Biochemical Roles of Bile Acids in Intrahepatic Cholestasis of Pregnancy: A Review

Abstract

This article reviews the biochemical role of bile acids in intrahepatic cholestasis of pregnancy (ICP), one of the most common pregnancy-related liver diseases. ICP is associated with pruritus and elevated blood bile acid concentrations, and increases the risk of fetal mortality and preterm delivery. Bile acids, which are synthesized from cholesterol, play a central role in the pathophysiology of ICP, as changes in their synthesis and metabolism lead to their toxic accumulation in the liver.

The article explains the mechanism of action of this accumulation through the activation of cellular and inflammatory signaling pathways, specifically through receptors such as FXR and TGR5, leading to oxidative stress, mitochondrial dysfunction, and liver cell damage. Elevated bile acids also cross the placenta, negatively affecting its function and fetal health. Bile acid levels and ratios can be used as biomarkers for diagnosis and assessment, and understanding these mechanisms opens up possibilities for targeted therapies.