Does ursodeoxycholic acid improve perinatal outcomes in women with intrahepatic cholestasis of pregnancy?

Intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis, is the commonest primary liver disorder in pregnant women.1 It is characterised by itching (or pruritus) in the absence of a rash (fig 1) and raised concentrations of maternal bile acid (normal range 0-10 µmol/L).2 ICP affects around 0.7% of pregnancies in the UK.3 It is usually seen in the second half of pregnancy and is more common in women with a family history of the disease, a multi-fetal pregnancy, assisted reproductive treatment, higher maternal age, and certain ethnic groups, including Asian (Pakistani and Indian),4 Chilean, and indigenous American.5

The symptom of itching can be intensely unpleasant for the woman and gestational cholestasis has implications for the future health of the mother,6 however, the principal concern during pregnancy is the risk of adverse perinatal outcomes for the baby. Reports from case series and cohort studies describe increased perinatal risks, including spontaneous preterm labour, meconium staining, and intrapartum fetal distress.7 A prospective Swedish cohort study of 505 women with pruritus and raised maternal bile acids reported that the probability of fetal complications did not increase until bile acid concentrations were ≥40 µmol/L and increased by 1%–2% per additional 1 µmol/L of serum bile acids.8 More recently, a UK-wide case …