Cholestasis of pregnancy, medically known as intrahepatic cholestasis, is a liver disorder that typically develops late in pregnancy. It makes the affected women extremely uncomfortable, triggering itching with no rash on hands, feet or other body parts, but resolves after childbirth. However, the aspect to worry about is that it can cause potential issues to the baby and due to complications, your healthcare provider may suggest delivery as early as 37 weeks. Continue reading to know all about this condition.
Also known as ICP, intrahepatic cholestasis of pregnancy, or obstetric cholestasis, is a liver disorder that appears late in pregnancy and results in severe itching. This condition reduces liver function due to the accumulation of bile in the bloodstream and the liver. Bile is produced by the liver and stored in the gallbladder. When you eat, this substance breaks down fats and food gets digested properly. When bile levels are high, it causes itching. This condition, though not serious for the mother, can cause complications for the fetus. If you are diagnosed with this condition, it should be carefully monitored to reduce complications.
The exact reason for this condition is not clear and can be the result of high levels of bile acids in the bloodstream, which lead to symptoms and complications. Genetics, hormones and pregnancy may play a role.
● Genes: Certain genes have been identified that may cause this condition. This typically runs in the family.
● Hormones: As your due date approaches, the pregnancy hormones (progesterone and estrogen) increase, and that may slow bile flow, causing it to accumulate in the liver and enter the blood, resulting in ICP.
● Environment: The exact factors are unclear, and the risk depends on the season and geographical location.
● Family or personal history of this liver condition.
● A history of liver disease or damage, including gallbladder stones and hepatitis C.
● Carrying multiple babies.
● Pregnancy at over 35 years of age
If you have had cholestasis in your previous pregnancy, the risk of having it in another pregnancy increases in about 60-70% of women and is called recurrence. In some cases, the percentage can go as high as 90%.
Pruritus or severe itching is one of the primary signs of this condition. The itching spreads to various parts, starting from the hands and feet and worsens at night. Even if you experience itching during pregnancy, this condition does not cause a rash. Other symptoms may include:
● Dark urine
● Nausea
● Pale or clay-coloured stools
● Reduced appetite
● Extreme fatigue
● Pain in the upper right abdomen
● Yellowing of the whites of the eyes and skin (jaundice)
Cholestasis is an uncommon condition and affects 1 in 1000 women in pregnancy. Typically, more women are diagnosed with this condition during winter than at other times. It is likely to begin in the third trimester or after 28 weeks, but may start earlier.
If you have itching without any rashes, your doctor may diagnose it as cholestasis in pregnancy. Lab tests are recommended to confirm it. The following tests are prescribed:
● Liver function: This test detects the levels of bile acid in your blood. If it is high, then you have cholestasis of pregnancy. It also checks your liver function
● Prothrombin time: This detects how the blood clots
● Ultrasound: To examine the functioning of the liver and the bile duct tube, which transports bile.
The diagnosis is confirmed when the bile acids are more than 10 micromoles/litre. A micromole is a measurement unit used in such tests. If you have this condition, regular blood tests will be a feature for the rest of your pregnancy to monitor the bile levels.
Your doctor will provide treatment based on your health history, overall health, your pregnancy, how well you feel and how you can handle therapies, procedures and medications. The treatment goal is to relieve itching and prevent complications for the baby. Treatment includes:
● Medicine: Anti-itch medicine to relieve itching and reduce bile levels in the blood. If the serum bile acid is high, your doctor will treat it.
● Fetal monitoring: The doctor may check your fetus for any possible issues.
● Management: Wearing loose-fitting and soft clothing. Soak in a lukewarm bath and rest.
● Early delivery: You may deliver between 37 and 38 weeks to reduce complications for the baby. It can be a vaginal or a cesarean delivery depending on your pregnancy history, test results and symptoms. If you deliver the baby early, you may be given steroids to help the baby’s lungs mature, along with vitamin K supplements to reduce the risk of haemorrhage.
This liver condition may lead to complications. You may have issues with vitamin K absorption, which puts you at a risk of heavy internal bleeding (haemorrhage). It can also increase the risk of gestational diabetes and preeclampsia.
The fetal complications of cholestasis of pregnancy are:
● Fetal distress: This means the fetus is not well. For instance, there may not be enough oxygen supply to the baby.
● Premature birth: There is an increased risk of giving birth early
● Stillbirth: There is an increased risk of the death of the baby.
● Meconium in amniotic fluid: The first stool, meconium, is present in the amniotic fluid before birth, which may cause serious respiratory issues and breathing problems.
An early delivery may be recommended to prevent complications for the baby. However, because you have this liver condition, it does not mean an unhealthy baby will be born. If the condition is monitored and managed carefully, you can have a healthy baby.
Call your doctor if the itching increases or if you see yellowing of your eyes, skin, or mucous membranes (jaundice).
Outlook for Women with Cholestasis of Pregnancy
For most women, this liver condition goes away after a few days of childbirth. Bile acid levels return to optimal post-delivery, and you can stop medications after they return to normal. Most women will not have any liver issues until they get pregnant again. There is more than a 60% chance of you having cholestasis in your subsequent pregnancy. If you have had a severe case of this condition, the chances drastically increase.
There is no way to prevent this condition during pregnancy. You may undergo genetic tests to determine the chances of passing it to your baby.
A pregnancy liver disorder, cholestasis, causes severe itching. If you have this condition, your doctor will monitor you by recommending regular blood tests to make sure there are no risks to the baby. This condition is not life-threatening for you and goes away after the baby’s birth. If there are risks for the baby, your doctor may deliver the baby as early as 37 weeks of pregnancy as a safe option.
