Touching Lives - October 2008
Liver disease and stillbirth: getting to the heart of the problem
Obstetric cholestasis (OC) is associated with fetal distress, spontaneous pre-term delivery and stillbirth, and is characterised by intense itching during pregnancy. Some women scratch their skin until it bleeds. It may account for up to 40 stillbirths each year in Britain, but some women do not report their symptoms because they are told to expect itching as part of a normal pregnancy.
Professor Catherine Williamson is heading a team of researchers from Imperial College London. Their work has already made them one of the leadingOC research groups in Europe and has shed new light on the condition, and in particular how the level of bile acids (a product of the liver which helps break down fats during digestion) and pregnancy hormones in the mother’s blood can interact and impair liver function, leading to OC.
Building on their previous findings, the research team has recently been awarded a grant of £131,566 by Action Medical Research to look at why the increased level of bile acids in the mother’s blood may cause fetal heart problems. This work is performed in collaboration with Dr Julia Gorelik at the National Heart and Lung Institute. In the laboratory they will study the mechanism behind the proposed abnormal heart rhythms in the baby and the way drugs could be used to provide protection.
The hope for the long-term is that this work will help prevent stillbirth in OC, and possibly in other conditions such as diabetes in pregnancy. There are wider implications too — the findings could also improve our understanding of how to prevent deaths from abnormal heart rhythm in adult disease.
Professor Williamson says, “Our previous research has shown that bile acids influence immature heart cells more than adult heart cells. This may explain why mothers with OC do not have heart problems themselves. We have also demonstrated that a drug called UDCA can protect immature heart cells from these problems, but we do not know how it does this, so our new project will look at the mechanisms whereby bile acids cause abnormal heart beats and the ways the drugs could help.”
This two year study is partly funded by Avanti Systems Ltd
Help for women with OC
One member of the research team knows only too well the devastating consequences of OC. Jenny Chambers lost two babies to the condition, and is now working as a post graduate research assistant at Imperial and Hammersmith Hospital, helping Professor Williamson and Dr Gorelik in this new study. After her own experience, she set up a helpline and website for women affected by OC and has worked tirelessly to make it more recognised.
Losing a baby — the tragedy of OC
Suzanne McDonnell now has three gorgeous daughters, but her first pregnancy, in 1999, ended in tragedy. She and husband Gerard were eagerly awaiting the arrival of their first child. Suzanne had been plagued by intense itching across her breasts and chest from about 18 weeks, but was assured that itching was a normal part of pregnancy. However, at 35 weeks, Suzanne started to have severe pains.
She says, “I was taken into hospital and given a steroid injection to help the baby’s lungs and for the first time the itching vanished! It was incredible, but no one mentioned OC and I knew nothing about it. I went into labour while I was in hospital but later when I was put onto the monitor they could not find a heartbeat. A scan confirmed that my baby had died.
“We were devastated, but during the questions that followed I mentioned the itching again and a blood test showed that the rise in my liver function tests had been astronomical. A post mortem could find nothing at all wrong with my little girl.”
Several weeks later, Suzanne saw a newspaper article about Jenny Chambers and OC, and realised what had happened. Though OC had been mentioned after the loss of her baby, it had never been given as a cause of her daughter’s death. However the intense itching and the dark colour of her urine during pregnancy made the pieces of the jigsaw fall into place.
When Suzanne fell pregnant again, she switched hospitals and her consultant agreed to an early delivery if signs of OC returned. Her daughter was born early after the telltale itching returned shortly before 29 weeks.
The same pattern followed in her next two pregnancies, with OC symptoms appearing very late, and though Suzanne and Gerard’s daughters Shauna, Grace and Lily are all thriving, they still feel angry and frustrated at what happened.
Suzanne says,”What we went through was an absolute nightmare and the tragedy is that it was probably preventable. We are lucky to have three healthy daughters now, but we can’t ever forget what happened the first time.
“This condition needs a much higher profile. More research is absolutely vital. If sharing my experience can help just one woman then it is worthwhile.”