Preeclampsia with abnormal liver function tests is associated with cholestasis in a subgroup of cases

Objective: To investigate whether women with preeclampsia and abnormal liver function tests have raised serum bile acids. Design: Measurement of serum bile acids in serum specimens collected at the John Radcliffe Hospital, Oxford. Setting: Imperial College School of Medicine. Sample: Stored sera from 37 women with preeclampsia and abnormal liver function tests and from 19 controls. Methods: Enzymic total bile acid assay. Main outcome measures: Total bile acid levels. Results: Women with preeclampsia and abnormal liver function tests had higher median bile acid levels than controls (5.7 vs. 3.2, p = 0.01). The reason for the raised median serum bile acid levels in the patient group is that three (8%) women with preeclampsia had markedly raised serum bile acids levels. There were no obvious clinical or biochemical features specific to these patients. Conclusions: The pathological mechanisms causing hepatic impairment in some women with preeclampsia may predispose to cholestasis. As some women with preeclampsia and abnormal liver function complain of pruritus, we recommend checking the serum bile acids in this group of women. If these acids are raised the fetal prognosis may be adversely affected.