Every day, our nurses and attorneys receive calls from expectant mothers with concerns about symptoms they’re experiencing during their 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.
What Is Cholestasis of Pregnancy?
Cholestasis of pregnancy 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 gall bladder. Bile acids then pile up in the liver and are released into the bloodstream.
How Common Is Cholestasis of Pregnancy?
According to the Cincinnati Children’s Hospital Medical Center, Cholestasis happens in about 1 out of 1,000 pregnancies.
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
- Exhaustion or Fatigue
Other, less common symptoms:
- 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.
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. Your doctor will usually conduct a blood test to measure the bile salts in your blood and your liver function.
Cholestasis of pregnancy is diagnosed with a blood test that shows bile acids over 10 µmol/L or a liver function test that reveals elevated levels of AST (Aspartate Aminotransferase) or ALT (Alanine Aminotransferase). To view a sample of a normal liver function blood test, click here.
What Treatments Are Available for My Symptoms?
Your doctor will likely recommend you take a prescription medication called ursodiol (Urso, Actigall). This medication will help reduce the levels of bile in your bloodstream and may reduce complications in the baby. Other treatments include topical anti-itch medications or washing in cold or lukewarm water to help alleviate the itching.
It is recommended that you avoid treating itching sensations through the use of antihistamines or corticosteroid creams yourself. Without a doctor’s supervision, antihistamines and corticosteroid creams may harm the baby. All medical treatment should be undertaken under a doctor’s care.
Will Cholestasis of Pregnancy Harm Me or My Baby?
Cholestasis doesn’t pose any long-term risk 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. Though cholestasis research is constantly developing, it is suspected that there is an increased risk of stillbirth for babies whose mothers have the condition. There is an increase in the risk of the baby passing meconium while in the womb (Meconium Aspiration Syndrome, or MAS), which, if inhaled during delivery, can damage the lungs and cause respiratory difficulty. 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 decide to induce the baby early. They will usually monitor the baby as soon as they have a diagnosis with repeated biophysical profiles (BPPs) and nonstress tests (NSTs). The decision to induce labor early is made to prevent complications or health problems for the baby. Induction usually occurs around 37 weeks, but this can vary depending on the patient’s history and the results of these tests. 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.
- Meconium Aspiration (MAS) and Birth Injury
- Hypoxic-Ischemic Encephalopathy (HIE)
- High-Risk Pregnancy
- Premature Birth and its Prevention
- American Pregnancy Association: Cholestasis of Pregnancy
- Mayo Clinic: Cholestasis of Pregnancy
- ICP Care: Diagnosis
- Patient: Obstetric Cholestasis
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.