Cholestasis of Pregnancy

What is cholestasis of pregnancy?

Cholestasis of pregnancy is a liver condition that causes severe itching late in pregnancy. It’s also known as intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis.

ICP temporarily lowers liver function in some pregnant people. This causes bile to build up in your liver and bloodstream. Bile is a substance produced by your liver and stored in your gallbladder. Every time you eat, bile breaks down fats so you can digest them properly. When levels of bile in your blood reach a certain level, you may begin to itch.

Cholestasis of pregnancy can cause complications for you and the fetus. To lower the risk of complications, your pregnancy care provider may monitor you closely for the remainder of your pregnancy.

What happens if I have cholestasis while pregnant?

During pregnancy, a fetus relies on your liver to remove waste from its blood. If your liver isn’t functioning properly, bile levels may increase to unsafe levels that may stress the fetus's liver. Your liver is an important organ responsible for removing waste from your body, so when it’s not fully functioning, it can cause complications.

Your pregnancy care provider will monitor you closely to ensure cholestasis doesn’t harm you or the fetus.

How common is cholestasis of pregnancy?

Cholestasis affects about 1 to 2 in 1,000 people during pregnancy. More people are diagnosed with ICP during the winter than other times of the year, but researchers aren’t sure why. Data suggests it’s more common in people of Hispanic and Swedish backgrounds.

What is the main cause of cholestasis of pregnancy?

Bile is a substance made by your liver and stored in your gallbladder. Your liver helps break down fats during digestion. Increased levels of estrogen and progesterone during pregnancy affect your liver’s ability to transport bile. This means your bile doesn’t move through your body, causing it to build up in your liver and enter your bloodstream. Bile entering your blood can make you feel extremely itchy.

Cholestasis of pregnancy typically develops in the third trimester (around week 28 of pregnancy) when pregnancy hormone levels are at their highest. In some cases, it’s genetic, meaning you’re at higher risk if your biological parents have cholestasis.

What are the symptoms of cholestasis of pregnancy?

The main symptom of cholestasis of pregnancy is severe itching (pruritus). This itching starts on your hands and feet and spreads to other body parts. The itching is usually worse at night. Unlike other conditions that cause itching, cholestasis doesn’t involve a rash.

Less common signs of cholestasis may include:

• Nausea.
• Dark urine.
• Light gray or pale brown poop.
• Extreme tiredness.
• Decreased appetite.
• Pain in the upper right of your belly.
• Jaundice (yellowing of your skin and whites of your eyes).

What week does cholestasis of pregnancy start?

Cholestasis of pregnancy is more likely to begin after the 28th week of pregnancy but it can start earlier.

How is cholestasis of pregnancy diagnosed?

Your pregnancy care provider diagnoses cholestasis of pregnancy during a physical examination and blood test. These tests tell your provider how your liver is functioning. They’ll also measure the level of bile acids in your bloodstream using a serum bile acid test.

Tests confirm the diagnosis when total bile acids are 10 micromoles per liter or above. A micromole is a unit of measurement used in some medical tests. You may have blood tests regularly for the remainder of your pregnancy to monitor bile levels in your blood.

Your provider may also order a prothrombin time test to see how well your blood clots or an ultrasound to look at your bile ducts and liver.

How is cholestasis of pregnancy managed or treated?

Healthcare providers use a medication called ursodeoxycholic acid (UDCA, ursodiol or Actigall®) to treat cholestasis of pregnancy. This medicine can improve your liver’s ability to function and reduce bile levels in your blood.

Treatments to manage the symptoms of cholestasis of pregnancy include:

• Anti-itch medicine (talk to your provider before taking any medication).
• Wearing soft and loose-fitting clothing.
• Rest.
• Soaking in a warm bath.

If medication doesn’t lower bile levels, your provider may recommend delivering your baby early. Inducing labor around weeks 37 or 38 of pregnancy may reduce the risk of complications of cholestasis of pregnancy. Your provider will monitor the fetus for signs of any potential problems using tests like a biophysical profile or nonstress test.

If your provider delivers your baby early, they’ll likely give you a steroid that helps mature your baby’s lungs and a vitamin K supplement to prevent internal bleeding (hemorrhage).

What complications are associated with cholestasis of pregnancy?

Cholestasis of pregnancy may cause complications. You may have problems absorbing vitamin K, which increases the risk of hemorrhage (heavy internal bleeding). It’s also associated with preeclampsia and gestational diabetes.

Fetal complications related to cholestasis of pregnancy include:

• Premature birth.
• Stillbirth.
• Fetal distress.
• Meconium aspiration.

Your pregnancy care provider may deliver your baby early to decrease the risk of these complications.

Can you have a healthy baby with cholestasis of pregnancy?

Yes, just because you have cholestasis during pregnancy doesn’t mean your baby will be unhealthy.

What foods should I avoid if I have cholestasis in pregnancy?

Your pregnancy care provider may recommend limiting certain foods based on your condition. However, there isn’t a standard diet to follow if you have cholestasis of pregnancy. You should eat a balanced diet with an emphasis on fruits, vegetables, lean meat or other protein sources during pregnancy.

Can cholestasis of pregnancy be prevented?

You can’t prevent cholestasis of pregnancy. Genetic testing may help you understand the chance of passing this disorder on to your child.

What are the risk factors for cholestasis of pregnancy?

You’re at higher risk for developing cholestasis of pregnancy if you:

• Have a family member with the condition.
• Had ICP before.
• Are pregnant with twins, triplets or more.
• Have a history of liver disease or hepatitis C.
• Have a history of liver damage.
• Have a genetic condition that affects how your body makes and uses bile.

What is the prognosis (outlook) for people with cholestasis of pregnancy?

Cholestasis of pregnancy goes away a few days after your baby is born. Your bile levels return to normal after delivery. You can stop taking medication once your levels return to typical levels.

Most people with the condition don’t have any more liver problems unless they become pregnant again. There’s about a 60% chance you’ll get cholestasis in future pregnancies. If you had a severe case of cholestasis, the likelihood you’ll get cholestasis in future pregnancies increases to up to 90%.

When should I call my healthcare provider?

Contact your pregnancy care provider if you develop intense itchiness that doesn’t go away during pregnancy or if your skin or the whites of your eyes seem yellow.

What questions should I ask my provider?

If you have cholestasis of pregnancy, you may want to ask the following questions:

• How serious is cholestasis of pregnancy?
• What are my treatment options?
• How can I protect myself and my baby?
• What should I know about future pregnancies if I’ve had ICP?

A note from Cleveland Clinic

Cholestasis of pregnancy causes severe itching during pregnancy. Your pregnancy care provider will monitor you closely to ensure there are no complications. Cholestasis goes away after your baby is born and isn’t usually life-threatening. Your provider may deliver your baby early if it’s the safest treatment option. Don’t be afraid to ask your provider questions about your diagnosis. They’re there to listen and reassure you that you and your baby will be OK.