Does mild intrahepatic cholestasis of pregnancy require an aggressive management? Evidence from a prospective observational study focused on adverse perinatal outcomes and pathological placental findings

Triunfo, Stefania; Tomaselli, Marta; Ferraro, Maria Immacolata; Latartara, Elisabetta; Sassara, Giulia Maria; Carrozza, Cinzia

doi:10.1080/14767058.2020.1714583

Cited by 7 publications

(7 citation statements)

References 24 publications

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“…In animal models, SAMe has been shown to reduce cholestasis; the exact mechanism of action is unclear 145 . Studies on SAMe in pregnant women with ICP as a single agent or additive with a dosage of 400 – 1600 mg per day did not demonstrate clinical superiority to treatment with UDCA alone 131 , 146 , 147 , 148 .…”

Section: Treatmentmentioning

confidence: 92%

“…Im Tiermodell konnte durch SAMe eine Cholestase reduziert werden; der genaue Wirkmechanismus dabei ist unklar 145 . Untersuchungen zu SAMe bei Schwangerschaften mit ICP als Monotherapeutikum oder Additivum mit einer Dosierung von 400 – 1600 mg pro Tag zeigten zur alleinigen Behandlung mit UDCA keine klinische Überlegenheit 131 , 146 , 147 , 148 .…”

Section: S-adenosyl-l-methionin (Same)unclassified

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Management of Intrahepatic Cholestasis of Pregnancy: Recommendations of the Working Group on Obstetrics and Prenatal Medicine – Section on Maternal Disorders

Hagenbeck

Hamza

Kehl

et al. 2021

Geburtshilfe Frauenheilkd.

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Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease specific to pregnancy. The cardinal symptom of pruritus and a concomitant elevated level of bile acids in the serum and/or alanine aminotransferase (ALT) are suggestive for the diagnosis. Overall, the maternal prognosis is good. The fetal outcome depends on the bile acid level. ICP is associated with increased risks for adverse perinatal outcomes, including preterm delivery, meconium-stained amniotic fluid, and stillbirth. Acute fetal asphyxia and not chronic uteroplacental dysfunction leads to stillbirth. Therefore, predictive fetal monitoring is not possible. While medication with ursodeoxycholic acid (UDCA) improves pruritus, it has not been shown to affect fetal outcome. The indication for induction of labour depends on bile acid levels and gestational age. There is a high risk of recurrence in subsequent pregnancies.

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Section: Treatmentmentioning

confidence: 92%

Section: S-adenosyl-l-methionin (Same)unclassified

Management of Intrahepatic Cholestasis of Pregnancy: Recommendations of the Working Group on Obstetrics and Prenatal Medicine – Section on Maternal Disorders

Hagenbeck

Hamza

Kehl

et al. 2021

Geburtshilfe Frauenheilkd.

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“…This is also confirmed by a meta-analysis from 2016, in which UDCA was more effective than SAM in the treatment of ICP and significantly and effectively reduced the pruritus score, bile acids and rate of preterm delivery 68 . Combined treatment with both medications in 89 pregnant women with mild ICP (bile acid concentration < 40 µmol/l) was shown to be equivalent with regard to an unfavourable perinatal outcome 69 .…”

Section: Treatmentmentioning

confidence: 97%

“…Dies bestätigt auch eine Metaanalyse aus dem Jahr 2016, in der UDCA effektiver in Behandlung von ICP als SAM war und den Pruritus-Score, Gallensäuren sowie die Frühgeburtsrate effektiv und signifikant senkte 68 . Eine Kombinationsbehandlung aus beiden Medikamenten erwies sich bei 89 Schwangeren mit einer milden ICP (Gallensäurekonzentration < 40 µmol/l) als gleichwertig hinsichtlich eines ungünstigen perinatalen Outcomes 69 .…”

Section: Therapieunclassified

Intrahepatic Cholestasis of Pregnancy

Jurk¹,

Kremer

Schleußner

2021

Geburtshilfe Frauenheilkd.

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Intrahepatic cholestasis of pregnancy (ICP) is a rare but potentially serious complication of pregnancy, the main symptom of which is intense pruritus with elevated serum levels of bile acids. The elevated serum bile acid concentration is regarded as a predictor for poor perinatal outcome including intrauterine death. Ursodeoxycholic acid (UDCA) has become established as the treatment of choice in clinical management to achieve a significant improvement in symptoms and reduce the cholestasis. Pregnant women with severe intrahepatic cholestasis should always be managed in a perinatal centre with close interdisciplinary monitoring and treatment involving perinatologists and hepatologists to minimise the markedly increased perinatal morbidity and mortality as well as maternal symptoms.

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“…Even though medication helps improve laboratory abnormalities, it is still uncertain whether it could reduce adverse perinatal outcomes (13,14) , so someone begins to question aggressive UDCA usage for women with mild TBA levels (15), (16) or try to nd more predictable indicators for adverse perinatal outcomes in ICP (11) . The varied incidence of ICP is 0.3%-5.6% among pregnant women, but it could be 20.9%~24.6% during twin pregnancies because ART has been widely applied in infertile women (17),( 18), (19) .…”

Section: Introductionmentioning

confidence: 99%

Perinatal Outcomes Of Ursodeoxycholic Acid Treatment In Twin Pregnancies With Intrahepatic Cholestasis: A Five-Year Retrospective Cohort Study

Zhang

Gong

et al. 2022

Preprint

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Background: Intrahepatic cholestasis of pregnancy is one of the common complications during pregnancy, and ursodeoxycholic acid has been recommended as the first-line drug. However, if ursodeoxycholic acid could improve the perinatal outcomes of multiple pregnancies is unclear, we aimed to investigate perinatal outcomes in twin pregnancies with intrahepatic cholestasis by assisted reproductive technology or spontaneous conception. Methods: From January 2014 to January 2019, we retrospectively analysed the clinical data of twin pregnant women with intrahepatic cholestasis, excluding those who did not receive ursodeoxycholic acid treatment. In total, 864 women were included, among whom 500 conceived by assisted reproductive technology and 364 conceived by spontaneous conception. The primary assessment for perinatal outcomes included premature birth, meconium-stained amniotic fluid, low Apgar score, neonatal intensive care unit and still birth, and secondary indicators were serum bile acid and liver enzymes level during medication, so we also finished subgroup analysis based on different elevated bile acid level and drug usage. The statistical analysis was performed by SPSS 22.0.Results: The study demonstrated that compared to spontaneous conception, assisted reproductive technology conceived twin pregnancies diagnosed as intrahepatic cholestasis earlier (p=0.003), and lower birth weight(p=0.001), less incidence of preterm delivery(p=0.000) and neonatal intensive care unit admission (p=0.001), but the rate of meconium-stained amniotic fluid, low Apgar score and still birth have no statistic differences. Moreover, the subgroup analysis showed no significant difference in elevated bile acid levels and medication between assisted reproductive technology and spontaneous conception groups.Conclusions: Assisted reproductive technology may increase the risk of early-onset intrahepatic cholestasis in twin pregnancies, but it does not seem to increase adverse effects on bile acid levels and perinatal outcomes. Regardless of the use of ursodeoxycholic acid alone or combination, ursodeoxycholic acid for bile acid reduction and improving perinatal outcomes in twin pregnancies is limited. Our conclusions still need more prospective randomized controlled studies to confirm.

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Does mild intrahepatic cholestasis of pregnancy require an aggressive management? Evidence from a prospective observational study focused on adverse perinatal outcomes and pathological placental findings

Cited by 7 publications

References 24 publications

Management of Intrahepatic Cholestasis of Pregnancy: Recommendations of the Working Group on Obstetrics and Prenatal Medicine – Section on Maternal Disorders

Management of Intrahepatic Cholestasis of Pregnancy: Recommendations of the Working Group on Obstetrics and Prenatal Medicine – Section on Maternal Disorders

Intrahepatic Cholestasis of Pregnancy

Perinatal Outcomes Of Ursodeoxycholic Acid Treatment In Twin Pregnancies With Intrahepatic Cholestasis: A Five-Year Retrospective Cohort Study

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