Intrahepatic Cholestasis of Pregnancy Clinical Trial
Official title:
The Use of Fish Oil Supplementation in Treatment of Intrahepatic Cholestasis of Pregnancy
Intrahepatic cholestasis of pregnancy (ICP) is a unique disease of the liver resulting in
abnormal bile acid levels and liver function. The incidence of ICP ranges from 0.1 - 15.6%.
Women diagnosed with ICP most often present with itching, which may be severe. More
concerning, however, is the impact of ICP on adverse fetal and pregnancy outcomes, including
preterm delivery, meconium exposure, fetal demise, and increased neonatal respiratory
complications. The risk for fetal demise has been estimated to be 1-3%. The mechanism of
fetal demise in ICP is unknown, and therefore cannot be reliably predicted. There is
evidence to suggest that extremely elevated bile acids levels are associated with worse
fetal outcomes, particularly levels greater than 40 μmol/L.
Ursodeoxycholic acid (UDCA) has anticholestatic effects, and is used to treat a variety of
cholestatic liver diseases. Many studies have demonstrated superiority of UDCA over other
agents, including dexamethasone and cholestyramine, for relief of maternal pruritus,
improvement in transaminitis, reduction in serum bile acid concentrations, and improved
pregnancy outcomes. As a result, UDCA is now widely used as first-line treatment for
symptomatic relief in patients with ICP.
Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are two omega-3 long chain
polyunsaturated fatty acids found in fish. DHA is known to play a key role in early fetal
brain development, and has been associated with modest beneficial effects on
neurodevelopmental and cognitive outcomes in children. In neonates with parental
nutrition-induced cholestasis (PN-cholestasis), parental fish oil has been shown to be
hepatoprotective not only for treatment of PN-cholestasis, but for prevention of cholestasis
in premature infants at risk for the disease. Our hypothesis is that fish oil
supplementation with DHA in women with ICP who are treated with UDCA will increase the rate
of decline in serum total bile acid levels.
The incidence of ICP at a single hospital center in Queens, NY is estimated to be 5%
secondary to a high concentration of patients from high-risk ethnic groups. High risk
patients with bile acid levels greater than or equal to 40 μmol/L are managed aggressively
with inpatient admission for continuous fetal monitoring, treatment with UDCA, and serial
total bile acid levels weekly. These are patients are routinely offered early delivery after
documented fetal lung maturity between 36 and 37 weeks gestation, or for any signs of fetal
distress. This study is a prospective randomized controlled trial comparing weekly serum
total bile acid levels in women admitted for inpatient management of ICP among women
supplemented with a standard prenatal vitamin versus supplementation with a prenatal vitamin
and DHA.
Status | Withdrawn |
Enrollment | 0 |
Est. completion date | May 2013 |
Est. primary completion date | May 2013 |
Accepts healthy volunteers | No |
Gender | Female |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - All pregnant women aged 18 years or older admitted to Elmhurst Hospital Center (EHC) for inpatient management of ICP due to a serum total bile acid level > 40 µmol/L, or serum total bile acid level > 10 µmol/L with elevated AST or ALT, are eligible for enrollment Exclusion Criteria: - Women < 18 years - Women with allergies to fish |
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment
Country | Name | City | State |
---|---|---|---|
n/a |
Lead Sponsor | Collaborator |
---|---|
Icahn School of Medicine at Mount Sinai |
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Bile acid levels | reduction in bile acid levels. Weekly (as part of standard hospital laboratory protocol for admission with intrahepatic cholestasis of pregnancy) | up to 9 months | No |
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