Interventions for treating cholestasis in pregnancy

Gurung, Vinita; Stokes, Michael B.; Middleton, Philippa; Milan, Stephen J; Hague, William; Thornton, Jim

doi:10.1002/14651858.cd000493.pub2

Cited by 75 publications

(90 citation statements)

References 75 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Cholestyramine has been used to treat intrahepatic cholestasis in pregnancy (81,82). It is not absorbed from the gut, but it binds thyroid hormones during their enterohepatic circulation and thereby decreases circulating T 4 and T 3 in hyperthyroidism (83,84,85,86,87).…”

Section: Alternative Therapies For Graves' Hyperthyroidism In Early Pmentioning

confidence: 99%

ENDOCRINOLOGY IN PREGNANCY: Pregnancy and the incidence, diagnosing and therapy of Graves’ disease

Laurberg

Andersen

2016

European Journal of Endocrinology

View full text Add to dashboard Cite

Thyroid hormones are essential developmental factors, and Graves' disease (GD) may severely complicate a pregnancy. This review describes how pregnancy changes the risk of developing GD, how early pregnancy by several mechanisms leads to considerable changes in the results of the thyroid function tests used to diagnose hyperthyroidism, and how these changes may complicate the diagnosing of GD. Standard therapy of GD in pregnancy is anti-thyroid drugs. However, new studies have shown considerable risk of birth defects if these drugs are used in specific weeks of early pregnancy, and this should be taken into consideration when planning therapy and control of women who may in the future become pregnant. Early pregnancy is a period of major focus in GD, where pregnancy should be diagnosed as soon as possible, and where important and instant change in therapy may be warranted. Such change may be an immediate stop of anti-thyroid drug therapy in patients with a low risk of rapid relapse of hyperthyroidism, or it may be an immediate shift from methimazole/carbimazole (with risk of severe birth defects) to propylthiouracil (with less risk), or maybe to other types of therapy where no risk of birth defects have been observed. In the second half of pregnancy, an important concern is that not only the mother with GD but also her foetus should have normal thyroid function.Thyroid hormones are essential developmental factors as first shown by Gudernatsch when he, in 1912, fed tadpoles thyroid tissue and observed metamorphosis (1). In mammals, thyroid hormones are especially of importance for brain development (2, 3), and even a few months with lack of thyroid hormones in infant life may lead to irreversible brain damage. This is the background for the universal screening for congenital hypothyroidism performed in many countries. However, thyroid hormones are also important for normal pregnancy, and maternal thyroid disease may severely increase the risk of pregnancy complications, including Invited author's profile Peter Laurberg was Clinical Professor of Internal Medicine and Endocrinology, Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark. His research mainly focused on thyroid disease prevention, epidemiology, diagnosing and therapy, including studies on iodine and thyroid, and pregnancy and thyroid. He had special research interest on the risk from and optimal management of autoimmune hypo-and hyperthyroidism in pregnancy and post-partum, management of Graves' disease in general, and how the burden of thyroid disease can be minimized by adjusting the population's iodine intake. He has coauthored several international guidelines on thyroid disease management, including management of thyrotoxicosis, and thyroid disease in pregnancy. Peter Laurberg died June 20, 2016.

show abstract

Section: Alternative Therapies For Graves' Hyperthyroidism In Early Pmentioning

confidence: 99%

ENDOCRINOLOGY IN PREGNANCY: Pregnancy and the incidence, diagnosing and therapy of Graves’ disease

Laurberg

Andersen

2016

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…The Cochrane Review found that there was support for UDCA for the relief of maternal pruritus (Gurung et al, 2013;Saleh & Abdo, 2007) and restoring bile acids to a normal state (Saleh & Abdo, 2007), by increasing the biliary secretion that lowers the toxic bile salts, bilirubin (Gabzdyl & Schlaeger, 2015) and liver enzymes in maternal blood (Ozkan et al, 2015). This is further substantiated by a meta-analysis including non-randomized studies conducted by Grand'Maison et al (2014).…”

Section: Pharmacological Treatment Of Icpmentioning

confidence: 96%

“…Other causes for pruritus and abnormal liver enzymes need to be explored and ruled out before the diagnosis of ICP can be made (Clinical Guidelines Obstetrics and Midwifery, 2016;Gurung et al, 2013;Kenyon & Girling, 2011;Lindor & Lee, 2016).…”

Section: Diagnosismentioning

confidence: 99%

“…The Cochrane Review by Gurung, Stokes, Middleton, Hague, & Thorton (2013) examined interventions for treatment of intrahepatic cholestasis in pregnancy and concluded that the treatment of ICP with ursodoxycholic acid (UDCA) presents no adverse fetal effects and is substantiated as being the best intervention for relief of maternal symptoms and decreasing bile acid levels. The Cochrane Review found that there was support for UDCA for the relief of maternal pruritus (Gurung et al, 2013;Saleh & Abdo, 2007) and restoring bile acids to a normal state (Saleh & Abdo, 2007), by increasing the biliary secretion that lowers the toxic bile salts, bilirubin (Gabzdyl & Schlaeger, 2015) and liver enzymes in maternal blood (Ozkan et al, 2015).…”

Section: Pharmacological Treatment Of Icpmentioning

confidence: 99%

“…Ursodoxycholic acid is thought to increase excretion of bile acids and bilirubin, protect cholangiocytes and protect liver cells from cell death (Gabzdyl & Schlaeger, 2015). The UDCA's effect on bile acid levels are of utmost importance in that the severity of disease is associated with the rising of bile acid levels (Gurung et al, 2013). It is the high level of bile acids that are thought to be the mechanisms causing adverse perinatal outcomes and testing of bile acids is advised for surveillance (Geenes et al, 2014).…”

Section: Pharmacological Treatment Of Icpmentioning

confidence: 99%

See 2 more Smart Citations

Achieving Consensus in the Management of Intrahepatic Cholestasis in Pregnancy

Briglio

Heale

Beites

et al. 2017

DRHJ

View full text Add to dashboard Cite

The incidence of intrahepatic cholestasis (ICP) in pregnancy, a liver condition, is increasing, suggesting a greater awareness of the disease. While this condition is an annoyance for a mother, typically causing intense itchiness of the hands and soles of the feet, she will return to normal after delivery. However, this condition has the potential to cause premature delivery, fetal distress and fetal death, so appropriate management is very important. Currently, guidelines available in North America conflict with guidelines in the United Kingdom. The purpose of this research is to establish evidence-based, current practice guidelines for managing cholestasis in pregnancy within a local context. A modified Delphi technique will be utilized with the goal of achieving consensus among local obstetricians about the management of ICP. It is anticipated that two rounds of questionnaires will be disseminated to the group. The content of the questionnaires and the resulting guideline, will take into consideration the unique health care environment and resources in one northeastern Ontario community. Keywords: Intrahepatic Cholestasis in Pregnancy (ICP), E-Delphi, Consensus RésuméLa fréquence de cholestase intrahépatique pendant la grossesse, une affection hépatique, augmente, ce qui suggère une plus grande prise de conscience de la maladie. Bien que cette condition soit un ennui pour une mère, causant habituellement intenses démangeaisons des mains et la plante des pieds, elle va revenir à la normale après l'accouchement. Cependant, cette condition a le potentiel de causer l'accouchement prématuré, la détresse foetale et la mort foetale, ainsi, une gestion appropriée est très importante. Les lignes directrices disponibles en Amérique du Nord s'opposent aux lignes directrices du Royaume-Uni. Cette recherche a pour objet d'établir des lignes directrices fondées sur des données factuelles pour gérer la cholestase pendant la grossesse dans un contexte local. Une technique Delphi modifiée sera utilisée dans le but de parvenir à un consensus parmi les obstétriciens locaux sur la gestion du CIG. Il est prévu que deux séries de questionnaires seront diffusées au groupe. Le contenu des questionnaires et des lignes directrices qui en découlent prendront en considération l'environnement médical et les ressources dans une communauté du nord-est de l'Ontario.

show abstract