Cholestasis of Pregnancy

Cholestasis of pregnancy is a liver condition that causes severe itching during pregnancy. It’s also known as intrahepatic cholestasis of pregnancy (ICP). It typically occurs after the 28th week of pregnancy, but it can start earlier.

This condition affects how your liver works. It causes bile to build up in your body. Bile is a substance your liver makes to help digest fats. When bile levels get too high, it can cause severe itching.

If your liver isn’t working properly, bile can reach unsafe levels. This may increase the risk of pregnancy complications. Your pregnancy care provider will monitor you closely to help lower these risks.

Cholestasis affects about 1 to 2 in 1,000 pregnancies.

Symptoms of cholestasis of pregnancy

The main symptom is severe itching without a rash. It may start on your hands and feet and spread to other body parts. The itching is usually worse at night.

Less common signs of cholestasis may include:

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

Cholestasis of pregnancy causes

Bile is a substance your liver makes to help digest fats. During pregnancy, high levels of estrogen and progesterone can affect how your liver moves bile. This means bile doesn’t flow through your body as well.

When bile doesn’t move properly, it builds up in your liver. It can then enter your bloodstream. Bile in your blood can make you feel very itchy.

Cholestasis of pregnancy typically develops in the third trimester, when pregnancy hormone levels are at their highest. It can also be genetic. This means you’re at a higher risk if your biological parents have cholestasis.

Risk factors

You’re at a 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

Complications

You’re at risk for the following complications:

• Trouble absorbing vitamin K, which can raise the risk of severe bleeding during delivery
• Preeclampsia
• Gestational diabetes

Other complications of cholestasis of pregnancy include:

• Preterm birth
• Stillbirth
• Fetal distress
• Meconium aspiration

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

How doctors diagnose cholestasis of pregnancy

Your pregnancy care provider diagnoses cholestasis of pregnancy with a physical exam and blood tests. These tests show how your liver is working. They’ll also measure the level of bile acids in your blood using a serum bile acid test.

If you have this condition, you may need regular blood tests for the rest of your pregnancy. These tests help monitor bile levels in your blood.

Your provider may order other tests. A prothrombin time test checks how well your blood clots. An ultrasound can look at your bile ducts and liver.

How is it treated?

Healthcare providers use a medication called ursodeoxycholic acid (UDCA, ursodiol or Actigall^®) to treat cholestasis of pregnancy. This medicine helps your liver work better. It also lowers the amount of bile in your blood.

You can try these treatments to help with the itching, too:

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

Is delivery by 37 weeks necessary for cholestasis of pregnancy

If medication doesn’t lower bile levels, your provider may recommend delivering your baby early. It often happens around 37 or 38 weeks of pregnancy. An early delivery may reduce the risk of complications.

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 severe bleeding.

When should I see my healthcare provider?

Call your healthcare provider if you’re pregnant and have intense itching, light-colored poop and extreme fatigue. They may recommend you come in for an exam to check for cholestasis.

What is the prognosis for intrahepatic cholestasis of pregnancy?

Cholestasis of pregnancy usually goes away a few days after your baby is born. Your hormone levels return to pre-pregnancy levels. Your liver can move bile the way it should. You can stop taking medication once your bile levels return to typical levels.

Most people don’t have any more liver problems after pregnancy. But this condition can come back in future pregnancies. One study showed your risk can range from 40% to 90%.

How does intrahepatic cholestasis of pregnancy affect the baby?

Having IPC doesn’t mean your baby will be unhealthy. Your pregnancy care provider will monitor you closely. They’ll use ultrasounds and blood tests to check your bile levels. These tests help your provider watch for signs of stress. They also help decide the safest time for delivery. The goal is to keep both of you healthy.