Idiopathic cholestasis of pregnancy. The response to challenge with the synthetic estrogen, ethinyl estradiol.

The possible role of estrogens in the pathogenesis of pruritus gravidarum and cholestatic jaundice of pregnancy was examined. 13 women of childbearing age who had been studied during at least 1 of their previous pregnancies were the subjects in the investigation. 7 of these women had symptoms during pregnancy; 3 had pruritus gravidarum and 4 cholestatic jaundice. 6 women who had been free of symptoms during pregnancy served as controls. A dose of .5 mg twice daily was given to 10 subjects; 2 received .5 mg daily, and 1, .5 mg, 3 times a day. 10 subjects recieved estrogen for 2 weeks, but in 3 who had been symptomatic during pregnancy, the development of severe symptoms or jaundice necessitated earlier cessation of hormone administration. In women with normal pregnancies the only symptom during estrogen treatment was mild early-morning nausea and liver function was not significantly impaired. In those with a history of itching or jaundice during pregnancy, ethinyl estradiol administration precipitated symptoms similar to those experienced during pregnancy. In these women liver function was significantly impaired by estrogen.