The liver condition intrahepatic cholestasis of pregnancy, also known as cholestasis of pregnancy, develops in late pregnancy. The syndrome causes severe itching but no rash. Itching commonly occurs on the hands and feet, but it can occur anywhere on the body.
Cholestasis during pregnancy can be exceedingly uncomfortable. However, the possible consequences for you and your baby are more concerning. Because of the possibility of complications, your doctor may advise you to have your baby early.
WHAT ARE THE SYMPTOMS OF CHOLESTASIS OF PREGNANCY?
The main symptom of pregnant cholestasis is intense itching. There is nothing rash. Most women experience itching on the palms of their hands or the soles of their feet, while some have itching all over. The itching is usually stronger at night and can be so irritating that you can't sleep.
Itching is most frequent in the third trimester of pregnancy, but it can start earlier. It may get more difficult as your due date approaches. However, once your baby is born, the itchiness normally subsides within a few days.
Other less common indications and symptoms of pregnant cholestasis include:
- Yellowing of the skin and eye whites (jaundice)
- Nausea
- Appetite loss
WHAT ARE THE CAUSES OF CHOLESTASIS OF PREGNANCY?
The etiology of pregnant cholestasis is unknown. Your genes may be involved. The disease can sometimes run in families. A number of genetic variations have also been discovered.
Pregnancy hormones may also play a role. Pregnancy hormones surge as your due date approaches. Doctors believe this may impair the regular flow of bile — the digestive fluid produced by the liver that aids in fat digestion. Bile accumulates in the liver rather than leaving it. As a result, bile salts eventually reach the bloodstream, causing itching.
WHAT ARE THE RISK FACTORS FOR CHOLESTASIS OF PREGNANCY?
Some variables that may enhance your chances of having pregnant cholestasis include:
- Personal and family history of cholestasis of pregnancy
- A history of liver illness or damage
- Having twins or more
A recurrence affects 60 to 70 percent of women. In severe cases, the probability of recurrence can reach 90 percent.
WHAT ARE THE COMPLICATIONS OF CHOLESTASIS OF PREGNANCY?
Pregnancy cholestasis can cause complications in either the mother or the growing infant.
The disease may temporarily impair the way the body absorbs fat in mothers. Low levels of vitamin K-dependent components implicated in blood coagulation may come from poor fat absorption. However, this consequence is uncommon, and further liver problems are unlikely.
The effects of pregnancy cholestasis can be severe in newborns. They could include:
- Being born too soon (preterm birth)
- Lung issues caused by breathing in meconium — a sticky, green substance that ordinarily collects in the developing baby's intestines but can enter the amniotic fluid if the mother has cholestasis.
- Premature death of the infant during pregnancy (stillbirth)
Because difficulties can be extremely risky to your baby, your doctor may suggest inducing labor before your due date.
HOW IS CHOLESTASIS OF PREGNANCY DIAGNOSED?
To diagnose pregnant cholestasis, your pregnancy care provider will:
- Inquire about your symptoms and medical history.
- Conduct a physical examination
- Order blood tests to determine how well your liver is functioning and to determine the quantity of bile salts in your blood.
WHAT ARE THE TREATMENTS FOR CHOLESTASIS OF PREGNANCY?
The goals of treatment for pregnant cholestasis are to relieve itching and prevent issues in your baby.
Itching relief
Your prenatal care provider may recommend the following to relieve severe itching:
- Taking ursodiol (Actigall, Urso, Urso Forte), a prescription medication that helps to lower the level of bile in your blood. Other itching treatments may also be available.
- Soaking irritated areas with cool or warm water.
It is best to consult with your prenatal care provider before beginning any itching drugs.
Keeping track of your child's health
Pregnancy cholestasis has the potential to complicate your pregnancy. Your pregnancy care provider may advise you to keep a careful eye on your baby while you're pregnant.
Monitoring and therapy may involve the following:
- Nonstress testing: Your pregnancy care provider will examine your baby's heart rate and how much it increases with exercise during a nonstress test.
- Fetal biophysical profile (BPP): This battery of tests is used to keep track of your baby's health. It tells you about your baby's activity, muscle tone, respiration, and the amount of amniotic fluid in his or her womb. While the findings of a nonstress test or BPP can be comforting, they do not accurately predict the risk of preterm birth or other issues related with pregnancy cholestasis.
- Early labor induction: Even if your prenatal testing are normal, your pregnancy care provider may advise you to induce labor before your due date to reduce the risk of stillbirth.
HOME REMEDIES FOR CHOLESTASIS OF PREGNANCY
Home cures may not provide much comfort for itching caused by pregnant cholestasis. But it doesn't hurt to try these calming remedies:
- Cool baths may help some women's itching seem less acute.
- Oatmeal baths, creams, and lotions may help to calm the skin.
- Icing a very itchy spot of skin may provide temporary relief.