Clinical grading of Intrahepatic Cholestasis Pregnancy

Pradhan, Meena; Shao, Yina

doi:10.31729/jnma.1638

Cited by 6 publications

(10 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Environmental risk factors have also been noted. There is an increased incidence of ICP in the winter months [10]. Selenium deficiency increases the risk because selenium is a cofactor for enzymes in the oxidative metabolism of the liver [11].…”

Section: Risk Factors and Effects Of Icpmentioning

confidence: 99%

“…While pregnant, women can have jaundice, steatorrhea [10] and increased risk of preeclampsia [16]. Enhanced blood coagulation has been noted through increases in mean platelet volume [17] along with significant increases in factor VIII, von Willebrand factor and fibrinogen levels [18].…”

Section: Risk Factors and Effects Of Icpmentioning

confidence: 99%

“…Both peroxisome proliferator-activated receptors α (PPARα) and γ (PPARγ) have anti-inflammatory effects by inhibiting the signaling pathway of NF-κB [37]. High levels of estrogen, as observed in patients with ICP, have been found to inhibit the mRNA expression of PPARα [10]. In regards to PPARγ, one study found ICP patients to have increased levels of PPARγ but with no anti-inflammatory effect [37].…”

Section: Immunologymentioning

confidence: 99%

“…Currently, the mechanisms by which UDCA act are not completely revealed. One of the beneficial effects of this treatment is its ability to decrease bile acid accumulation [2, 3, 10]. Studies found that UDCA has this effect by increasing the activity of the canalicular BSEP and MDR3, used for exporting phospholipids, along with basolateral MRP4 which exports bile salt conjugates and placental ABCG2 protein, an export of bile acids and sulfated progesterone in the placenta [2, 73, 74].…”

Section: Immunologymentioning

confidence: 99%

See 3 more Smart Citations

Immunological basis in the pathogenesis of intrahepatic cholestasis of pregnancy

Larson

Kovilam

Agrawal

2015

Expert Review of Clinical Immunology

View full text Add to dashboard Cite

Summary Intrahepatic cholestasis of pregnancy poses a great risk to both maternal and fetal health. Despite extensive research, much of the pathogenesis of this disorder is unknown. The increase in bile acids observed in patients with intrahepatic cholestasis of pregnancy has been noted to cause a change in the immune system from the normally mediated TH2 response to one that is more oriented towards TH1. In this literature review, we have critically reviewed the current literature regarding the changes in the immune system and the potential effects of immunological changes in the management of the patient. The current treatment, ursodeoxycholic acid, is also discussed along with potential combination therapies and future directions for research.

show abstract

Section: Risk Factors and Effects Of Icpmentioning

confidence: 99%

Section: Risk Factors and Effects Of Icpmentioning

confidence: 99%

Section: Immunologymentioning

confidence: 99%

Section: Immunologymentioning

confidence: 99%

See 2 more Smart Citations

Immunological basis in the pathogenesis of intrahepatic cholestasis of pregnancy

Larson

Kovilam

Agrawal

2015

Expert Review of Clinical Immunology

View full text Add to dashboard Cite

show abstract

“…Increased level of bile acid (BA) is considered to be a hallmark of the disease [4] . It is generally believed that cardiac damage in ICP is intimately associated with increased level of BA in serum [5] .…”

mentioning

confidence: 99%

Effect of cholic acid on fetal cardiac myocytes in intrahepatic choliestasis of pregnancy

Gao

Chen

Luo

et al. 2014

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

View full text Add to dashboard Cite

This study examined the effect of cholic acid (CA) on cultured cardiac myocytes (CMs) from neonatal rats with an attempt to explore the possible mechanism of sudden fetal death in intrahepatic cholestasis of pregnancy (ICP). Inverted microscopy was performed to detect the impact of CA on the beating rates of rat CMs. MTT method was used to study the effect of CA on the viability of CMs. CMs cultured in vitro were incubated with 10 μmol/L Ca(2+)-sensitive fluorescence indicator fluo-3/AM. The fluorescence signals of free calcium induced by CA were measured under a laser scanning confocal microscope. The results showed that CA decreased the beating rates of the CMs in a dose-dependent manner. CA could suppress the activities of CMs in a time- and dose-dependent manner. CA increased the concentration of intracellular free calcium in a dose-dependent manner. Our study suggested that CA could inhibit the activity of CMs by causing calcium overload, thereby leading to the sudden fetal death in ICP.

show abstract

Evaluating the effectiveness and safety of ursodeoxycholic acid in treatment of intrahepatic cholestasis of pregnancy

Kong¹,

Kong²,

Zhang³

et al. 2016

Medicine

View full text Add to dashboard Cite

Background:Intrahepatic cholestasis of pregnancy (ICP) is a specific pregnancy-related disorder without standard medical therapies. Ursodeoxycholic acid (UDCA) is the most used medicine, but the efficacy and safety of UDCA remain uncertain. Several meta-analyses had been made to assess the effects of UDCA in ICP. However, the samples were not large enough to convince obstetricians to use UDCA. We conducted a meta-analysis to evaluate the effects and safety of UDCA in patients with ICP, which included only randomized controlled trials (RCTs).Methods:Six databases were searched. The search terms were “ursodeoxycholicacid,” “therapy,” “management,” “treatment,” “intrahepatic cholestasis of pregnancy,” “obstetric cholestasis,” “recurrent jaundice of pregnancy,” “pruritus gravidarum,” “idiopathic jaundice of pregnancy,” “intrahepatic jaundice of pregnancy,” and “icterus gravidarum.”Randomized controlled trials of UDCA versus control groups (included using other medicines) among patients with ICP were included. The primary outcomes were improved pruritus scores and liver function. Secondary outcomes were the maternal and fetal outcomes in patients with ICP.Data were extracted from included RCTs. The Mantel–Haenzel random-effects model or fixed-effects model was used for meta-analysis.Results:A total of 12 RCTs involving 662 patients were included in the meta-analysis. In pooled analyses that compared UDCA with all controls, UDCA was associated with resolution of pruritus (risk ratio [RR], 1.68; 95% confidence interval [CI],1.12–2.52; P = 0.01),decrease of serum levels of alanine aminotransferase (ALT) (standardized mean difference (SMD), −1.36; 95% CI, −2.08 to −0.63; P <0.001), reduced serum levels of bile acid (SMD, −0.68; 95% CI, −1.15 to −0.20; P <0.001), fewer premature births (RR, 0.56; 95% CI, 0.43–0.72; P <0.001),reduced fetal distress (RR, 0.68; 95% CI, 0.49–0.94; P = 0.02), high Apgar scores at 5 minutes (RR, 0.44; 95% CI, 0.24–0.82; P = 0.009), less frequent respiratory distress syndrome (RDS) (RR, 0.33; 95% CI, 0.13–0.86; P = 0.02), and fewer neonates in the intensive care unit (NICU) (RR, 0.55; 95% CI, 0.35–0.87; P <0.05), increased gestational age (SMD,0.44; 95% CI, 0.26–0.63; P <0.001), and birth weight (SMD, 0.21; 95% CI, 0.02–0.40; P = 0.03). There were no differences in meconium staining and intrauterine growth retardation (IUGR) between the groups (P >0.05). No trials reported adverse effects on mothers and fetuses except nausea and emesis.Conclusion:UDCA is effective and safe to improve pruritus and liver function in ICP. UDCA also reduced adverse maternal and fetal outcomes in pregnant women with ICP.

show abstract

Clinical grading of Intrahepatic Cholestasis Pregnancy

Cited by 6 publications

References 62 publications

Immunological basis in the pathogenesis of intrahepatic cholestasis of pregnancy

Immunological basis in the pathogenesis of intrahepatic cholestasis of pregnancy

Effect of cholic acid on fetal cardiac myocytes in intrahepatic choliestasis of pregnancy

Evaluating the effectiveness and safety of ursodeoxycholic acid in treatment of intrahepatic cholestasis of pregnancy

Contact Info

Product

Resources

About