Role of ursodeoxycholic acid on maternal serum bile acids and perinatal outcomes in intrahepatic cholestasis of pregnancy

Abstract

Aim Intrahepatic cholestasis of pregnancy (ICP) is associated with safe maternal outcomes but perinatal outcomes have been variable. We assessed clinical factors and impact of bile acid levels on maternal and neonatal outcomes in ICP. Methods Patients with ICP (defined as pruritus with serum bile acids ≥ 10 mmol/l) were included prospectively with an assessment of risk factors, modes of delivery as well as maternal and neonatal outcomes. Mild and severe ICP were diagnosed when serum bile acid was always <40 mmol/l and ≥40 mmol/l, respectively. Patients with gestational pruritus served as controls. Results Out of 643 patients, 375 patients (mean age 29 ± 7.6 years, 45.8% primigravida) met inclusion criteria. Pregnancy-induced hypertension [PIH: 10.5%; odds ratio (OR): 4.8; 95% confidence interval (CI): 2.4–8.5; P = 0.0014], gestational diabetes (GDM: 12.5%; OR: 2.6; 95% CI: 2.3–4.1; P = 0.045) and spontaneous preterm labor (15.1%; OR: 2.5; 95% CI: 1.2–3.5; P = 0.040) were higher in patients with ICP. Ursodeoxycholic acid (UDCA) (median dose 900 mg; 600–1800 mg) ameliorated symptoms of cholestasis, bile acid levels and liver aminotransferases in 79% cases. When compared with patients with mild ICP, patients with severe ICP presented at a lower gestational period (26 vs. 32 weeks, P = 0.036), required frequent induction (12.5%; OR: 3.2; 95% CI: 2.1–5.6; P = 0.045) and had increased fetal distress (15%; OR: 1.9; 95% CI: 1.3–4.9; P = 0.048).Overall eight stillbirths were recorded. Conclusion Severe ICP is associated with a higher incidence of GDM and PIH, risk of pre-term labor, elective induction and stillbirths. UDCA remains a first-line agent in treating ICP.

Placental Abruption and Partial Placental Prolapse During Induction of Labor in a 31-Year-Old Female With Intrahepatic Cholestasis of Pregnancy: A Case Report

“…Clinical treatment of ICP is aimed at improving patient symptoms and fetal prognosis [ 9 ]. Thus, UDCA is the first-line drug for the treatment of ICP and is essential in improving the pregnancy outcomes of patients with ICP [ 9 , 10 ].…”

“…Clinical treatment of ICP is aimed at improving patient symptoms and fetal prognosis [ 9 ]. Thus, UDCA is the first-line drug for the treatment of ICP and is essential in improving the pregnancy outcomes of patients with ICP [ 9 , 10 ]. The drug is characterized by safety, effectiveness, high compliance, and convenience and is widely used in clinical practice [ 9 ].…”

“…Thus, UDCA is the first-line drug for the treatment of ICP and is essential in improving the pregnancy outcomes of patients with ICP [ 9 , 10 ]. The drug is characterized by safety, effectiveness, high compliance, and convenience and is widely used in clinical practice [ 9 ]. However, the drug regulatory authorities have not yet approved UDCA as a pregnancy-safe drug, which accounts for the reluctance of obstetricians to use it on pregnant patients [ 10 ].…”

Effect of intrahepatic cholestasis of pregnancy on infantile food allergy: A retrospective longitudinal study cohort in Southwest China

“…Several studies conducted on pregnant women with intrahepatic cholestasis of pregnancy among the world population have investigated the morbidity. The incidence of intrahepatic cholestasis of pregnancy varies greatly among ethnic groups and geographic regions, ranges from 0.2% to 2.0%, which occurs most frequently in South American and Northern European ethnic groups [17,32]. In the study period, a total of 27,058 deliveries at our hospital, of these, 751 women (2.8%) were diagnosed with intrahepatic cholestasis of pregnancy.…”

“…Intrahepatic cholestasis of pregnancy has been consistently associated with a higher incidence of adverse pregnancy outcomes, including spontaneous and iatrogenic preterm delivery, non-reassuring fetal status, meconium staining of the amniotic fluid, and still birth [13][14][15]. The risk of complications for the fetus is associated with the serum level of maternal serum bile acids, and women with more severe cholestasis are at greater risk [2,16,17]. Previous studies mainly focused on the effects of intrahepatic cholestasis of pregnancy on pregnant mothers and fetuses, and few studies reported the postpartum growth and development of fetuses in pregnant women with intrahepatic cholestasis of pregnancy.…”