Abstract：
OBJECTIVE: Intrahepatic cholestasis of pregnancy (ICP) is often accompanied by fetal and maternal complications.
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.
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.
摘要：
目的：妊娠期肝内胆汁淤积症（ICP）常伴有胎儿和母体并发症。
方法：回顾性回顾了在我们的医疗中心治疗的ICP妇女及其新生儿的临床过程。特别注意母体和新生儿对两种不同熊去氧胆酸（UDCA）给药方式的反应。
结果：总胆汁酸水平高的母亲的新生儿复合结局较差。在怀孕后期出现的27名妇女没有接受UDCA。UDCA以2种模式施用：入院时的全剂量（76名女性）或逐渐增加的剂量直至达到所需剂量（25名女性）。94例接受全剂量UDCA的新生儿分娩时的平均胎龄最低（全剂量36±2.3周，从逐渐增加的剂量开始，30例新生儿37±1.4周，非治疗组29例新生儿38±1.6周，p<0.001)。暴露于完全UDCA剂量的新生儿组具有最高的不良复合新生儿结局（全剂量为53％，30％用于逐渐增加的剂量，24%为无治疗组，p=0.006)。
结论：与完整剂量的UDCA相比，逐渐增加剂量的UDCA的给药可能与更大的分娩胎龄和更少的不良复合新生儿结局相关.这些新发现应在大量患者中进行前瞻性重新测试。
方法：回顾性回顾了在我们的医疗中心治疗的ICP妇女及其新生儿的临床过程。特别注意母体和新生儿对两种不同熊去氧胆酸（UDCA）给药方式的反应。
结果：总胆汁酸水平高的母亲的新生儿复合结局较差。在怀孕后期出现的27名妇女没有接受UDCA。UDCA以2种模式施用：入院时的全剂量（76名女性）或逐渐增加的剂量直至达到所需剂量（25名女性）。94例接受全剂量UDCA的新生儿分娩时的平均胎龄最低（全剂量36±2.3周，从逐渐增加的剂量开始，30例新生儿37±1.4周，非治疗组29例新生儿38±1.6周，p<0.001)。暴露于完全UDCA剂量的新生儿组具有最高的不良复合新生儿结局（全剂量为53％，30％用于逐渐增加的剂量，24%为无治疗组，p=0.006)。
结论：与完整剂量的UDCA相比，逐渐增加剂量的UDCA的给药可能与更大的分娩胎龄和更少的不良复合新生儿结局相关.这些新发现应在大量患者中进行前瞻性重新测试。
