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Intrahepatic cholestasis of pregnancy: the severe form is associated with common variants of the hepatobiliary phospholipid transporter ABCB4 gene
  1. H E Wasmuth1,
  2. A Glantz2,
  3. H Keppeler3,
  4. E Simon3,
  5. C Bartz4,
  6. W Rath4,
  7. L-Å Mattsson2,
  8. H-U Marschall5,
  9. F Lammert3
  1. 1Third Department of Medicine, University Hospital Aachen, Aachen University, Aachen, Germany
  2. 2Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg, Sweden
  3. 3First Department of Internal Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
  4. 4Department of Obstetrics and Gynecology, University Hospital Aachen, Aachen University, Aachen, Germany
  5. 5Department of Internal Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
  1. Correspondence to:
    Professor Dr F Lammert
    First Department of Internal Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany; frank.lammert{at}


Background: Intrahepatic cholestasis of pregnancy (ICP) is characterised by troublesome maternal pruritus, raised serum bile acid levels and increased fetal risk. Mutations of the ABCB4 gene encoding the hepatobiliary phospholipid transporter have been identified in a small proportion of patients with cholestasis of pregnancy. In a recent prospective study on 693 patients with cholestasis of pregnancy, a cut-off level for serum bile acid (⩾40 μmol/l) was determined for increased risk of fetal complications.

Objectives: To investigate whether common combinations of polymorphic alleles (haplotypes) of the genes encoding the hepatobiliary ATP-binding cassette (ABC) transporters for phospholipids (ABCB4) and bile acids (ABCB11) were associated with this severe form of cholestasis of pregnancy.

Methods: For genetic analysis, 52 women with bile acid levels ⩾40 μmol/l (called cases) and 52 unaffected women (called controls) matched for age, parity and geographical residence were studied. Gene variants tagging common ABCB4 and ABCB11 haplotypes were genotyped and haplotype distributions were compared between cases and controls by permutation testing.

Results: In contrast with ABCB11 haplotypes, ABCB4 haplotypes differed between the two groups (p = 0.019), showing that the severe form of cholestasis of pregnancy is associated with the ABCB4 gene variants. Specifically, haplotype ABCB4_5 occurred more often in cases, whereas haplotypes ABCB4_3 and ABCB4_7 were more common in controls. These associations were reflected by different frequencies of at-risk alleles of the two tagging polymorphisms (c.711A: odds ratio (OR) 2.27, p = 0.04; deletion intron 5: OR 14.68, p = 0.012).

Conclusion: Variants of ABCB4 represent genetic risk factors for the severe form of ICP in Sweden.

  • ABC, ATP-binding cassette
  • ICP, intrahepatic cholestasis of pregnancy
  • SNP, single-nucleotide polymorphism

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  • Published Online First 4 August 2006

  • Funding: This study was supported in part by grants from the Department of Research and Development (FoU), Västra Götaland, Sweden, the Ministry of Innovation, Science, Research and Technology of North-Rhine-Westphalia (MIWFT-NRW) and BONFOR, University of Bonn, Germany.

  • Competing interests: None declared.