importance of the implications derived from these find-The effect of total blockage of maternal biliary excreings both in the nutrition and management of human tion during the last third of the pregnancy on the matuneonates demands further evaluation of the hepatobiliration of hepatobiliary function was investigated in neoary function of babies born after alterations of fetal-manatal rats. Extrahepatic obstruction of the common bile ternal bile acid homeostasis, such as in maternal obstetduct on day 14 of pregnancy induced a marked enhanceric cholestasis. (HEPATOLOGY 1996;23:1208-1217.) ment in serum bilirubin-mainly conjugated bilirubinand bile acid concentrations as compared with shamoperated pregnant rats. Excretion of bile acids by the Normal fetal development requires efficient transfer kidney was significantly increased, whereas fecal elimiacross the placenta. Nutrients are supplied by the nation of these compounds was almost abolished. Most mother while certain potentially toxic compounds cross of the cholestatic mothers (CMs) (77%) were able to carry the placenta, mainly in the fetus-to-mother direction. pregnancy to term and lactation until weaning (21 days Among the latter are bile acids. Both in humans and after birth). The body and liver weights of their offspring experimental animals, the onset of bile acid biosynthewere lower than for offspring of control healthy mothers sis precedes the development of efficient mechanisms in all postnatal periods considered. Serum bile acid concentrations were higher in the fetuses and neonates of involved in enterohepatic circulation. 1 Hepatic insuffi-CMs. This difference was evident up to 1 week after ciency with respect to bile acid secretion is found in weaning and disappeared in young adult animals (8 both premature and full-term infants. 2 This is accomweeks old). When the bile secretion rate was investipanied by a marked immaturity of small intestinal gated in these animals at 4 or 8 weeks of age, no signifitransport of bile acids. [3][4][5] Because the accumulation of cant difference was found as far as nonstimulated bile bile acids within the fetus can seriously challenge the flow and bile acid output was concerned. However, the viability of pregnancy, such compounds must be transbiliary response to stepwise sodium taurocholate (TC) ferred to the mother, whose liver is able to excrete them intravenous infusion showed that 4-week-old neonates into bile. Therefore, fetal-maternal bile acid homeostaof CMs had impaired bile acid secretion. Moreover, the sis requires both functional placental transfer and normaximal secretion rate (SR max ) for TC was significantly reduced (030%), whereas the choleretic ability of tauro-mal maternal hepatobiliary function.
cholate was not modified. This alteration was not selec-Obstetric cholestasis is a pathological situation chartive for bile acids. The SR max for bromosulfophthalein acterized by a 10-to 100-fold increase in postprandial (BSP) was also significantly lowered (040%). These dysbile acid concentrations in the mother and, occasionfunctions were overcome during subsequent developally, jaundice. This disease is more common than prement. No impaired biliary response to either TC or BSP viously suspected and occurs during the second half or infusion was observed at 8 weeks of age. Morphological the third trimester of the pregnancy in women who abnormalities in the canaliculi were found in animals were healthy before and after the pregnancy. 6 Besides with impaired biliary function. In summary, these reskin pruritus, subclinical fat malabsorption, and mildly sults indicate that maternal cholestasis may profoundly abnormal results of routine biochemical liver tests, delbut transiently impair the normal liver maturation. The eterious effects on the mother are absent. By contrast, cholestasis of the pregnancy, as well as any other situation leading to marked increases in maternal serum Abbreviations: TC, sodium taurocholate; BSP, bromosulfophthalein; CM, cholestatic mothers; SRmax, maximal secretion rate.