The effect of intrahepatic cholestasis of pregnancy and ursodeoxycholic acid treatment on Doppler parameters of fetal and maternal circulation
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Abstract
Objectives: We aimed to evaluate feto-maternal blood flow parameters using Doppler ultrasonography (USG) in pregnant women with intrahepatic cholestasis of pregnancy (ICP) and the effect of ursodeoxycholic acid (UDCA) treatment on these parameters.
Material and methods: This prospective cohort study was performed at Dr. Sami Ulus Women’s and Children’s Health Teaching and Research Hospital, in Turkey between September 2022 and February 2023. Sixty pregnant women, 30 with ICP disease and 30 healthy women were included in the study. Obstetric Doppler parameters were measured by USG at diagnosis and after 48 hours of UDCA treatment for the ICP group.
Results: The obstetric Doppler parameters did not significantly differ in the ICP group and the healthy control group. The Doppler findings were similar after UDCA treatment in the ICP group. Gestational week at delivery and birth weight were lower in the ICP group in our study.
Conclusions: We demonstrated that pregnant women with ICP had similar obstetric Doppler parameters when compared with healthy pregnant women and that the UDCA agent used for treatment of ICP disease did not affect these parameters.
Keywords: intrahepatic cholestasis of pregnancyfetomaternal circulationdoppler ultrasonographyursodeoxycholic acid
References
- Marathe JA, Lim WH, Metz MP, et al. A retrospective cohort review of intrahepatic cholestasis of pregnancy in a South Australian population. Eur J Obstet Gynecol Reprod Biol. 2017; 218: 33–38.
- Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol. 2009; 15(17): 2049–2066.
- Wolf MF, Sgayer I, Yaron L, et al. Intrahepatic cholestasis of pregnancy - prevalence and ethnic distribution in northern Israel. Ginekol Pol. 2022 [Epub ahead of print].
- Ovadia C, Williamson C. Intrahepatic cholestasis of pregnancy: Recent advances. Clin Dermatol. 2016; 34(3): 327–334.
- Marschall HU, Wikström Shemer E, Ludvigsson JF, et al. Intrahepatic cholestasis of pregnancy and associated hepatobiliary disease: a population-based cohort study. Hepatology. 2013; 58(4): 1385–1391.
- Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol. 2014; 124(1): 120–133.
- Hague WM, Callaway L, Chambers J, et al. A multi-centre, open label, randomised, parallel-group, superiority Trial to compare the efficacy of URsodeoxycholic acid with RIFampicin in the management of women with severe early onset Intrahepatic Cholestasis of pregnancy: the TURRIFIC randomised trial. BMC Pregnancy Childbirth. 2021; 21(1): 51.
- Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: Relationships between bile acid levels and fetal complication rates. Hepatology. 2004; 40(2): 467–474.
- Carey EJ, Lindor KD. Current pharmacotherapy for cholestatic liver disease. Expert Opin Pharmacother. 2012; 13(17): 2473–2484.
- Roma MG, Toledo FD, Boaglio AC, et al. Ursodeoxycholic acid in cholestasis: linking action mechanisms to therapeutic applications. Clin Sci (Lond). 2011; 121(12): 523–544.
- Walker KF, Chappell LC, Hague WM, et al. Pharmacological interventions for treating intrahepatic cholestasis of pregnancy. Cochrane Database Syst Rev. 2020; 7(7): CD000493.
- Committee opinion no 611: method for estimating due date. Obstet Gynecol. 2014; 124(4): 863–866.
- Rioseco AJ, Ivankovic MB, Manzur A, et al. Intrahepatic cholestasis of pregnancy: a retrospective case-control study of perinatal outcome. Am J Obstet Gynecol. 1994; 170(3): 890–895.
- Ovadia C, Seed PT, Sklavounos A, et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet. 2019; 393(10174): 899–909.
- Geenes V, Chappell LC, Seed PT, et al. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Hepatology. 2014; 59(4): 1482–1491.
- Papacleovoulou G, Abu-Hayyeh S, Nikolopoulou E, et al. Maternal cholestasis during pregnancy programs metabolic disease in offspring. J Clin Invest. 2013; 123(7): 3172–3181.
- Williamson C, Gorelik J, Eaton BM, et al. The bile acid taurocholate impairs rat cardiomyocyte function: a proposed mechanism for intra-uterine fetal death in obstetric cholestasis. Clin Sci (Lond). 2001; 100(4): 363–369.
- Abdul Kadir SH, Ali NN, Mioulane M, et al. Embryonic stem cell-derived cardiomyocytes as a model to study fetal arrhythmia related to maternal disease. J Cell Mol Med. 2009; 13(9B): 3730–3741.
- Guerra F, Guzmán S, Campos G. [Evaluation of maternal and fetal blood flow indices in intrahepatic cholestasis of pregnancy]. Rev Chil Obstet Ginecol. 1994; 59(1): 17–21.
- Suri V, Jain R, Aggarwal N, et al. Usefulness of fetal monitoring in intrahepatic cholestasis of pregnancy: a prospective study. Arch Gynecol Obstet. 2012; 286(6): 1419–1424.
- Kurtulmuş S, Gür EB, Öztekin D, et al. The impact of intrahepatic cholestasis of pregnancy on fetal cardiac and peripheral circulation. J Turk Ger Gynecol Assoc. 2015; 16(2): 74–79.
- Serrano MA, Brites D, Larena MG, et al. Beneficial effect of ursodeoxycholic acid on alterations induced by cholestasis of pregnancy in bile acid transport across the human placenta. J Hepatol. 1998; 28(5): 829–839.
- Chappell LC, Bell JL, Smith A, et al. PITCHES study group. Ursodeoxycholic acid versus placebo in the treatment of women with intrahepatic cholestasis of pregnancy (ICP) to improve perinatal outcomes: protocol for a randomised controlled trial (PITCHES). Trials. 2018; 19(1): 657–860.
- Gorelik J, Shevchuk AI, Diakonov I, et al. Dexamethasone and ursodeoxycholic acid protect against the arrhythmogenic effect of taurocholate in an in vitro study of rat cardiomyocytes. BJOG: An International Journal of Obstetrics & Gynaecology. 2003; 110(5): 467–474.
- Vasavan T, Deepak S, Jayawardane IA, et al. Fetal cardiac dysfunction in intrahepatic cholestasis of pregnancy is associated with elevated serum bile acid concentrations. J Hepatol. 2021; 74(5): 1087–1096.
