Routine Viral and Autoimmune Tests in Intrahepatic Cholestasis of Pregnancy: Are They Really Necessary?

Öz

Objective To assess whether routine viral and autoimmune hepatitis tests and hepatobiliary ultrasonography aid in diagnosing and managing intrahepatic cholestasis of pregnancy. Material and Method This retrospective study reviewed 120 pregnant women diagnosed with ICP at a tertiary care center from 2020 to 2025. Demographic, clinical, and laboratory data-including viral (HBsAg, Anti-HCV, Anti-HIV, CMV, EBV), autoimmune (ANA, SMA, AMA, Anti-LKM), and ultrasonographic findings— were analyzed to evaluate their role in diagnosis and treatment planning. Results The mean age and BMI of patients were 29.6 ± 5.3 years and 29.3 ± 5.5 kg/m², respectively. The mean gestational week at diagnosis was 32.5 ± 4.2, and the mean delivery week was 36.3 ± 2.1. HBsAg positivity was observed in 0.83% of patients, while no cases were positive for Anti-HCV or Anti-HIV. Autoimmune markers were completely negative. Abnormal ultrasound findings were detected in 31.8% of patients, most commonly gallstones and grade 1 hepatic steatosis. However, these did not result in changes in clinical management. Conclusion Routine testing for viral and autoimmune hepatitis markers and hepatobiliary ultrasound in ICP patients offers limited diagnostic benefit and seldom affects treatment decisions. These findings support a more targeted and cost-effective strategy, reserving additional tests for atypical cases or patients with treatment resistance.

Anahtar Kelimeler

• Autoimmune hepatitis markers
• Bile acids
• Hepatobiliary ultrasonography
• Intrahepatic cholestasis of pregnancy
• Viral hepatitis markers

Kaynakça

1. 1. Paus TC, Schneider G, Van De Vondel P, Sauerbruch T, Reichel C. Diagnosis and therapy of intrahepatic cholestasis of pregnancy. Z Gastroenterol. 2004;42(7):623-8.
2. 2. Ovadia C, Seed PT, Sklavounos A, Geenes V, Di Ilio C, Chambers J et.al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet 2019;393(10174):899-909.
3. 3. Mays JK.The active management of intrahepatic cholestasis of pregnancy. Curr Opin Obstet Gynecol. 2010;22(2):100-3.
4. 4. Lammert F, Marschall HU, Glantz A, Matern S. Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. J Hepatol. 2000;33(6):1012-21.
5. 5. Floreani A, Caroli D, Lazzari R, Memmo A, Vidali E, Colavito D, D'Arrigo A, Leon A, Romero R, Gervasi MT. Intrahepatic cholestasis of pregnancy: new insights into its pathogenesis. J Matern Fetal Neonatal Med. 2013;26(14):1410-5.
6. 6. Dixon PH, Williamson C. The pathophysiology of intrahepatic cholestasis of pregnancy. Clin Res Hepatol Gastroenterol. 2016;40(2):141-53.
7. 7. Smith DD, Rood KM. Intrahepatic Cholestasis of Pregnancy. Clin Obstet Gynecol. 2020;63(1):134-151.
8. 8. Conti-Ramsden F, McEwan M, Hill R, Wade J, Abraham G, Buckeldee O, Williamson C, Knight CL, Girling J, Chappell LC. Detection of additional abnormalities or co-morbidities in women with suspected intrahepatic cholestasis of pregnancy. Obstet Med. 2020;13(4):185-191.

9. 9. Lee RH, Kwok KM, Ingles S, Wilson ML, Mullin P, Incerpi M, Pathak B, Goodwin TM. Pregnancy outcomes during an era of aggressive management for intrahepatic cholestasis of pregnancy. Am J Perinatol. 2008;25(6):341-5.
10. 10. Bechtel MA. Pruritus in Pregnancy and Its Management. Dermatol Clin. 2018;36(3):259-265.
11. 11. Hagenbeck C, Pecks U, Lammert F, Hütten MAC, Borgmeier F, Fehm T, Schleußner E, Maul H, Kehl S, Hamza A, Keitel V. Schwangerschaftscholestase: In Zusammenarbeit mit der AG Geburtshilfe und Pränatalmedizin in der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe – Sektion Maternale Erkrankungen (Intrahepatic cholestasis of pregnancy, German). Gynakologe. 2021;54(5):341-356.
12. 12. Donet A, Girault A, Pinton A, Lepercq J. Intrahepatic cholestasis of pregnancy: Is a screening for differential diagnoses necessary? J Gynecol Obstet Hum Reprod. 2020:49(10);101907.
13. 13. Girling J, Knight CL, Chappell L, Royal College of Obstetricians and Gynaecologists. Intrahepatic cholestasis of pregnancy: Green-top Guideline No. 43. BJOG. 2022;129(13):e95-e114. doi: 10.1111/1471-0528.17206.
14. 14. Cohen HL, McGahan JP, Hertzberg BS, et al. The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum. J Ultrasound Med. 2022;41(4):E1-E8. doi: 10.1002/jum.15874.
15. 15. Kim BH, Choi HY, Ki M, Kim KA, Jang ES, Jeong SH. Population-based prevalence, incidence, and disease burden of autoimmune hepatitis in South Korea. PLoS One 2017;12(8):e0182391.