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

Choose the test that is both specific to ICP and tracks its danger, namely fetal risk. Alkaline phosphatase fails immediately because the placenta pours out its own alkaline phosphatase, so the level rises in every normal pregnancy and tells you nothing specific. Bilirubin is a late and inconsistent finding, often staying normal even when the mother is itching severely. The transaminases AST and ALT can wobble upward but are non-specific and do not reliably grade the disease. Serum bile acids stand out: they accumulate when bile flow is impaired, they correlate tightly with the intensity of pruritus and, crucially, their height predicts adverse fetal outcomes including stillbirth, with severe disease flagged at high concentrations. Because they are the most sensitive, most specific and most prognostically useful test, serum bile acids are the best marker for intrahepatic cholestasis of pregnancy.

\[\boxed{\text{Bile acids (serum bile acids)}}\]