The role of ursodeoxycholic acid in the treatment of intrahepatic cholestasis in pregnant women after ART

Abstract

Intrahepatic cholestasis of pregnancy (IHCP) is of significant practical interest as this pathology is a borderline case between obstetric, infectious and hepatic pathology. The issues of etiology, pathogenesis, risk factors triggering intrahepatic cholestasis, the principles of its treatment and prevention are still an object of debate. At present, ursodeoxycholic acid (UDCA) is considered to be the medicine of choice for the treatment of intrahepatic cholestasis of pregnancy. The peculiarity of this medicine lies in its 4 mechanisms of action: replacement of toxic endogenous bile acids, cytoprotective action for hepatocytes and cholangiocytes, immunomodulation and choleretic action [3]. To test the efficiency of the suggested drug, we selected 71 women who got pregnant owing to ART and who presented a high risk of IHCP at the first prognostication stage. By way of randomization, they were divided into 2 groups: the basic group – 29 patients, who were treated with the recommended complex of therapy and prophylaxis, and the comparison group – 42 pregnant women, whose pregnancy was managed in accordance with the WHO guidelines. The recommended ursodeoxycholic acid has enabled a more effective normalization of biochemical indicators associated with IHCP (reduction of the levels of total bilirubin, bile acids, ALT, AP and total cholesterol in terms of the low-density and the very-low-density lipoprotein fraction) and a significant decrease in the incidence of complications of pregnancy.