Reference standard for serum bile acids in pregnancy

Serum bile acids do not change significantly during gestation in uncomplicated pregnancies and a single reference range can be used throughout pregnancy.


Caroline Joyce, Keelin O'Donoghue

Journal Name
British Journal of Obstetrics and Gynecology (BJOG)
Journal Article
Full Citation

Egan N, Bartels A, Khashan AS, Broadhurst DI, Joyce C, O'Mullane J, O'Donoghue K. Reference standard for serum bile acids in pregnancy. British Journal of Obstetrics and Gynecology. 2012;119(4):493-8.

Link to Publication


Cholestasis is a liver disorder which can present as a rare complication of pregnancy and is associated with itchy skin and an elevation in bile acids. Importantly, it can affect pregnancy outcome resulting in early delivery or death of the baby. Bile acids greater than 10 umol/L in blood are associated with cholestasis and levels greater than 40 umol/L in blood are liked to serve disease and poor outcomes. However, normal levels for bile acids during pregnancy are not well established. We sought to establish a normal range for bile acids throughout pregnancy so cholestasis could be easily recognised. We recruited 219 women with a singleton pregnancy who presented to our hospital at 12, 20, 28 and 36 weeks of their pregnancy and up to 72 hours after delivery. We excluded women with high alcohol consumption, liver disease/cholestasis or obesity. The average age of women recruited to the study was 30 years. Our results show that bile acid levels do not change much during pregnancy. The bile acid results from our study are consistent with established ranges of normality. Therefore, our current bile acid reference range can be used to identify cholestasis in women at all stages of their pregnancy.

Pregnancy Loss Research Group

Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Fifth Floor, Cork University Maternity Hospital, Wilton, Cork, T12 YE02, Ireland,