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Meta-Analysis
. 2013 Jun 24;2013(6):CD000493.
doi: 10.1002/14651858.CD000493.pub2.

Interventions for treating cholestasis in pregnancy

Vinita Gurung  1 , Philippa Middleton, Stephen J Milan, William Hague, Jim G Thornton
Affiliations
Meta-Analysis

Interventions for treating cholestasis in pregnancy

Vinita Gurung et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Obstetric cholestasis has been linked to adverse maternal and fetal/neonatal outcomes. As the pathophysiology is poorly understood, therapies have been empiric. The first version of this review, published in 2001, and including nine randomised controlled trials involving 227 women, concluded that there was insufficient evidence to recommend any of the interventions alone or in combination. This is the first update.

Objectives: To evaluate the effectiveness and safety of therapeutic and delivery interventions in women with cholestasis of pregnancy.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 February 2013) and reference lists of identified studies.

Selection criteria: Randomised controlled trials that compared two intervention strategies for women with a clinical diagnosis of obstetric cholestasis.

Data collection and analysis: The review authors independently assessed trials for eligibility and risk of bias. We independently extracted data and checked these for accuracy.

Main results: We included 21 trials with a total of 1197 women. They were mostly at moderate to high risk of bias. They assessed 11 different interventions resulting in 15 different comparisons.Compared with placebo, ursodeoxycholic acid (UDCA) showed improvement in pruritus in five (228 women) out of seven trials. There were no significant differences in instances of fetal distress in the UDCA groups compared with placebo (average risk ratio (RR) 0.67; 95% confidence interval (CI) 0.22 to 2.02; five trials, 304 women; random-effects analysis: T² = 0.74; I² = 48%). There were significantly fewer total preterm births with UDCA (RR 0.46; 95% CI 0.28 to 0.73; two trials, 179 women). The difference for spontaneous preterm births was not significant (RR 0.99; 95% CI 0.41 to 2.36, two trials, 109 women).Two trials (48 women) reported lower (better) pruritus scores for S-adenosylmethionine (SAMe) compared with placebo, while two other trials of 34 women reported no significant differences between groups.UDCA was more effective in improving pruritus than either SAMe (four trials; 133 women) or cholestyramine (one trial; 84 women), as was combined UDCA+SAMe when compared with placebo (one trial; 16 women) and SAMe alone (two trials; 68 women). However, combined UDCA+SAMe was no more effective than UDCA alone in regard to pruritus improvement (one trial; 53 women) and two trials (80 women) reported data were insufficient to draw any conclusions from. In one trial comparing UDCA and dexamethasone (83 women), a significant improvement with UDCA was seen only in a subgroup of women with severe obstetric cholestasis (23 women).Danxiaoling significantly improved pruritus in comparison to Yiganling. No significant differences were seen in pruritus improvement with other interventions.Eight trials reported fetal or neonatal deaths, with two deaths reported overall (both in the placebo groups).Women receiving UDCA and cholestyramine experienced nausea, vomiting and diarrhoea. Guar gum caused mild abdominal distress, diarrhoea and flatulence during the first days of treatment. Women found charcoal suspension unpleasant to swallow. Dexamethasone caused nausea, dizziness and stomach pain in one woman.One trial (62 women) looked at the timing of delivery intervention. There were no stillbirths or neonatal deaths in 'early delivery' or the 'await spontaneous labour' group. There were no significant differences in the rates of caesarean section, meconium passage or admission to neonatal intensive care unit between the two groups.

Authors' conclusions: Different approaches to assessing and reporting pruritus precluded pooling of trials comparing the effects of UDCA versus placebo on pruritus, but examination of individual trials suggests that UDCA significantly improves pruritus, albeit by a small amount. Fewer instances of fetal distress/asphyxial events were seen in the UDCA groups when compared with placebo but the difference was not statistically significant. Large trials of UDCA to determine fetal benefits or risks are needed.A single trial was too small to rule in or out a clinically important effect of early term delivery on caesarean section.There is insufficient evidence to indicate that SAMe, guar gum, activated charcoal, dexamethasone, cholestyramine, Salvia, Yinchenghao decoction (YCHD), Danxioling and Yiganling, or Yiganling alone or in combination are effective in treating women with cholestasis of pregnancy.

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Conflict of interest statement

Jim Thornton and Vinita Gurung are the authors of PITCH 2012. Assessment, data extraction and data entry for this trial was conducted by Philippa Middleton and Stephen Milan.

Figures

1
1
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 UDCA versus placebo, Outcome 1 Pruritus improvement.
1.2
1.2. Analysis
Comparison 1 UDCA versus placebo, Outcome 2 Mean of worst itching scores over preceding 24 hours between randomisation and delivery.
1.3
1.3. Analysis
Comparison 1 UDCA versus placebo, Outcome 3 Mean of average itching scores over preceding 24 hours between randomisation and delivery.
1.4
1.4. Analysis
Comparison 1 UDCA versus placebo, Outcome 4 Stillbirth.
1.5
1.5. Analysis
Comparison 1 UDCA versus placebo, Outcome 5 Fetal distress/asphyxial event.
1.6
1.6. Analysis
Comparison 1 UDCA versus placebo, Outcome 6 Subgroup analysis ‐ fetal distress/asphyxial events.
1.7
1.7. Analysis
Comparison 1 UDCA versus placebo, Outcome 7 Bile acid reduction, µmol/L.
1.8
1.8. Analysis
Comparison 1 UDCA versus placebo, Outcome 8 ALT, IU/L.
1.9
1.9. Analysis
Comparison 1 UDCA versus placebo, Outcome 9 ALT, IU/L.
1.10
1.10. Analysis
Comparison 1 UDCA versus placebo, Outcome 10 ALT reduction, IU/L.
1.11
1.11. Analysis
Comparison 1 UDCA versus placebo, Outcome 11 Caesarean section.
1.12
1.12. Analysis
Comparison 1 UDCA versus placebo, Outcome 12 Postpartum haemorrhage.
1.13
1.13. Analysis
Comparison 1 UDCA versus placebo, Outcome 13 Adverse effects.
1.14
1.14. Analysis
Comparison 1 UDCA versus placebo, Outcome 14 Meconium‐stained liquor.
1.15
1.15. Analysis
Comparison 1 UDCA versus placebo, Outcome 15 Mean gestational age at birth.
1.16
1.16. Analysis
Comparison 1 UDCA versus placebo, Outcome 16 Spontaneous birth at less than 37 weeks.
1.17
1.17. Analysis
Comparison 1 UDCA versus placebo, Outcome 17 Total preterm birth at less than 37 weeks.
1.18
1.18. Analysis
Comparison 1 UDCA versus placebo, Outcome 18 Admission to neonatal intensive care unit.
2.1
2.1. Analysis
Comparison 2 SAMe versus placebo, Outcome 1 Stillbirth/neonatal death.
2.2
2.2. Analysis
Comparison 2 SAMe versus placebo, Outcome 2 Bile acid reduction, µmol/L.
2.3
2.3. Analysis
Comparison 2 SAMe versus placebo, Outcome 3 ALT reduction, IU/L.
2.4
2.4. Analysis
Comparison 2 SAMe versus placebo, Outcome 4 Caesarean section.
2.5
2.5. Analysis
Comparison 2 SAMe versus placebo, Outcome 5 Spontaneous birth at less than 37 weeks.
2.6
2.6. Analysis
Comparison 2 SAMe versus placebo, Outcome 6 Total preterm birth at less than 37 weeks.
3.1
3.1. Analysis
Comparison 3 Guar gum versus placebo, Outcome 1 Pruritus improvement.
3.2
3.2. Analysis
Comparison 3 Guar gum versus placebo, Outcome 2 Total bile acids (µmol/L).
3.3
3.3. Analysis
Comparison 3 Guar gum versus placebo, Outcome 3 ALT, U/L.
3.4
3.4. Analysis
Comparison 3 Guar gum versus placebo, Outcome 4 Adverse effects of medication.
3.5
3.5. Analysis
Comparison 3 Guar gum versus placebo, Outcome 5 Mean gestational age at birth.
4.1
4.1. Analysis
Comparison 4 Activated charcoal versus no treatment, Outcome 1 Pruritus improvement.
4.2
4.2. Analysis
Comparison 4 Activated charcoal versus no treatment, Outcome 2 Bile acids after 8 days treatment, µmol/L.
4.3
4.3. Analysis
Comparison 4 Activated charcoal versus no treatment, Outcome 3 ALT after 8 days treatment, U/L.
4.4
4.4. Analysis
Comparison 4 Activated charcoal versus no treatment, Outcome 4 Mean gestational age at birth.
5.1
5.1. Analysis
Comparison 5 Dexamethasone versus placebo, Outcome 1 Stillbirths.
5.2
5.2. Analysis
Comparison 5 Dexamethasone versus placebo, Outcome 2 Fetal distress/asphyxial event.
5.3
5.3. Analysis
Comparison 5 Dexamethasone versus placebo, Outcome 3 Subgroup analysis ‐ fetal distress/asphyxial event.
5.4
5.4. Analysis
Comparison 5 Dexamethasone versus placebo, Outcome 4 Meconium‐stained liquor.
5.5
5.5. Analysis
Comparison 5 Dexamethasone versus placebo, Outcome 5 Spontaneous birth at less than 37 weeks.
5.6
5.6. Analysis
Comparison 5 Dexamethasone versus placebo, Outcome 6 Total preterm births at less than 37 weeks.
6.1
6.1. Analysis
Comparison 6 UDCA versus SAMe, Outcome 1 Pruritus improvement.
6.2
6.2. Analysis
Comparison 6 UDCA versus SAMe, Outcome 2 Fetal distress/asphyxial events.
6.3
6.3. Analysis
Comparison 6 UDCA versus SAMe, Outcome 3 Bile acids, µmol/L.
6.4
6.4. Analysis
Comparison 6 UDCA versus SAMe, Outcome 4 ALT, µkat/L.
6.5
6.5. Analysis
Comparison 6 UDCA versus SAMe, Outcome 5 Caesarean section.
6.6
6.6. Analysis
Comparison 6 UDCA versus SAMe, Outcome 6 Meconium‐stained liquor.
6.7
6.7. Analysis
Comparison 6 UDCA versus SAMe, Outcome 7 Mean gestational age at birth.
6.8
6.8. Analysis
Comparison 6 UDCA versus SAMe, Outcome 8 Spontaneus birth at less than 37 weeks.
6.9
6.9. Analysis
Comparison 6 UDCA versus SAMe, Outcome 9 Total preterm birth at less than 37 weeks.
6.10
6.10. Analysis
Comparison 6 UDCA versus SAMe, Outcome 10 Admission to neonatal intensive care unit.
7.1
7.1. Analysis
Comparison 7 UDCA versus dexamethasone, Outcome 1 Fetal distress/asphyxial events.
7.2
7.2. Analysis
Comparison 7 UDCA versus dexamethasone, Outcome 2 Adverse effects of medication.
7.3
7.3. Analysis
Comparison 7 UDCA versus dexamethasone, Outcome 3 Meconium‐stained liquor.
7.4
7.4. Analysis
Comparison 7 UDCA versus dexamethasone, Outcome 4 Spontaneous birth at less than 37 weeks.
7.5
7.5. Analysis
Comparison 7 UDCA versus dexamethasone, Outcome 5 Total preterm birth at less than 37 weeks.
8.1
8.1. Analysis
Comparison 8 UDCA versus cholestyramine, Outcome 1 Pruritus score (> 50% reduction after 14 days treatment).
8.2
8.2. Analysis
Comparison 8 UDCA versus cholestyramine, Outcome 2 Fetal distress/asphyxial event.
8.3
8.3. Analysis
Comparison 8 UDCA versus cholestyramine, Outcome 3 Bile acids, µmol/L.
8.4
8.4. Analysis
Comparison 8 UDCA versus cholestyramine, Outcome 4 ALT, U/L.
8.5
8.5. Analysis
Comparison 8 UDCA versus cholestyramine, Outcome 5 Caesarean section.
8.6
8.6. Analysis
Comparison 8 UDCA versus cholestyramine, Outcome 6 Adverse effects of medication.
8.7
8.7. Analysis
Comparison 8 UDCA versus cholestyramine, Outcome 7 Mean gestational age at birth.
8.8
8.8. Analysis
Comparison 8 UDCA versus cholestyramine, Outcome 8 Total preterm birth at less than 37 weeks.
9.1
9.1. Analysis
Comparison 9 UDCA + SAMe versus placebo, Outcome 1 Bile acid reduction at 20 days, µmol/L.
10.1
10.1. Analysis
Comparison 10 UDCA + SAMe versus SAMe, Outcome 1 Pruritus improvement.
10.2
10.2. Analysis
Comparison 10 UDCA + SAMe versus SAMe, Outcome 2 Stillbirths/neonatal deaths.
10.3
10.3. Analysis
Comparison 10 UDCA + SAMe versus SAMe, Outcome 3 Fetal distress/asphyxial event.
10.4
10.4. Analysis
Comparison 10 UDCA + SAMe versus SAMe, Outcome 4 Bile acids, µmol/L.
10.5
10.5. Analysis
Comparison 10 UDCA + SAMe versus SAMe, Outcome 5 ALT, µkatl/L.
10.6
10.6. Analysis
Comparison 10 UDCA + SAMe versus SAMe, Outcome 6 Caesarean section.
10.7
10.7. Analysis
Comparison 10 UDCA + SAMe versus SAMe, Outcome 7 Postpartum haemorrhage.
10.8
10.8. Analysis
Comparison 10 UDCA + SAMe versus SAMe, Outcome 8 Meconium‐stained liquor.
10.9
10.9. Analysis
Comparison 10 UDCA + SAMe versus SAMe, Outcome 9 Spontaneous birth at less than 37 weeks.
10.10
10.10. Analysis
Comparison 10 UDCA + SAMe versus SAMe, Outcome 10 Total preterm birth at less than 37 weeks.
10.11
10.11. Analysis
Comparison 10 UDCA + SAMe versus SAMe, Outcome 11 Admission to neonatal intensive care unit.
11.1
11.1. Analysis
Comparison 11 UDCA + SAMe versus UDCA, Outcome 1 Pruritus improvement.
11.2
11.2. Analysis
Comparison 11 UDCA + SAMe versus UDCA, Outcome 2 Stillbirths/neonatal deaths.
11.3
11.3. Analysis
Comparison 11 UDCA + SAMe versus UDCA, Outcome 3 Fetal distress/asphyxial event.
11.4
11.4. Analysis
Comparison 11 UDCA + SAMe versus UDCA, Outcome 4 Bile acids, µmol/L.
11.5
11.5. Analysis
Comparison 11 UDCA + SAMe versus UDCA, Outcome 5 ALT, µkatl/L.
11.6
11.6. Analysis
Comparison 11 UDCA + SAMe versus UDCA, Outcome 6 Reduction in ALT (IU/L) after treatment.
11.7
11.7. Analysis
Comparison 11 UDCA + SAMe versus UDCA, Outcome 7 Caesarean section.
11.8
11.8. Analysis
Comparison 11 UDCA + SAMe versus UDCA, Outcome 8 Meconium‐stained liquor.
11.9
11.9. Analysis
Comparison 11 UDCA + SAMe versus UDCA, Outcome 9 Spontaneous birth at less than 37 weeks.
11.10
11.10. Analysis
Comparison 11 UDCA + SAMe versus UDCA, Outcome 10 Total preterm births at less than 37 weeks.
11.11
11.11. Analysis
Comparison 11 UDCA + SAMe versus UDCA, Outcome 11 Admission to neonatal intensive care unit.
12.1
12.1. Analysis
Comparison 12 UDCA + Salvia versus UDCA, Outcome 1 Reduction in pruritus from moderate/severe to mild (0‐4 scale).
12.2
12.2. Analysis
Comparison 12 UDCA + Salvia versus UDCA, Outcome 2 Caesarean section for fetal distress.
12.3
12.3. Analysis
Comparison 12 UDCA + Salvia versus UDCA, Outcome 3 Reduction in ALT (IU/L) after treatment.
12.4
12.4. Analysis
Comparison 12 UDCA + Salvia versus UDCA, Outcome 4 Meconium‐stained liquor.
13.1
13.1. Analysis
Comparison 13 YCHD versus SAMe, Outcome 1 Degree of pruritus after treatment.
13.2
13.2. Analysis
Comparison 13 YCHD versus SAMe, Outcome 2 Stillbirths/neonatal deaths.
13.3
13.3. Analysis
Comparison 13 YCHD versus SAMe, Outcome 3 Fetal distress/asphyxial event.
13.4
13.4. Analysis
Comparison 13 YCHD versus SAMe, Outcome 4 Bile salt (CGA) levels.
13.5
13.5. Analysis
Comparison 13 YCHD versus SAMe, Outcome 5 ALT.
13.6
13.6. Analysis
Comparison 13 YCHD versus SAMe, Outcome 6 Caesarean section.
13.7
13.7. Analysis
Comparison 13 YCHD versus SAMe, Outcome 7 Meconium‐stained liquor.
13.8
13.8. Analysis
Comparison 13 YCHD versus SAMe, Outcome 8 Mean gestational age at birth.
14.1
14.1. Analysis
Comparison 14 Danxiaoling versus Yiganling, Outcome 1 Pruritus.
14.2
14.2. Analysis
Comparison 14 Danxiaoling versus Yiganling, Outcome 2 Stillbirths/neonatal deaths.
14.3
14.3. Analysis
Comparison 14 Danxiaoling versus Yiganling, Outcome 3 Bile acid levels (CGA).
14.4
14.4. Analysis
Comparison 14 Danxiaoling versus Yiganling, Outcome 4 ALT.
14.5
14.5. Analysis
Comparison 14 Danxiaoling versus Yiganling, Outcome 5 Caesarean section.
14.6
14.6. Analysis
Comparison 14 Danxiaoling versus Yiganling, Outcome 6 Meconium‐stained liquor.
14.7
14.7. Analysis
Comparison 14 Danxiaoling versus Yiganling, Outcome 7 Spontaneous birth at less than 37 weeks.
15.1
15.1. Analysis
Comparison 15 Early term delivery v expectant management, Outcome 1 Stillbirths/neonatal deaths.
15.2
15.2. Analysis
Comparison 15 Early term delivery v expectant management, Outcome 2 Caesarean section.
15.3
15.3. Analysis
Comparison 15 Early term delivery v expectant management, Outcome 3 Meconium‐stained liquor.
15.4
15.4. Analysis
Comparison 15 Early term delivery v expectant management, Outcome 4 Admission to neonatal intensive care unit.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Binder 2006 {published data only}
    1. Binder T, Salaj P, Zima T, Vitek L. Randomized prospective comparative study of ursodeoxycholic acid and S‐adenosyl‐L‐methionine in the treatment of intrahepatic cholestasis of pregnancy. Journal of Perinatal Medicine 2006;34:383‐91. - PubMed
    1. Binder T, Salaj P, Zina T, Vitek L. [Ursodeoxycholic acid, S‐adenosyl‐L‐methionine and their combinations in the treatment of gestational intrahepatic cholestasis (ICP)]. Ceska Gynekologie 2006;71(2):92‐8. - PubMed
Diaferia 1996 {published data only}
    1. Diaferia A, Nicastri PL, Tartagni M, Loizzi P, Iacovizzi C, Leo A. Ursodeoxycholic acid therapy in pregnant women with cholestasis. International Journal of Gynecology and Obstetrics 1996;52(2):133‐40. - PubMed
Fang 2009 {published data only}
    1. Fang J, Gou WL, Li QL. [Effect of integrative Chinese and Western medicine in treating pregnant women with intrahepatic cholestasis]. [Chinese]. [Zhongguo Zhong Xi Yi Jie He Za Zhi Zhongguo Zhongxiyi Jiehe Zazhi/Chinese] Journal of Integrated Traditional and Western Medicine [Zhongguo Zhong Xi Yi Jie He Xue Hui, Zhongguo Zhong Yi Yan Jiu Yuan Zhu Ban] 2009;29(10):869‐71. - PubMed
Floreani 1996 {published data only}
    1. Floreani A, Paternoster D, Melis A, Grella PV. S‐adenosylmethionine versus ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy: preliminary results of a controlled trial. European Journal of Obstetrics & Gynecology 1996;67:109‐3. - PubMed
    1. Floreani A, Paternoster D, Melis A, Zappala F, Chiaramonte M, Grella PV. A controlled trial with S‐adenosylmethionine versus ursodeoxycholic acid in intrahepatic cholestasis of pregnancy [EASL abstract]. Journal of Hepatology 1996;25 Suppl 1:S136.
Frezza 1984 {published data only}
    1. Frezza M, Pozzato G, Chiesa L, Stramentinoli G, Padova C. Reversal of intrahepatic cholestasis of pregnancy in women after high dose S‐adenosyl‐L‐methionine. Hepatology 1984;4(2):274‐8. - PubMed
Frezza 1990 {published data only}
    1. Frezza M, Cammareri G, Padova C, Italian Study Group for ICP. Beneficial effects of S‐adenosylmethionine in pregnant women with cholestasis: results of a multicenter controlled trial (abstract). Journal of Hepatology 1987;5(Suppl 1):S27.
    1. Frezza M, Centini G, Cammareri G, Grazie C, Padova C. S‐adenosylmethionine for the treatment of intrahepatic cholestasis of pregnancy. Results of a controlled clinical trial. Hepato‐Gastroenterology 1990;37(Suppl 2):122‐5. - PubMed
Glantz 2005 {published data only}
    1. Glantz A, Marschall HU, Lammert F, Mattsson LA. Intrahepatic cholestasis of pregnancy: a randomized controlled trial comparing dexamethasone and ursodeoxycholic acid. Hepatology 2005;42:1399‐405. - PubMed
    1. Glantz A, Reilly SJ, Benthin L, Lammert F, Mattsson LA, Marschall HU. Intrahepatic cholestasis of pregnancy: amelioration of pruritus by UDCA is associated with decreased progesterone disulphates in urine. Hepatology 2008;47(2):376‐9. - PubMed
Huang 2004 {published data only}
    1. Huang JY, Liu H. Analysis on therapeutic effect of Western and Chinese drug in treating intrahepatic cholestasis pregnancy. Chinese Journal of Integrated Traditional & Western Medicine 2004;24(4):309‐11. - PubMed
Kaaja 1994 {published data only}
    1. Kaaja RJ, Kontula KK, Raiha A, Laatikainen T. Treatment of cholestasis of pregnancy with peroral activated charcoal. A preliminary study. Scandinavian Journal of Gastroenterology 1994;29(2):178‐81. - PubMed
Kondrackiene 2005 {published data only}
    1. Kondrackiene J, Beuers U, Kupcinskas L. Efficacy and safety of ursodeoxycholic acid versus cholestyramine in intrahepatic cholestasis of pregnancy. Gastroenterology 2005;129:894‐901. - PubMed
    1. Kondrackiene J, Kupcinskas L, Sumskiene J. Efficacy of moderate doses of ursodeoxycholic acid in comparison to cholestyramine in the treatment of intrahepatic cholestasis of pregnancy [abstract]. Journal of Hepatology 2001;34(1):186.
Leino 1998 {published data only}
    1. Leino R, Ekblad U, Irjala K, Erkkola R. Ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy. Prenatal and Neonatal Medicine 1998;3 Suppl 1:67.
Liu 2006 {published data only}
    1. Liu Y, Qiao F, Liu H, Liu D. Ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy. Journal of Huazhong University of Science and Technology. Medical Sciences 2006;26(3):350‐2. - PubMed
Luo 2008 {published data only}
    1. Luo DH. Clinical observation on the effect on of Transmetil combined with ursodeoxycholic acid for intrahepatic cholestasis of pregnancy. Modern Journal of Integrated Traditional Chinese and Western Medicine [Xian Dai Zhong Xi Yi Jie He Za Zhi] 2008;17(7):1011‐2.
Nicastri 1998 {published data only}
    1. Nicastri PL, Diaferia A, Tartagni M, Loizzi P, Fanelli M. A randomised placebo‐controlled trial of ursodeoxycholic acid and S‐adenosylmethionine in the treatment of intrahepatic cholestasis of pregnancy. British Journal of Obstetrics and Gynaecology 1998;105:1205‐7. - PubMed
Palma 1997 {published data only}
    1. Meng LJ, Reyes H, Axelson M, Palma J, Hernandez I, Ribalta J, et al. Progesterone metabolites and bile acids in serum of patients with intrahepatic cholestasis of pregnancy: effect of ursodeoxycholic acid therapy. Hepatology 1997;26(6):1573‐9. - PubMed
    1. Palma J, Reyes H, Ribalta J, Hernandez I, Sandoval L, Alumna R, et al. Ursodeoxycholic acid in the treatment of cholestasis of pregnancy: a randomized, double‐blind study controlled with placebo. Journal of Hepatology 1997;27(6):1022‐8. - PubMed
    1. Palma J, Reyes H, Ribalta J, Hernandez I, Sandoval L, Silva O, et al. Ursodeoxycholic acid in cholestasis of pregnancy: final report of a randomized, double‐blind, placebo controlled study. Hepatology 1996;24(4 Pt 2):373A. - PubMed
PITCH 2012 {published data only}
    1. Chappell LC, Gurung V, Chambers J, Seed PT, Williamson C, Thornton JG. PITCH: Two randomised controlled trials in obstetric cholestasis: Ursodeoxycholic acid versus placebo and early delivery versus expectant management. Archives of Disease in Childhood: Fetal and Neonatal Edition 2011;96:Fa110‐Fa111.
    1. Chappell LC, Gurung V, Seed PT, Chambers J, Williamson C, Thornton JG. Ursodeoxycholic acid versus placebo, and early term delivery versus expectant management, in women with intrahepatic cholestasis of pregnancy: semifactorial randomised clinical trial. BMJ 2012;344:e3799. - PMC - PubMed
    1. Gurung V, Chappell L, Seed P, Chambers J, Williamson C, Thornton J. Pitch: Ursodeoxycholic acid versus placebo, and early delivery versus expectant management in the management of intrahepatic cholestasis of pregnancy: Two randomised controlled trials. International Journal of Gynecology and Obstetrics 2012;119(Suppl 3):S363‐4.
    1. Gurung V, Williamson C, Chappell L, Chambers J, Briley A, Broughton Pipkin F, et al. Pilot study for a trial of ursodeoxycholic acid and/or early delivery for obstetric cholestasis. BMC Pregnancy and Childbirth 2009;9:19. - PMC - PubMed
    1. Nelson‐Piercy C. Obstetric cholestasis. BJOG: an international journal of obstetrics and gynaecology 2008;115(s1):20. - PubMed
Ribalta 1991 {published data only}
    1. Ribalta J, Reyes H, Gonzalez MC, Iglesias J, Arrese M, Poniachik J, et al. S‐adenosyl‐L‐methionine in the treatment of patients with intrahepatic cholestasis of pregnancy: a randomized, double‐blind, placebo‐controlled study with negative results. Hepatology 1991;13(6):1084‐9. - PubMed
Riikonen 2000 {published data only}
    1. Gylling H, Riikonen S, Nikkila K, Savonius H, Miettinen TA. Oral guar gum treatment of intrahepatic cholestasis and pruritus in pregnant women: effects on serum cholesterol and other non‐cholesterol sterols. European Journal of Clinical Investigation 1998;28(5):359‐63. - PubMed
    1. Riikonen S, Savonius H, Gylling H, Nikkila K, Tuomi AM, Miettinen TA. Oral guar gum, a gel‐forming dietary fiber relieves pruritus in intrahepatic cholestasis of pregnancy. Acta Obstetricia et Gynecologica Scandinavia 2000;79(4):260‐4. - PubMed
Roncaglia 2004 {published data only}
    1. Roncaglia N, Arreghini A, Locatelli A, Bellini P, Andreotti C, Ghidini A. Obstetric cholestasis: outcome with active management. European Journal of Obstetrics and Gynaecology and Reproductive Biology 2002;100(2):167‐70. - PubMed
    1. Roncaglia N, Locatelli A, Arreghini A, Assi F, Cameroni I, Pezzullo JC, et al. A randomised controlled trial of ursodeoxycholic acid and S‐adenosyl‐L‐methionine in the treatment of gestational cholestasis. BJOG: an International Journal of Obstetrics and Gynaecology 2004;111:17‐21. - PubMed
    1. Roncaglia N, Locatelli A, Bellini P, Arreghini A, Andreotti C, Ghidini A. A randomised controlled trial of ursodeoxycholic acid and S‐adenosyl‐l‐methionine in the treatment of gestational cholestasis [abstract]. American Journal of Obstetrics and Gynecology 2000;182(1 pt 2):S167. - PubMed
Shi 2002 {published data only}
    1. Shi DY, Chen H, Xiao M. Observation on the effect of danxiaoling in supplementary treatment of intrahepatic cholestasis in pregnancy. Zhongguo Zhong Xi Yi Jie He Za Zhi 2002;22(2):116‐8. - PubMed
Zhang 2012 {published data only}
    1. Zhang L, Qi HB, Li Z, Fu XD, Chen L. Multicenter randomized prospective controlled study of ursodeoxycholic acid and s‐adenosyl‐l‐methionine in the treatment of intrahepatic cholestasis of pregnancy. International Journal of Gynecology and Obstetrics 2012;119(Suppl 3):S526.

References to studies excluded from this review

Elias 2001 {published data only}
    1. Elias E. A double blind, randomized placebo controlled trial (DBRCT) or ursodeoxycholic acid in obstetric cholestasis (OC). National Research Register (www.controlled‐trials.com) (accessed 21 November 2001).
Shi 2006 {published data only}
    1. Shi DY, Chen H, Tian XY. Clinical and experimental study on wuling pill in treating gestation period intrahepatic cholestasis. Chinese Journal of Integrated Traditional and Western Medicine 2006;26(2):114‐8. - PubMed

References to studies awaiting assessment

Wang 2003 {published data only}
    1. Wang DZ, Chen J. Study of ursodeoxycholic acid in 64 patients with intrahepatic cholestasis of pregnancy. Journal of Practical Medical Techniques 2003;10(9):991‐2.

References to ongoing studies

Mazzella 2010 {published data only}
    1. Mazzella G, Azzaroli F. Ursodeoxycholic acid and cholestasis of pregnancy. ClinicalTrials.gov accessed 6 June 2011.

Additional references

Alsulyman 1996
    1. Alsulyman OM, Ouzounian JG, Ames‐Castro M, Goodwin TM. Intrahepatic cholestasis of pregnancy: perinatal outcome associated with expectant management. American Journal of Obstetrics and Gynecology 1996;175:957‐60. [MEDLINE: ] - PubMed
Azzaroli 2007
    1. Azzaroli F, Mennone A, Feletti V, Simoni P, Baglivo E, Montagnani M, et al. Clinical trial: modulation of human placental multidrug resistance proteins in cholestasis of pregnancy by ursodeoxycholic acid. Alimentary Pharmacology and Therapeutics 2007;26(8):1139‐46. - PubMed
Bacq 1997
    1. Bacq Y, Sapey T, Brechot MC, Pierre F, Fignon A, Dubois F. Intrahepatic cholestasis of pregnancy: a French prospective study. Hepatology 1997;26:358‐64. - PubMed
Berg 1986
    1. Berg B, Helm G, Petersohn L, Tryding N. Cholestasis of pregnancy. Clinical and laboratory studies. Acta Obstetricia et Gynecologica Scandinavica 1986;65(2):107‐13. - PubMed
Bernhard 1994
    1. Bernhard, JD. General principles, overview and miscellaneous treatments of itching. Itch Mechanisms and Management of Pruritus. New York: McGraw‐Hill, 1994:367‐81.
Beuers 2001
    1. Beuers U, Bilzer M, Chittattu A, Kullak‐Ublick GA, Keppler D, Paumgartner G, et al. Tauroursodeoxycholic acid inserts the apical conjugate export pump, Mrp2, into canalicular membranes and stimulates organic anion secretion by protein kinase C‐dependent mechanisms in cholestatic rat liver. Hepatology 2001;33(5):1206‐16. - PubMed
Beuers 2006
    1. Beuers U, Pusl T. Intrahepatic cholestasis of pregnancy ‐ a heterogenous group of pregnancy‐related disorders?. Hepatology 2006;43(4):647‐9. - PubMed
Boelsterli 1983
    1. Boelsterli UA, Rakhit G, Balazs T. Modulation by S‐adenosyl‐L‐methionine of hepatic Na+,K+‐ATPase, membrane fluidity, and bile flow in rats with ethinyl estradiol‐induced cholestasis. Hepatology 1983;3(1):12‐7. - PubMed
Briggs 2001
    1. Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation. 6th Edition. Philadelphia: Lippincott Williams & Wilkins, 2001.
Bromma 1995
    1. Bromma B, Scharein E, Darsow U, Ring J. Effects of menthol and cold on histamine‐induced itch and skin reactions in man. Neuroscience Letters 1995;187(3):157‐60. - PubMed
Cai 2006
    1. Cai H, Song YH, Xia WJ, Jin MW. Aqueous extract of Yin‐Chen‐Hao decoction, a traditional Chinese prescription, exerts protective effects on concanavalin A‐induced hepatitis in mice through inhibition of NF‐k B. Journal of Pharmacy and Pharmacology 2006;58(5):677‐84. - PubMed
Cantoni 1952
    1. Cantoni GL. The nature of the active methyl donor formed enzymatically from L‐methionine and adenosinetriphosphate. Journal of the American Chemical Society 1952;74(11):2942‐3.
Cunningham 1968
    1. Cunningham MD, Kelley LR, Peters ER. Phenobarbitone in cholestasis. Lancet 1968;291(7551):1089. - PubMed
Davies 1995
    1. Davies MH, Silva RC, Jones SR, Weaver JB, Elias E. Fetal mortality associated with cholestasis of pregnancy and the potential benefit of therapy with ursodeoxycholic acid. Gut 1995;37:580‐4. [MEDLINE: ] - PMC - PubMed
de Swiet 2002
    1. Swiet M. Medical Disorders in Obstetric Practice. Oxford: Blackwell Publishing, 2002.
Diac 2006
    1. Diac M, Kenyon A, Nelson‐Piercy C, Girling J, Cheng F, Tribe RM, et al. Dexamethasone in the treatment of obstetric cholestasis: a case series. Journal of Obstetrics and Gynaecology 2006;26(2):110‐4. - PubMed
Eloranta 2001
    1. Eloranta ML, Heinonen S, Mononen T, Saarikoski S. Risk of obstetric cholestasis in sisters of index patients. Clinical Genetics 2001;60:42‐5. [MEDLINE: ] - PubMed
Fisk 1988
    1. Fisk NM, Storey GN. Fetal outcome in obstetric cholestasis. British Journal of Obstetrics and Gynaecology 1988;95(11):1137‐43. - PubMed
Gaudet 2000
    1. Gaudet R, Merviel P, Berkane N, Schouppe S, Cocheton JJ, Uzan S. Fetal impact of cholestasis of pregnancy: experience at Tenon Hospital and literature review. Fetal Diagnosis Therapy 2000;15(4):191‐7. - PubMed
Germain 2002
    1. Germain A, Carvajal JA, Glasinovic JC, Kato KS, Williamson C. Intrahepatic cholestasis of pregnancy: an intriguing pregnancy‐specific disorder. Journal of the Society for Gynaecologic Investigation 2002;9:10‐4. - PubMed
Gonzalez 1989
    1. Gonzalez MC, Reyes H, Arrese M, Figueroa D, Lorca B, Andresen M, et al. Intrahepatic cholestasis of pregnancy in twin pregnancies. Journal of Hepatology 1989;9:84‐90. [MEDLINE: ] - PubMed
Heikkinen 1981
    1. Heikkinen J, Maentausta O, Ylostalo P, Janne O. Changes in serum bile acid concentrations during normal pregnancy, in patients with intrahepatic cholestasis of pregnancy and in pregnant women with itching. British Journal of Obstetrics and Gynaecology 1981;88(3):240‐5. - PubMed
Heinonen 1999
    1. Heinonen S, Kirkinen P. Pregnancy outcome with intrahepatic cholestasis. Obstetrics and Gynecology 1999;94(2):189‐93. - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Insel 2010
    1. Insel P, Ross D, McMahon K, Bernstein M. Nutrition. Fourth. London, United Kingdom: Jones and Barlett, 2010:154.
Jiang 1986
    1. Jiang ZH, Qiu ZD, Liu WW, Liu YH, Wang QN, Miao HZ, et al. Intrahepatic cholestasis of pregnancy and its complications. Analysis of 100 cases in Chongqing area. Chinese Medical Journal 1986;99(12):957‐60. [MEDLINE: ] - PubMed
Johnston 1979
    1. Johnston WG, Baskett TF. Obstetric cholestasis; a 14 year review. Journal of Obstetrics and Gynecology 1979;133(3):299‐301. - PubMed
Jones 1990
    1. Jones EA, Bergasa NU. The pruritus of cholestasis: from bile acids to opiate antagonists. Hepatology 1990;11:884‐7. - PubMed
Kauppila 1979
    1. Kauppila A, Tuimala R, Ylikorkala O, Reinila M, Ylostalo P. Placental steroid synthesis from DHEAS during dexamethasone therapy. Obstetrics and Gynecology 1979;54:39‐41. - PubMed
Kenyon 2001
    1. Kenyon AP, Piercy CN, Girling J, Williamson C, Tribe RM, Shennan AH. Pruritus may precede abnormal liver function tests in pregnant women with obstetric cholestasis: a longitudinal analysis. BJOG: an international journal of obstetrics and gynaecology 2001;108:1190‐2. [MEDLINE: ] - PubMed
Kenyon 2002
    1. Kenyon AP, Piercy CN, Girling J, Williamson C, Tribe RM, Shennan AP. Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG: an international journal of obstetrics and gynaecology 2002;109:282‐8. - PubMed
Kenyon 2005
    1. Kenyon AP, Girling JC. Obstetric cholestasis. Progress in Obstetrics and Gynaecology 2005;16:37‐56.
Kirkinen 1984
    1. Kirkenen P, Ylostalo P, Heikkinen J, Maentausta O. Gallbladder function and maternal acids in intrahepatic cholestasis of pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology 1984;18:29‐34. - PubMed
Klaasen 1970
    1. Klaasen CD. Effects of phenobarbital on the plasma disappearance and biliary excretion of drugs in rats. Journal of Pharmacology and Experimental Therapeutics 1970;175:289‐300. - PubMed
Krasopoulos 1980
    1. Krasopoulos JC, Bari VA, Needle MA. The adsorption of bile salts on activated carbon. Lipids 1980;15(5):365‐70. - PubMed
Laatikainen 1975
    1. Laatikainen T, Ikonen E. Fetal prognosis in obstetric hepatosis. Annales Chirurgiae et Gynaecologiae Fenniae 1975;64:155‐64. [MEDLINE: ] - PubMed
Lammert 2000
    1. Lammert F, Marshall HU, Glantz A, Matern S. Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. Hepatology 2000;33:1012‐21. - PubMed
Lee 2007
    1. Lee TY, Changa HH, Chen JH, Hsueh ML, Kuo JJ. Herb medicine Yin‐Chen‐Hao‐Tang ameliorates hepatic fibrosis in bile duct ligation rats. Journal of Ethnopharmacology 2007;109(2):318‐24. - PubMed
Lee 2008
    1. Lee RH, Kwok KM, Ingles S, Wilson ML, Mullin P, Incerpi M, et al. Pregnancy outcomes during an era of aggressive management for intrahepatic cholestasis of pregnancy. American Journal of Perinatology 2008;25:341‐5. - PubMed
Lee 2009
    1. Lee TY, Chang HH, Kuo JJ, Shen JJ. Changes of hepatic proteome in bile duct ligated rats with hepatic fibrosis following treatment with Yin‐Chen‐Hao‐Tang. International Journal of Molecular Medicine 2009;23:477‐84. - PubMed
Leevy 1997
    1. Leevy CB, Koneru B, Klein KM. Recurrent familial prolonged intrahepatic cholestasis of pregnancy associated with chronic liver disease. Gastroenterology 1997;113:966‐72. - PubMed
Locatelli 1999
    1. Locatelli A, Roncaglia N, Arreghini A, Bellini P, Vergani P, Ghidini A. Hepatitis C virus infection is associated with a higher incidence of cholestasis of pregnancy. British Journal of Obstetrics and Gynaecology 1999;106(5):498‐500. - PubMed
Meng 1997
    1. Meng LJ, Reyes H, Palma J, Hernandez I, Ribalta J, Sjovall J. Effects of ursodeoxycholic acid on conjugated bile acids and progesterone metabolites in serum and urine of patients with intrahepatic cholestasis of pregnancy. Journal of hepatology 1997;27(6):1029‐40. [PUBMED: 9453429] - PubMed
Milkiewicz 2002
    1. Milkewicz P, Elias E, Williamson C, Weaver J. Obstetric cholestasis. BMJ 2002;324:123‐4. - PMC - PubMed
Mitsuyoshi 1999
    1. Mitsuyoshi H, Nakashima T, Sumida Y, Yoh T, Nakajima Y, Ishikawa H, et al. Ursodeoxycholic acid protects hepatocytes against oxidative injury via induction of antioxidants. Biochemical and Biophysical Research Communications 1999;263:537‐42. - PubMed
Morgan 1993
    1. Morgan LM, Tredger JA, Shavila Y, Travis JS, Wright J. The effect of non‐starch polysaccharide supplementation on circulating bile acids, hormone and metabolite levels following a fat meal in human subjects. British Journal of Nutrition 1993;70:491‐501. - PubMed
Paternoster 2002
    1. Paternoster DM, Fabris F, Palù G, Santarossa C, Bracciante R, Snijders D, et al. Intra‐hepatic cholestasis of pregnancy in hepatitis C virus infection. Acta Obstetricia et Gynecologica Scandinavica 2002;81(2):99‐103. - PubMed
Qui 1983
    1. Qui ZD, Wang QN, et al. Intrahepatic cholestasis of pregnancy: Clinical analysis and follow up of 22 cases. Chinese Medical Journal (English) 1983;96:902‐6. - PubMed
RCOG 2011
    1. Royal College of Obstetricians and Gynaecologists. Obstetric Cholestasis (Guideline No. 43). London: RCOG, 20.
Reid 1976
    1. Reid R, Ivey KJ, Rencoret RH, Storey B. Fetal complications of obstetric cholestasis. British Medical Journal 1976;1(6014):870‐2. - PMC - PubMed
RevMan 2012 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Reyes 1976
    1. Reyes H, Ribalta J, Gonzalez‐Ceron M. Idiopathic cholestasis of pregnancy in a large kindred. Gut 1976;17:709‐13. [MEDLINE: ] - PMC - PubMed
Reyes 1992
    1. Reyes H. The spectrum of liver and gastrointestinal disease seen in cholestasis of pregnancy. Gastroenterology Clinics of North America 1992;21(4):905‐21. - PubMed
Reyes 1997
    1. Reyes H. Review: Intrahepatic cholestasis. A puzzling disorder of pregnancy. Gastroenterology and Hepatology 1997;12:211‐6. - PubMed
Ribalta 1995
    1. Ribalta J, Reyes H, Hernandez I, Fuentes O, Baez M, Gonzalez M, et al. Can a selenium deficiency affect the pathogenesis of cholestasis in pregnancy?. Gastroenterology and Hepatology 1995;18:114‐20. - PubMed
Rioseco 1994
    1. Rioseco AJ, Ivankovic MB, Alejandro M, Hamed F, Kato SR, Parer JT, et al. Intrahepatic cholestasis of pregnancy: a retrospective case‐control study of perinatal outcome. American Journal of Obstetrics and Gynecology 1994;170:890‐5. - PubMed
Robinson 1971
    1. Robinson S H, Yannoni C, Nagasawa S. Bilirubin excretion in rats with normal and impaired bilirubin conjugation: effect of Phenobarbital. Journal of Clinical Investigation 1971;50(12):2602‐13. - PMC - PubMed
Rodrigues 1998
    1. Rodrigues CM, Fan G, Ma X, Kren BT, Steer CJ. A novel role for ursodeoxycholic acid in inhibiting apoptosis by modulating mitochondrial membrane perturbation. Journal of Clinical Investigation 1998;101:2790‐9. - PMC - PubMed
Roncaglia 2002
    1. Roncaglia N, Arreghini A, Locatelli A, Bellini P, Andreotti C, Ghidini A. Obstetric cholestasis: outcome with active management. European Journal of Obstetrics and Gynaecology and Reproductive Biology 2002;100(2):167‐70. - PubMed
Ropponen 2006
    1. Ropponen A, Sund R, Riikonen S, Ylikorkala, Aittomaki K. Intrahepatic cholestasis of pregnancy as an indicator of liver and biliary diseases: a population‐based study. Hepatology 2006;43:723‐8. - PubMed
Roszkowski 1968
    1. Roszkowski I, Pisarek‐Miedzinska D. Jaundice in pregnancy. II. Clinical course of pregnancy and delivery and condition of neonate. American Journal of Obstetrics and Gynecology 1968;101(4):500‐3. - PubMed
Sackett 2000
    1. Sackett DL, Strauss SE, Richardson WS, Rosenberg W, Haynes RB. Therapy. Evidence‐based Medicine: How to Practice and Teach EBM. Second Edition. New York: Churchill Livingstone, 2000:105‐53.
Sadler 1995
    1. Sadler LC, Lane M, North R. Severe fetal intracranial haemorrhage during treatment with cholestyramine for intrahepatic cholestasis of pregnancy. BJOG: an international journal of obstetrics and gynaecology 1995;102(2):169‐70. - PubMed
Shaw 1982
    1. Shaw D, Frohlich J, Wittmann BA, Willms M. A prospective study of 18 patients with cholestasis of pregnancy. American Journal of Obstetrics and Gynecology 1982;142:621‐5. - PubMed
Simmer 1975
    1. Simmer HH, Frankland M, Greipel M. On the regulation of fetal and maternal 16‐a‐hydroxydehydroepiandrosterone and its sulphates by cortisol and ACTH in human pregnancy at term. American Journal of Obstetrics and Gynecology 1975;121:646‐52. - PubMed
Stiehl 1999
    1. Stiehl A, Benz C, Sauer P. Mechanism of hepatoprotective action of bile salts in liver disease. Gastroenterology Clinics of North America March 1999;28(1):195‐209. - PubMed
Stramentinoli 1981
    1. Stramentinoli G, Padova C, Gualano M, Rovagnati P, Galli‐Kienle M. Ethynylestradiol‐induced impairment of bile secretion in the rat: protective effects of S‐adenosyl‐L‐methionine and its implication in estrogen metabolism. Gastroenterology 1981;80(1):154‐8. - PubMed
Vallejo 2006
    1. Vallejo M, Briz O, Serrano MA, Monte MJ, Marin JJ. Potential role of trans‐inhibition of the bile salt export pump by progesterone metabolites in the etiopathogenesis of intrahepatic cholestasis of pregnancy. Journal of Hepatology 2006;44:1150‐7. - PubMed
Walker 2002
    1. Walker IA, Nelson‐Piercy C, Williamson C. Role of bile acid measurement in pregnancy. Annals of Clinical Biochemistry 2002;39:105‐13. - PubMed
Williamson 2001
    1. Williamson C, Gorelik J, Eaton BM, Lab M, Korchev Y, Swiet M. The bile acid taurocholate impair rat cardiomyocyte function: a proposed mechanism for intra‐uterine fetal death in obstetric cholestasis. Clinical Science 2001;100:363‐9. - PubMed
Williamson 2004
    1. Williamson C, Hems LM, Goulis DG, Walker I, Chambers J, Donaldson O, et al. Clinical outcome in a series of cases of obstetric cholestasis identified via a patient support group. BJOG: an international journal of obstetrics and gynaecology 2004;111:676‐81. [MEDLINE: ] - PubMed
Wilson 1979
    1. Wilson BR, Haverkamp AD. Cholestatic jaundice of pregnancy: new perspectives. Obstetrics and Gynecology 1979;54(5):650‐2. [MEDLINE: ] - PubMed
Ylostalo 1975
    1. Ylostalo P, Ylikorkala O. Hepatosis of pregnancy. A clinical study of 107 patients. Annales Chirurgiae et Gynaecologiae Fenniae 1975;64:128‐34. [MEDLINE: ] - PubMed
Zecca 2006
    1. Zecca E, Luca D, Marras M, Caruso A, Tommaso B, Romagnoli C. Intrahepatic cholestasis of pregnancy and neonatal respiratory distress syndrome. Pediatrics 2006;117(5):1669‐72. - PubMed
Zecca 2008
    1. Zecca E, Luca D, Baroni S, Vento G, Tiberi E, Romagnoli C. Bile acid‐induced lung injury in newborn infants: a bronchoalveolar lavage fluid study. Pediatrics 2008;121:e146‐e149. - PubMed

References to other published versions of this review

Burrows 2001
    1. Burrows RF, Clavisi O, Burrows E. Interventions for treating cholestasis in pregnancy. Cochrane Database of Systematic Reviews 2001, Issue 4. [DOI: 10.1002/14651858.CD000493] - DOI - PubMed

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