URSODEOXYCHOLIC ACID IN INTRAHEPATIC CHOLESTASIS OF PREGNANCY

Abstract

Background: Intrahepatic cholestasis of pregnancy (ICP) is a liver condition unique to pregnancy that is primarily manifested by pruritus in the mother and is associated with risk for adverse perinatal outcome. Symptomatic treatment is generally carried out with ursodeoxycholic acid (UDCA) and the relative effectiveness of cholestyramine is not as well known. Objective: To compare the outcome of ursodeoxycholic acid in (UDCA) vs cholestyramine in the management of intrahepatic cholestasis of pregnancy (ICP) in primigravidae. Methods: This was a randomized controlled trial that was carried out at Lahore General Hospital, Lahore OBS & GYNE department from February 2025 to May 2025. 60 primigravidae aged between 20 and 35 years, who developed pruritus from the second or third trimester of pregnancy, with alanine aminotransferase (ALT) >45 IU/L. The participants who experienced pruritus from the second or third trimester of pregnancy, with alanine aminotransferase (ALT) >45 IU/L, divided into two equal groups by randomisation using lottery system. Group A was given 500 mg of UDCA twice a day and Group B was given cholestyramine four times a week. Itching (Pruritus) was evaluated by a numeric rating scale (NRS, 0–10) at baseline, 2 and 4 weeks. Other tests done were liver function tests and perinatal outcomes. Data were analysed using SPSS version 25. Results: The mean scores for pruritus were significantly different between the two groups at 4 weeks (1.12 ± 0.71 for UDCA, 2.85 ± 0.94 for cholestyramine, p<0.001). There was a significant reduction in ALT in the group treated with UDCA. The numerical differences were not consistently statistically significant for preterm birth, low birth weight, meconium-stained liquor, and NICU admission. No stillbirth occurred. Conclusion: UDCA achieved greater symptomatic and biochemical results than cholestyramine and a positive trend in perinatal results. It continues to be a suitable first line medical therapy for the mother's ICP symptoms.