Bile acids and gestation

Mol Aspects Med. 2017 Aug:56:90-100. doi: 10.1016/j.mam.2017.05.003. Epub 2017 May 18.


There are numerous profound maternal physiological changes that occur from conception onwards and adapt throughout gestation in order to support a healthy pregnancy. By the time of late gestation, when circulating pregnancy hormones are at their highest concentrations, maternal adaptations include relative hyperlipidemia, hypercholanemia and insulin resistance. Bile acids have now been established as key regulators of metabolism, and their role in gestational changes in metabolism is becoming apparent. Bile acid homeostasis is tightly regulated by the nuclear receptor FXR, which has been shown to have reduced activity during pregnancy. This review focuses on the gestational alterations in bile acid homeostasis that occur in normal pregnancy, which in some women can become pathological, leading to the development of intrahepatic cholestasis of pregnancy. As well as their important role in maternal metabolic health, we will review bile acid metabolism in the feto-placental unit.

Keywords: Bile acids; Fetus; Intrahepatic cholestasis of pregnancy; Metabolism; Placenta; Pregnancy.

Publication types

  • Review

MeSH terms

  • Bile Acids and Salts / metabolism*
  • Cholestasis, Intrahepatic / genetics
  • Cholestasis, Intrahepatic / metabolism*
  • Cholestasis, Intrahepatic / pathology
  • Diabetes, Gestational / genetics
  • Diabetes, Gestational / metabolism*
  • Diabetes, Gestational / pathology
  • Enterohepatic Circulation / physiology
  • Female
  • Fetus
  • Gene Expression Regulation
  • Gestational Age
  • Homeostasis / physiology*
  • Humans
  • Liver / metabolism
  • Placenta / metabolism
  • Pregnancy
  • Receptors, Cytoplasmic and Nuclear / genetics*
  • Receptors, Cytoplasmic and Nuclear / metabolism
  • Signal Transduction


  • Bile Acids and Salts
  • Receptors, Cytoplasmic and Nuclear
  • farnesoid X-activated receptor