Bile Acid

​Elevated bile acid levels can indicate impaired liver function, which may lead to complications for both mother and baby. In this article, we’ll explore the importance of bile acid testing in pregnancy, optimal ranges, and how to interpret abnormal results to ensure a safer, healthier pregnancy.

Bile Acid Testing

The bile acid, serum blood test—also known as serum bile acids test or total bile acids test—measures the levels of bile acid in the blood. 

​Elevated levels of serum bile acid may indicate impaired liver function, cholestasis (a condition characterized by reduced bile flow), or other liver disorders. This test is particularly relevant in the context of conditions such as intrahepatic cholestasis of pregnancy (ICP) and liver diseases that affect bile acid synthesis and secretion.

Currently there is not enough data to recommend adjusted ranges from the current accepted ranges in pregnancy. 

Bile Acid in Pregnancy

Serum bile acid increases slightly beginning in the first trimester and it peaks in the third trimester close to term.

​This rise is primarily driven by elevated estrogen levels. Estrogens increase the activity of bile acid synthase and inhibit their metabolic enzymes, as well as promote the increase of bile acid content in hepatocytes. This causes an overproduction of bile acid.

​The serum bile acid test is heavily influenced by fasting, and postprandial levels may be several µmol/L higher than fasting values. Therefore, this test should always be run fasting for accuracy.

High Bile Acid in Pregnancy

​Levels up to 11.0 μmol/L are accepted as normal in late gestation. 

Due to the normal increase in serum bile acid associated with pregnancy, researchers now suggest that even high-reference range intervals should be used to diagnose ICP.

Most Common Causes of High Bile Acids in Pregnancy

• Hypothyroidism
• Gut Dysbiosis
• Liver Damage/Inflammation
• Gallbladder Obstruction
• Nutritional Deficiencies (vitamin D, selenium)
• Genetics

Low Bile Acid in Pregnancy

​Not considered pathogenic

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Medical Disclaimer:
This content is for educational purposes only and is intended for licensed medical professionals. It is based on current research, subject to change, and not intended to diagnose, treat, or prevent any medical condition. This information does not replace consultation with a qualified healthcare provider. Seek professional medical evaluation and treatment from a licensed provider. Use of this information is at your own risk.​

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