Is normal pregnancy cholestatic?

Fasting and 2-h postprandial concentrations of conjugated cholate and conjugated chenodeoxycholate in plasma were measured sequentially through normal pregnancy in a consecutive series of 26 women. Fasting concentrations of cholate significantly increased by 34 weeks and remained so up to 6 weeks post partum. No significant changes were found in fasting or 2-h postprandial concentrations of chenodeoxycholate. Postprandial concentrations of cholate were significantly higher post partum than at 22 weeks of pregnancy. The ratio of fasting cholate: chenodeoxycholate rose from 1.1 : 1.0 at 20 weeks to 1.9 : 1.0 at 38 weeks. In the third trimester, concentrations of conjugated cholate were elevated above the laboratory reference range in 5 of these 26 normal pregnancies. It is concluded that normal pregnancy is associated with mild sub-clinical cholestasis.