Biochemical Milieu in Intrahepatic Cholestasis of Pregnancy and Its Improvement with Ursodeoxycholic Acid

The aim of this study is to assess biochemical parameters, particularly total serum bile acid (SBA) and liver and renal function tests, in patients with intrahepatic cholestasis of pregnancy (IHCP).

This was prospective study conducted at tertiary care centre at north Indian over a period of one year.. A total of 70 pregnant women in the late second (26-28 weeks) and third trimester suffering from intrahepatic cholestasis of pregnancy were included in the study. Exclusion criteria encompass preeclampsia, eclampsia, acute fatty liver of pregnancy, viral hepatitis (hepatitis a virus, hepatitis b virus, hepatitis c virus, and hepatitis e virus), liver cirrhosis, tumors, autoimmune liver disease, obstructive biliary disease, known kidney diseases, pregnancy-related dermatoses (such as gestational pemphigoid, PUPPP, and atopic eruption), and impetigo herpetiformis triggered by pregnancy.

A total of 70 patients with IHCP, most (73.7%) were aged 21-28 years and primarily primigravida (62.86%). A significant portion (64%) came from lower socioeconomic backgrounds. Pruritus was reported in 77.14% of patients, with a notable recurrence in multigravida cases. The onset of pruritus typically occurred between 34 and 37 weeks of gestation, making late pregnancy assessments critical for timely diagnosis through liver enzyme tests. Biochemical results revealed elevated total SBAs (TSBA) and liver enzymes, with significant risks linked to TSBA levels over 100 μmol/L, including adverse pregnancy outcomes like preterm delivery. The study advocated for using ursodeoxycholic acid (UDCA) as a first-line treatment to mitigate symptoms and improve outcomes, noting low birth weights and fetal distress but no significant renal function impairment in IHCP patients.

UDCA treatment effectively alleviated these abnormalities, improved symptoms like pruritus and enhanced outcomes for both mother and fetus. The findings advocate for UDCA's safety and efficacy in treating IHCP and emphasize the need for early diagnosis and biochemical monitoring to optimize care and reduce complications.