Intrahepatic cholestasis of pregnancy
Cholestasis developing in the third trimester and resolving after delivery. Characterised by intense pruritus and elevated serum bile acids. Associated with preterm birth and stillbirth. First-line therapy is ursodeoxycholic acid, which reduces bile acids and relieves pruritus.
ICD-10 O26.62 drugs
Also known as: ICP, Obstetric cholestasis
Drugs used for this condition
- BUrsodeoxycholic acidFirst line · Bile acid preparationsGuidelines (RCOG 2022, SOGC) recommend ursodeoxycholic acid in intrahepatic cholestasis of pregnancy as a symptomatic option for marked pruritus. Its effect on itching in the largest RCT, PITCHES (Lancet 2019, n=605), is small, and a drop in maternal bile acids and ALT reflects only a surrogate biochemical shift, not a clinical outcome. Evidence on fetal outcomes diverges: PITCHES did not reduce the composite perinatal outcome, and the authors proposed reconsidering routine use. The IPD meta-analysis by Ovadia (2021) found a benefit signal on the composite outcome in the RCT subgroup, though not on stillbirth alone. Clinicians discuss a possible niche in severe cholestasis, when bile acids reach 100 micromol/L or higher. Clinicians individualize the decision alongside monitoring and delivery timing.
- CAdemetionineSecond line · Amino acids and derivatives. Hepatoprotective agentFor intrahepatic cholestasis of pregnancy, first-line therapy remains ursodeoxycholic acid. Recommended by RCOG 2022 and SMFM 2021. Ademetionine is mentioned in these documents as second-line therapy with limited data. Meta-analyses show improvement in biochemical markers (bilirubin, bile acids) but not in maternal or perinatal outcomes.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit