Cholestasis of Pregnancy

Overview

What is cholestasis of pregnancy?

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

ICP temporarily impairs (lowers) liver function in some pregnant women. This liver impairment causes bile (a substance made by the liver that helps digestion) to build up in the liver and bloodstream. When levels of bile in the blood reach a certain point, it causes the itching.

Cholestasis of pregnancy can cause complications for both the expectant mother and baby.

How common is cholestasis of pregnancy?

Cholestasis is a common liver disease during pregnancy. About 1 to 2 in 1,000 pregnant women develop ICP. Women with Scandinavian, Indian, Pakistani or Chilean backgrounds are more likely to develop it.

Symptoms and Causes

What causes cholestasis of pregnancy?

Bile is a substance made by the liver. It helps break down fats during digestion. In some people, when levels of hormones such as estrogen increase during pregnancy, the flow of bile in the liver stops or slows down. This slowdown can cause bile to build up in the liver and enter the bloodstream.

Cholestasis of pregnancy typically develops in the third trimester when pregnancy hormone levels are at their highest. In some cases, it is genetic, meaning it is passed down among family members.

What are the symptoms of cholestasis of pregnancy?

The main symptom of cholestasis of pregnancy is severe itching (pruritus). This itching starts on the hands and feet and spreads to other parts of the body. Itching is usually worse at night. It does not involve a rash.

Less-common signs of obstetric cholestasis may include:

  • Nausea
  • Dark urine
  • Light-colored stool
  • Fatigue (extreme tiredness)
  • Decreased appetite
  • Pain in the upper right belly
  • Jaundice (yellowing of the skin and eyes)

Diagnosis and Tests

How is cholestasis of pregnancy diagnosed?

A doctor diagnoses cholestasis of pregnancy with a physical examination and blood tests. These tests tell the doctor how the liver is functioning. They also measure the level of bile acids in the blood.

Tests confirm the diagnosis when total bile acids measure 10 micromoles per liter and above. (A micromole is a measure of tiny amounts for some medical tests.)

Your doctor may test your blood regularly during your pregnancy to monitor levels of bile in the blood.

Management and Treatment

How is cholestasis of pregnancy managed or treated?

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

Treatments to manage the symptoms of cholestasis of pregnancy include:

  • Anti-itch medicines
  • Wearing soft and loose clothing
  • Rest

If medication does not lower bile levels, your doctor may recommend delivering the baby early. Early delivery may reduce the risk of serious complications including premature birth (baby is born before full term) and stillbirth (infant has died before birth). Doctors usually induce labor around weeks 37 or 38 of the pregnancy to reduce the risk of complications of cholestasis of pregnancy.

What complications are associated with cholestasis of pregnancy?

Cholestasis of pregnancy may involve complications for the expectant mother and baby. In the mother, problems absorbing vitamin K may increase the risk of hemorrhage (heavy internal bleeding).

Complications for the baby related to cholestasis of pregnancy include:

  • Premature birth: A baby born before organs are fully developed.
  • Stillbirth: A baby that dies before delivery.
  • Fetal distress: Abnormal heart rate or decreased movement.
  • Breathing problems: Meconium (a baby’s first stool) may enter the amniotic fluid before birth. If the baby inhales this thick substance, it can cause respiratory (breathing) problems.

Your doctor may deliver your baby early to decrease the risk of these complications.

Prevention

Can cholestasis of pregnancy be prevented?

You cannot 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?

Women are at a higher risk for developing cholestasis of pregnancy if they have:

  • A family member with the condition
  • Pregnancy with two or more babies
  • Undergone in vitro fertilization (IVF) treatments
  • History of liver damage
  • Chronic hepatitis C

Outlook / Prognosis

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

Cholestasis of pregnancy goes away as soon as the baby is born. After delivery, bile levels return to normal. Women can stop taking UDCA medication, with their doctor’s guidance, at this point.

Most women with the disorder do not have any more liver problems unless they become pregnant again. Women who develop cholestasis of pregnancy during one pregnancy are more likely to develop it in later pregnancies.

Living With

When should I call the doctor?

Contact your doctor if you develop intense itchiness that does not go away during pregnancy.

What questions should I ask my doctor?

If you have cholestasis of pregnancy, you may want to ask your doctor:

  • 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?

When can I go back to my regular activities?

Most women with cholestasis of pregnancy return to normal activities after the baby is born.

Last reviewed by a Cleveland Clinic medical professional on 03/26/2019.

References

  • American Liver Foundation. Intrahepatic Cholestasis of Pregnancy (ICP). (https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/intrahepatic-cholestasis-of-pregnancy/) Accessed 3/27/2019.
  • American Pregnancy Association. Cholestasis of Pregnancy. (https://americanpregnancy.org/pregnancy-complications/cholestasis-of-pregnancy/) Accessed 3/27/2019.
  • National Health Service. Itching and intrahepatic cholestasis of pregnancy. (https://www.nhs.uk/conditions/pregnancy-and-baby/itching-obstetric-cholestasis-pregnant/) Accessed 3/27/2019.
  • Society for Maternal-Fetal Medicine. Understanding Intrahepatic Cholestasis of Pregnancy. (https://www.smfm.org/publications/96-understanding-intrahepatic-cholestasis-of-pregnancy) Accessed 3/27/2019.
  • U.S. National Library of Medicine. Intrahepatic cholestasis of pregnancy. (https://ghr.nlm.nih.gov/condition/intrahepatic-cholestasis-of-pregnancy) Accessed 3/27/2019.

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