Keywords :
Intrahepatic cholestasis, Liver disease in pregnancy, Progesterone
Citation Information :
Ranjan K, Soumyashree T, Nair P, Prasad M, Mounika MS. Progesterone Support as a Cause for Early Intrahepatic Cholestasis of Pregnancy: A Case Series. J South Asian Feder Obs Gynae 2023; 15 (5):627-628.
Progesterone is extensively used in pregnancy support and the increasing incidence of high-risk pregnancy may need further extensive progesterone usage. While intrahepatic cholestasis of pregnancy (IHCP) is primarily a third trimester problem, few cases of early onset IHCP are documented. In this context, a series of three cases of IHCP among pregnant patients who used progesterone is described. Mechanisms of this otherwise rare occurrence are discussed. Association between progesterone use and early onset IHCP merits further study.
Dante G, Vaccaro V, Facchinetti F. Use of progestagens during early pregnancy. Facts Views Vis Obgyn 2013;5(1):66–71. PMID: 24753930.
Saccone G, Schoen C, Franasiak JM, et al. Supplementation with progestogens in the first trimester of pregnancy to prevent miscarriage in women with unexplained recurrent miscarriage: a systematic review and meta-analysis of randomized, controlled trials. Fertil Steril 2017;107(2):430–438.e3. DOI: 10.1016/j.fertnstert.2016.10.031.
Smith DD, Rood KM. Intrahepatic cholestasis of pregnancy. Clin Obstet Gynecol 2020;63(1):134–151. DOI: 10.1097/GRF.0000000000000495.
Girling J, Knight CL, Chappell L. Royal College of Obstetricians and Gynaecologists. Intrahepatic cholestasis of pregnancy: Green-top Guideline No. 43 June 2022. BJOG 2022;129(13):e95–e114. DOI: 10.1111/1471-0528.17206.
Meng LJ, Reyes H, Axelson M 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):1573–1579. DOI: 10.1002/hep.510260627.
Maiskar V, Surve S. Early onset intrahepatic cholestasis of pregnancy: Is progesterone supplementation to be blamed for? J Obstet Gynaecol India 2019;69(2):192–193. DOI: 10.1007/s13224-018-1174-9.
Abu-Hayyeh S, Papacleovoulou G, Lövgren-Sandblom A, et al. Intrahepatic cholestasis of pregnancy levels of sulfated progesterone metabolites inhibit farnesoid X receptor resulting in a cholestatic phenotype. Hepatology 2013;57(2):716–726. DOI: 10.1002/hep. 26055.
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012–. Progestins. 2020 Jun 1. PMID: 31643562.
Estiú MC, Monte MJ, Rivas L, et al. Effect of ursodeoxycholic acid treatment on the altered progesterone and bile acid homeostasis in the mother-placenta-foetus trio during cholestasis of pregnancy. Br J Clin Pharmacol. 2015;79(2):316–329. DOI: 10.1111/bcp.12480.
Maiskar V, Surve S. Early onset intrahepatic cholestasis of pregnancy: is progesterone supplementation to be blamed for? J Obstet Gynaecol India 2019;69(2):192–193. DOI: 10.1007/s13224-018- 1174-9.
