Bile acids

Are you pregnant and troubled by itchy palms and soles, particularly at night? Measuring total bile acids in blood is the most important test for detecting cholestasis in pregnancy, a condition in which the liver has difficulty excreting bile. A doctor also requests it for other liver and biliary diseases to assess how well the liver is functioning.

Who the test is for

• pregnant women with itchy skin without a rash, most often on the palms and soles and worse at night, usually in the second half of pregnancy;
• pregnant women who had cholestasis in a previous pregnancy;
• pregnant women with already confirmed cholestasis, for monitoring;
• people with elevated liver enzymes, jaundice or dark urine, when a doctor needs additional information;
• people with chronic liver or bile duct disease, for monitoring;
• for prolonged itchy skin without a clear cause, on a doctor’s recommendation.

What the test reveals

Bile acids are produced in the liver from cholesterol and travel with bile to the intestine, where they help digest fats. Most then return to the liver and are reused. When the liver cannot excrete bile normally or is damaged, bile acids accumulate in the blood.

During pregnancy, hormones slow bile excretion in some women. Cholestasis of pregnancy develops: it causes unpleasant itching for the mother, and at high levels increases the risk of premature delivery and complications for the baby. Regular checks are therefore important. Alongside bile acids, a doctor usually requests liver enzymes, for example Extended liver health panel.

The procedure and preparation

A blood sample is taken from a vein, and the draw takes a few minutes. You do not need to fast; the cut-offs for cholestasis of pregnancy specifically apply to a non-fasting sample. Bile acid levels naturally rise after a meal, so for follow-up it is useful to provide samples under the same conditions and at a similar time of day. If your gynaecologist or another doctor gives different instructions, follow those.

If you take ursodeoxycholic acid, a medicine often prescribed for cholestasis, mention this when your blood is drawn and to the doctor interpreting the result.

What your result means

The reference value depends on the method; up to around 10 µmol/L is approximately normal, but the interval printed on the report applies. A doctor, or a gynaecologist in pregnancy, interprets the result alongside your symptoms and liver enzymes.

• Normal result: currently there are no signs of bile acid accumulation. If itching in pregnancy persists, the test is usually repeated, because levels may rise only after itching begins.
• Elevated result in pregnancy: with itching, this suggests cholestasis of pregnancy. According to British guidelines, diagnosis is made at values of 19 µmol/L or above. The higher the value, the more frequent the checks; at very high levels of 100 µmol/L or above, a doctor may suggest earlier delivery.
• Elevated result outside pregnancy: suggests impaired bile flow or liver disease, such as hepatitis, cirrhosis or bile duct disease. Your doctor investigates the cause with other tests and imaging.

Cholestasis of pregnancy usually resolves after delivery, and a doctor generally repeats tests a few weeks later. If you notice your baby moving less than usual during pregnancy, contact the maternity unit immediately. Jaundice with abdominal pain, fever or confusion requires urgent assessment (194 or 112).

How to arrange testing

You can have blood taken without an appointment or referral at one of our branches across Croatia (listed under Contact). Prices for all tests and panels are available in the price list.

Frequently asked questions

Is itching in pregnancy always cholestasis?

No. Mild abdominal itching from stretching skin is common and harmless. Cholestasis should be considered when itching affects the palms and soles, is worse at night and there is no skin rash.

Is cholestasis of pregnancy dangerous for the baby?

The risk is small in mild forms. With high bile acid values, the risk of premature delivery and complications is greater, so a doctor monitors the pregnancy more frequently and plans delivery timing.

How is cholestasis of pregnancy treated?

A gynaecologist manages treatment. Ursodeoxycholic acid is most commonly prescribed to relieve itching, and the pregnancy is monitored with regular examinations and test results. The condition usually resolves after delivery.

What other tests are performed alongside bile acids?

Most often liver enzymes ALT and AST, GGT, alkaline phosphatase and bilirubin. Together, these show the degree of strain on the liver.