LCA in pregnancy most commonly refers to lithocholic acid, a specific bile acid that can become elevated in a condition called intrahepatic cholestasis of pregnancy (ICP). Less often, LCA stands for Leber congenital amaurosis, a genetic eye disorder that may come up during prenatal carrier screening. If your doctor mentioned LCA in the context of blood work, itching, or liver function, they’re almost certainly talking about lithocholic acid. If it came up during genetic testing, it refers to the eye condition.
Lithocholic Acid and Cholestasis of Pregnancy
Lithocholic acid is one of several bile acids your liver produces to help digest fats. During pregnancy, hormonal changes can slow the flow of bile, causing these acids to build up in your bloodstream. When bile acid levels climb high enough, the result is intrahepatic cholestasis of pregnancy, a liver condition that typically appears in the third trimester and causes intense, relentless itching, especially on the palms of the hands and soles of the feet.
Doctors diagnose ICP by measuring total bile acids in a blood sample. The upper limit of normal for total bile acids is around 10 µmol/L when fasting and roughly 20 µmol/L after eating. Current guidelines recommend drawing blood in a non-fasting state because bile acid levels rise after meals, and testing only fasting samples can miss high-risk cases.
Why LCA Levels Matter
While total bile acid levels are the standard screening tool, research has looked at whether individual bile acids like lithocholic acid can help distinguish ICP from other causes of elevated bile acids in pregnancy. In one study comparing pregnant women with ICP to healthy controls, average LCA levels were about five times higher in the ICP group (1.63 µmol/L vs. 0.31 µmol/L). When lithocholic acid was combined with cholic acid (another bile acid), the pair had strong predictive accuracy for identifying ICP, with a combined cutoff of 3.28 µmol/L.
That said, testing individual bile acid fractions like LCA requires specialized lab techniques that are more expensive and take longer to process. Most international guidelines currently recommend sticking with total bile acid measurements for routine clinical care, since there isn’t yet enough data to validate risk thresholds for individual bile acids on their own.
Risks of Cholestasis for the Baby
The concern with ICP isn’t the itching itself, which is miserable but not dangerous. The real worry is what elevated bile acids can do to the pregnancy. Clinical studies show that cholestasis can lead to premature birth in up to 60% of cases, fetal distress in up to 33%, and stillbirth in up to 2%. Animal research suggests bile acids themselves play a direct role in these complications, crossing the placenta and accumulating in the fetus.
The risk of serious outcomes rises with the severity of the bile acid elevation. Pregnancies with total bile acid levels reaching 100 µmol/L or higher carry the greatest risk, which is why guidelines recommend repeating blood tests at least weekly after 32 weeks so that care decisions can be adjusted as levels change.
Treatment for Cholestasis
The primary treatment is a medication called ursodiol, which helps lower bile acid levels in the blood and may protect the fetus from excessive bile acid exposure. Research has shown that ursodiol reduces the accumulation of bile acids in the fetus and normalizes certain bile acid ratios that become imbalanced during cholestasis. It also helps relieve itching, though the main goal is reducing risk to the baby.
For managing the itch itself, cool or lukewarm baths can take the edge off, and oatmeal-based creams or lotions may soothe irritated skin. Icing a particularly itchy area can provide brief relief. Home remedies alone rarely control the intense itching that comes with cholestasis, which is why medication is typically the first-line approach.
Many women with ICP are offered early delivery, often between 36 and 37 weeks, depending on how high bile acid levels climb. The timing balances the risks of prematurity against the risks of prolonged exposure to elevated bile acids.
LCA as Leber Congenital Amaurosis
If LCA came up during genetic carrier screening rather than blood work, it refers to Leber congenital amaurosis, a group of inherited eye disorders that cause severe vision loss or blindness from birth. At least 12 different genes have been linked to LCA, with mutations in one gene alone accounting for 10% to 24% of cases depending on the population studied.
LCA follows an autosomal recessive inheritance pattern, meaning a child only develops the condition if they inherit a non-working copy of the same gene from both parents. When both parents are carriers, there’s a 25% chance with each pregnancy that the baby will have the condition and a 75% chance the baby will not. Most people who carry a single copy of the mutation have no vision problems themselves and may not know they’re carriers until screening reveals it.
Prenatal testing for LCA is possible when the specific gene mutations in both parents are already known. Chorionic villus sampling (a biopsy of placental tissue) can confirm whether the fetus has inherited both mutations. Researchers have also demonstrated that fetal DNA circulating in the mother’s blood can be analyzed as early as 12 weeks of gestation, though this non-invasive approach is not yet part of standard clinical practice for LCA. If you’ve been identified as a carrier couple, a genetic counselor can walk you through the testing options and what results would mean for your pregnancy.