Gradual dosing of ursodeoxycholic acid in mothers with intrahepatic cholestasis of pregnancy may improve composite neonatal outcome

IF 3.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Annals of hepatology Pub Date : 2024-02-23 DOI:10.1016/j.aohep.2024.101490
Amir Hamud , Matan J. Cohen , Drorith Hochner-Celnikier , Benjamin Bar-Oz , Zvi Ackerman
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Abstract

Introduction and Objectives

Intrahepatic cholestasis of pregnancy (ICP) is often accompanied by fetal and maternal complications.

Materials and Methods

Retrospective review of the clinical course of women with ICP and their neonates treated at our medical center over a 10-year period. Special attention was paid to the maternal and neonatal response to 2 different modes of ursodeoxycholic acid (UDCA) administration.

Results

Neonates of mothers with high total bile acid levels had a poorer composite neonatal outcome. Twenty-seven women who presented at an advanced stage of their pregnancies did not receive UDCA. UDCA was administered in 2 modes: either a full dose at admission (76 women) or a gradually increasing dose until the desired dosage was reached (25 women). The mean gestational age at delivery for the 94 neonates that were exposed to full UDCA dose was the lowest (36±2.3 weeks for the full dose, 37±1.4 weeks for the 30 neonates from the gradually increasing dose, 38±1.6 weeks for the 29 neonates from the no treatment group, p<0.001). The group of neonates that were exposed to full UDCA dose had the highest rate of unfavorable composite neonatal outcome (53% for full dose, 30% for gradually increasing dose, 24% for the no treatment group, p=0.006).

Conclusions

Compared to the administration of a full UDCA dose, the administration of a gradually increasing dose of UDCA may be associated with a greater gestational age at delivery and fewer events of unfavorable composite neonatal outcomes. These novel findings should be retested prospectively in a large cohort of patients.

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妊娠期肝内胆汁淤积症母亲逐渐服用熊去氧胆酸可改善新生儿的复合预后。
妊娠肝内胆汁淤积症(ICP)常伴有胎儿和母体并发症。材料与方法回顾性分析本医疗中心 10 年间收治的ICP 妇女及其新生儿的临床病程。结果母亲总胆汁酸水平高的新生儿综合预后较差。27名处于妊娠晚期的产妇未接受UDCA治疗。UDCA有两种给药方式:入院时足量给药(76名产妇)或逐渐增加剂量直至达到理想剂量(25名产妇)。接受全剂量 UDCA 治疗的 94 名新生儿的平均胎龄最小(全剂量为 36±2.3 周,逐渐增加剂量的 30 名新生儿为 37±1.4 周,未接受治疗组的 29 名新生儿为 38±1.6 周,p<0.001)。结论与给予全剂量 UDCA 相比,给予逐渐增加剂量的 UDCA 可能与更大的分娩胎龄和更少的新生儿不良综合结局有关。这些新发现应在一大批患者中进行前瞻性的再测试。
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来源期刊
Annals of hepatology
Annals of hepatology 医学-胃肠肝病学
CiteScore
7.90
自引率
2.60%
发文量
183
审稿时长
4-8 weeks
期刊介绍: Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.
期刊最新文献
Editorial board Global multi-societies endorsement of the MAFLD definition An Acknowledgement Biological aging accelerates hepatic fibrosis: Insights from the NHANES 2017-2020 and genome-wide association study analysis. Development of a biodegradable prosthesis through tissue engineering, for the organ-replacement or substitution of the extrahepatic bile duct
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