Clinical study| Volume 54, ISSUE 5, P600-604, May 1973

Recurrent jaundice in pregnancy

III. Quantitative determination of urinary estriol conjugates, including studies in pruritus gravidarum
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      Estriol metabolism was studied in 23 patients with pruritus gravidarum and eight patients with recurrent jaundice of pregnancy by determining the urinary excretion of the four known estriol conjugates. Comparison of the results with those obtained in normal pregnant women revealed marked changes in estriol metabolism in the two cholestatic conditions. These include a decrease in the urinary excretion of estriol-3-glucuronide and an increase in the proportions of urinary estriol-3-sulfate, 16-glucuronide and estriol-3-sulfate. These changes are considered to be secondary to the cholestasis and are mostly due to impaired enterohepatic circulation of estrogens. The results are thus consistent with the view that although pruritus gravidarum and recurrent jaundice of pregnancy are not caused by a primary abnormality of estrogen metabolism, they probably represent an abnormal reaction of the liver to the elevated estrogen levels produced in pregnancy in susceptible women.
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