Bile acids and pregnancy: clinical emergency

Abstract

Abstract

Introduction: Bile acids are signaling molecules with a dual action in the body: anti-inflammatory and pro-inflammatory, maintaining the health-disease balance. Currently, it is a clinical emergency issue in complicated pregnancy. The biological actions of protective bile acids when the intestinal microbiota- hepatobiliary-intestine-maternal brain axis is broken and dysbiosis occurs, are biotransformed into toxic hydrophobic bile acids, which in pregnant women when increased in the blood and passing the maternal-placental-fetal barrier cause loss of fetal well-being or a non-calming fetal state. Objective: To expose the theoretical foundations of the toxic effects of bile acids on the fetus during pregnancy by disturbing maternal-placental-fetal circulation. Material and method: A systematic review were conducted of the evidence on the protective and toxic effects of bile acids in physiological and pathological pregnancy, reported on websites (PubMed, SciELO, LILACS, and Elservier), between 1990 and 2024. Results: The biomolecular mechanisms that could constitute the theoretical basis linking the toxicity of bile acids in pregnancy and how they can influence maternal and infant mortality or cause fetal death are described. Conclusion: Bile acids constitute a clinical emergency issue in complicated pregnancy, which justifies their indication in routine hemochemistry as a predictive and prognostic biomarker of comorbidities associated with or acquired in pregnancy, placental dysfunction, hypoxia, cellular and organelle damage, in order to reduce maternal and infant mortality.

Keywords: bile acids 1; pregnancy 2; maternal-infant death 3.