Effects of Ursodeoxycholic Acid Treatment for Intrahepatic Cholestasis of Pregnancy on Maternal and Fetal Outcomes

Madiha Iqbal; Zia Muhammad; Naheed Akhter; Samina Shams Alam

doi:10.7759/cureus.70800

Effects of Ursodeoxycholic Acid Treatment for Intrahepatic Cholestasis of Pregnancy on Maternal and Fetal Outcomes

Cureus. 2024 Oct 3;16(10):e70800. doi: 10.7759/cureus.70800. eCollection 2024 Oct.

Authors

Madiha Iqbal¹, Zia Muhammad², Naheed Akhter³, Samina Shams Alam⁴

Affiliations

¹ Department of Obstetrics and Gynecology, Hayatabad Medical Complex Peshawar, Peshawar, PAK.
² Department of Pediatrics, Khyber Teaching Hospital, Peshawar, PAK.
³ Department of Obstetrics and Gynecology, Khyber Teaching Hospital, Peshawar, PAK.
⁴ Department of Neonatology, Hayatabad Medical Complex Peshawar, Peshawar, PAK.

Abstract

Background: Intrahepatic cholestasis of pregnancy (ICP) appears in the second or third trimester of pregnancy and is characterized by pruritus and elevated blood bile acid (BA) levels. Complications from these symptoms may include preterm birth, fetal distress, or stillbirth. Although the precise causes of ICP are unknown, genetic, hormonal, and environmental variables may be involved. First-line treatment for ICP is ursodeoxycholic acid (UDCA), which improves bile flow and consequently lowers BA levels and pruritus.

Objective: The objective of this study is to investigate the impact of UDCA therapy on maternal and fetal outcomes in women with ICP.

Materials and methods: This was a prospective observational study of 123 pregnant women with ICP, aged between 20 and 45 years who were diagnosed clinically (pruritus) supported by abnormal laboratory results including elevated serum BA levels, and abnormalities in liver function tests, over the course of three years, from July 2021 to June 2024. Every patient received UDCA, commencing at 10-15 mg/kg/day and being titrated according to clinical guidelines. Maternal and fetal outcomes were tracked for the duration of the pregnancy, with data being collected at baseline (15 ± 1 weeks) and every two weeks until delivery.

Results: The mean age of the study participants was 29.6 ± 5.4 years, with the youngest patient being 20 years and the oldest being 45 years. Most women were multipara 65.9%, and the mean BMI was 27.8 ± 3.5 kg/m ². The mean time of gestational age at ICP diagnosis was 31.2 ± 2.7 weeks, and the time of gestational age at delivery was 37.1 ± 2.4 weeks. On average, the serum BA level at diagnosis was 23.5 ± 8.1 µmol/L.

Conclusion: In the majority of ICP patients with good fetal outcomes, UDCA not only normalizes serum BA levels but also reduces maternal symptoms. In addition to addressing patient response variability to this therapy and optimizing dissemination procedures, the researchers expect that the results of this study will support the continued use of UDCA as first-line treatment for ICP, at least until more evidence becomes available.

Keywords: fetal; icp; maternal; serum bile acid; udca.