Cholestasis of pregnancy
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often without a visible rash. This itching typically occurs on the hands and feet, although it can also manifest on other parts of the body.
ICP can temporarily reduce liver function in some pregnant individuals. This results in an accumulation of bile in the liver and bloodstream. Bile, produced by the liver and stored in the gallbladder, plays a crucial role in breaking down fats during digestion. As bile levels in the blood reach a certain threshold, it can trigger itching.
The discomfort caused by pregnancy-related cholestasis can be significant. However, of greater concern are the potential risks it poses, particularly for the baby. Due to these potential complications, healthcare providers may advise considering an early delivery around the 37-week mark of the pregnancy.
Symptoms
The primary symptom of cholestasis of pregnancy is intense itching (pruritus), which occurs without the presence of a rash. Typically, this itching sensation is felt on the palms of the hands or the soles of the feet, although it can be experienced throughout the body. The itchiness is often more pronounced at night and can become so bothersome that it interferes with sleep.
While this itching mainly arises during the third trimester of pregnancy, it can occasionally start earlier. It may feel worse as your due date approaches. However, once the baby is born, the itching usually subsides within a few days.
Less commonly observed signs and symptoms of cholestasis of pregnancy may include:
- Yellowing of the skin and the whites of the eyes, known as jaundice
- Nausea
- Reduced appetite
- Stools with an oily and unpleasant odor
- Darkened urine
- Light gray or pale brown stool
- Fatigue
- Discomfort in the upper right abdomen.
Causes
The cause of pregnancy-related cholestasis remains uncertain. It involves a disruption in bile flow, which is a digestive fluid produced by the liver to break down fats. Instead of progressing to the small intestine, bile accumulates in the liver, allowing bile acids to enter the bloodstream. Elevated bile acid levels seem to contribute to the symptoms and complications of pregnancy-related cholestasis.
The factors that play a role in pregnancy-related cholestasis include:
- Hormones: Pregnancy hormones increase as your due date approaches, potentially leading to a slowdown in bile flow.
- Genetics: Occasionally, the condition is familial, with specific gene variations associated with pregnancy-related cholestasis.
- Environment: While the exact environmental factors aren’t well-defined, the risk fluctuates based on geography and season.
Risk factors
Several factors that could elevate your susceptibility to cholestasis of pregnancy are:
- Personal or familial background of cholestasis during pregnancy.
- Previous liver damage or disorders, including hepatitis C and gallbladder stones.
- Carrying multiple pregnancies concurrently.
- Pregnancy at an advanced age, specifically 35 years or older.
If you have previously experienced cholestasis in a past pregnancy, your likelihood of developing it again during another pregnancy is considerable.
Diagnosis
In order to diagnose cholestasis of pregnancy, the prenatal care provider typically undertakes the following procedure:
- Physical examination: The healthcare provider will assess and ask about the symptoms and any medical history.
- Blood test: They would order blood tests to assess the concentration of bile acids in the blood and to evaluate the liver’s functionality.
The diagnosis is typically confirmed through tests if the total bile acids measure 10 micromoles per liter or higher. Throughout the remaining duration of the pregnancy, patient might undergo periodic blood tests to monitor the levels of bile in their bloodstream.
- Prothrombin time test: This examination is conducted to evaluate the blood’s clotting ability.
- Imaging test: The healthcare provider may order ultrasound to assess the bile ducts and liver.
Treatment
The goals of treating cholestasis of pregnancy are to alleviate itching and prevent complications for your baby.
To ease itching: Make sure to consult your prenatal care provider before starting any medication for itch relief. Your prenatal care provider may recommend:
- Taking a prescription medicine that helps lower bile acid levels in your blood.
- Soaking itchy areas in cool or lukewarm water.
Monitor your baby’s health closely: As cholestasis of pregnancy could lead to pregnancy complications. Your prenatal care provider might suggest the following for monitoring your baby during pregnancy:
- Nonstress testing: This assesses your baby’s heart rate and its response to movement.
- Fetal biophysical profile (BPP): This set of tests monitors various aspects of your baby’s well-being, including heart rate, movement, muscle tone, breathing, and amniotic fluid levels.
However, while these tests can provide reassurance, they can’t predict the risk of preterm birth or other cholestasis-related complications.
Early delivery might be recommended: Even if prenatal tests show normal results, your prenatal care provider might advise inducing labor before your due date, typically around 37 weeks. This early-term delivery can help reduce the risk of stillbirth. Vaginal delivery is preferred through labor induction unless specific reasons necessitate a cesarean section.
Future birth control: A previous history of pregnancy-related cholestasis could elevate the risk of symptom recurrence with estrogen-containing contraceptives. Hence, alternative birth control methods are typically advised. These options encompass progestin-based contraceptives, intrauterine devices (IUDs), and barrier methods like condoms or diaphragms.
