Cholestasis of Pregnancy

What Is Cholestasis of Pregnancy?

Cholestasis of pregnancy, also known as intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis, occurs when bile flow from the liver slows down or becomes blocked.

The liver produces bile, a digestive fluid that normally flows into the intestines. In cholestasis, bile cannot flow properly and builds up in the liver, leaking into the bloodstream. This leads to high bile acid levels, which cause symptoms and increase health risks for the baby.

Causes and Risk Factors

The exact cause of cholestasis of pregnancy is not fully known, but several factors are involved:

• Hormonal Factors: High levels of estrogen and progesterone during pregnancy can slow bile flow.

• Genetic Factors: Certain genes affect how bile is transported in the liver, increasing risk.

• Environmental Factors: Seasonal changes and geographic location may influence occurrence.

• Higher Risk If You Have:

  • A family history of cholestasis

  • Cholestasis in a previous pregnancy

  • Twin or multiple pregnancies

  • Age over 35 years

  • Existing liver disease

  • Pregnancy during winter months

Signs and Symptoms of Cholestasis of Pregnancy

The most common symptom is severe itching without a rash, usually affecting the palms of the hands and soles of the feet, often worsening at night.

Other symptoms may include:

• Dark-colored urine

• Pale or clay-colored stools

• Yellowing of skin or eyes (jaundice)

• Fatigue

• Poor appetite

• Pain in the upper right side of the abdomen

Complications of Cholestasis for Mother and Baby

For the Mother

Complications are usually mild and may include difficulty absorbing vitamin K, which can increase bleeding risk.

For the Baby

Risks are more serious and include:

• Preterm birth

• Meconium aspiration

• Fetal distress

• Stillbirth

The risk increases significantly when bile acid levels exceed 100 micromol/L.

Diagnosis

After ruling out other causes, doctors usually order the following tests:

Blood Tests

• Liver function tests (LFTs)

• Serum bile acid levels

A bile acid level above 10 micromol/L confirms the diagnosis. Fasting is not required for bile acid testing.

Studies show that liver enzymes are elevated in about 60% of cases, with ALT being the most helpful marker.

Treatment Options for Cholestasis of Pregnancy

The primary treatment is Ursodeoxycholic Acid (UDCA) at a dose of 10–21 mg/kg per day. This medication helps lower bile acid levels, improve liver function, and reduce itching.

Doctors may also prescribe vitamin K supplements if there is a risk of bleeding.

Managing Itching and Discomfort During Pregnancy

To reduce itching, doctors may recommend:

• Cool baths or ice packs on itchy areas

• Aqueous creams with menthol

• Antihistamines such as chlorphenamine to help with sleep

Living With Cholestasis During Pregnancy

Women with cholestasis require:

• Weekly bile acid testing

• Regular liver function tests

• Close monitoring of the baby, especially after 32 weeks of pregnancy

Prevention and Early Detection

There is no proven way to prevent cholestasis of pregnancy. To reduce the risk of stillbirth, doctors usually plan delivery between 36 and 39 weeks, depending on bile acid levels.

Women with bile acid levels above 100 micromol/L are often advised to deliver at 36 weeks due to increased risk.

When to See a Doctor

Contact your doctor immediately if you experience persistent itching, especially on your palms and soles.

Seek urgent medical care if you notice:

• Severe itching affecting sleep or daily life

• Yellowing of skin or eyes

• Sudden abdominal pain or swelling

• Reduced fetal movements

• Dark urine or pale stools

• Loss of appetite or nausea

Prepare for your appointment by noting all symptoms and listing medications, vitamins, and supplements you are taking.

Conclusion

Cholestasis of pregnancy is a serious liver condition that affects a small number of pregnant women but carries significant risks for the baby. Persistent itching without a rash, especially on the hands and feet, is the most important warning sign.

Although cholestasis cannot be prevented, early diagnosis, proper treatment, and close monitoring can greatly reduce complications. Always trust your instincts and consult your healthcare provider if something feels wrong during pregnancy.

FAQs

1. What is cholestasis of pregnancy?

   Intrahepatic cholestasis of pregnancy is a liver disorder where bile flow slows or stops, causing bile acids to build up in the bloodstream.

2. What causes itching in pregnancy due to cholestasis?

   Itching occurs when bile acids accumulate in the skin. Hormonal changes and genetic factors affect bile flow and liver function.

3. At what stage of pregnancy does cholestasis usually occur?

   It usually develops in the late second or early third trimester, often after 30 weeks.

4. Can cholestasis harm my baby?

   Yes. It can lead to fetal distress, preterm birth, meconium aspiration, and stillbirth.

5. How is cholestasis of pregnancy diagnosed?

   Diagnosis is confirmed through blood tests measuring bile acid levels above 10 micromol/L, along with liver function tests.

6. What treatments are available?

   The main treatment is Ursodeoxycholic Acid (UDCA). Vitamin K may also be prescribed if needed.

7. Are there home remedies to relieve itching?

   While nothing fully stops the itching, relief may come from cool baths, loose clothing, menthol creams, cool rooms, pine tar soap, and staying hydrated.

8. Is cholestasis dangerous for the mother?

   It usually resolves after delivery and rarely causes long-term liver damage, though vitamin K deficiency and gallstones can occur.

9. Can cholestasis recur in future pregnancies?

   Yes. It recurs in about 60–70% of future pregnancies.

10. How can cholestasis be detected early?

    There is no prevention, but women with prior cholestasis should have early liver tests, watch for itching, and get follow-up liver tests after delivery.