In plain words
Ursodeoxycholic acid, often called UDCA or ursodiol, is a bile acid that occurs naturally in small amounts. It is a prescription medicine used in some liver conditions. In pregnancy, some providers prescribe it for intrahepatic cholestasis, a liver condition that causes , usually on the hands and feet and worse at night. Its effect on the itch is mixed. A large trial found it did not lower the combined risk of , preterm birth, or newborn unit admission. Some guidelines allow it for the itch, and they use bile acid levels to decide when to deliver. Whether it belongs in a given plan is a question for the provider.
The deeper version
UDCA is a hydrophilic bile acid that displaces more toxic hydrophobic , stabilizes hepatocyte membranes, and may reduce cholangiocyte injury. The PITCHES randomized trial (Chappell et al., Lancet 2019; 605 women) found no reduction in the composite of adverse perinatal outcomes, and the effect on itch was mixed. The SMFM Consult Series 53 (2021) and RCOG Green-top Guideline 43 (2022) incorporate these findings, use bile acid level for delivery timing, and differ on how much weight to give itch relief. Whether UDCA lowers stillbirth risk in subgroups remains an open question.
Where it comes up
- Itching that won't stop: cholestasisPregnancy: Your Body
- Skin in pregnancy: stretch marks, linea nigra, melasma, itchingPregnancy: Your Body
- Baby moving less: what to doPregnancy: Your Body
What mothers here say about ursodeoxycholic acid
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Sources
- Chappell LC et al. for the PITCHES trial — Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial. Lancet 2019
- Society for Maternal-Fetal Medicine — Consult Series 53: Intrahepatic cholestasis of pregnancy, 2021
- Royal College of Obstetricians and Gynaecologists — Green-top Guideline No. 43: Intrahepatic Cholestasis of Pregnancy, 2022