Efficacy and Safety of Intravenous S-Adenosyl-L-Methionine Therapy in the Management of Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) requires the earliest possible treatment, as it increases the risk of premature delivery and fetal distress. Furthermore, the severity of pruritus in ICP may interfere with the mother’s well-being. We present results of a trial involving an additional 55 cases of ICP (mean age 29 years), who received SAMe 800 mg/day intravenously at the onset of ICP, for 10 to 30 days. Clinical assessment of pruritus and measurements of serum total bile salts (STBS), serum total and conjugated bilirubin (STB, SCB), serum alkaline phosphatase (SAP), and aspartate and alanine aminotransferases (AST, ALT) were performed before and after therapy. SAMe treatment significantly (p < 0.01) decreased STBS (18.3 ± 3.4 vs 23.1 ± 3.4 μmol/L), SCB (7.8 ± 0.8 vs 10.7 ± 1.2 μmol/L), SAP (4.7 ± 0.2 vs 6.1 ± 0.3 μkat/L), AST (0.9 ± 0.1 vs 2.0 ± 0.2 μkat/L), and ALT (1.6 ± 0.1 vs 2.9 ± 0.2 μkat/L) levels compared with basal values. At baseline, most patients exhibited normal STB and therefore no significant change in this parameter was recorded after therapy. Pruritus was significantly improved after SAMe treatment, and was reduced in 15 patients and had disappeared in 40 patients. No adverse reactions were observed. There were no cases of premature labour, and all newborns had normal Apgar scores (mean 8.2) and were of normal weight for gestational age. These results further support the use of SAMe therapy in ICP.