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Treatment with ursodeoxycholic acid improves pruritus and supports earlier clinical recognition of pregnancy-related intrahepatic cholestasis.
In a randomized controlled trial, ursodeoxycholic acid (UDCA) remarkably reduced itching in pregnant women with intrahepatic cholestasis of pregnancy (ICP), while also contributing to earlier diagnosis and favorable perinatal outcomes.
The study included 100 pregnant women diagnosed with ICP, evenly randomized into two groups: 50 received UDCA, and 50 received placebo. The primary aim was to check the severity of maternal pruritus—measured using a visual analog scale (VAS)—at the last clinical visit before delivery. The data were analyzed using SPSS version 25, with means and standard deviations calculated for both age and VAS scores at baseline and the last pre-delivery visit.
As found, women in the UDCA group reported substantially lower itch scores than those given placebo (mean VAS 49.5 ± 12.9 mm vs. 56.9 ± 13.3 mm; mean difference -5.7 mm). Beyond symptom relief, UDCA use was linked with earlier detection of ICP—by approximately 5 weeks—compared to those not receiving the drug. Notably, those in the UDCA group had higher baseline total bile acid and alanine transaminase (ALT) levels at diagnosis. The majority of deliveries were induced, especially among women with severe ICP (defined as total bile acid > 40 μmol/L), who were also more likely to experience preterm labor.
Among these severe cases, 30 women underwent early delivery shortly after diagnosis—24 of whom were on UDCA and 6 who were not receiving any medication. In this subgroup, preterm birth was linked to higher total bile acid and ALT levels and earlier onset of pruritus. Despite lower Apgar scores at 5 minutes in the UDCA group, there was no vital difference in umbilical artery pH levels between the two groups, indicating no major compromise in immediate neonatal acid-base status.
The findings support the clinical benefit of UDCA not only in ameliorating maternal symptoms but also in enhancing early identification of severe ICP, which may allow for more timely obstetric interventions. The medication was well-tolerated, and low-dose UDCA therapy was linked with favorable obstetric outcomes. Researchers conclude that while UDCA appears to be a safe and effective option in tackling ICP, especially in severe cases, close monitoring throughout pregnancy remains fundamental.
Journal of Medical & Health Sciences Review
Effect of Ursodeoxycholic Acid on Pruritus and Fetal Outcomes in Intrahepatic Cholestasis of Pregnancy: a Randomized Controlled Trial
Dr Sara Shafi et al.
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