutic efficacy of ursodeoxycholic acid in cholestatic liver disease. Clin Liver Dis. 2004;8(1):67-81.
Sánchez Pozzi EJ, Crocenzi FA, Pellegrino JM, Catania VA, Luquita MG, Roma MG, Rodriguez EA, Mottino AD. Ursodeoxycholate reduces ethinylestradiol glucuronidation in the rat: role in prevention of estrogen-induced cholestasis. J Pharmacol Exp Ther. 2003;306(1):279-86.
Tan J, Surti B, Saab S. Pregnancy and Cirrhosis. Liver Transplant. 2008;14(8):1081-91.
Mullally B, Hansen W. Intrahepatic Cholestasis of Pregnancy: Review of the Literature. Obstet Gynecol Surv. 2002;57(1):47-52.
Burrows RF, Clavisi O, Burrows E. Intervenciones para el tratamiento de la colestasis durante el embarazo (Revisión Cochrane traducida). En: La biblioteca Cochrane Plus, 2008, Número 2. Oxford: Update Software Ltd.
Glantz A, Marschall MU, Lammert F, Mattsson LA. Intrahepatic Cholestasis of Pregnancy: a Randomised Controlled Trial Comparing Dexamethasone and Ursodeoxycholic Acid. Hepatology. 2005;42(6):1399-405.
Roncaglia N, Locatelli A, Arreghini A, Assi F, Cameroni I, Pezullo J, Ghidini A. A randomised controlled trial of ursodeoxycholic acid and S-adenosyl-L-methionine in the treatment of gestational cholestasis. Br J Obstet Gynaec. 2004;111(1):17-21.
Kondrackiene J, Beuers U, Kupcinskas L. Efficacy and Safety of Ursodeoxycholic Acid Versus Cholestyramine in Intrahepatic Cholestasis of Pregnancy. Gastroenterology. 2005;129(3):894-901.

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[1] Geenes V, Williamson C. Intrahepatic Cholestasis of Pregnancy. World J Gastroenterol. 2009; 15(17): 2049-66.

[2] Pusl T, Beuers U. Intrahepatic Cholestasis of Pregnancy. Orphanet Journal of Rare Diseases. 2007, 2:26.

[3] Eileen J. Liver Disease in Pregnancy. Hepatology. 2008; 47(3): 1068-76.

[4] Guntapalli S, Steingrub J. Hepatic disease and pregnancy: An overview of diagnosis and management. Crit Care Med. 2005; 33(10):332-39.

[5] Lee R, Goodwin T, Greenspoon J, Incerpi M. The prevalence of intrahepatic cholestasis of pregnancy in a primarily latina los angeles population. Journal of Perinatology. 2006; 26(9):527-32.

[6] Lee NM, Brady CW. Liver disease in pregnancy. World J Gastroenterol. 2009; 15(8): 897-906.

[7] Müllenbach R, Linton KJ, Wiltshire S, Weerasekera N, Chambers J, Elias E, Higgins CF, Johnston DG, Mcarthy MI, C Williamson C. ABCB4 gene sequence variation in women with intrahepatic cholestasis of pregnancy. J Med Genet. 2003; 40(5): 1-5.

[8] Zollner G, Trauner M. Mechanisms of Cholestasis. Clin Liver Dis. 2008;12(1):1-26.

[9] Lausman A, Al-Yaseen E, Sam D, Nitsch R, Barret J, Wee-Shian C. Intrahepatic Cholestasis of Pregnancy in Women with a Multiple Pregnancy: An Analysis of Risks and Pregnancy Outcomes. J Obstet Gynaecol Can. 2008;30(11):1008-13.

[10] Kondrackiene J, Kupcinskas L. Intrahepatic cholestasis of pregnancy –current achievements and unsolved problems. World J Gastroenterol. 2008; 14(38): 5781-88.

[11] Arrese M, Reyes H. Intrahepatic cholestasis of pregnancy: A past and present riddle. Annals of Hepatology 2006; 5(3): 202-05.

[12] Medina-Lomelí JM, Jáuregui-Meléndrez RA, Medina-Castro N, Medina-Castro D. Colestasis intrahepática del embarazo: una revisión. Ginecol Obstet Mex. 2012;80(4):285-94.

[13] Locatelli A, Roncaglia N, Arreghini A, Bellini P, Vergani P, Ghidini A. Hepatitis C virus infection is associated with a higher incidence of cholestasis of pregnancy. Br J Obstet Gynaecol. 1999;106(5):498-500.

[14] Ambros-Rudolph C, Glatz M, Trauner M, Kerl H, Müllegger R. The Importance of Serum Bile Acid Level Analysis and Treatment with Ursodeoxycholic Acid in Intrahepatic Cholestasis of Pregnancy. Arch Dermatol. 2007;143(6):757-62.

[15] Arrese M. Cholestasis during pregnancy: Rare hepatic diseases unmasked by pregnancy. Ann Hepatol. 2006; 5(3): 216-18.

[16] Obstetric Cholestasis. Royal College of Obstetricians and Gynaecologists Guidelines (RCOG). 2006;43:1-12.

[17] Dann A, Kenyon A, Wierzbicki A, Seed P, Shennan A, Tribe R. Plasma Lipid Profile of Women with Intrahepatic Cholestasis of Pregnancy. Obstet Gynecol. 2006;107(1):107-14.

[18] Bacq Y, Sapey T, Brechot MC, Pierre F, Fignon A, Dubois F. Intrahepatic Cholestasis of Pregnancy: A French Prospective Study. Hepatology. 1997; 26(2):358-64.

[19] Zecca E, De Luca D, Marras M, Caruso A, Bernardini T, Romagnoli C. Intrahepatic Cholestasis of Pregnancy and Neonatal Respiratory Distress Syndrome. Pediatrics. 2006;117(5):1669-72

[20] Turunen K, Sumanen M, Haukilahti RL, Kirkinen P, Mattila K. Good pregnancy outcome despite intrahepatic cholestasis. Scand J Prim Health. 2010;28(2):102-7.

[21] Davies MH, da Silva RC, Jones SR, Weaver JB, Elias E. Fetal mortality associated with cholestasis of pregnancy and the potential benefit of therapy with ursodeoxycholic acid. Gut. 1995;37(4):580-84.

[22] Sepúlveda WH, González C, Cruz MA, Rudolph MI. Vasoconstrictive effects of bile acids on isolated human placental chorionic veins. Eur J Obstet Gynecol Reprod Biol. 1991;42(3):211-15.

[23] Kondrackiene J, Beuers U, Zalinkevicius R, Tauschel HD, Gintautas V, Kupcinskas L. Predictors of preterm delivery in patients with intrahepatic cholestasis of pregnancy. World J Gastroenterol. 2007;13(46):6226-30.

[24] Glantz A, Marschall H, Mattson L. Intrahepatic Cholestasis of Pregnancy: Relationships Between Bile Acid Levels and Fetal Complication Rates. Hepatology. 2004;40(2):467-74.

[25] Joshi D, James A, Quaglia A, Westbrook R, Heneghan M. Liver disease in pregnancy. Lancet. 2010;375(9714):595-605.

[26] Paumgartner G, Beuers U. Mechanisms of action and therapeutic efficacy of ursodeoxycholic acid in cholestatic liver disease. Clin Liver Dis. 2004;8(1):67-81.

[27] Sánchez Pozzi EJ, Crocenzi FA, Pellegrino JM, Catania VA, Luquita MG, Roma MG, Rodriguez EA, Mottino AD. Ursodeoxycholate reduces ethinylestradiol glucuronidation in the rat: role in prevention of estrogen-induced cholestasis. J Pharmacol Exp Ther. 2003;306(1):279-86.

[28] Tan J, Surti B, Saab S. Pregnancy and Cirrhosis. Liver Transplant. 2008;14(8):1081-91.

[29] Mullally B, Hansen W. Intrahepatic Cholestasis of Pregnancy: Review of the Literature. Obstet Gynecol Surv. 2002;57(1):47-52.

[30] Burrows RF, Clavisi O, Burrows E. Intervenciones para el tratamiento de la colestasis durante el embarazo (Revisión Cochrane traducida). En: La biblioteca Cochrane Plus, 2008, Número 2. Oxford: Update Software Ltd.

[31] Glantz A, Marschall MU, Lammert F, Mattsson LA. Intrahepatic Cholestasis of Pregnancy: a Randomised Controlled Trial Comparing Dexamethasone and Ursodeoxycholic Acid. Hepatology. 2005;42(6):1399-405.

[32] Roncaglia N, Locatelli A, Arreghini A, Assi F, Cameroni I, Pezullo J, Ghidini A. A randomised controlled trial of ursodeoxycholic acid and S-adenosyl-L-methionine in the treatment of gestational cholestasis. Br J Obstet Gynaec. 2004;111(1):17-21.

[33] Kondrackiene J, Beuers U, Kupcinskas L. Efficacy and Safety of Ursodeoxycholic Acid Versus Cholestyramine in Intrahepatic Cholestasis of Pregnancy. Gastroenterology. 2005;129(3):894-901.

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