Does mild intrahepatic cholestasis of pregnancy require an aggressive management? Evidence from a prospective observational study focused on adverse perinatal outcomes and pathological placental findings.

OBJECTIVE

To ascertain the most effective approach in pregnancies complicated by mild intrahepatic cholestasis of pregnancy (mICP) by evaluating rates of adverse perinatal outcomes (APOs) and pathological placental findings.

METHODS

A total of 89 pregnancies complicated by mICP (defined as total serum bile acids (TSBAs) levels <40 µmol/L) were included. One-drug (ursodeoxycholic acid [UDCA]) ( = 49, 55.1%) and combined (UDCA S-adenosyl methionine (SAMe)) ( = 40, 44.9%) therapies were compared.

RESULTS

No differences were found in demographic, obstetric, and placental characteristics. In UDCA SAMe group, premature delivery was a common clinical decision (14.3 versus 25%, -value = .201), with increased rates of instrumental vaginal delivery (VD; 28.6 versus 40%, -value = .522), but similar cesarean section (CS) rates (26.5 versus 25%, -value = .498). Mean placental weight was comparable (UDCA, mean 595.7 g, SD 213.1 g versus UDCA SAMe, mean 586.4 g, SD 102.9 g, -value = .875). A total of 110 lesions were identified, 64 in 25 placentas of patients assigned to the UDCA and 46 in 15 placentas of patients managed by UDCA SAMe. Placental findings attributable to maternal malperfusion were found in 41/25 and 32/15 cases treated by UCDA and UDCA SAMe (165 versus 213%, -value = .774), pathological fetal vascular supply in 17/25 and 8/15 placentas (68 versus 53%, value = .777), and inflammatory lesions in 6/25 and 6/15 cases (24 versus 40%, -value = .757).

CONCLUSIONS

Pregnancies complicated by mICP and managed by UDCA alone present similar APO rates and placental histopathology if compared with those treated by UDCA SAMe, failing to recognize advantages in the combined therapy. Further prospective studies and data sharing from ongoing RTCs could drive changes in therapeutic plan.