Ursodeoxycholic acid for the treatment of intrahepatic cholestasis of pregnancy

Abstract

O bje ctive: To report our experience in managing intrahepatic cholestasis of pregnancy with ursodeoxycholic acid. Meth ods: All cases of intrahepatic cholestasis of pregnancy that were diagnosed at Bridgeport Hospital from January 1997 to August 1999 were identified. Information was abstracted on demographics, medical and obstetric history, symptoms, laboratory data, therapy and pregnancy outcome. Statistical analysis was primarily descriptive; continuous variables were analyzed with t tests. Re sults: A total of 20 cases of intrahepatic cholestasis of pregnancy were identified (0.32% of live births). All patients presented with pruritus. The mean gestational age at onset of symptoms was 31.1 weeks (range 13-38.4, median 32.4). Bile acids were measured in 18 cases and were elevated in all. The mean gestational age at delivery was 36.4 weeks (32.3-39.9). Eight patients were treated with ursodeoxycholic acid (600-1200 mg). All eight patients experienced subjective improvement in pruritus after initiation of treatment with ursodeoxycholic acid. Ursodeoxycholic acid was associated with a decrease in bile acids in most patients (p = 0.16) and with a significant decrease in serum transaminases (p = 0.03). C onclusions: Ursodeoxycholic acid is an effective therapy for relief of pruritus and improvement of the liver dysfunction that occurs with intrahepatic cholestasis of pregnancy. J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by RMIT University on 08/14/15 For personal use only. U rsodeoxycholic acid and cholestasis of pregn an cy Laifer et al. 132 J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by RMIT University on 08/14/15 For personal use only. U rsodeoxycholic acid and cholestasis of pregn an cy Laifer et al.

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

“…10 The prevalence of ICP in the United States has been reported from two studies to be between 0.001 and 0.32%. 10,11 The reported low prevalence in the United States is contrary to our clinical observation of treating ICP at the University of Southern California in Los Angeles. To our knowledge, there is no prevalence data on ICP in the Latina population based in the United States.…”

“…The pruritus scale resulted with maximum sensitivity and negative predictive values with a pruritus score threshold of >4 for detecting ICP as defined as serum bile acid X20 mmol/l, which agrees with our original definition of ICP in this study. 11 Before this study, the prevalence of ICP in the United States had been reported to be on the order of 7/1000 and less than 1/1000 patients. 13,14 Our comparatively higher prevalence (5.6%) could possibly be attributed to the primarily Latina patient population whom we serve.…”

Intrahepatic cholestasis of pregnancy

“…Since then, other groups have reported similar effects in open series and case reports [3,[29][30][31][32][33], and four randomized controlled trials have been published [34,35,36•,37]. However, methodologic differences limit the validity of pooling results from these studies [38].…”

The Liver in Pregnancy

“…For unknown reasons, the prevalence has more recently appeared to decrease (to between 4.0% and 6.5%) [15,16]. In the United States, the prevalence has been estimated from 0.3% to 5.6% according to ethnic origin [17,18]. The prevalence is Europe is about 0.5-1.5% [13].…”