Fruit of the Womb
Fruit of the Womb

Intrahepatic Cholestasis of Pregnancy - Reprise

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On January 10 and 13, 2007, I wrote a couple of posts related to intrahepatic cholestasis of pregnancy (ICP), otherwise know as 'obstetric cholestasis.' ICP affects 1-2 of every 1000 pregnancies and is more common in certain subpopulations around the world, particularly in Scandinavia and South America. Indeed, in the Araucanian Indians in Chile, about 28% of pregnancies are complicated by ICP. As we discussed in the previous posts, this condition usually begins in the third trimester, is associated with intense itching, especially on the palms and soles, and may be accompanied by loss of appetite, sleep deprivation, depression, fatigue, and dark urine (or pale stools). On rare occasions, frank jaundice, right upper quadrant pain, and nausea are present.

ICP is thought to be the result of hepatic dysfunction that results in the decreased clearance and accumulation of bile acids which, subsequently, cause the various symptoms of the condition. Although most women who develop ICP are absolutely miserable, generally, the condition resolves completely following delivery. However, there appears to be a true genetic predisposition to develop ICP and recurrence rates are as high as 90% with subsequent pregnancies. For reasons that are not completely understood, babies of women with ICP are at increased risk for unexplained fetal death in utero as was the case in the patient who was the incentive for my first post on this subject.

Today, I received a comment from the reader below who had several excellent questions related to ICP that were not addressed in my previous posts, so I thought this would be a good time to revisit the condition and provide some additional thoughts for our readers...

At Mon Aug 20, 05:22:00 PM 2007, Rani B said…
I am interested in knowing what I can do to prevent or at least delay the onset of cholestasis of pregnancy. I had cholestasis of pregnancy in 2004 when I was pregnant with my son. I was diagnosed at 35-1/2 weeks and induced for delivery at 37 weeks (because tests showed my bile acids were significantly elevated). Thankfully, my beautiful baby boy was born healthy (though a bit jaundiced). I am now pregnancy (at 19 weeks) with my second child (another boy). So far, so good, but I am watchful for symptoms due to the high rate of recurrence of this condition. I would like to take any steps that I can in terms of diet, exercise, homeopathic treatments, etc. to aid my son's healthy arrival into this world. Do you have any suggestions? For example, should I take water-soluble prenatal vitamins? (and if so, can you recommend one)? Thanks in advance for any guidance you can provide.

At Fri Aug 24, 06:12:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…
To Rani B Aug 20: You are correct. There is a very high rate of recurrence if you truly had cholestasis because of the genetic predisposition to this condition. There is no way to absolutely prevent its recurrence either. I think you have the right ideas though. I would recommend that you minimize the fat content of your diet (at least during pregnancy), consider the use of a water-soluble PRENATAL vitamin (there are many on the market such as Vegan Prenatal), and try to get some light exercise every day - I suggest walking, swimming, treadmill, stepper or elliptical trainer, or stationary bike. Drink lots of water in your diet and stay away from too much free sugar as well. Although ursodeoxycholate appears to be of some benefit in treating this condition, as far as I know, no one has ever done a study to see if it helps to prevent the RECURRENCE of cholestasis on a prophylactic basis. By the way, for any readers who would like a link to an excellent site that is dedicated to pregnant women with ICP, and explains the salient issues in very comprehensible terms, go to "Itchymoms.com" . Thanks for reading and for VERY good questions! Dr T

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About the Author

Dr. Trofatter is an expert on maternal-fetal medicine.

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