Definition

What is cholestasis of pregnancy?

Cholestasis of pregnancy occurs in late pregnancy and triggers intense itching, usually on the hands and feet but often on many other parts of the body.

Cholestasis of pregnancy can make you intensely uncomfortable but poses no long-term risk to an expectant mother. For a developing baby, however, cholestasis of pregnancy can be dangerous. Doctors usually recommend early delivery.

The term “cholestasis” refers to any condition that impairs the flow of bile — a digestive fluid — from the liver. Pregnancy is one of many possible causes of cholestasis. Other names for cholestasis of pregnancy include obstetric cholestasis and intrahepatic cholestasis of pregnancy.

How common is cholestasis of pregnancy?

According to Cincinnati Children’s Hospital Medical Center, cholestasis occurs in about 1 out of 1,000 pregnancies but is more common in Swedish and Chilean ethnic groups. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of cholestasis of pregnancy?

The common symptoms of cholestasis of pregnancy are:

  • Itching, particularly on the hands and feet (often is the only symptom noticed)
  • Dark urine color
  • Pain in the right upper quadrant (RUQ), without gallstones
  • Pale/Light coloring of bowel movements
  • Fatigue or exhaustion
  • Loss of appetite
  • Depression

Less common symptoms include:

  • Jaundice (yellow coloring of skin, eyes, and mucous membranes)
  • Upper-right quadrant pain
  • Nausea

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes cholestasis of pregnancy?

What causes cholestasis of pregnancy is unclear. There may be a genetic component, as the condition sometimes runs in families and certain genetic variants have been associated with it.

Pregnancy hormones also may play a role. Bile is a digestive fluid produced in the liver that helps the digestive system break down fats. It’s possible that the increase in pregnancy hormones — such as occurs in the third trimester — may slow the normal flow of bile out of the liver. Eventually, the buildup of bile in the liver allows bile acids to enter the blood stream. Bile acids deposited in the mother’s tissues can lead to itching.

Risk factors

What increases my risk for cholestasis of pregnancy?

There are many risk factors for cholestasis of pregnancy, such as:

  • A personal or family history of cholestasis of pregnancy
  • A history of liver disease
  • A twin pregnancy

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is cholestasis of pregnancy diagnosed?

A diagnosis of cholestasis can be made by doing a complete medical history, physical examination, and blood tests that evaluate liver function, bile acids, and bilirubin.

The Society for Maternal-Fetal Medicine concurs that ICP should be diagnosed when the total bile acids (TBA) or serum bile acids are measured at 10 micromol/L and above.

How is cholestasis of pregnancy treated?

The treatment goals for cholestasis of pregnancy are to relieve itching. Make sure you speak with your healthcare provider before taking any medications or supplements.

Some treatment options include:

  • Topical anti-itch medications or medication with corticosteroids
  • Medication to decrease the concentration of bile acids such as ursodeoxycholic acid
  • Cold baths and ice water slow down the flow of blood in the body by decreasing the temperature
  • Dexamethasone is a steroid that increases the maturity of the baby’s lungs
  • Vitamin K supplements administered to the mother before delivery and again once the baby is born to prevent intracranial hemorrhaging
  • Dandelion Root and Milk Thistle are natural substances that are beneficial to the liver (talk to your healthcare provider before taking these)
  • Bi-weekly non-stress tests which involve fetal heart monitoring and contraction recordings
  • Regular blood tests monitoring both bile serum levels and liver function

Treatment for cholestasis of pregnancy needs to be determined by your physician, who will take the following criteria into consideration:

  • Your pregnancy, overall health, and medical history
  • The extent of the disease
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

There are conflicting views on using the medication Cholestyramine for the treatment of cholestasis. In the past, this medication was readily used to treat this condition, but some studies have shown that Cholestyramine may not be as effective as other treatments and potentially has some adverse side effects such as blocking essential vitamins like Vitamin K (a vitamin that is already deficient in women with cholestasis).

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage cholestasis of pregnancy?

The following lifestyles and home remedies might help you cope with cholestasis of pregnancy:

  • Warm baths, which seem to lower the intensity of the itching for some women
  • Icing a particularly itchy patch of skin, which may temporarily reduce the itch

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: August 4, 2017 | Last Modified: August 4, 2017

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