According to MedPage Today, ursodeoxycholic acid significantly improves patient outcomes in relation to intrahepatic cholestasis of pregnancy. This rare liver disorder increases the risk of fetal issues, stillbirths, or preterm births. Thus, being able to protect both mother and child is crucial. After performing both a systemic data review and a meta-analysis, researchers determined that ursodeoxycholic acid reduced preterm births and stillbirths compared to untreated patients. Check out the full study findings published in The Lancet Gastroenterology & Hepatology.

Ursodeoxycholic Acid

According to PubChem:

Ursodeoxycholic acid or ursodiol is a naturally occurring bile acid that is used dissolve cholesterol gall stones and to treat cholestatic forms of liver diseases including primary biliary cirrhosis. Used therapeutically, it prevents the synthesis and absorption of cholesterol.

Additionally, the study researchers note that ursodeoxycholic acid prevents inflammation, reduces serum bile acid concentrations in developing fetuses, and improves the flow of bile. In prior studies, researchers determined that bile acid concentrations over 40 µmol/L contributed to poor pregnancy outcomes. For example, bile acid concentrations that high heightened the risk of preterm births. However, additional studies, like the PITCHES clinical trial, showed no significant benefits as opposed to a placebo. So is ursodeoxycholic acid effective?

In the more recent systemic data review and meta-analysis, researchers evaluated data from 6,974 females. Altogether, these females participated in 34 studies and trials. Of those included, 67.8% received ursodeoxycholic acid. Researchers determined:

• 0.7% of fetuses in treated females, and 0.6% of fetuses in untreated females, resulted in stillbirth.
• Ursodeoxycholic acid reduced preeclampsia in women with intrahepatic cholestasis of pregnancy. Treated women were 2% less likely to develop preeclampsia.
• Women receiving treatment were significantly more likely to be able to have an unassisted vaginal birth.
• Patients with serum bile acid concentrations of 40 µmol/L or 100 µmol/L or higher saw higher levels of neonatal admission, meconium-stained amniotic fluid, and fetal distress or death.
• Altogether, ursodeoxycholic acid reduced meconium-stained amniotic fluid and increased the chance of larger fetuses/babies.
• Early treatment with ursodeoxycholic acid reduced the odds of late preterm birth (before 37 weeks).

Overall, researchers cannot say with certainty whether ursodeoxycholic acid could prevent or even protect against stillbirth. However, data suggests that it can greatly reduce the risk of preterm birth or stillbirth in patients. More so, the treatment could be most beneficial for those with high serum bile acid concentrations.

Intrahepatic Cholestasis

Altogether, the cause of intrahepatic cholestasis of pregnancy, a rare liver disorder, is unclear. Some doctors believe the condition may have underlying genetic factors, but pregnancy hormones may also play a role. Normally, bile, a digestive fluid made in the liver, helps to break down fats throughout the digestive system. But in patients with intrahepatic cholestasis, the liver does not release bile. As it accumulates, the bile causes a loss of liver function and releases bile salts into the blood. Most patients begin to experience symptoms within their third trimester. While it can occur during later pregnancies, most patients also see bile flow returning to normal following birth. Symptoms include:

• Jaundice (yellowing of the skin and eyes)
• Appetite loss
• Nausea
• Intense itching
  • Note: In many cases, this itching occurs on the palms or soles. However, the itching can affect other parts of the body. Additionally, the itching may grow progressively worse at night, even inhibiting sleep.

Learn more about intrahepatic cholestasis of pregnancy.