Protocol · Women's Health
Intrahepatic Cholestasis of Pregnancy Supportive Care Protocol
S-Adenosylmethionine (SAMe) and Ursodeoxycholic Acid (UDCA) are the core of this stack, with 4 supporting supplements. Each row gives the amount the protocol lists and the grade our evidence database holds for that supplement in Intrahepatic Cholestasis of Pregnancy Supportive Care.
We are re-verifying the studies cited on protocol pages; only confirmed citations are shown.
The stack
6 supplements · none graded yet
| Grade | Supplement | Amount listed | Why it’s in the stack | Evidence on file |
|---|---|---|---|---|
| Primary stackThe core of this protocol | ||||
| S-Adenosylmethionine (SAMe) | Amount listed: 800–1,600 mg daily in divided doses | Supports liver methylation and bile acid metabolism; may reduce symptoms and improve liver function
| Not graded yet | |
| Ursodeoxycholic Acid (UDCA) | Amount listed: 10–15 mg/kg/day (prescription medication) | Primary treatment; reduces bile acid levels and improves liver function (prescription) | Not graded yet | |
| Supporting stackListed as additions to the core | ||||
| Vitamin K | Amount listed: 2.5–10 mg daily (as directed by physician) | May be depleted in cholestasis due to fat malabsorption; supports clotting and fetal bone development | Not graded yet | |
| Vitamin D | Amount listed: 2,000–4,000 IU daily | Absorption may be impaired in cholestasis; supports maternal and fetal bone health | Not graded yet | |
| Vitamin E | Amount listed: 200–400 IU daily | Fat-soluble vitamin that may be depleted in cholestasis; antioxidant protection | Not graded yet | |
| Omega-3 Fatty Acids | Amount listed: 1–2 g DHA+EPA daily | Supports fetal development; may have anti-inflammatory effects | Not graded yet | |
How this protocol works
In plain language
Intrahepatic Cholestasis of Pregnancy (ICP) is a liver condition that occurs in the third trimester, causing intense itching (especially on the palms and soles) due to elevated bile acids in the blood. ICP affects about 1% of pregnancies and is associated with increased risks of preterm birth, fetal distress, and stillbirth if not managed. The condition resolves after delivery but may recur in future pregnancies.
CRITICAL: ICP requires medical management and close monitoring. The primary treatment is ursodeoxycholic acid (UDCA), a prescription medication that reduces bile acid levels and improves outcomes. Fetal monitoring (non-stress tests, sometimes biophysical profiles) is essential, and early delivery (typically 36-37 weeks) is often recommended depending on bile acid levels and other factors. These supplements may provide additional support but DO NOT replace UDCA therapy or obstetric monitoring. Inform your obstetrician about all symptoms - severe itching should prompt bile acid testing.
S-Adenosylmethionine (SAMe)* supports liver methylation pathways involved in bile acid metabolism. Meta-analyses show SAMe can reduce symptoms (itching, liver enzymes) in ICP, sometimes used in combination with UDCA.
Ursodeoxycholic Acid (UDCA)* is the primary treatment (prescription medication included here for completeness). It's a bile acid that reduces toxic bile acid levels and has been shown to improve maternal symptoms and possibly fetal outcomes.
Vitamin K* may be depleted in cholestasis due to reduced bile salts impairing fat absorption. Supplementation is important to prevent bleeding complications in mother and baby.
Vitamin D* absorption may also be impaired. Maintaining adequate levels supports maternal and fetal bone health.
Vitamin E* is another fat-soluble vitamin that may be affected by cholestasis.
Omega-3 Fatty Acids* support fetal brain and eye development and may have anti-inflammatory effects.
Expected timeline: SAMe effects may be noticed within 2-3 weeks. UDCA typically improves itching and bile acids within 1-2 weeks. ICP resolves quickly after delivery.