Skip to main content
SpringerLink
Log in

Biliary Lipids in Pregnancy

  • Chapter
The Hepatobiliary System

Part of the book series: NATO Advanced Study Institutes Series ((NSSA,volume 7))

Abstract

Although there is remarkably little known about the effect of pregnancy on the human liver and particularly about its effect on the secretion and composition of bile there is evidence, much of it indirect and some of it controversial, that there is a general alteration in liver function during pregnancy (11,13,27,33,38,68, 69,71). In the latter part of pregnancy one finds an increased activity of serum alkaline phosphatase and leucine amino peptidase which is not entirely attributable to placental contributions. There is an increased activity of 5′-nucleotidase and there is a general hyperlipemia (7,8,11,14,62,70). This latter phenomenon, first documented by Virchow in 1867, must involve the liver which plays such a central role in lipid metabolism. And it must involve several different mechanisms. Although the concentrations of total triglycerides, cholesterol, phospholipids and free fatty acids are all increased the relative increase of triglyceride is greater than that of cholesterol which is in turn greater than that of phospholipid. In fact plasma lysolecithin is selectively decreased and quite dramatically (70,76).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. ADLERCREUTZ H: Hepatic metabolism of estrogens in health and disease. New Eng J Med, 290,; 1081–1083, 1974.

    Article  PubMed  CAS  Google Scholar 

  2. ADLERCREUTZ H, ERVAST HS, TENHUNEN A, et al: Gas chromatographic and mass spectrometric studies on oestrogens in bile: Part I. Pregnant women. Acta Endocrinol, 73,: 543–554, 1973.

    PubMed  CAS  Google Scholar 

  3. ADLERCREUTZ H, LUUKKAINEN T: Biochemical and clinical aspects of the enterohepatic circulation of oestrogens. Acta Endocrinol, Suppl, 124,: 101–140, 1967.

    CAS  Google Scholar 

  4. ADLERCREUTZ H, SVANBORG A, ANBERG A: Recurrent jaundice in pregnancy. II. A study of the estrogens and their conjugation in late pregnancy. Amer J Med, 42,: 341–347, 1967.

    Article  PubMed  CAS  Google Scholar 

  5. ADLERCREUTZ H, TENHUNEN R: Some aspects of the interaction between natural and synthetic female sex hormones and the liver. Amer J Med, 49,: 630–648, 1970.

    Article  PubMed  CAS  Google Scholar 

  6. ADLERCREUTZ H, TIKKANEN MJ, WICHMANN K, et al: Recurrent jaundice in pregnancy. IV. Quantitative determination of urinary and biliary estrogens, including studies in pruritus gravidarum. J Clin Endocrinol Metab, 38,: 51–57, 1974.

    Article  PubMed  CAS  Google Scholar 

  7. ALFIN-SLATER RB, AFTERGOOD L: Lipids and the pill. Lipids, 6,: 693–705, 1971.

    Article  PubMed  CAS  Google Scholar 

  8. ALVAREZ RR, GAISER DF, SIMKINS DM, et al: Serial studies of serum lipids in normal human pregnancy. Amer J Obstet & Gynecol 77,: 743–758, 1959.

    Google Scholar 

  9. ARIAS IM: Some effects of contraceptive steroids on hepatic function in normal women and in patients with acquired and inheritable defects in hepatic excretory function. In Metabolic effects of gonadal hormones and contraceptive steroids,. Eds HA Salhanick, DM Kipnis, RL Vande Wiele. Plenum Press, N.Y., 1969. pp. 30–39.

    Chapter  Google Scholar 

  10. BACK P, SJOVALL J, SJOVALL K: Monohydroxy bile acids in plasma in intrahepatic cholestasis of pregnancy. Identification by computerized gas chromatography — mass spectrometry. Medical Biology, 52,: 31–38, 1974.

    PubMed  CAS  Google Scholar 

  11. BECKER H, BERLE P, WALLE A, et al: Influence of late gestation and early puerperium on lipid and carbohydrate metabolism in normal females. Acta Endocrinol, 67,: 570–576, 1971.

    PubMed  CAS  Google Scholar 

  12. BEKERSKY I, MOSBACH EH: Effect of hormones on bile acid metabolism. In The Bile Acids,, vol. 2,. Ed PP Nair, D Kritchevsky. Plenum Press, N.Y., 1973. pp. 249–257.

    Google Scholar 

  13. BREWER DW, AUBRY RH: The Physiology of Pregnancy. Clinical pathologic correlations. Part 2. Postgrad Med, 53,: 221–226, 1973.

    PubMed  Google Scholar 

  14. BURT RL: Plasma nonesterified fatty acids in normal pregnancy and the puerperium. Obstet & Gynecol, 15,: 460–464, 1960.

    CAS  Google Scholar 

  15. CAHLIN E, JONSSON H, NILSSON S, et al: Synthesis of phospholipids and triglycerides in human liver slices. III. Influence of bile acids, choline and linoleic acid. Scand J Clin Lab Invest, 29,: 109–114, 1972.

    Article  PubMed  CAS  Google Scholar 

  16. COMBES B, SHIBATA H, ADAMS R, et al: Alterations in sulfobromophthalein sodium — removal mechanisms from blood during normal pregnancy. J Clin Invest, 42,: 1431–1442, 1963.

    Article  PubMed  CAS  Google Scholar 

  17. DEAN PD, WHITEHOUSE MW: Inhibition of hepatic sterol oxidation by cholanic (bile) acids and their conjugates. Biochim Biophys Acta, 137,: 328–334, 1967.

    Article  CAS  Google Scholar 

  18. DEITRICK JE, McSHERRY CK, JAVITT NB, et al: Bile salt kinetics in the pregnant baboon: a new model for the study of gallbladder function. Gastroenterology, 65,: 536, 1973.

    Google Scholar 

  19. DESPOPOULOS A: Hepatic and renal excretory metabolism of bile salts : a background for understanding steroid-induced cholestasis. J Pharmacol Exp Therap, 176,; 273–283, 1971.

    CAS  Google Scholar 

  20. DRILL VA: Benign cholestatic jaundice of pregnancy and benign cholestatic jaundice from oral contraceptives. Amer J Obstet Gynecol, 119,: 165–174, 1974.

    CAS  Google Scholar 

  21. EINARSSON K, HELLSTROM K, KALLNER M: Bile acid kinetics in relation to sex, serum lipids, body weights and gallbladder disease in patients with various types of hyperlipoproteinemia. J Clin Invest, 54,: 1301–1311, 1974.

    Article  PubMed  CAS  Google Scholar 

  22. FAHIM MS, HALL DG: Effect of ovarian steroids on hepatic metabolism. I. Progesterone. Amer J Obstet & Gynecol, 106,: 183–186, 1970.

    CAS  Google Scholar 

  23. FISHER MM, MAGNUSSON R, MIYAI K: Bile acid metabolism in mammals. I. Bile acid-induced intrahepatic cholestasis. Lab Invest, 25,: 88–91, 1971.

    PubMed  CAS  Google Scholar 

  24. FISHER MM, MAGNUSSON R, PHILLIPS MJ et al; Bile acid metabolism in mammals. IV. Sex difference in chenodeoxycholic acid metabolism in the rat. Lab Invest, 27,: 254–262, 1972.

    PubMed  CAS  Google Scholar 

  25. FISHER MM, YOUSEF IM: Sex differences in the bile acid composition of human bile: studies in patients with and without gallstones. Can Med Assoc J, 109,: 190–193, 1973.

    PubMed  CAS  Google Scholar 

  26. FORKER EL: The effect of estrogen on bile formation in the rat. J Clin Invest, 48,: 654–663, 1969.

    Article  PubMed  CAS  Google Scholar 

  27. GEALL MG, WEBB MJ: Liver disease in pregnancy. Med Clin NA, 58,; 817–822, 1974.

    CAS  Google Scholar 

  28. GERDES MM, BOYDEN EA; The rate of emptying of the human gall bladder in pregnancy. Surgery, Gynecol & Obstet, 66,: 145–156, 1938.

    Google Scholar 

  29. GLENN F, McSHERRY CK: Pregnancy, cholesterol metabolism and gallstones. Ann Surg, 169,: 712–723, 1969.

    Article  PubMed  CAS  Google Scholar 

  30. HARKAVY M, JAVITT NB: Effect of ethynyl estradiol on hepatic excretory function of the rat. In Metabolic effects of gonadal hormones and contraceptive steroids,. Eds HA Salhanick, DM Kipnis, RL Vande Wiele. Plenum Press, N.Y.,1969. pp.11–18.

    Chapter  Google Scholar 

  31. HEIKEL TA, LATHE GH; The effect of oral contraceptive steroids on bile secretion and bilirubin Tm in rats. Br J Pharmac, 38,; 593–601, 1970.

    Article  CAS  Google Scholar 

  32. HOLZBACH RT, MARSH ME, HALLBERG MC: The effect of pregnancy on lipid composition of guinea pig gallbladder bile. Gastroenterology, 60,; 288–293, 1971.

    PubMed  CAS  Google Scholar 

  33. HYTTEN FE, LEITCH I: The physiology of human pregnancy. Blackwell Scientific Publications, Oxford, London, Edinburgh, 1971. pp. 176–178.

    Google Scholar 

  34. JOHNSON J, KALANT N; Bile composition in the pregnant rabbit. Amer J Dig Dis, 17,: 1–5, 1972.

    Article  PubMed  CAS  Google Scholar 

  35. JOHNSON P: Studies in cholestasis of pregnancy with special reference to lipids and lipoproteins. Acta Obstet Gynecol Scand Suppl, 27,; 1–75, 1973.

    PubMed  Google Scholar 

  36. KAPPAS A: Studies in endocrine pharmacology. Biologic actions of some natural steroids on the liver. New Eng J Med, 278,; 378–384, 1968.

    Article  PubMed  CAS  Google Scholar 

  37. KELLIE AE: The pharmacology of the estrogens. Ann Rev Pharmacol, 11,: 97–112, 1971.

    Article  PubMed  CAS  Google Scholar 

  38. KREEK MJ: Cholestasis of pregnancy and during ethinyl estradiol administration in the human and rat. In Metabolic effects of gonadal hormones and contraceptive steroids,. Eds HA Salhanik, DM Kipnis, RL Vande Wiele. Plenum Press, N.Y. 1969. pp.40–58.

    Chapter  Google Scholar 

  39. KREEK MJ, PETERSON RE, SLEISENGER MH, et al: Effects of ethinylestradiol-induced cholestasis on bile flow and biliary excretion of estradiol and estradiol glucuronide by the rat. Proc Soc Exp Biol Med, 131,: 646–650, 1969.

    PubMed  CAS  Google Scholar 

  40. KREEK MJ, SLEISENGER MH: Estrogen induced cholestasis due to endogenous and exogenous hormones. Scand J Gastroent Suppl, 7,: 123–131, 1970.

    CAS  Google Scholar 

  41. KREEK MJ, SLEISENGER MH, JEFFRIES GH: Recurrent cholestatic jaundice of pregnancy with demonstrated estrogen sensitivity. Amer J Med, 43,: 795–803, 1967.

    Article  PubMed  CAS  Google Scholar 

  42. KREEK MJ, WESER E, SLEISENGER MH, et al: Idiopathic cholestasis of pregnancy. The response to challenge with the synthetic estrogen, ethinyl estradiol. New Eng J Med, 277,: 1391–1395, 1967.

    Article  PubMed  CAS  Google Scholar 

  43. LAATIKAINEN T: Excretion of neutral steroid hormones in human bile. Ann Clin Res, 2,: Suppl 5, 1–28, 1970.

    PubMed  Google Scholar 

  44. LAATIKAINEN T, KARJALAINEN O: Excretion of conjugates of neutral steroids in human bile during late pregnancy. Acta Endocrinol, 69,: 775–788, 1972.

    PubMed  CAS  Google Scholar 

  45. LAATIKAINEN T, KARJALAINEN O, JANNE O: Excretion of progesterone metabolites in urine and bile of pregnant women with intrahepatic cholestasis. J Steroid Biochem, 4,: 641–648, 1973.

    Article  PubMed  CAS  Google Scholar 

  46. LARGE AM, JOHNSTON CG, KATSUKI T, et al: Gallstones and pregnancy: the composition of gallbladder bile in the pregnant woman at term. Amer J Med Sci, 239,: 713–720, 1960.

    Article  PubMed  CAS  Google Scholar 

  47. LYNN J, WILLIAMS L, O’BRIEN J, et al: Effects of estrogen upon bile: implications with respect to gallstone formation. Ann Surg, 178,: 514–524, 1973.

    Article  PubMed  CAS  Google Scholar 

  48. MARTIN DE, WOLF RC, MEYER RK: The effects of pregnancy on biliary lipids in Rhesus monkeys. Proc Soc Exp Biol Med, 139,: 115–117, 1972.

    PubMed  CAS  Google Scholar 

  49. MARTIN DE, WOLF RC, HOUSER WD: Naturally occurring cholelithiasis in a Rhesus monkey and its effects on plasma and biliary lipid concentrations. Am J Vet Res, 34,: 971–974, 1973.

    PubMed  CAS  Google Scholar 

  50. McSHERRY CK, JAVITT NB, CARVALHO JM, et al: Cholesterol gallstones and the chemical composition of bile in baboons. Ann Surg 173,: 569–577, 1971.

    Article  PubMed  CAS  Google Scholar 

  51. McSHERRY CK, MORRISSEY KP, JAVITT NB, et al: Role of hepatic bile composition in gallstone formation in baboons. Ann Surg, 178,: 669–675, 1973.

    PubMed  CAS  Google Scholar 

  52. MIYAI K, PRICE VM, FISHER MM: Bile acid metabolism in mammals. Ultrastructural studies on the intrahepatic cholestasis induced by lithocholic and chenodeoxycholic acids in the rat. Lab Invest, 24,: 292–302, 1971.

    PubMed  CAS  Google Scholar 

  53. MUELLER MN, KAPPAS A: Estrogen pharmacology. I. The influence of estradiol and estriol on hepatic disposal of sulfobromophthalein (BSP) in man. J Clin Invest, 43,: 1905–1914, 1964.

    Article  PubMed  CAS  Google Scholar 

  54. NILSSON S: Synthesis and secretion of biliary phospholipids in man. Acta Chir Scand Suppl, 405,: 1–38, 1970.

    PubMed  CAS  Google Scholar 

  55. PALMER RH, GALLAGHER TF, MUELLER MN, et al: The effect of natural and synthetic estrogens on the excretion of BSP by the liver. In Metabolic effects of gonadal hormones and contraceptive steroids,. Eds HA Salhanick, DM Kipnis, RL Vande Wiele. Plenum Press, NY, 1969. pp. 19–29.

    Chapter  Google Scholar 

  56. PERTSEMLIDIS D, PANVELIWALLA D, KIMBALL A: Effects of clofibrate and of oral contraceptives on biliary lipid composition and bile acid kinetics in man. Gastroenterology, 64,: 782, 1973.

    Google Scholar 

  57. PERTSEMLIDIS D, PANVELIWALLA D, AHRENS EH: Effects of clofibrate and of an estrogen-progestin combination on fasting biliary lipids and cholic acid kinetics in man. Gastroenterology, 66,: 565–573, 1974.

    PubMed  CAS  Google Scholar 

  58. POTTER MG: Observations of the gallbladder and bile during pregnancy at term. J Amer Med Assoc, 106,: 1070–1074, 1936.

    Article  Google Scholar 

  59. RANNEVIK G, JEPPSSON S, KULLANDER S: Effect of oral contraceptives on the liver in women with recurrent cholestasis (hepatoses) during previous pregnancies. J Obstet Gynaecol Br Commonw, 79,: 1128–1136, 1972.

    Article  PubMed  CAS  Google Scholar 

  60. RIEGEL C, RAVDIN IS, MORRISON PJ, et al: Studies of gallbladder function. XI. The composition of the gallbladder bile in pregnancy. J Amer Med Assoc, 105,: 1343–1344, 1935.

    Article  Google Scholar 

  61. RIEGEL C, RAVDIN IS, JOHNSTON CG, et al: Studies of gall bladder function. XIII. The composition of the gallbladder bile and calculi in gallbladder disease. Surgery Gynecol & Obstet, 62,: 933–940, 1936.

    Google Scholar 

  62. SAMSIOE G, JOHNSON P, GUSTAFSON A: Aspects of the pathogenesis of cholestasis of pregnancy with reference to the serum lipid abnormalities. Scand J Gastroent 10,: 1–4, 1975.

    PubMed  CAS  Google Scholar 

  63. SCHERSTEN T: Formation of lithogenic bile in man. Digestion, 9,: 540–553, 1973.

    Article  PubMed  CAS  Google Scholar 

  64. SHAW HM, HEATH T: Effect of pregnancy on the excretion of sulphobromophthalein in bile. Aust J Biol Sci, 25,: 1101–1104, 1972.

    PubMed  CAS  Google Scholar 

  65. SJOVALL J, SJOVALL K: Steroid sulphates in plasma from pregnant women with pruritus and elevated plasma bile acid levels. Ann Clin Res, 2,: 321–338, 1970.

    PubMed  CAS  Google Scholar 

  66. SMITH RL: Biliary excretion and hepatotoxicity of contraceptive steroids. Acta Endocrinol Suppl, 185,: 149–168, 1974.

    CAS  Google Scholar 

  67. SOFFER LJ: Bilirubin excretion as a test for liver function during normal pregnancy. Bull Johns Hopkins Hospital, 52, : 365–375, 1933.

    Google Scholar 

  68. SONG CS, KAPPAS A: The influence of estrogens, progestins, and pregnancy on the liver. Vitamins and Hormones, 26,: 147–195, 1968.

    Article  PubMed  CAS  Google Scholar 

  69. SONG CS, RIFKIND AB, GILLETTE PN, et al: Hormones and the liver. Am J Obstet & Gynecol, 105,: 813–847, 1969.

    CAS  Google Scholar 

  70. SVANBORG A, VIKROT O: Plasma lipid fractions, including individual phospholipids, at various stages of pregnancy. Acta Med Scand, 178,: 615–630, 1965.

    Article  PubMed  CAS  Google Scholar 

  71. TAYLOR W: The excretion of steroid hormone metabolites in bile and feces. Vitamins and Hormones, 29,: 201–285, 1971.

    Article  PubMed  CAS  Google Scholar 

  72. TINDALL VR, BEAZLEY JM: An assessment of changes in liver function during normal pregnancy — using a modified bromsulphthalein test. J Obstet Gynecol, 72,: 717–737, 1965.

    CAS  Google Scholar 

  73. UCHIDA K, NOMURA Y, KADOWAKI M, et al : Effects of estradiol, dietary cholesterol and 1-thyroxine on biliary bile acid composition and secretory rate, and on plasma, liver and bile cholesterol levels in rats. Endocrinol Japon, 17,; 107–121, 1970.

    Article  CAS  Google Scholar 

  74. UCHIDA K, NOMURA Y, KADOWAKI M, et al; Stimulative and inhibitive effects of estrogen on cholesterol synthesis in rats. Endocrinol Japon, 20,; 129–134, 1973.

    Article  CAS  Google Scholar 

  75. VAN DER LINDEN W, NORMAN A; Composition of human hepatic bile. Acta Chir Scand, 133,; 307–313, 1967.

    PubMed  Google Scholar 

  76. VIKROT O; Quantitative determination of plasma phospholipids in pregnant and nonpregnant women, with special reference to lysolecithin. Acta Med Scand, 175,; 443, 1964.

    Article  PubMed  CAS  Google Scholar 

  77. WATANABE H; Effect of 17α-ethinylestradiol on biliary excretion of bile acids. Biochim Biophys Acta, 399,; 79–84, 1975.

    Article  PubMed  CAS  Google Scholar 

  78. YOUNG D; Estradiol- and testosterone-induced alterations in phosphatidylcholine and triglyceride synthesis in hepatic endoplasmic reticulum. J Lipid Res, 12,; 590–595, 1971.

    PubMed  CAS  Google Scholar 

  79. YOUSEF IM, FISHER MM: Influence of pregnancy on the bile acid pool of rats. Clin Res, 21,: 1036, 1973.

    Google Scholar 

  80. YOUSEF IM, KAKIS G, FISHER MM; Bile acid metabolism in mammals. III. Sex difference in the bile acid composition of rat bile. Can J Biochem, 50,: 402–408, 1972.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Toronto, Toronto, Ontario, Canada

    M. M. Fisher, V. M. Price & I. M. Yousef

Authors
  1. M. M. Fisher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. M. Price
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. M. Yousef
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. The Medical School, The University, Newcastle upon Tyne, England

    W. Taylor

Rights and permissions

Reprints and permissions

Copyright information

© 1976 Springer Science+Business Media New York

About this chapter

Cite this chapter

Fisher, M.M., Price, V.M., Yousef, I.M. (1976). Biliary Lipids in Pregnancy. In: Taylor, W. (eds) The Hepatobiliary System. NATO Advanced Study Institutes Series, vol 7. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-8900-6_26

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-8900-6_26

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4615-8902-0

  • Online ISBN: 978-1-4615-8900-6

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation