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Cholestasis of pregnancy, or intrahepatic cholestasis of pregnancy, is a liver disorder affecting one to two pregnancies per 1,000. The cause is not clearly understood, and although the condition poses few risks to the mother, it can cause potentially life-threatening complications for your child. A diagnosis of cholestasis of pregnancy can be incredibly stressful as you seek to learn its implications on your health and the health of your unborn child. Many women and their partners will be understandably concerned and frightened. This article delves deeper into the diagnosis, symptoms, treatments, and potential complications of cholestasis of pregnancy.1
Cholestasis of pregnancy, or intrahepatic cholestasis of pregnancy or ICP, occurs when bile from the liver does not follow its normal path into the intestinal system. Bile normally facilitates the breakdown of fats in the digestive system, but bile flow is blocked or reduced with cholestasis of pregnancy. This causes bile to back up in the liver, and bile acids leak into the pregnant woman’s bloodstream.1,2,5
Cholestasis of pregnancy is diagnosed with blood tests measuring bile acid levels and liver function, as well as the results of a physical exam.2
Doctors do not know precisely what causes cholestasis in pregnancy. Ongoing research suggests it may result from a combination of factors. According to the American Liver Foundation, genetic predisposition, hormones, and the environment have been identified as either known or potential contributing factors:1,6
Intrahepatic cholestasis of pregnancy can run in female family members, suggesting a genetic component. People of Hispanic and Swedish descent have higher rates of ICP.
A pregnant woman’s increasing hormones can affect liver function and the ability to manage bile secretions properly. Hormonal increases occur in the third trimester and for women carrying twins or triplets or having in-vitro fertilization.
More women receive cholestasis of pregnancy diagnosis during winter, suggesting geographical regions or exposure to natural sunlight may be contributing factors.
Additionally, a pre-pregnancy history of liver diseases or disorders, like hepatitis, increases the risk of developing ICP. There is no known cause of cholestasis during pregnancy; unfortunately, there is no known prevention.
Cholestasis of pregnancy typically starts in the third trimester. The condition tends to worsen as the pregnancy progresses and hormones peak. Although less common, it can begin earlier, so it is essential to familiarize yourself with the signs and symptoms of ICP no matter how far along you are in your pregnancy.1,6
A diagnosis of cholestasis of pregnancy does not usually place the mother’s life at risk. However, it increases the risk of developing maternal complications like gestational diabetes, preeclampsia, profuse bleeding, or hemorrhage.3
Doctors will monitor your condition closely leading up to delivery. This may require additional blood testing, liver ultrasounds, and close monitoring of your baby’s well-being, including measuring their movements and heart rate.
Symptoms usually disappear within a few days after giving birth when the woman’s bile acids return to normal. Your doctor will likely require follow-ups for a few months. Most times, there are no long-term effects on the mother’s health. If your provider is concerned about your progress, they may refer you to a liver specialist called a hepatologist.6
If you had it once before, you might be at higher risk of developing ICP in future pregnancies.3
Severe itching is often the first sign that most women report with cholestasis of pregnancy. The itchiness can be felt all over the body and may be worse on the palms of the hands and soles of the feet. The itching is extreme, frequently worse at night, and can significantly interrupt sleep patterns. It is very uncomfortable, may be constant or come and go, and typically there is no rash on the skin.1,2,3
Other symptoms may include:1,2,3
- Fatigue
- Nausea
- Loss of appetite
- Abdominal pain
- Pale, foul-smelling stools
- Dark urine
- Jaundice (yellowing of your skin or the white part of your eyes)
Managing cholestasis of pregnancy requires a two-part approach. Your doctor will likely prescribe a medicine to improve your liver’s function and decrease the level of bile acids in your blood. This medicine is ursodeoxycholic acid, commonly known as Ursodiol or Actigall. Ursodeoxycholic acid is the first line of treatment for ICP and has been proven safe for pregnant women and their unborn children. It is taken by mouth, and your provider will determine the correct dosage, adjusting it as necessary.1
This medicine does not relieve the itchiness, but by improving liver function, some women report an improvement in their itchiness within two weeks.1,2
Other ways to manage the symptoms of cholestasis of pregnancy include:8
- Taking anti-itch medicines approved by your physician.
- Soaking in a warm or cool bath.
- Wearing clothing made from natural fibers.
- Wearing loose-fitting clothing.
- Eating a healthy diet, and avoiding processed foods.
- Drinking 8-12 glasses of water daily.
- Getting exercise and rest.
Cholestasis of pregnancy can have life-threatening impacts on an unborn child, which tends to increase after 37 weeks of gestation. For this reason, your OBGYN may decide to induce a delivery by 37 weeks. The risk of stillbirth increases after 37 weeks, as do other neonatal complications that can have long-lasting consequences for the child’s physical, mental, and developmental abilities in the future. However, your doctor will consider the severity of ICP and the potential risks to your child before proceeding, and they should thoroughly discuss the care plan with you.4,5,7
The following complications require admission to a neonatal intensive care unit, and your baby could be on a ventilator or a breathing machine and require several medical interventions:4
- Preterm birth
- Respiratory distress
- Cardiac arrhythmias
- Meconium aspiration
Although not all infants will require the most intense care, some will. This is why medical providers recommend delivery by 37 weeks gestation when a mom has cholestasis of pregnancy. Delivering your baby early, but not too early, is to avoid complications.
Many healthy children are born to moms diagnosed with intrahepatic cholestasis of pregnancy. Still, it is vital to know that the potential complications can be severe, and you’ll need close management by your OBGYN. If you are experiencing any of the symptoms of cholestasis of pregnancy, you should contact your physician’s office and arrange an appointment immediately.
