Question

The best marker for intrahepatic cholestasis of pregnancy is?

• A. Bile acids (serum bile acids)
• B. Liver enzymes (AST and ALT)
• C. Bilirubin
• D. Alkaline phosphatase

Hint:

Pick the test whose level predicts fetal stillbirth risk.

Answer 1

The Correct Option is A

Step 1: Recall intrahepatic cholestasis of pregnancy (ICP), which presents in the second or third trimester with pruritus (typically palms and soles) without a rash.
Step 2: Evaluate the markers. Transaminases (AST/ALT) may be mildly raised but are non-specific. Bilirubin is often normal or only mildly elevated late in the course. Alkaline phosphatase is physiologically raised in normal pregnancy (placental origin), so it is unreliable.
Step 3: Serum total bile acids are the most sensitive and specific marker; they are the key to diagnosis and correlate with severity and with the risk of adverse fetal outcomes such as stillbirth. Markedly elevated bile acids (for example 40 micromol/L or more) indicate severe disease.
Step 4: Hence the best marker is bile acids.
Answer: Option A, Bile acids.