Iqbal Madiha, Muhammad Zia, Akhter Naheed, Shams Alam Samina
Department of Obstetrics and Gynecology, Hayatabad Medical Complex Peshawar, Peshawar, PAK.
Department of Pediatrics, Khyber Teaching Hospital, Peshawar, PAK.
Cureus. 2024 Oct 3;16(10):e70800. doi: 10.7759/cureus.70800. eCollection 2024 Oct.
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.
The objective of this study is to investigate the impact of UDCA therapy on maternal and fetal outcomes in women with ICP.
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.
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.
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.
妊娠期肝内胆汁淤积症（ICP）出现在妊娠中晚期，其特征为瘙痒和血胆汁酸（BA）水平升高。这些症状的并发症可能包括早产、胎儿窘迫或死产。尽管ICP的确切病因尚不清楚，但可能涉及遗传、激素和环境因素。ICP的一线治疗药物是熊去氧胆酸（UDCA），它可改善胆汁流动，从而降低BA水平和瘙痒症状。
本研究的目的是调查UDCA治疗对ICP女性母婴结局的影响。
这是一项对123例ICP孕妇进行的前瞻性观察研究，这些孕妇年龄在20至45岁之间，在2021年7月至2024年6月的三年时间里，通过临床诊断（瘙痒）并辅以异常实验室检查结果确诊，包括血清BA水平升高以及肝功能检查异常。每位患者均接受UDCA治疗，起始剂量为10 - 15mg/kg/天，并根据临床指南进行滴定。在整个孕期跟踪母婴结局，在基线期（15±1周）以及直至分娩前每两周收集一次数据。
研究参与者的平均年龄为29.6±5.4岁，最年轻的患者为20岁，最年长的为45岁。大多数女性为经产妇，占65.9%，平均体重指数为27.8±3.5kg/m²。ICP诊断时的平均孕周为31.2±2.7周，分娩时的孕周为37.1±2.4周。诊断时血清BA水平平均为23.5±8.1µmol/L。
在大多数胎儿结局良好的ICP患者中，UDCA不仅能使血清BA水平正常化，还能减轻母体症状。除了解决患者对该治疗的反应变异性并优化传播程序外，研究人员预计本研究结果将支持继续将UDCA作为ICP的一线治疗药物，至少在有更多证据之前如此。
