Conclusions
Normal pregnancy is a sub-cholestatic state and is associated with a
physiological elevation of TSBA levels, therefore a higher threshold
should be considered for the diagnosis of ICP. We suggest using the
upper reference limit observed in our healthy pregnant population
(fasting ≥14 µmol/L and postprandial ≥20 µmol/L). As the fasting
measurement is more specific for the diagnosis, and the postprandial is
essential for severity assessment, it is recommended to measure both
values, rather than use random samplings.