Ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy. A 12-year experience.
OBJECTIVE
To assess the efficacy of ursodeoxycholic acid (UDCA) in patients with intrahepatic cholestasis of pregnancy (ICP) and in the outcome of pregnancy.


METHODS
Retrospective analysis of our 12-year experience treating ICP patients with UDCA. Thirty-two patients with pruritus starting before week 34 of pregnancy and with increased serum bile salts (BS) and alanine aminotransferase (ALT) received UDCA (15 mg/kg/day) for at least 3 weeks before delivery. They were compared with 16 historical controls who did not receive UDCA. All patients were followed up until delivery and in puerperium. Newborns were followed up during 3 months.


RESULTS
UDCA treatment attenuated pruritus (P < 0.05), serum bilirubin and ALT decreased (P < 0.05) and BS declined. Delivery at term (> or = 37 weeks) occurred in 65.7% of UDCA-treated patients compared with only 12.5% in controls (P < 0.01). Infants born to mothers treated with UDCA weighed a mean of 500 g more than the controls (2882+/-582 vs 2385+/-582; P < 0.01). At 3 months, all infants developed normally. Twenty-six children whose mothers received UDCA were re-examined after 1-12 years and they and their mothers were healthy.


CONCLUSIONS
UDCA improved pruritus and biochemical cholestasis, and facilitated deliveries at term in ICP patients, with a higher birthweight compared with historical controls. The drug was well tolerated and no adverse effects were detected in their infants.
Zapata
Rodrigo
R
Department of Medicine, University of Chile School of Medicine, Hospital del Salvador, Santiago, Chile.
Sandoval
Lorena
L
Palma
Joaquín
J
Hernández
Ismael
I
Ribalta
José
J
Reyes
Humberto
H
Sedano
Manuel
M
Tohá
Dolores
D
Silva
Juan Jorge
JJ
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D002756:Cholagogues and Choleretics / Q000008:administration & dosage* / Q000009:adverse effects; D002780:Cholestasis, Intrahepatic / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007297:Inpatients; D010045:Outpatients; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011256:Pregnancy Outcome; D011537:Pruritus / Q000188:drug therapy; D012189:Retrospective Studies; D014580:Ursodeoxycholic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D005723:gamma-Glutamyltransferase / Q000097:blood
D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase