Distinct response to treatment and characteristics of bile acid composition of early- and late-onset intrahepatic cholestasis of pregnancy: A prospective pilot study.

OBJECTIVE

To evaluate the treatment response in early-onset intrahepatic cholestasis of pregnancy (ICP) and the alterations in the bile acid composition during treatment.

METHODS

Pregnant women diagnosed with ICP at this institution between January 2020 and December 2021 were screened for enrollment in this prospective cohort. The clinical manifestations, treatment responses, and outcomes of early- and late-onset ICP were analyzed. The bile acid profile was analyzed using liquid chromatography-tandem mass spectrometry.

RESULTS

Of the 26 ICP patients enrolled, 14 were diagnosed with early-onset (within the first 28 weeks of gestation). There was no significant difference in the serum level of total bile acid (TBA) at diagnosis between early-onset and late-onset ICP, and the TBA level in patients with late-onset ICP was significantly lower than in patients with early-onset ICP after treatment with ursodeoxycholic acid (UDCA) (median, 32.15 μmol/L vs. 10.75 μmol/L, P = 0.004). The composition of bile acids at diagnosis was comparable between the two groups and changed dramatically in both groups following UDCA treatment. Additionally, significant differences were observed in the bile acid composition between the women with early-onset and late-onset ICP after treatment. Patients with early-onset ICP experienced more adverse pregnancy outcomes compared with those with late-onset ICP (8/14 vs. 3/11).

CONCLUSION

Early-onset ICP demonstrated a distinct response to UDCA treatment, as reflected in a different pattern of bile acid composition. Assessing the bile acid profile might facilitate the identification of high-risk women who do not respond well to UDCA therapy.