COMMENTARY

Itchy Palms During Pregnancy? It Might Suggest Chronic Liver Disease

Digestive Disease Week (DDW) 2019

Erica Monrose, MD/MSCR Candidate

Disclosures

May 29, 2019

The connection between itchy palms during pregnancy and the world's most common chronic liver disease is not immediately obvious but may soon be. Our team of researchers explored this possible link and recently presented our findings at Digestive Disease Week.

Erica Monrose

Nonalcoholic fatty liver disease (NAFLD) is steadily becoming more prominent around the world, especially in Western nations, with an estimated prevalence of 10%-40%. It is associated with such risk factors as obesity and type 2 diabetes. In the United States alone, NAFLD affects an estimated 80-100 million people and is now the second-leading cause of liver transplant and the leading cause among women. Given its prevalence and limited therapies, identifying the underlying mechanism behind the progression of NAFLD is of interest, and so far, leading investigators have identified bile acids as a potential key factor.

By contrast, intrahepatic cholestasis of pregnancy (ICP) is a rare disease, estimated to affect roughly 1 of every 300 pregnancies. The cause of ICP remains unknown, but the mechanism includes a disruption in the path of bile exiting the liver, leading to increased bile acids which can cross the placenta and result in fetal death. Severe itching, which occurs most often on the palms and the soles of the feet, without any signs of a rash, is ICP's main associated symptom.

What these divergent conditions appear to have in common is the role of bile acid metabolism.

We believed that the centrality of bile acids to both disease processes warranted investigation into a possible connection between ICP and NAFLD, as there is currently no known association in the scientific literature. If an association could be established, ICP may prove to be a novel model through which to investigate bile acid metabolism in patients with NAFLD.

Our study looked at medical records of 149 pregnancies complicated by ICP among a largely Latina population, one of three ethnic groups (along with Bengali and Swedish women) most often diagnosed with ICP. We compared these ICP pregnancies to a control group of 200 women, using liver imaging and other criteria, and found the rate of NAFLD to be significantly higher in women with ICP.

This research may provide another link between NAFLD and bile acid dysregulation that could be used to better understand the role of bile acids in fatty liver. Because NAFLD is often silent, if its connection to ICP is confirmed, then pregnant women with ICP would also greatly benefit from screening and linkage to liver specialty care postpartum.

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