Serum bile acid levels in intrahepatic cholestasis of pregnancy during treatment with phenobarbital or cholestyramine

Heikkinen, Jorma; Mäentausta, O.; Ylöstalo, Pekka; Jänne, Olli A.

doi:10.1016/0028-2243(82)90090-9

Cited by 46 publications

(31 citation statements)

References 16 publications

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“…In addition, other studies require the use of additional biochemical markers such as elevated transaminases as inclusion criteria for ICP. 26,27 Rioseco et al 28 diagnosed ICP based on clinical criteria alone. Our decision to use a total serum bile acid concentration of 20 mmol/l or greater is the highest threshold to our knowledge for the diagnosis of ICP.…”

Section: Resultsmentioning

confidence: 99%

The prevalence of intrahepatic cholestasis of pregnancy in a primarily Latina Los Angeles population

et al. 2006

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Objective: To establish the prevalence of intrahepatic cholestasis of pregnancy (ICP) in a primarily Latina population in the United States.Study design: Over a period of 16 months, a convenience sample of subjects admitted to labor and delivery in the third trimester was enrolled. Each subject completed a questionnaire rating their severity of pruritus on a numeric scale of 1 to 10. Serum was analyzed via radioimmunoassay for total bile acid concentration. ICP was defined as pruritus score >4 and a total serum bile acid concentration of X20 mmol/l. Ethnicity was determined from hospital record demographic data.Results: All invited participants enrolled in the study. Three hundred and forty subjects were enrolled. Three hundred and sixteen subjects (93%) were identified as Latina. The serum bile acid concentration range for the entire study population was 1 to 580 mmol/l with a mean of 10.4±34.9 mmol/l. Twenty-four (7.1%) subjects had a serum bile acid concentration X20 mmol/l. A pruritus score >4 was found in 19.7% (67/ 340). Of the 24 subjects with a bile acid concentration X20 mmol/l, 19 also had a pruritus score >4. Thus, the prevalence of ICP in this population was 5.6% (19/340). In subjects with ICP, the mean serum bile acid concentration was 89.5±124.0 mmol/l. When controlling for confounders, women with ICP were associated with higher rates of chorioamnionitis (P ¼ 0.043) and their fetuses had higher rates of thick meconium (P ¼ 0.053). Conclusions:The overall prevalence of ICP in this population was 5.6%, 10 to 100 times higher than previously reported data from the United States. Larger studies of perinatal morbidity examining the diagnostic criteria of cholestasis need to be conducted.

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Section: Resultsmentioning

confidence: 99%

The prevalence of intrahepatic cholestasis of pregnancy in a primarily Latina Los Angeles population

et al. 2006

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“…Agents such as phenobarbital, anion exchangers, S-adenosyl methionine, and others have been tested but not introduced into clinical practice due to uncertain efficacy and/or intolerable side effects. [11][12][13] However, small studies with ursodeoxycholic acid (UDCA) and dexamethasone indicate that pharmacologic treatment may provide relief from pruritus and reduce serum bile acid and liver enzyme levels. UDCA has been tested in two randomized, placebo-controlled studies, with 8 patients in each group.…”

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confidence: 99%

Intrahepatic cholestasis of pregnancy

Glantz¹,

Marschall²,

Lammert³

et al. 2005

Hepatology

234

143

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Intrahepatic cholestasis of pregnancy (ICP) is characterized by troublesome maternal pruritus, elevated serum bile acids (>10 mol/L) and increased fetal risk. Recently we determined a cutoff level of serum bile acids, >40 mol/L, to be associated with impaired fetal outcome. We have now studied the effects of ursodeoxycholic acid (UDCA) and dexamethasone on pruritus, biochemical markers of cholestasis, and fetal complication rates in a double-blind, placebo-controlled trial. For this purpose, 130 women with ICP were randomly allocated to UDCA (1 g/day for three weeks), or dexamethasone (12 mg/day for 1 week and placebo during weeks 2 and 3), or placebo for 3 weeks. Pruritus and biochemical markers of cholestasis were analyzed at inclusion and after 3 weeks of treatment. Fetal complications (spontaneous preterm delivery; asphyxial events; and meconium staining of amniotic fluid, placenta, and membranes) were registered at delivery. An intention-to-treat analysis showed significant reduction of alanine aminotransferase (ALT) (P ‫؍‬ .01) and bilirubin (P ‫؍‬ .002) in the UDCA group only. In a subgroup analysis of ICP women with serum bile acids >40 mol/L at inclusion (n ‫؍‬ 34), UDCA had significant effects on pruritus (؊75%), bile acids (؊79%), ALT (؊80%), and bilirubin (؊50%) as well, but not on fetal complication rates. Dexamethasone yielded no alleviation of pruritus or reduction of ALT and was less effective than UDCA at reducing bile acids and bilirubin. In conclusion, 3 weeks of UDCA treatment improved some biochemical markers of ICP irrespective of disease severity, whereas significant relief from pruritus and marked reduction of serum bile acids were only found in patients with severe ICP. (HEPATOLOGY 2005;42:1399-1405

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“…No consistent and sustained effect of cholestyramine on pruritus has been achieved symptomatically or on bile acid levels [49][50][51].…”

Section: Cholestyraminementioning

confidence: 96%

Intrahepatic cholestasis of pregnancy

Lammert

Marschall

Matern

2003

Curr Treat Options Gastro

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Intrahepatic cholestasis of pregnancy (or obstetric cholestasis) is a liver disorder that occurs in late pregnancy. Despite the potential adverse maternal and fetal/neonatal outcomes, cholestasis of pregnancy is often neglected and treated expectantly. More research is needed to improve the molecular and genetic understanding of the disease and to define a safe and effective medical treatment that improves clinical outcome. Ursodeoxycholic acid is considered to be a safe treatment option in the third trimester, but further randomized controlled trials are needed before ursodeoxycholic acid treatment can be generally recommended. Ursodeoxycholic acid is preferentially administered to patients with severe cholestasis (onset before week 33 or serum bile acid levels > 70 mmol/L) or to patients with a history of sudden fetal death, while maintaining close obstetric and regular biochemical surveillance (transaminases, bilirubin, and bile acid levels). Ursodeoxycholic acid can decrease pruritus and ameliorate liver tests, but effects on obstetric complications are ambiguous. S-Adenosylmethionine, dexamethasone, and cholestyramine can provide some relief of itching. Because none of these drugs have been shown to be harmful to mother or fetus, the individual woman and her clinician may decide whether to try one of the treatments described.

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Serum bile acid levels in intrahepatic cholestasis of pregnancy during treatment with phenobarbital or cholestyramine

Cited by 46 publications

References 16 publications

The prevalence of intrahepatic cholestasis of pregnancy in a primarily Latina Los Angeles population

The prevalence of intrahepatic cholestasis of pregnancy in a primarily Latina Los Angeles population

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy

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