Managing Recurring Obstetric Cholestasis With Metformin.
Obstetric cholestasis is a pregnancy-related disorder associated with an adverse pregnancy outcome. It is characterized by generalized pruritus, elevated bile acids, and abnormal liver enzymes. Recent publications show that obstetric cholestasis is associated with, and likely to potentiate, the risk of developing gestational diabetes mellitus.



This case describes an unusual pattern of the disease, in which obstetric cholestasis occurred in five consecutive pregnancies with a different course of the disease in the fifth pregnancy.



A patient with recurrent cholestasis of pregnancy had worsening disease in her first four pregnancies. In her fifth pregnancy, treatment for gestational diabetes mellitus with metformin was associated with a lowering effect on bile acids and liver enzymes, indicating a possible role for metformin in the management of obstetric cholestasis.
Epsom and St Helier University Hospitals, Surrey, United Kingdom.
Abdullatif
A
Elfituri
Amanda
A
Ali
Hassan
H
Shehata
D000328:Adult; D001647:Bile Acids and Salts / Q000097:blood; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002780:Cholestasis, Intrahepatic / Q000097:blood* / Q000188:drug therapy*; D016640:Diabetes, Gestational / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008687:Metformin / Q000627:therapeutic use*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood* / Q000188:drug therapy*; D012008:Recurrence; D012293:Rifampin / Q000627:therapeutic use; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D001647:Bile Acids and Salts; D002756:Cholagogues and Choleretics; D007004:Hypoglycemic Agents; D014580:Ursodeoxycholic Acid; D008687:Metformin; D012293:Rifampin