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Intrahepatic cholestasis of pregnancy

Nature Reviews Disease Primers volume 11, Article number: 51 (2025) Cite this article

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Abstract

Intrahepatic cholestasis of pregnancy is the most common pregnancy-related liver disease, manifesting typically during the third trimester of pregnancy with pruritus and elevated serum bile acids. This condition is associated with increased fetal morbidity and mortality, and its pathogenesis is still incompletely understood, but is most likely multifactorial, involving ethnicity, genetics, hormones and environmental factors. Available evidence covering the pathophysiology of both maternal and fetal manifestations, and potential new areas of interest such as microbiota and the environment, have been reviewed, as well as available biomarkers that can be used particularly with regard to genetics, multiomics and the possible use of machine learning algorithms to predict intrahepatic cholestasis of pregnancy. Ursodeoxycholic acid is still the mainstay of therapy with limited alternative options; however, a new class of drugs inhibiting intestinal bile acid transport might be on the horizon. Intrahepatic cholestasis of pregnancy is still not completely understood, warranting a critical appraisal of its epidemiology, pathogenesis, diagnosis and management.

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Fig. 1: Global incidence of ICP.
Fig. 2: Pathogenesis of intrahepatic cholestasis of pregnancy.
Fig. 3: Algorithm for the diagnosis and management of ICP.

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Authors and Affiliations

  1. Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    Elton Dajti & Francesco Azzaroli

  2. Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy

    Elton Dajti, Giuseppe Mazzella & Francesco Azzaroli

  3. Departamento de Tecnología Farmacéutica, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina

    Valeria Tripodi

  4. Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China

    Yayi Hu & Dan Shan

  5. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China

    Yayi Hu & Dan Shan

  6. Ramón Sardá Mother’s and Children’s Hospital, Buenos Aires, Argentina

    Maria Cecilia Estiù

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  1. Elton Dajti
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  2. Valeria Tripodi
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  3. Yayi Hu
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  4. Maria Cecilia Estiù
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  5. Dan Shan
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  6. Giuseppe Mazzella
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  7. Francesco Azzaroli
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Contributions

Introduction (E.D.); Epidemiology (M.C.E. and E.D.); Mechanisms/pathophysiology (G.M. and F.A.); Diagnosis, screening and prevention (V.T.); Management (Y.H. and D.S.); Quality of life (E.D.); Outlook (E.D. and F.A.); overview of the Primer (E.D. and F.A.).

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Dajti, E., Tripodi, V., Hu, Y. et al. Intrahepatic cholestasis of pregnancy. Nat Rev Dis Primers 11, 51 (2025). https://doi.org/10.1038/s41572-025-00633-2

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  • DOI: https://doi.org/10.1038/s41572-025-00633-2

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