In pregnant women with high total bile acids, there is an increase in serum bile acid levels during pregnancy. The elevation of bile acids becomes more pronounced as the pregnancy progresses. In the event of cholestasis during pregnancy, serum bile acid levels can be significantly elevated, so bile acid measurements can help identify cholestatic pruritus from non-cholestatic pruritus. Because itching caused by elevated bile acids is common, a high biliary total bile acid during pregnancy is a normal physiologic response. If there are no obvious symptoms, it can be temporarily observed and does not require special treatment. If itching symptoms are more severe, symptomatic treatment can be given. In general, simple elevation of bile acids in pregnant women can be observed. If cholestasis is present, treatment is needed. The fetus needs to be monitored in utero.