Intrahepatic cholestasis of pregnancy (ICP) is a frequent liverdisorder, mostly occurring in the third trimester. ICP is notharmful to the mothers but threatens the fetus. The authorsevaluated steroid alterations in maternal and mixed umbilicalblood to elucidate their role in the ICP development. Tenwomen with ICP were included in the study. Steroids in thematernal blood were measured by Gas Chromatography-MassSpectrometry (GC-MS) (n=58) and RIA (n=5) at the diagnosis ofICP, labor, day 5 postpartum, week 3 postpartum and week 6postpartum. The results were evaluated by ANOVA consisting ofthe subject factor, between subject factors ICP, gestational ageat the diagnosis of ICP and gestational age at labor, withinsubjectfactor Stage and ICP × Stage interaction. The 17 controlswere firstly examined in the week 36 of gestation. ICP patientsshowed reduced CYP17A1 activity in the C17,20 lyase step thusshifting the balance between the toxic conjugated pregnanediolsand harmless sulfated 5α/β-reduced-17-oxo C19 steroids. Hence,more toxic metabolites originating in maternal liver from theplacental pregnanes may penetrate backward to the fetalcirculation. As these alterations persist in puerperium, thecirculating steroids could be potentially used for predicting thepredisposition to ICP even before next pregnancy.
展开▼
