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 to the individual’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:

The itchiness may be the only symptom, and it often becomes worse during the night.

A pregnant person who has any of the signs or symptoms mentioned above should tell a health care professional as soon as possible, as they could indicate a risk for their unborn baby.

To diagnose cholestasis of pregnancy, a doctor will consider an individual’s signs and symptoms, such as itchiness and the color of their urine and stool. The person may also need to tell the doctor about any personal and family medical histories. Next, the doctor will do a physical examination.

Even if the symptoms match, the most precise way to test for the condition is to look at a person’s total serum bile acid, which a doctor can determine through a blood test.

There are also some additional blood tests a doctor can order to see how well the liver is functioning. This includes an alanine aminotransferase test, a bilirubin test, and an aspartate aminotransferase test.

Ultrasound scans can detect abnormalities in the individual’s liver but not in the fetus.

To prevent complications before they occur, a person will also need ongoing blood tests to monitor their liver function and blood bile levels.

Ultrasound scans may also become more frequent to monitor fetal health and development. The doctor may order a non-stress test to check how often the fetus moves in a given period and measure the fetal heartbeat in relation to body movements.

Doctors often recommend induced labor at about 38 weeks or earlier if cholestasis is severe.

It is important to follow a healthy, balanced diet with plenty of fresh fruit and vegetables to reduce the risk of cholestasis and other problems during pregnancy.

Eating a balanced diet may also help a person with cholestasis of pregnancy reduce the condition’s severity. Foods that can help the function of the liver may be particularly helpful. Since the condition interferes with nutrient absorption, eating as many nutrient-rich foods as possible is also important.

Foods to eat include:

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 using canned produce, check that manufacturers have preserved it 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.

Avoid the following:

A person should also drink 8–12 glasses of water a day and avoid alcoholic drinks and sodas, such as cola.

Drinking alcohol will not cause cholestasis in pregnancy. Still, a person should avoid alcohol during pregnancy, as it can lead to a number of complications, including other types of liver disease.

It is important to follow a doctor’s instructions regarding treatment and diet. Diet is not an alternative to medication that a doctor prescribes.

It is also important to check that any produce with an organic label is 100% organic. Foods with a “natural” label are not necessarily organic or healthy.

Treatment normally aims to relieve symptoms, mainly the itching, and prevent potential complications.

The primary treatment is ursodeoxycholic acid, which relieves itching and increases bile flow. A person will typically start on a dose of 300 milligrams (mg) daily and go up to 300 mg three times daily until delivery. They will usually experience fewer symptoms within 2 weeks. If not, the dose can increase to a maximum of 21 mg per kilogram a day.

Other treatments that doctors may use to treat cholestasis of pregnancy include:

People with cholestasis will have low levels of vitamin K, increasing the chance of hemorrhage, so a person will often need Vitamin K supplements before and after delivery.

Research also discusses using antihistamines as a treatment. However, these do not appear to help with itching.

Home remedies

In addition, a person can try soaking the affected areas of skin in lukewarm water to get some temporary relief. Dabbing with baking soda or apple cider vinegar may also help, and people may try applying coconut oil after a bath.

Natural remedies for liver health include dandelion root and milk thistle. Lotion may help with skin itching. Some sources also recommend oatmeal baths. People should speak with a doctor before trying any alternative treatments to check their effects during pregnancy.

Many people choose to take herbs, creams, baths, and tinctures instead of medication. However, some herbs are difficult to break down, especially when the liver is already compromised.

It is very important to check with a doctor beforehand to make sure a natural remedy is safe and to consult a doctor if symptoms get worse.

Bile is a yellow-green fluid that helps digest fat. It mainly consists of cholesterol, bile salts, and the pigment bilirubin.

The liver produces bile and the gallbladder stores it. From the gallbladder, it passes through the common bile duct into the duodenum.

Sometimes, a blockage outside the liver prevents the bile from leaving it, 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 occurs during pregnancy.

Pregnancy hormones, and especially the additional estrogen, may affect the proper functioning of the gallbladder and the liver.

Factors that may increase a person’s risk of developing cholestasis of pregnancy include:

  • having a close relative who had the condition
  • having had cholestasis of pregnancy before, as the risk of recurrence during subsequent pregnancies is 60–70%
  • a multiple pregnancy, for example, if a person is having twins or triplets
  • a history of liver damage
  • being pregnant as a result of in vitro fertilization

As well as intense itching, a person 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.

There is a significantly higher risk of preterm birth for the fetus if the pregnant person has cholestasis of pregnancy, although the reasons for this are unclear.

An infant 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 pregnant person’s liver to remove bile acids from the blood. If their liver has too much bile acid, they can pass this on to the fetus.

The baby also has a higher risk of inhaling meconium during childbirth, resulting in breathing difficulties.

Doctors often induce labor early if the pregnant person has cholestasis of pregnancy because of the potentially serious complications for the baby.

Research suggests that cholestasis of pregnancy may increase the risk of cardiovascular disorders and metabolic disorders such as obesity when the child reaches adulthood.

Below are answers to some frequently asked questions about the condition.

Is delivery by 37 weeks necessary for cholestasis of pregnancy?

Since most stillbirths occur after 37 weeks of pregnancy, most research recommends delivery by this time for people with cholestasis of pregnancy. This is also the point at which doctors would consider the baby full-term if born.

How common is it?

The prevalence of cholestasis of pregnancy is not known. One estimate suggests that up to 1 in 50–5,000 pregnancies are affected, depending on the population.

How serious is it?

Cases of cholestasis of pregnancy can be mild or severe. In mild cases, a person may just experience some discomfort due to the itching on their skin. However, severe cholestasis of pregnancy can cause more severe itching and other symptoms. It can also lead to serious complications for both the pregnant person and the fetus.

Does it cause liver damage?

Having previous liver damage is a risk factor for developing cholestasis of pregnancy. The condition itself can also lead to liver dysfunction.

When does it start?

Typically cholestasis of pregnancy will present in the second or third semesters of pregnancy. The pruritus rash often develops around the 30th week of pregnancy.

Will I get it for all pregnancies?

A person who has had the condition is highly likely to develop it again in another pregnancy. The recurrence rate is 60–70%.

Cholestasis of pregnancy is a condition that interferes with the liver’s ability to excrete bile, a fluid that a person needs to process fat. The main symptom is a rash, but there can be other symptoms and serious complications for both the pregnant person and the fetus. A person should speak with a doctor about any rash or other symptoms they develop during pregnancy.