This is a pilot study aimed at comparing the effect of metformin versus ursodeoxycholic acid in women with intrahepatic cholestasis in pregnancy. The study will be conducted in three NHS hospital sites, over an 18 month period.
Intrahepatic cholestasis is a condition that affects pregnant women. It is characterised by itching, usually in the third trimester of pregnancy and is associated with an increase in the liver enzymes and bile salts. This can be associated with maternal and neonatal morbidity, and rarely perinatal mortality. The investigators propose to assess and compare the effect of Metformin versus Ursodeoxycholic acid on lowering liver enzymes and bile salts, improving maternal morbidity and improving neonatal outcomes. This study is a pilot study that will be conducted at 3 NHS hospital sites where patients will randomly assigned to receive either Metformin or Ursodeoxycholic acid. There will be 20 patient in each arm. Recruitment will commence in February 2017 and will run for an 18 month period.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
40
Metformin Hydrochloride (HCl) Tablets, is an oral antihyperglycemic drug used in the management of type 2 diabetes
Ursodeoxycholic acid (UDCA) is used to treat gallstones and primary biliary cirrhosis. UDCA is also used to treat obstetric cholestasis (OC), a liver condition that occurs specifically in pregnancy.
Normalisation of maternal serum concentration of bile salts and liver enzymes
Normalisation of Bile acids and liver enzymes - both parameters are the cornerstone for a diagnosis of intrahepatic cholestasis. They have been separated into two outcomes due to to the different laboratory indices of measurement. Results will be aggregated together to report number of patients with abnormal results
Time frame: From date of randomisation to date of delivery assessed up to 26 weeks
Normalisation of maternal serum concentration of liver enzymes
Normalisation of liver enzymes Alanine transaminase Aspartate transaminase Bilirubin (total) Gamma glutamyl transferase Results will be aggregated together to report the number of patients with abnormal liver enzymes
Time frame: From date of randomisation to date of delivery assessed up to 26 weeks
Fetal outcomes
Perinatal death
Time frame: From date of randomisation to date of delivery assessed up to 26 weeks
Fetal outcomes
Preterm delivery
Time frame: From date of randomisation to date of delivery assessed up to 26 weeks
Fetal outcomes
Respiratory distress syndrome
Time frame: Immediately upon delivery date
Fetal outcomes
Birth weight (g)
Time frame: Immediately upon delivery date
Fetal outcomes
Birth weight percentile
Time frame: Immediately upon delivery date
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Fetal outcomes
Gestational age at delivery
Time frame: Immediately upon delivery date