title: Pregnancy course in patients with intrahepatic cholestasis of pregnancy treated with very low doses of ursodeoxycholic acid.
abstract: OBJECTIVE
  Ursodeoxycholic acid (UDCA) has been proposed as the optimal pharmacological treatment for intrahepatic cholestasis of pregnancy (ICP). The lowest effective dosage of UDCA in women with ICP has not been established. The objective is to determine the risk of adverse pregnancy outcomes resulting from ICP and to measure changes in liver function parameters and pruritus severity in ICP patients treated with low doses of UDCA.
  
  
  METHODS
  ICP was diagnosed in 203 patients on the basis of pruritus and elevated liver biochemical parameters. Patients with total bile acids (TBA) ≥ 10 μmol/l (n = 157) received UDCA (300-450 mg/day; 4-6 mg/kg/day) until delivery. Maternal and fetal outcomes of women with ICP were compared with 100 patients without cholestasis. Patients with ICP were hospitalized for treatment and fetal surveillance.
  
  
  RESULTS
  There was no correlation between fetal and neonatal complication rates in ICP patients and biochemical markers of cholestasis. Significant declines in serum TBA (p = 0.003), bilirubin concentration (p = 0.026) and aminotransferase activity (p < 0.001) were observed during treatment with low doses of UDCA. Moreover, severity of pruritus was ameliorated during the 2 weeks of therapy (p = 0.037). A total of 17 patients (10.9%) did not respond to treatment.
  
  
  CONCLUSIONS
  UDCA at low doses improved biochemical markers and clinical symptoms in almost 90% of ICP patients.
authors.affiliation: a 1 Department of Gynecological Endocrinology, Warsaw Medical University , Warsaw, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Grymowicz
authors.affiliation: b 2 II Department of Obstetrics and Gynaecology, Warsaw Medical University , Warsaw, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Czajkowski
authors.affiliation: a 1 Department of Gynecological Endocrinology, Warsaw Medical University , Warsaw, Poland.
authors.forename: Roman
authors.initials: R
authors.lastname: Smolarczyk
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001647:Bile Acids and Salts / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D016022:Case-Control Studies; D002756:Cholagogues and Choleretics / Q000008:administration & dosage* / Q000009:adverse effects; D002780:Cholestasis, Intrahepatic / Q000188:drug therapy*; D005260:Female; D005865:Gestational Age; D006801:Humans; D016014:Linear Models; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011256:Pregnancy Outcome; D011537:Pruritus / Q000188:drug therapy*; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D001647:Bile Acids and Salts; D015415:Biomarkers; D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin
keywords: aminotransferase; bile acids; neonatal complications; pregnancy outcome; pruritus