Intrahepatic cholestasis of pregnancy and treatment with ursodeoxycholic acid.
Authors:
V. Kupčová; L. Turecký 1; K. Plank 2 3
Authors place of work:
III. interná klinika LF UK a FNsP akad. Dérera
1; Ústav lekárskej chémie, biochémie a klinickej biochémie LF UK
2; Gynekologicko‑pôrodnícka klinika SZU, Bratislava
3
Published in the journal:
Prakt Gyn 2009; 13(2): 99-105
Summary
Intrahepatic cholestasis of pregnancy (ICP) is a disease characterized by generalized pruritus and biochemical signs of cholestasis that appears typically during the last trimester of gestation. Despite that this is essentially benign ilness for the mother, evidence associates ICP with fetal poor prognosis resulting from increased transfer of bile acids from mother to fetus. Those conditions lead to an accumulation of bile acids in amniotic fluid which may account for a diminished state of fetal well‑being and sudden intra-uterine death by ICP. One of the most predictive and accurate markers for diagnosis and follow‑up of ICP is increasing total bile acid levels. Ursodeoxycholic acid (UDCA) treatment was shown to reduce the toxic bile acid content in the fetal compartment, while decreasing bile acid levels in maternal serum and its passage to the fetus. We observed the levels of total serum bile acid, alanine aminotransferase (ALP), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gammaglutamyl transferase (GMT) and bilirubin during pregnancy in women with diagnosis of ICP. Serum levels of bile acids were determined enzymatically with commercial diagnostic kit BILE ACIDS kit 450-A (SIGMA Chemicals, USA). In 83,38 % of patients the level of total bile acids was between 11 and 40 μmol. l-1 (milder form of intrahepatic cholestasis of pregnancy) on average with double increase of the bile acids compared to control group. In remaining 16,62 % the level of total bile acids was higher than 40 μmol . l-1 (heavier form of intrahepatic cholestasis of pregnancy) on average with 10 times increase of the bile acids compared to control group. From the examined parameters, examination of the level of total bile acids proved statistically most important differences between heavier form of ICP and milder form of ICP, as well as with their comparison with the control group. Bilirubine levels showed statistically important difference between heavier and milder form, heavier form and control group, however not between the control group and milder form of the illness, while they moved in range of normal values. ALP and GMT values did not show statistically important differences between heavier and milder form of the illness and likewise, not even between the control group and milder form of ICP. ALP values were statistically importantly different only between heavier form of the illness and control group. AST and ALT values showed statistically important difference between heavier form of the illness and control group, as well as between control group and milder form of the illness but not between milder form and heavier form of the illness. Administration of UDCA was well tolerated and it was shown that the concentration of total bile acid had decreasing trend after UDCA administration. After UDCA administration there was also decrease of aminotransferases (ALT, AST) and we confirmed the beneficial effect on other investigated parameters as well (Tab. 1, Scheme 1, Ref. 20).
Key words:
intrahepatic cholestasis of pregnancy – treatment with ursodeoxycholic acid – preliminary report
Zdroje
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Štítky
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineČlánok vyšiel v časopise
Practical Gynecology
2009 Číslo 2
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