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Bile acid test is very important during pregnancy as it is an important market of a rare liver disease called Intrahepatic cholestasis of pregnancy (ICP). The condition mainly occurs during the late second and early third trimester of pregnancy.
ICP is also known as obstetric cholestasis and intense itching due to increased bile acids in the body is its main characteristics. This is the reason why intense itching during pregnancy is not considered a normal symptom. 
Women with ICP are at an increased risk of several pregnancy complications such as fetal asphyxiation, stillbirth, respiratory distress and bradycardia. This makes serum bile acids test important to identify the condition at an early stage with its proper management.
What Happens In Intrahepatic Cholestasis Of Pregnancy?
Bile is a yellow-green liquid produced in the liver and stored in the gallbladder. It helps with digestion and fat absorption. During pregnancy, sometimes the elevated levels of estrogen interfere with the functioning of the liver and gallbladder and cause problems.
Cholestasis can be genetic or due to environmental factors such as deficiency of vitamin D and selenium, infection of hepatitis C, sensitivities to certain drugs during pregnancy can also cause the disease. 
The build-up of bile acids increases due to increased estrogen levels and causes the prior to leak in the bloodstream. This results in pruritus or intense itching, especially palms and soles of the feet, which may get worsen during nighttime. Other additional symptoms of cholestasis include dark urine, pale stools, tiredness, jaundice and pain under the ribs (where the liver is present). 
The condition, however, clears up within one to three days after delivery. If it persists, the diagnosis of cholestasis is likely incorrect and it may be a sign or other diseases.
A study reports the largest number of stillbirths due to cholestasis in women with a gestation of more than 37 weeks.  This shows how life-threatening can be the condition for the baby is early diagnosis is not carried out.
Why Are HIV-Infected pregnant Women More Prone To Intrahepatic Cholestasis Of Pregnancy?
HIV-infected pregnant women are at increased risk of many diseases, including cholestasis. This is mainly because of the effect of antiretroviral drug used on HIV therapy. The drugs tend to alter the enzyme-producing ability of the liver which affects the bile acid metabolism and cause cholestasis. 
What Is the Purpose Of Bile Acids test?
The bile acids test help determine
- number of healthy cells of the liver,
- proper blood supply to the liver and
- movement of bile in and out of the liver.
As persistent itching is the main symptom of cholestasis, medical experts usually suggest aqueous cream with methanol to improve the symptom. It helps provide a soothing effect to the skin and ease itching, redness and swelling.
Certain prescribed medications like ursodiol and chlorpheniramine are prescribed to lower bile acids in the bloodstream.
Itching is common during pregnancy due to stretched tummy skin or other factors. However, persistent itching, especially during the third trimester, cannot be ignored. Diagnosis of intrahepatic cholestasis of pregnancy at an early stage can help prevent the condition, without affecting the health of both the mother and the foetus.