Cholestasis is a condition that can develop in your liver during the latter part of your pregnancy. You may also hear it referred to as intrahepatic cholestasis of pregnancy (ICP).
It causes intense itching, and it can make your skin and eyes appear yellow. Those might not sound so serious, but unfortunately, untreated or poorly managed cholestasis can also lead to serious complications for both you and your unborn baby.
How common is this?
Cholestasis of pregnancy is actually a fairly common condition. It affects 1 or 2 per 1,000 pregnancies in the United States. But unless you’ve had it before, you might not know very much about it at all.
The biggest (and most annoying) symptom of cholestasis is the itching. Oh, the itching! In fact, most people who eventually get diagnosed with cholestasis know that something’s wrong because they’re itching so much without a clear reason why.
You might be a little confused, since there’s no rash associated with this condition. You may notice that your hands are itchy, or maybe your feet — or both. Then the itch begins to spread to other parts of your body.
It typically develops in the third trimester, but it’s possible for it to start earlier.
Beyond the itching, there are other possible symptoms that you might also develop if you have cholestasis during pregnancy:
- dark-colored urine
- loss of appetite
- light-colored stools
- yellowing of your skin and eyes
- pain in the right upper part of your abdomen
Not everyone with cholestasis will have the exact same symptoms, and it can range from a mild case to a severe case.
The exact cause isn’t really known. There does seem to be a genetic component, to some degree. And it looks like you can probably blame your liver, and you can also blame those pregnancy hormones.
When you’re pregnant, your estrogen levels rise. That increase can slow down the flow of bile from your liver to your gallbladder. (Bile is a substance that your liver produces to help your body break down fats.)
Unfortunately, when this normal process is disrupted, bile tends to build up in your liver. Some of the bile salts wind up entering your bloodstream. As a result, you may develop some of those symptoms like dark-colored urine and jaundice (some yellowing of your skin, eyes and mucous membranes). And yes, you’ll very likely begin feeling the itch.
Your doctor may assess you to see if you have any existing risk factors, just in case you need to keep watch for any developing symptoms.
How do you know if you’re at risk for developing cholestasis of pregnancy? Ask your mom. If you have a family history of this condition, you may be at increased risk for developing it yourself.
Your own history matters, too. If you’ve ever experienced cholestasis yourself during a previous pregnancy, you’re at significantly greater risk.
You’re also more likely to develop cholestasis of pregnancy if you have:
- a history of liver damage
- chronic hepatitis C
- a history of in vitro fertilization (IVF)
- a history of being pregnant with two babies or more at once
The American Liver Foundation points out that Latina women in the United States have a higher prevalence of cholestasis. Rates are higher in Scandinavia and South America, specifically Chile.
If you start itching and have no idea what’s causing it, notify your doctor. You’ll probably need to visit your doctor and roll up your sleeve, as a physical exam and some blood work will be next on the agenda.
Blood tests are necessary to gauge your liver function and measure the level of bile salts (or bile acids) in your blood.
Your doctor might also be interested in checking how well your blood clots. That’s because people with cholestasis sometimes have trouble absorbing fat, and that can lead to lower levels of vitamin K.
If you don’t have enough vitamin K, your body will also have trouble making the proteins that help your blood clot. That can put you at risk for excessive bleeding.
Ideally, you want to eliminate that itching that’s driving you nuts, while also minimizing or eliminating any possible complications that could harm your unborn baby.
Your doctor is likely to prescribe a medication known as ursodeoxycholic acid (such as UDCA, Actigall, or Ursodiol) that will reduce the levels of bile salts in your bloodstream. This should relieve the itching.
Your doctor will probably want to continue monitoring you for the duration of your pregnancy to make sure the levels are staying low enough.
Even if you and your doctor agree that you would benefit from taking medication, you might also want to embrace some lifestyle changes. For example, consider your wardrobe. Forego the tight-fitting fabrics and wear soft, loose clothing that won’t aggravate your sensitive, itchy skin instead.
Another strategy to try: a warm bath. Soaking in a tub can already feel pretty great when you’re feeling heavy and bloated, but a lukewarm bath can also relieve some of the itch. Add a little oatmeal for its soothing qualities. Your doctor might also recommend some over-the-counter anti-itch medications.
If you’re wondering, “What’s the big deal about some itching?” consider this: Cholestasis of pregnancy does pose some risk to your baby, both before and after birth. Possible serious complications of untreated cholestasis can include:
- preterm birth
- fetal distress
- breathing problems from inhaling meconium in the amniotic fluid
You may also have trouble with excessive bleeding or hemorrhaging, as a result of a vitamin K deficiency that can develop.
Research also suggests that more serious cases of cholestasis are more likely to have more serious complications.
Possibility of early delivery
Sometimes the medication works just fine, and your pregnancy can proceed as usual. But in certain cases, your doctor may discuss the possibility of delivering your baby a little ahead of schedule.
Given that your baby’s health may be at risk, some doctors prefer to go with an early induction of labor. Your doctor will want to assess your symptoms and your blood work, as well as your baby’s development, before making a recommendation.
If you’ve ever had cholestasis with a previous pregnancy, you’re at risk for developing it again with a future pregnancy. In fact, some estimate that between
The likelihood of a recurrence during a future pregnancy could rise as high as 90 percent for women who’ve had a severe case of cholestasis during pregnancy.
The good news is if you’ve had it before, you’re equipped with that knowledge. Your healthcare team can monitor your liver function and the level of bile acids or bile salts in your bloodstream from the get-go.
Typically, cholestasis goes away once you’ve given birth to your baby. Your bile acid levels will drop back down to normal levels, and the itching will cease. Your doctor will give you the sign to stop taking your medication if you’ve been taking ursodeoxycholic acid to keep those bile levels in check.
Your life will return to normal — well, except for that adorable brand-new little person you’re now in charge of caring for. And if you decide to have another baby later on, be sure your doctor knows about your history of cholestasis of pregnancy, so you can be monitored for it.