Progesterone sulfates are enterohepatically recycled and stimulate G protein-coupled bile acid receptor 1-mediated gut hormone release

Sulfated progesterone species (PMxSs) increase postprandially in women with intrahepatic cholestasis of pregnancy (ICP) but not in women with uncomplicated pregnancy. PMxS can be enterohepatically recycled via active transport from the gut lumen by apical sodium-dependent bile acid transporter (ASBT) and stimulate gut hormone secretion. Active reabsorption of PMxS may play a role in the pruritus suffered by women with ICP. ASBT inhibition is a plausible therapy for ICP-associated pruritus.