Cholestasis of pregnancy is a liver disease, also called intrahepatic cholestasis of pregnancy(ICP), that develops in late pregnancy. The disorder causes severe itching without causing a rash. Itching is most common on the hands and feet, but it can occur anywhere on the body.
Your skin may be drier and itchier than normal due to hormonal changes during pregnancy. But in the case of ICP, you will feel a sharp itch on the palms of your hands and the soles of your feet.
Cholestasis during pregnancy can be very uncomfortable. However, the possible consequences for the mother and the unborn baby are of more concern. Your doctor may recommend a premature birth because of the risk of problems.
What Is Cholestasis?
Cholestasis of pregnancy is a potentially dangerous liver disorder that produces extreme itching. It occurs when bile begins to build up in the liver.
The liver is a vital organ for processing and cleaning. Your liver, in addition to producing nutrients for your body to consume, helps remove wastes that your body does not need, in part through the production of bile. Cholesterol, water, electrolytes, bile salts or bile acids, and bilirubin make up this greenish-yellow liquid.
The liver excretes bile, which is then stored in the gallbladder. Your gallbladder sends bile into your small intestine every time you eat, which helps break down lipids. However, when you have cholestasis when you are pregnant, bile salts start to build up in your liver. The bile acids can then seep into the bloodstream and tissues, causing them to be excruciatingly itchy.
Although the specific origin of cholestasis of pregnancy is unknown, hormonal and genetic factors are believed to play a role. During the third trimester, when pregnancy hormones are at their highest, high levels of progesterone and estrogen can restrict the passage of bile through the liver. Cholestasis is more common in women who have a family history of the disease.
About two-thirds of women who have had cholestasis during pregnancy will experience it again in subsequent pregnancies. It is also more likely in women who are pregnant with multiple people or with a history of liver disease or injury.
Cholestasis of Pregnancy Symptoms
If you have any of the following symptoms of cholestasis during pregnancy, contact your doctor or midwife:
- Intense itching: The earliest and most visible symptom of cholestasis is severe itching without a rash. The itching normally begins in the third trimester and affects the palms and soles of the feet, although it can occur elsewhere on your body and is usually worse at night. Itching from cholestasis of pregnancy is much worse than the moderate itching that many pregnant women experience from dry, stretched skin.
- Malaise or Lack of Appetite: You may have moderate nausea or a general feeling of sickness or discomfort, and you may have trouble eating. You may also feel pain in the upper right part of your abdomen.
- Jaundice: You may notice yellowing of the skin or eyes when bilirubin levels rise in your blood.
- Unusual urine and faeces: Your urine may be darker than usual, while your faeces are lighter than usual (or greyish).
Although cholestasis of pregnancy cannot cause a rash, you may have red, itchy, and small cuts in areas where you scratch frequently.
If you think you have cholestasis, contact your doctor. Cholestasis can be risky for your infant if it is not treated and monitored.
Intrahepatic Cholestasis of Pregnancy
Cholestasis of pregnancy is also known as ICP (intrahepatic cholestasis of pregnancy). Although the term is slightly different, the causes, symptoms, and therapies are the same.
How Is Cholestasis of Pregnancy Diagnosed?
If you have significant itching, your doctor likely suspects that you have cholestasis of pregnancy. Laboratory tests will help confirm the diagnosis.
It can be subjected to the following tests:
- Prothrombin time is one of the other laboratory tests. This procedure determines how well your blood clots.
- The amount of bile acid in the blood is measured as part of liver function tests. The result of this test is abnormally high in pregnant cholestasis.
Other diagnoses may be made, such as an ultrasound examination of the bile ducts (bile ducts).
Treatment of Cholestasis of Pregnancy
Ursodeoxycholic acid is the most common treatment for cholestasis during pregnancy (AUDC, also known as Actigall or Ursodiol). This medicine can help your liver to work better by reducing the amount of bile acid in your blood.
Your doctor may prescribe anti-itch medication if you are still itchy. You can also relieve itching by squeezing an ice cube on it or soaking in a cold or oatmeal bath. Wear loose, loose clothing.
As part of your treatment for pregnancy cholestasis, you will likely have regular ultrasounds and fetal heart monitoring to keep an eye on your baby. You may continue to have blood tests to monitor your liver function and bile levels.
If medications fail to lower bile levels, or if an ultrasound or heart monitor shows a problem, your baby will deliver immediately. Otherwise, the birth may be postponed to give your baby more time to mature, depending on you and your baby’s condition and the progress of your pregnancy. However, to reduce the risk of stillbirth, you will most likely be induced or have a Caesarean section before the due date.
The cholestasis and itching will go away once your baby is born, usually within a few days, and will only cause minor liver problems in the future. Cholestasis can occur again in a subsequent pregnancy, so be sure to let your doctor know if you have had it before.
Can You Have a Healthy Baby With Cholestasis?
Cholestasis increases the risk of various problems during pregnancy, including:
- Premature Birth, or childbirth before the 37th week of pregnancy
- Respiratory Distress Syndrome (RDS), a disorder in which a baby’s lungs do not have enough surfactant to properly inflate; is more common in premature infants.
- Stillbirth, or death of an unborn child after the 20th week of pregnancy
- Postpartum Bleeding in mothers: Vitamin K deficiency and blood clotting problems are rare consequences of a temporarily reduced ability to absorb fat from the diet.
- Aspiration of Meconium, because cholestasis of pregnancy makes it more likely that meconium (your baby’s first stools) will pass from the intestines into the amniotic fluid, your baby may inhale meconium into his lungs.
The higher the levels of bile acids in your blood and the closer you are to your due date, the greater the risk to your baby. As a result, your provider will keep a close eye on you and your baby will likely be born before you reach term.
Symptoms of cholestasis usually go away a few days after childbirth for most pregnant women. If you still have itching and other symptoms, your doctor will examine you to find out if you have a liver problem or other health problems.