Cholestasis of Pregnancy: Symptoms & Causes

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Most pregnant women experience severe itching (main symptom) in their late pregnancy and the common cause behind this is cholestasis, which is a common liver disease or liver disorder that is experienced only in pregnancy. In other words, the intrahepatic Cholestasis of Pregnancy (ICP) is a condition where the normal flow of bile acid is affected due to the increased amounts of the pregnancy hormones.

The symptoms of cholestasis occur in the third trimester of pregnancy, that is when hormones are at their peak and also fade away within a few days post giving birth. It is also at times referred to as extrahepatic cholestasis when it occurs outside the liver, and on the other hand, when it occurs inside the liver, the term used is intrahepatic cholestasis or obstetric cholestasis.

As noticed by the Cincinnati Children’s Hospital Medical Center, intrahepatic cholestasis of pregnancy affects about 1 out of 1,000 pregnant women and is more common in Swedish and Chilean ethnic groups.

But, what causes cholestasis of pregnancy ICP? What are the signs and symptoms of cholestasis? Can it be treated? If you have these questions in mind, continue reading this article curated by Parenthood bliss to get all your answers, also feel free to contact us regarding any questions.

What causes intrahepatic cholestasis of pregnancy ICP?

None other than the pregnancy hormones causes cholestasis. It affects the bile acid levels of the liver in pregnant women and results in liver disease as it slows or stops the flow of bile. In ICP, the gallbladder tends to hold the bile that is responsible to break down fats in the digestion, produced by the liver. This causes a build-up of the bile acids in the liver and is capable of spilling into the bloodstream, which as per pregnant women tends to get worse at night.

As far as diagnosing an ICP is concerned, it is done when the total bile acid (TBA) or the serum bile acid is measured at about 10 micromol/L and above. The studies have shown that the cause of the increase in the bile acids is due to the pregnancy hormone called estrogen alone. But, recent research suggests the progesterone to rather contribute just as much as to its backup.

Symptoms of obstetric cholestasis

As per the health information, the symptoms of obstetric cholestasis may include:

  • Severe itching, particularly on the palms of the hands and feet
  • Yellow dark urine
  • Pain in the right upper quadrant (RUQ) with no gallstones
  • Bowel movements that are pale or light in color
  • Fatigue or exhaustion
  • Loss of appetite
  • Depression
  • Whites of the eyes
  • Fetal distress
  • Jaundice or yellowing of the skin to the soles of the feet and mucous membranes
  • Nausea

What are the risks caused by the decrease of bile acids in ICP?

As per the studies, about 1 to 2 pregnancies amongst the total of 1,000 pregnant women experience the risk of developing cholestasis due to the decreased bile flow in their last weeks of pregnancy.

Here are the women who have a higher risk of getting intrahepatic cholestasis of pregnancy or ICP:

  • Women carrying multiples
  • Those who had faced liver damage in the past
  • The women with mothers or sisters who had cholestasis or ICP

How is obstetric cholestasis diagnosed?

The obstetric cholestasis is diagnosed by the doctor by considering a complete medical history of your family, a physical examination, or via blood tests to evaluate the functioning of the liver, bile acids, and bilirubin.

According to the Maternal-Fetal Medicine, the ICP must be diagnosed when the total bile acid (TBA) or the serum bile acid is measured around 10 micromol/L or above.

If you are diagnosed with cholestasis, there is an increased risk of fetal distress, preterm birth, or stillbirth. This distress late in pregnancy affects the baby as they rely on the mother’s liver to remove bile acids from the blood, therefore, the elevated levels of the maternal bile cause stress on the baby’s liver.

Treatment for cholestasis of pregnancy

The main symptom of cholestasis of pregnancy is severe itching. Therefore, if you experience any, make sure you consult your healthcare provider before you take any medications or supplements.

Here are a few treatments to treat ICP:

  • Topical anti-itch medications that include corticosteroids
  • Medication to help decrease the concentration of the bile acids like ursodeoxycholic acid
  • Take cold baths as ice water helps slow down the flow of blood in the body resulting in the decrease of the temperature
  • Dexamethasone increases the maturity of the lungs of the baby
  • Vitamin K supplements for the mother before delivery and then once the baby is born. This will help prevent intracranial hemorrhaging
  • You can have dandelion root and milk thistle. They are natural substances beneficial for the liver
  • Have a bi-weekly non-stress test. This involves fetal heart monitoring and contraction recordings
  • Regular blood tests that help monitor both, the levels of bile serum and liver function

 

Also, the physician who will determine the test will need to take an account of the following into consideration:

  • The pregnancy
  • Overall health
  • Medical history
  • The extent of the disease
  • Your tolerance on specific medications, procedures, or therapies
  • Expectations of the course of the disease
  • Your preference

 

Note – Treatments like Antihistamines, Aveeno, and Oatmeal Bath must not be used for cholestasis.

Does cholestasis of pregnancy affect future pregnancies?

Cholestasis of pregnancy has a nearly zero percent chance to affect future pregnancies. Therefore, if at all you are planning for a future pregnancy, make sure to consult your healthcare provider to take the necessary steps in order to prevent intrahepatic cholestasis of pregnancy.

Conclusion

Cholestasis of pregnancy is a liver function that affects the expecting women in their weeks of pregnancy up to their early delivery. However, this ICP condition goes away within a few days after delivery and helps relieve itching naturally. Just in case it does not, make sure to contact your doctor immediately.

FAQs on Cholestasis of Pregnancy

1) How serious is cholestasis of pregnancy?

Cholestasis of pregnancy is a severe complication for your developing baby. The complications may include, fetal distress.

2) How is cholestasis treated in pregnancy?

In order to soothe the severe itching, the health care provider could recommend taking a prescription drug called ursodiol (Actigall, Urso, Urso Forte). This drug helps lower the level of bile acid in the blood. You can also try soaking the itchy areas in cool or lukewarm water.

3) How do I know if I have cholestasis of pregnancy?

The main symptom or condition of cholestasis of pregnancy include severe itching amongst the other less common symptoms. This itching is sometimes called pruritus that may affect the whole body but is commonly found on the palms and the soles of the feet.

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