INTRAHEPATIC CHOLESTASIS OF PREGNANCY - AN ESTROGEN-RELATED DISEASE

Cholestasis related to estrogens has been of clinical interest for over three decades. Although the association of pregnancy and cholestasis is said to have been initially described in 1883 by Ahlfeld and subsequently in 1937 by Eppinger in his text, 'Die Leberkrankheiten,' it was not until the mid 1950s that several reports were published describing the clinical features in detail. These observations led to a number of clinical studies revealing the deleterious effects of pregnancy and estrogens on organic anion clearance and the subsequent reproduction of the hepatic transport abnormality in a rat model. Inspite of intensive clinical and experimental investigation, the pathogenesis of intrahepatic cholestasis of pregnancy (ICP) and estrogen- induced cholestasis is still an enigma. However, the epidemiologic and experimental data suggest an inheritable abnormality in estrogen metabolism or hepatic reactivity, or both.