Pregnancy Spotlight: Cholestasis - Reiter & Walsh

Pregnancy Spotlight: Cholestasis of Pregnancy

Every day, our nurses and attorneys receive calls from expectant mothers with concerns about symptoms they’re experiencing during pregnancy. They’re curious if their symptoms are normal, and they wonder what their next steps should be. Patients should always visit a medical professional with concerns like these and receive appropriate care for maternal-fetal conditions and illnesses that can arise during pregnancy. We kickstarted the Pregnancy Spotlight Series, a monthly column that highlights specific pregnancy health concerns, to help educate and empower patients for these medical visits. Today, we’re focusing on Cholestasis of Pregnancy.

Cholestasis of Pregnancy


What is Cholestasis of Pregnancy?

Intrahepatic cholestasis of Pregnancy, abbreviated ICP and commonly known as Cholestasis of Pregnancy or simply Cholestasis, is a liver disease which only occurs during pregnancy (usually during late pregnancy). It happens when pregnancy hormones affect the flow of bile in the gallbladder. Bile acids then pile up in the liver and can be released into the bloodstream. Typically, Cholestasis goes away within a few days after delivery, but if improperly managed, it can seriously harm the baby (1).

Pregnancy Spotlight: Cholestasis - Reiter & Walsh

How common is Cholestasis of Pregnancy?

In the United States, reported incidence rates range from 0.32% to 5.6%; worldwide, rates range from as low as <1% to as high as 27.6%.  It occurs more frequently in women who are carrying multiples, who have chronic hepatitis C, who have previously experienced Cholestasis or have a family history of it, or who are considered to be of advanced maternal age. In some countries, Cholestasis is more common during the winter, although it is unclear why (2).

What are the symptoms of Cholestasis?

The most common symptoms of Cholestasis include:

  • Severe itching, specifically on the feet and hands
  • Loss of appetite
  • Dark-colored urine
  • Light-colored stools
  • Depression
  • Fatigue
  • Nausea
  • Jaundice (yellow coloring of eyes and skin)
  • Pain in the Upper-Right Quadrant

The itchiness and other symptoms should cease a few days after the birth of the baby (1).

How will I know if I have Cholestasis?

You should contact your doctor if you feel severely itchy, especially since that can be the only symptom experienced by women with Cholestasis of Pregnancy. In order to diagnose Cholestasis, doctors may do a complete medical history and physical examination. They should also conduct blood tests to evaluate liver function and concentrations of bile acids and bilirubin (1). It is important for doctors to differentiate between cholestasis and conditions that may present similar symptoms, such as preeclampsia, HELLP syndrome, and skin conditions that cause itchiness which is unrelated to cholestasis (2).

What treatments are available for my symptoms?

Treatment for Cholestasis of Pregnancy has two main goals: relieving maternal symptoms, and reducing the possibility of harm to the baby (2). Doctors may recommend topical anti-itch creams or corticosteroids, but it is important that they select options which will not negatively affect the fetus.

Your doctor will likely recommend you take a prescription medication called ursodeoxycholic acid (UDCA), also known as ursodiol. This medication can help reduce the levels of bile in your bloodstream, resolve itching symptoms, and may improve outcomes for the baby. Other treatments include the following (this is not a complete list):

  • Cold baths
  • Ice water
  • Vitamin K supplements (to prevent the baby from having an intracranial hemorrhage/brain bleed)
  • Dandelion root and milk thistle (these natural substances may benefit the liver)
  • Dexamethasone (a steroid that can accelerate the baby’s lung maturity) (1)

The American Pregnancy Association (APA) emphasizes the importance of consulting a doctor before attempting to treat Cholestasis oneself. Additionally, they recommend against the use of antihistamines, Aveeno, and oatmeal baths.

While treating a mother with Cholestasis, doctors must be very careful to also monitor the health of the baby. This means conducting bi-weekly non-stress tests to monitor the fetus’s heart and the mother’s uterine activity. The mother should also have regular blood tests to assess progress.

Will Cholestasis of Pregnancy harm me or my baby?

Cholestasis doesn’t pose any major long-term risks to the mother, but it can be very dangerous for the baby. Elevated bile levels in the mother’s blood can put a strain on the baby’s liver (1). In pregnancies involving Cholestasis, there is an increased risk of stillbirth, as well of birth injuries.  There is an increase in the risk of the baby passing meconium while in the womb. Meconium, if inhaled during delivery, can damage the lungs and cause respiratory difficulty. This is called meconium aspiration syndrome (MAS). MAS increases the risk of diagnoses like hypoxic-ischemic encephalopathy (HIE), cerebral palsy, and other developmental delays stemming from hypoxic-ischemic injury.

With cholestasis, doctors will most likely recommend early induction in order to prevent the baby from suffering health complications or injuries . They should carefully monitor the baby’s maturity and wellbeing in order to determine optimal timing of delivery.  Induction usually occurs around 37 weeks, but this can vary depending on individual factors (3). It’s important that patients consult with their doctor often about their plan for treating cholestasis. Some women have also found it helpful to add the guidance of a maternal-fetal medicine doctor to this decision.


Sources

1. Cholestasis of Pregnancy: Causes, Symptoms and Treatment. (2017, July 21). Retrieved September 13, 2018, from http://americanpregnancy.org/pregnancy-complications/cholestasis-of-pregnancy/

2. (n.d.). Retrieved September 13, 2018, from https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy?search=cholestasis of pregnancy&source=search_result&selectedTitle=1~59&usage_type=default&display_rank=1

3. Obstetric cholestasis: Outcome with active management. (2001, December 14). Retrieved September 13, 2018, from https://www.sciencedirect.com/science/article/pii/S0301211501004638


Related resources


The information presented above is intended only to be a general educational resource. It is not intended to be (and should not be interpreted as) medical advice. If you have questions about the topic, please consult with a medical professional.


 

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