MATERNAL AND FETAL OUTCOMES IN WOMEN RECEIVING URSODEOXYCHOLEIC ACID (UDCA) AS TREATMENT FOR INTRAHEPATIC CHOLESTASIS OF PREGNANCY (IHCP), A SINGLE CENTER EXPERIENCE: ARE WE DOING ENOUGH?

SR QURESHI; AH ALVI; AZK CHACHAR; M SOHAIB; S ALI; M ABDULLAH

doi:10.54112/bcsrj.v2023i1.559

Authors

SR QURESHI Department of Gastroenterology, Fatima Memorial Hospital, College of Medicine & Dentistry, Lahore, Pakistan
AH ALVI Department of Gastroenterology, Fatima Memorial Hospital, Lahore, Pakistan
AZK CHACHAR Department of Medicine, Fatima Memorial Hospital College of Medicine & Dentistry, Lahore, Pakistan
M SOHAIB Department of Gastroenterology, Fatima Memorial Hospital, College of Medicine & Dentistry, Lahore, Pakistan
S ALI Division of Infectious Diseases, Wayne State University, Datroit, Michigan, USA.
M ABDULLAH Department of Medicine, Fatima Memorial Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2023i1.559

Keywords:

Intrahepatic, Cholestasis, Pregnancy

Abstract

Intrahepatic cholestasis of pregnancy (IHCP) is a common type of hormonally driven cholestasis in the late second or early third trimester of pregnancy. It's a reversible condition and has a genetic predisposition. This study aimed to analyze the maternal and fetal outcomes of women being treated with Ursodeoxycholic acid (UDCA) for IHCP. Seventy-five pregnant women with IHCP were included in this observational cross-sectional study, with a study duration of one year. SPSS software version 24.0 was used to analyze the data collected by the investigating officer. Laboratory and clinical parameters were assessed at presentation and after treatment. Results showed that 92% of pregnant women with IHCP had significantly raised serum bile acid levels. However, UDCA treatment caused complete resolution of itching in 57.7% of patients, reduced to mild in 40.4%, and moderate itching in 1.9% of patients. Mean Alkaline Phosphatase and ALT levels significantly decreased after UDCA treatment, with p-values of 0.001 and 0.004, respectively. The dose of UDCA required ranged from 10-25 mg/kg/day. A positive family history of IHCP was found in 36.5% of patients, while 33% had a history of IHCP in previous pregnancies, and 16% had twin pregnancies. The incidence of early delivery was high at 98%, with a mean gestational age of 36.4 weeks. Among these early deliveries, 8% had vaginal delivery, and 92% had C-sections. The indications of delivery were intractable itching and no improvement in LFTS in 15%, PROM and fetal distress in 21%, failed induction in 31%, previous cesarean in 23%, and other reasons in 10%. The study found that 99% of babies had good APGAR scores and no morbidity. However, 1% mortality was reported due to severe IHCP in the mother. In conclusion, UDCA treatment significantly improved physical and laboratory parameters and effectively treated IHCP. Early delivery had better maternal and fetal outcomes.

Downloads

Download data is not yet available.

References

Awanti Jr, Y., Anjali, K., and Anuja, B. (2023). Acute Fatty Liver of Pregnancy: A Diagnostic Challenge. Cureus 15.

Ayyash, M., Smith, N., Keerthy, M., Singh, A., and Shaman, M. (2021). Benign recurrent intrahepatic cholestasis in pregnancy: fetal death at 36 weeks of gestation. Case Reports in Obstetrics and Gynecology 2021.

Bosma, P. J., Wits, M., and Oude-Elferink, R. P. (2020). Gene therapy for progressive familial intrahepatic cholestasis: current progress and future prospects. International Journal of Molecular Sciences 22, 273.

Ferrando, J. F., Lauría, W., and Rey, G. (2020). Nuevas miradas en la colestasis Intrahepática del embarazo. Archivos de ginecología obstetricia 58, 177-190.

Himeles, J. R., and Pomeranz, M. K. (2022). Recognizing, Diagnosing, and Managing Pregnancy Dermatoses. Obstetrics & Gynecology 140, 679-695.

Khunweeraphong, N., and Kuchler, K. (2021). Multidrug resistance in mammals and fungi—From MDR to PDR: A rocky road from atomic structures to transport mechanisms. International Journal of Molecular Sciences 22, 4806.

Majsterek, M., Wierzchowska-Opoka, M., Makosz, I., Kreczyńska, L., Kimber-Trojnar, Ż., and Leszczyńska-Gorzelak, B. (2022). Bile Acids in Intrahepatic Cholestasis of Pregnancy. Diagnostics 12, 2746.

Natarajan, T., Rengaraj, S., Chaturvedula, L., and Wyawahare, M. (2022). Predictors of adverse maternal outcome in jaundiced pregnant women identified as having pregnancy-specific liver disease (P-sLD). Journal of Obstetrics and Gynaecology 42, 1072-1078.

NIRMALADEVI, P. (2019). INTRAHEPATIC CHOLESTASIS OF PREGNANCY-A CASE REPORT. University Journal of Pre and Paraclinical Sciences 5.

Shao, H., Gao, S., Ying, X., Zhu, X., and Hua, Y. (2021). Expression and regulation of aquaporins in pregnancy complications and reproductive dysfunctions. DNA and Cell Biology 40, 116-125.

Soria-Jasso, L. E., Cariño-Cortés, R., Muñoz-Pérez, V. M., Pérez-Hernández, E., Pérez-Hernández, N., and Fernández-Martínez, E. (2019). Beneficial and deleterious effects of female sex hormones, oral contraceptives, and phytoestrogens by immunomodulation on the liver. International journal of molecular sciences 20, 4694.

White, J. (2020). Association of Metabolic Improvements Following Sleeve Gastrectomy with Circadian Rhythm Alterations, The University of Chicago.

Yang, L., Meng, Y., Shi, Y., Fang, H., and Zhang, L. (2023). Maternal hepatic immunology during pregnancy. Frontiers in Immunology 14.