Published: 2020-02-27

Effectiveness of ursodeoxycholic acid therapy in intrahepatic cholestatsis of pregnancy

Devdatt I. Pitale, Sujata N. Jadhav


Background: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy specific disorder and commonly presents with maternal pruritus, abnormal liver function tests and adverse maternal -foetal outcomes. ICP lacks protocol-based therapy as etiology is multifactorial and is based on symptomatic treatment. The overall incidence of ICP is variable from 0.1 to 15.6% worldwide. The aim of this study is to assess the effectiveness of UDCA in ICP with regards to reduction in pruritus, normalizing LFTs and maternal-foetal outcomes.

Methods: This multicentric prospective study was performed from June 2017 to December 2019 in pregnant women with ICP attending the Antenatal clinic at INHS Patanjali, MH Dehradun, INHS Asvini, INHS Sandhani. In this study, 50 women with ICP. who satisfied the inclusion and exclusion criteria were started on UDCA therapy. The effectiveness of therapy was evaluated on the basis of normalization of LFT levels, reduction in pruritus, safe confinement, maternal-foetal outcomes and adverse effects if any

Results: The pregnant women with ICP on UDCA therapy showed marked improvement in pruritus, near normal LFT levels. After the UDCA therapy the frequency and intensity of pruritus was reduced in 50 (100%) of women. Safe confinement was achieved, with normal delivery in 45 (90%) women with no any major adverse effects and adverse maternal-foetal outcomes.

Conclusions: This study shows the effectiveness of URCA therapy in reducing the ICP associated pruritus, normalizing LFTs and safe confinement without any major adverse effects. UDCA therapy is an effective and safe option in ICP.


Intrahepatic cholestasis, Pregnancy, Ursodeoxycholic acid

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Diken Z, Usta IM, Nassar AH. A clinical approach to intrahepatic cholestasis of pregnancy. Am J Perinatol. 2014;31:1-8.

Lammert F, Marschall HU, Glantz A, Matern S. Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. J Hepatol. 2000;33:1012-21.

Reyes H. Review: intrahepatic cholestasis. A puzzling disorder of pregnancy. J Gastroenterol Hepatol. 1997;12:211-6.

Dixon PH, Wadsworth CA, Chambers J, Donnelly J, Cooley S, Buckley R, et al. A comprehensive analysis of common genetic variation around six candidate loci for intrahepatic cholestasis of pregnancy. Am J Gastroenterol. 2014;109(1):76-84.

Mackillop L, Williamson C. Liver disease in pregnancy. Postgrad Med J. 2010;86:160-4.

Saleh MM, Abdo KR. Intrahepatic cholestasis of pregnancy: review of the literature and evaluation of current evidence. J Womens Health (Larchmt). 2007;16:833-41.

Pevtichev S, Dimitrova V. Intrahepatic cholestasis of pregnancy. Akush Ginekol (Sofiia). 2013;52:35-41.

Glantz A, Marschall HU, Lammert F, Mattsson LÅ. Intrahepatic cholestasis of pregnancy: a randomized controlled trial comparing dexametasone and ursodeoxycholic acid. Hepatol. 2005;42:1399-405.

Lorente S, Montoro MA. Cholestasis of pregnancy. Gastroenterol Hepatol. 2007;30:541-7.

Roncaglia N, Locatelli A, Arreghini A, Assi F, Cameroni I, Pezzullo JC, et al. A randomized controlled trial of ursodeoxycholic acid and S-adenosyl-l-methionine in the treatment of gestational cholestasis. BJOG. 2004;111:17-21.

European Association for the Study of the Liver. Clinical practice guidelines: management of cholestatic liver diseases. J Hepatol. 2009;51(2):237-67.

Diaferia A, Nicastri P, Tartagni M, Loizzi P, Iacovizzi C, Di Leo A. Ursodeoxycholic acid therapy in pregnant women with cholestasis. Int J Gynecol Obstet. 1996;52:133-40.

Palma J, Reyes H, Ribalta J, Iglesias J, Gonzalez M, Hernandez I et al. Effects of ursodeoxycholic acid in patients with intrahepatic cholestasis of pregnancy. Hepatol. 1992;15:1043-7.

Palma J, Reyes H, Ribalta J, Hernandez I, Sandoval L, Almura R, et al. Ursodeoxycholic acid in the treatment of cholestasis of pregnancy: a randomised, double-blind study controlled with placebo. J Hepatol. 1997;27:1022-8.

Grand’Maison S, Durand M, Mahone M. The effects of ursodeoxycholic acid treatment for intrahepatic cholestasis of pregnancy on maternal and fetal outcomes: a meta-analysis including non-randomized studies. J Obstet Gynaecol Can. 2014;36:632-41.

Bacq Y, Sentilhes L, Reyes HB, Glantz A, Kondrackiene J, Binder T, et al. Efficacy of ursodeoxycholic acid in treating intrahepatic cholestasis of pregnancy: a meta-analysis. Gastroenterol. 2012;143:1492-501.

Mazzella G, Rizzo N, Azzaroli F, Simoni P, Bovicelli L, Miracolo A, et al. Ursodeoxycholic acid administration in patients with cholestasis of pregnancy: effects on primary bile acids in babies and mothers. Hepatol. 2001;33:504–8.

Zapata R, Sandoval L, Palma J, Hernandez I, Ribalta J, Rayes H, et al. Ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy. A 12-year experience. Liver Int. 2005;25:548-54.

Puljic A, Kim E, Page J, Esakoff T, Shaffer B, LaCoursiere D, et al. The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy by gestational age. Am J Obstet Gyn. 2015;212:667.

Chappell LC, Gurung V, Seed PT. Ursodeoxycholic acid versus placebo, and early term delivery versus expectant management, in women with intrahepatic cholestasis of pregnancy: semifactorial randomised clinical trial. BMJ. 2012;344:e3799.

De Luca D, Marras M, Caruso A, Bernardini T, Romagnoli C. Intrahepatic cholestasis of pregnancy and neonatal respiratory distress syndrome. Pediatr. 2006;117:1669-72.

Rioseco AJ, Ivankovic MB, Manzur A, Hamed F, Kato SR, Parer JT, et al. Intrahepatic cholestasis of pregnancy: a retrospective case‐control study of perinatal outcome. Am J Obstet Gynecol. 1994;170:890-5.