Pregnancy is an exciting but sometimes challenging time. During the late stages of pregnancy you’re more aware of every ache and pain.
But what about itchiness in pregnancy? Although it’s rare, some women experience intense itchiness due to cholestasis of pregnancy.
What is cholestasis of pregnancy and what can be done to manage it?
What is intrahepatic cholestasis of pregnancy?
Intrahepatic cholestasis of pregnancy (ICP) is a condition that only occurs during pregnancy.
It causes an abnormal build-up of bile acids in the liver. Normally, bile flows down ducts to your intestines. Intrahepatic cholestasis of pregnancy happens when the normal flow of bile is slowed down.
The name of this condition comes from the Greek chole, meaning ‘bile’, and stasis, meaning ‘standing still’.
Cholestasis of pregnancy is a rare condition. It usually occurs in the later part of the 2nd trimester or the 3rd trimester of pregnancy. It’s unlikely to occur earlier in pregnancy.
What causes intrahepatic cholestasis of pregnancy?
The exact cause of cholestasis in pregnancy isn’t clear. There’s a strong genetic link and it can run in families. Health experts believe it’s a reaction to high estrogen levels.
You’re more likely to develop cholestasis of pregnancy if:
- Have had this condition in a previous pregnancy
- Your sister or mother had this condition while pregnant
- You’re carrying twins or triplets
- You live in Scandinavia, Chile, Bolivia, Finland, or Portugal
- You’re of South Asian or Latino origin
- Have a history of liver disease such as hepatitis C
- You have taken oral contraceptives
- You have had in vitro fertilization
- You are over 35 years old.
Rates of ICP are about 1 in 140 in the UK and Australia, up to 1 in 26 in Bolivia, and only about 1 in 1000 in the US (with higher rates – up to 5% – in Latinas).
Cholestasis of pregnancy symptoms
The most common symptom of cholestasis of pregnancy is itching on the palms of the hands and soles of the feet – especially at night time.
Itching all over the body is also a sign of cholestasis.
Itching in pregnancy can occur for other reasons – for example, stretching skin, PUPPS, or hives from an allergic reaction.
If you’re unsure whether your itchiness is from ICP, look out for these other symptoms of cholestasis of pregnancy:
- Pain in your liver area (upper right abdomen)
- Dark urine
- Pale stool
- Jaundice (yellow tinge to the skin or whites of the eyes)
- Nausea and lack of appetite.
If you experience any of these symptoms, be sure to contact your healthcare provider right away. They are signs of changes in the liver and need immediate attention.
Cholestasis of pregnancy rash
Cholestasis of pregnancy doesn’t cause a rash or spots on your skin. However, the itching is intense and often worse at night. You can scratch so hard you break the skin. This might appear as a rash later on.
Cholestasis of pregnancy diagnosis
If you’re experiencing any of the symptoms of ICP, see your doctor straight away. To diagnose cholestasis you’ll have a blood test to check your bile acid levels. Other liver function tests might be ordered as well.
For the most accurate results, you might need to fast for 8-12 hours before having this blood test.
Generally healthcare providers diagnose ICP if your serum bile acids are over 10 mmol/L.
Follow-up management of cholestasis includes:
- Blood tests (at least weekly) to check for rising levels of serum bile acids
- Frequent fetal monitoring of your baby; non-stress tests and biophysical profile ultrasounds might be recommended
What are the effects of ICP on baby?
The biggest concern for babies of mothers with ICP is an increased risk of preterm birth, fetal distress and stillbirth.
Other risks include:
- Higher incidence of meconium staining (baby passing stool before birth)
- Respiratory problems for baby
- Premature labour and birth.
Although these risks are serious it’s important to remember most women with ICP have normal, healthy babies.
What are the effects of ICP on the mother?
The severe itching that accompanies pregnancy cholestasis can reduce sleep. This can really affect your mood and ability to function during pregnancy. Keep reading for ways to deal with this annoying symptom.
For some women cholestasis can have an effect on blood clotting. There might be a higher incidence of postpartum hemorrhage in the birthing person with ICP, but more research is needed.
Is delivery by 37 weeks necessary for cholestasis of pregnancy?
Because of the increased risk of stillbirth, most healthcare practitioners will plan an induction at 37 weeks gestation if cholestasis is diagnosed.
Recent research shows it’s possible to wait until 39 weeks to be induced, if blood tests continue to check bile acid levels, and results are available within 24 hours.
There is a significantly increased risk of stillbirth when bile levels are very high (>100mmol/L).
How serious is cholestasis of pregnancy?
ICP can be serious if left untreated. There are complications for you and for your baby during pregnancy, and some research suggests it can also affect children later in life.
If you have a family history of cholestasis, let your doctor know and a plan can be made to monitor for symptoms.
Cholestasis of pregnancy treatment
The only cure for cholestasis is to give birth. The main goals of treating cholestasis are to manage symptoms and to prevent problems.
The medications you might be offered for ICP are:
- Ursodeoxycholic acid (UCDA). This is the most common drug given for treatment of cholestasis of pregnancy. This drug can reduce itching and lower levels of bile acids and liver enzymes
- Steroids to reduce itching. These drugs have side effects and risks, and won’t have an effect on reducing bile acid levels
- Vitamin K might be offered if blood clotting is an issue. If you had ICP, it is also important your baby receive Vitamin K at birth.
Natural remedies for cholestasis of pregnancy
Here are some things you can try to help relieve the itching that comes with cholestasis of pregnancy:
- Take liver support herbs such as dandelion and blessed milk thistle. Always check with your healthcare provider and work with a trained herbalist before taking herbal medicines
- Oatmeal baths and peppermint soaps can bring some relief
- Apply calamine lotions and/or calendula salves. Calamine might have a drying effect
- Stay cool, have cool baths or showers, and sit in front of a fan
- Use ice packs on affected areas
- Wear loose cotton clothing.
What happens after birth with cholestasis?
It’s recommended your baby be given the vitamin K injection after birth. This is because of the higher risk of blood clotting.
The itching and symptoms of cholestasis generally disappear within 1-2 days after the baby’s birth.
You should have follow-up blood work at 2-6 weeks after birth. This will check your liver is functioning properly and confirm the diagnosis of ICP.
If you had cholestasis of pregnancy in a previous pregnancy there’s up to 50% chance it will occur again in your next pregnancy. There’s an even higher chance of recurrence if this condition runs in your family.
You might be advised to avoid birth control pills with high estrogen, as this has the potential to trigger cholestasis again.
You also have an increased chance of developing gallstones and chronic liver disease in the future. Speak to your doctor about this and any other concerns you have.