The impact of gallbladder motility in intrahepatic cholestasis of pregnancy: a prospective observational study.

BACKGROUND

Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that occurs during pregnancy, typically in the third trimester, and is associated with adverse fetal outcomes. Despite being well-recognized, the exact pathogenesis of ICP remains incompletely understood, with impaired hepatobiliary function hypothesized to play a significant role in its development.

PURPOSE

The study aims to evaluate the relationship between altered gallbladder motility and hepatobiliary dysfunction in pregnancies complicated by ICP.

MATERIALS AND METHODS

This was a prospective hospital-based study involving 90 participants: 30 non-pregnant controls and 60 pregnant women (30 with intrahepatic cholestasis of pregnancy (ICP), and 30 pregnant controls). The cholestasis group was further subdivided into an icteric group (elevated serum bilirubin levels) and an anicteric group (abnormal liver function tests but normal bilirubin levels). Gallbladder volume (GBV) was initially measured after an overnight fast (12-14 h). Following a standardized meal (75 g of bread and butter or 100 g of groundnut), GBV and ejection fraction were re-measured at multiple postprandial time points (15, 30, 45, 60, 75, and 90 min).

RESULTS

The study enrolled 60 pregnant women in their third trimester (gestational weeks 28-40) and 30 non-pregnant controls. Among the pregnant women, 30 were diagnosed with ICP, which was further divided into an icteric group (n = 6) and an anicteric group (n = 24). The ICP group demonstrated consistently higher GB volumes and lower ejection fraction (EF) compared to non-pregnant and pregnant controls, with statistically significant differences across all time intervals. Within the ICP patients, the icteric group consistently exhibited higher GB volumes and lower EF values compared to anicteric group. Receiver operating characteristic (ROC) curve analysis revealed that the best post-prandial 15-min GB ejection fraction cutoff for predicting ICP was 53% and postprandial 15-min GB volume cutoff for predicting ICP was 9.5 ml, CONCLUSION: Impaired gallbladder motility, characterized by increased GB volume and decreased EF, is a key feature of obstetric cholestasis. Gallbladder ultrasound measurements, particularly postprandial GB volume and EF, can serve as useful diagnostic tools for distinguishing between cholestasis of pregnancy and healthy pregnancies, with high sensitivity and specificity for identifying ICP in late pregnancy.