Cholestasis of pregnancy, also known as obstetric cholestasis or intrahepatic cholestasis of pregnancy, can cause severe itching, especially on the hands and feet.
It usually occurs late in the second trimester or during the last trimester of pregnancy.
The condition does not usually pose a serious risk for the mother's long-term health, but it may cause severe complications for the infant.
The term "cholestasis" comes from the Greek words "chole" meaning "bile" and "stasis," meaning "still."
Cholestasis happens when the liver cannot excrete bile properly. Bile is a fluid that helps the body process fat.
The following signs and symptoms may be present in cases of cholestasis of pregnancy:
- intense itching, especially on the palms of the hands and soles of the feet
- dark urine
- light-colored feces
- jaundice, giving the whites of the eyes, skin and tongue a yellowish or orangey tinge
The itchiness may be the only symptom, and it often becomes worse during the night.
A pregnant woman who has any of the signs or symptoms mentioned above should tell a health care professional as soon as possible, because they could indicate a risk for her unborn baby.
Treatment may not be necessary if cholestasis is mild and occurs late in pregnancy. Treatment normally aims to relieve symptoms, mainly the itching, and to prevent potential complications.
The following medications may be prescribed:
- ursodeoxycholic acid, to relieve itching and increase bile flow
- menthol creams, to help soothe the itching, as there is no evidence that they cause harm during pregnancy
Soaking the affected areas of skin in lukewarm water may provide some temporary relief. Dabbing the affected areas with baking soda or apple cider vinegar may help, or applying coconut oil after a bath.
Patients with cholestasis will have low levels of vitamin K, increasing the chance of hemorrhage, so a mother will often need Vitamin K supplements before and after delivery.
According to the American Pregnancy Association, natural remedies for liver health include and dandelion root and milk thistle, and calamine lotion may help with itching, but any supplements or alternative treatments should be discussed first with a physician, as the effects during pregnancy may be unknown.
Many women choose to take herbs, creams, baths, and tinctures instead of medication. Some herbs are difficult to break down, especially when the liver is already compromised.
It is very important to check with the doctor beforehand, to make sure a natural remedy is safe, and to consult the doctor if symptoms get worse.
The doctor will consider the patient's signs and symptoms, such as urine and stool color, and itchiness. The mother will also be asked about her personal and family medical histories, and there will be a physical examination.
Blood tests may reveal how well the patient's liver is functioning. Blood levels of bile will also be measured.
Ultrasound scans can detect abnormalities in the mother's liver, but not in the fetus.
To reduce the risk of cholestasis and other problems during pregnancy, it is important to follow a healthful, balanced diet with plenty of fresh fruit and vegetables.
Organic produce is less likely to be affected by pesticides and other toxins. Apples, strawberries, and grapes often contain higher amounts of unwanted chemicals, while avocados, sweetcorn, and pineapple top the "clean" list.
If canned produce is used, check that it is preserved in its own juice and that there are no added sugars.
Choose certified organic meat and avoid fried fish and raw seafood. Dried beans and legumes, such as lentils and chickpeas, are a good source of protein.
Focus on whole foods, such as whole-grain bread.
Avoid the following:
- sugars and highly refined foods, such as white bread and corn syrup
- soy products
- processed meats
- full-fat dairy produce
You should drink 8 to 12 glasses of water a day, and avoid alcoholic drinks and sodas, such as cola.
Drinking alcohol will not cause cholestasis in pregnancy, but alcohol should be avoided during pregnancy, as it can lead to a number of complications, including other types of liver disease.
It is important to follow the doctor's instructions regarding treatment and diet. Diet is not an alternative to medication that is prescribed by the physician.
It is also important to check that any "organic" produce is really organic. It should be 100-percent organic. Foods labeled as "natural" are not necessarily organic or healthful.
Bile is a yellow-green fluid that helps to digest fat. It mainly consists of cholesterol, bile salts, and the pigment bilirubin.
It is produced by the liver and stored in the gallbladder. From the gallbladder, it passes through the common bile duct, into the duodenum.
Sometimes, a blockage outside the liver prevents the bile from leaving the liver, leading to a condition known as extrahepatic cholestasis.
Intrahepatic cholestasis happens when there is a problem with eliminating bile salts from the liver. This is the kind of cholestasis that happens during pregnancy.
The prevalence of cholestasis of pregnancy is not known. One estimate suggests that it affects 1 to 2 pregnancies in every 1,000 in the U.S. Other figures suggest that up to 1 in 50 women may develop it, depending on the population.
Factors that may increase a woman's risk of developing cholestasis of pregnancy include:
- having a close relative who had cholestasis of pregnancy
- having had cholestasis of pregnancy before, as the risk of recurrence during the subsequent pregnancies is between 45 and 90 percent
- a multiple pregnancy, for example, if there are twins or triplets
- a history of liver damage
- being pregnant as a result of in-vitro fertilization (IVF)
As well as intense itching, the mother may have some problems with absorbing fat-soluble vitamins, which are vitamins A, D, E and K. However, within a few days after giving birth, the problems should resolve. There will not usually be any further liver problems.
For the fetus, there is a significantly higher risk of preterm birth if the mother has cholestasis of pregnancy, although the reasons are unclear.
An infant who is born preterm may have breathing difficulties if the lungs are not yet fully developed.
The risk of fetal death is also higher.
During gestation, the fetus depends on the mother's liver to remove bile acids from the blood. If the mother has too much bile acid, this can be passed onto the fetus.
The neonate also has a higher risk of inhaling meconium during childbirth, resulting in breathing difficulties.
Doctors often induce labor early if the mother has cholestasis of pregnancy, because of the potentially serious complications for the baby.
Preventing potential complications
Blood tests will monitor the patient's liver function and blood levels of bile.
Ultrasound scans may become more frequent, to monitor fetal health and development.
A non-stress test may be ordered to check how often the fetus moves in a given period, and the fetal heartbeat in relation to body movements is also measured.
Induced labor is often recommended at about 38 weeks. If cholestasis is severe, induction may occur earlier.
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