the treatment of intrahepatic cholestasis of pregnancy by dexamethasone

Abstract

Objective To investigate whether dexamethasone supression of fetoplacental oestrogen production can reduce obstetric cholestasis. Design Observational study. Setting Department of Obstetrics and Gynaecology, University of Tampere, Finland. Subjects 10 women, at between 28 and 37 weeks gestation, with intrahepatic cholestasis of pregnancy. Interventions Treatment with 12 mg oral dexamethasone daily for 7 days, after which the therapy was gradually discontinued over 3 days. Main outcome measures Serum oestriol, oestradiol, total bile acids and ALAT were measured before and during therapy and on days 4 and 7 and ALAT also on day 12. Differences were tested by paired t test. Results Itching disappeared or was relieved in all patients. Serum oestriol level fell significantly by day 1 of treatment, serum oestradiol and total bile acid levels by day 4 and ALAT by day 12 from the beginning of the therapy. Conclusion Dexamethasone is a drug of choice in the treatment of intrahepatic colestasis of pregnancy.

Intrahepatic cholestasis of pregnancy

“…Efficacy in reducing maternal serum bile acid levels seems to be an important quality when choosing a drug for the treatment of ICP because bile acid levels have been demonstrated to have a dose-dependent association with fetal complication rates. 10 In conflict with a previous report on dexamethasone therapy in ICP women, 16 we found the effects on pruritus and biochemical markers of cholestasis to be transient in the dexamethasone group. A rapid decrease in pruritus and bile acids was seen after the first week of treatment, but was followed by an increase.…”

“…The reason for choosing only 1 week of active treatment followed by 2 weeks of placebo in the dexamethasone group was that this is the only dose regimen of dexamethasone treatment in ICP pregnancies previously reported in the literature. 16 Furthermore, questions have recently been raised concerning potentially harmful effects of corticosteroids on the developing fetal brain. This has lead to a more restrictive approach to corticosteroid treatment during pregnancy, 17,18 The data from the present study showed that dexamethasone was less effective than UDCA regarding all studied variables.…”

“…14,15 The effects of dexamethasone were investigated in an uncontrolled study of 10 women. 16 These studies were not able to prove the effectiveness of any of these treatments. Thus, we performed a randomized, placebo-controlled trial aiming at comparing the effects of UDCA and dexamethasone on: (i) alleviation of pruritus, (ii) improvement in serum liver tests, and (iii) the possible reduction of fetal complication rates after a treatment period of 3 weeks in women with ICP.…”

Management of Intrahepatıc Cholestasıs of Pregnancy: Revıew of Lıterature

“…These benefits of dexamatosone is linked to its estrogen secretion inhibitor effects at placenta [47].But it is not preferred commonly, because it crosses placenta and may result adverse effects on the fetus at higher doses [48].…”

The multiple facets of ABCB4 (MDR3) deficiency

“…• Dexamethasone has also been used for treating ICP associated pruritis 62 . A recent randomized controlled trial comparing Dexamethasone to UDCA and placebo, however, found that dexamethasone was not effective in improving pruritis or ALT, and less effective than UDCA in decreasing bilirubin or bile acids levels 51 .…”