Intrahepatic cholestasis of pregnancy: detection with urinary bile acid assays.
OBJECTIVE
To determine sensitivity and specificity of urine bile acid sulfate (UBAS) and non-sulfated urine bile acid (UBA) assays for detection of intrahepatic cholestasis of pregnancy (ICP).


METHODS
Urine was collected prospectively from healthy and pruritic patients evaluated for ICP. Results were expressed as a ratio to urinary creatinine.


RESULTS
Of 20 patients evaluated for ICP, 14 had confirmed ICP by serum testing and six had pruritus only. UBAS results were higher with ICP (P<0.001) and increased with gestational age in healthy controls. Adjusted for gestational age, the multiples of the median (MoM) were still higher (2.64+/-1.11, 1.05+/-0.54, P<0.001). The sensitivity was 100% and specificity 83% at 1.5 MoM in pruritic patients. UBA results were higher with ICP (23.0+/-9.8, 12.8+/-7.4, P<0.001), with sensitivity of 100% and specificity of 50% at 10.2 micromol/g cretinine.


CONCLUSIONS
Urinary bile acids can detect or exclude ICP with serum abnormalities. Urine bile acid sulfates have higher specificity than non-sulfated urine bile acids at equivalent sensitivities, but co-detection of progestin sulfates is suspected.
Huang
William M
WM
Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, New York University, New York, NY 10016, USA. wmhuang123@yahoo.com
Seubert
David E
DE
Donnelly
James G
JG
Liu
Mengling
M
Javitt
Norman B
NB
D000328:Adult; D001647:Bile Acids and Salts / Q000652:urine*; D016022:Case-Control Studies; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis* / Q000652:urine; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000652:urine; D012680:Sensitivity and Specificity
D001647:Bile Acids and Salts