title: Intrahepatic cholestasis of pregnancy: observational study of the treatment with low-dose ursodeoxycholic acid.
abstract: BACKGROUND
  To exam the biochemical, obstetric management and pregnancy outcome in women with intrahepatic cholestasis of pregnancy (ICP) and treatment with ursodeoxycholic acid (UDCA).
  
  
  METHODS
  Pregnancy outcome in patients with ICP (N = 307) was studied and patients treated with UDCA (N = 208) vs. no UDCA were compared. The data of the antenatal visits, deliveries and neonatal outcome of 307 pregnancies with ICP was collected from the hospital computerized delivery room log book. UDCA was used in 208 pregnancies. The diagnosis was made by maternal pruritus and elevation of total fasting bile acid (BA) (>6 μmol/l) and elevation of serum alanine aminotransferases (ALT) (>45 U/l). Maternal and neonatal data was analysed and data of the patients who used UDCA during pregnancy was analysed separately and compared with the data from patients without medication.
  
  
  RESULTS
  UDCA was well tolerated. Mothers receiving UDCA had ICP diagnosed five weeks earlier than mothers without medication. At the diagnosis, levels of total BA and ALT were higher in the group using UDCA compared to the group without medication. Most deliveries were induced and perinatal outcome was good. Apgar scores at 5 min were significantly lower in UDCA group (p < 0.05), but fetal umbilical artery pH values were similar in both groups (p > 0.05). There were 30 patients with total BA > 40 μmol/l at diagnosis, 24 with UDCA and 6 without medication and those deliveries were induced soon after diagnosis. The preterm labour was also more common in these patents (p < 0.05). Women with preterm babies had significantly early onset pruritus and ICP was diagnosed earlier. Serum ALT and total BA levels were significantly higher in those pregnancies at diagnosis and also at first control.
  
  
  CONCLUSIONS
  Preterm labour was associated in severe ICP (total BA > 40 μmol/l), ALT levels were also significantly higher and ICP was diagnosed earlier (p < 0.05). Apgar scores were lower in preterm babies (p < 0.05), but umbilical artery pHvalues were not significantly lower. UDCA was well tolerated by pregnant women. With low-dose UDCA treatment the obstetric outcome was good. We still recommend careful obstetrical follow-up.
authors.affiliation: Department of Obstetrics and Gynaecology, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland. titta.joutsiniemi@tyks.fi.
authors.forename: Titta
authors.initials: T
authors.lastname: Joutsiniemi
authors.affiliation: Department of Obstetrics and Gynaecology, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland. susanna.timonen@tyks.fi.
authors.forename: Susanna
authors.initials: S
authors.lastname: Timonen
authors.affiliation: Department of Obstetrics and Gynaecology, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland. maria.linden@hus.fi.
authors.forename: Maria
authors.initials: M
authors.lastname: Linden
authors.affiliation: Department of Obstetrics and Gynaecology, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland. pia.a.suvitie@tyks.fi.
authors.forename: Pia
authors.initials: P
authors.lastname: Suvitie
authors.affiliation: Department of Obstetrics and Gynaecology, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland. ulla.ekblad@tyks.fi.
authors.forename: Ulla
authors.initials: U
authors.lastname: Ekblad
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001034:Apgar Score; D001647:Bile Acids and Salts / Q000097:blood; D002756:Cholagogues and Choleretics / Q000008:administration & dosage*; D002780:Cholestasis, Intrahepatic / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D007752:Obstetric Labor, Premature / Q000097:blood* / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000188:drug therapy*; D011537:Pruritus / Q000209:etiology; D014580:Ursodeoxycholic Acid / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D001647:Bile Acids and Salts; D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid; D000410:Alanine Transaminase