Overview
Cholestasis of pregnancy, also known as intrahepatic cholestasis of pregnancy, is a liver condition that typically occurs during late pregnancy. It is characterized by intense itching without a rash, usually on the hands and feet, but it can appear on other parts of the body. The condition is caused by reduced or stopped bile flow, which leads to bile acids building up in the liver and entering the bloodstream. High levels of bile acids appear to cause the symptoms and complications of cholestasis of pregnancy. The exact cause is unknown, but certain factors may increase the risk, such as a history of liver damage or disease, pregnancy with multiple babies, or being pregnant at an older age. Complications can include preterm birth, lung problems, and, in severe cases, stillbirth. There is no known way to prevent cholestasis of pregnancy. If you experience constant or extreme itchiness, it is important to contact your pregnancy care provider right away.
Understanding the disease
Symptoms
The main symptom of cholestasis of pregnancy is intense itching, typically without a rash. The itching is usually on the hands and feet, but it can occur on other parts of the body. The itching is often worse at night and can disrupt sleep. Other less common symptoms include yellowing of the skin and whites of the eyes (jaundice), nausea, loss of appetite, and oily, foul-smelling stools. If you experience constant or extreme itchiness, it is essential to contact your pregnancy care provider right away.
Risk Factors
The risk factors for developing cholestasis of pregnancy include:
- Personal or family history of cholestasis of pregnancy
- History of liver damage or disease, including hepatitis C and gallbladder stones
- Being pregnant with multiple babies
- Pregnancy at an older age, such as 35 years or older It is important to note that if you have a history of cholestasis in a prior pregnancy, your risk of developing it during another pregnancy is high, with a recurrence rate of 60-70%, and potentially as high as 90% in severe cases.
Development
Cholestasis of pregnancy is a liver condition that can occur in late pregnancy and is characterized by intense itching without a rash, usually on the hands and feet. The exact cause of cholestasis of pregnancy is not clear, but it is believed to be related to the increased levels of pregnancy hormones, genetics, and environmental factors. Hormones, such as those produced during pregnancy, may slow the flow of bile, leading to its buildup in the liver. Genetic factors may also play a role, as cholestasis of pregnancy can run in families. Environmental factors, although not entirely clear, may vary based on geographic location and season. Certain factors may increase the risk of developing cholestasis of pregnancy, including a personal or family history of the condition, history of liver damage or disease, being pregnant with multiple babies, and pregnancy at an older age. Cholestasis of pregnancy can also increase the risk of complications during pregnancy, such as preeclampsia and gestational diabetes. Unfortunately, there is no known way to prevent cholestasis of pregnancy. It is essential to contact your pregnancy care provider right away if you experience constant or extreme itchiness, as this condition can have serious consequences for both the mother and the baby.
Assessment and Diagnosis
Triage
You should contact your pregnancy care provider right away if you begin to feel constant or extreme itchiness, which is the main symptom of cholestasis of pregnancy. Additionally, if you experience other symptoms such as yellowing of the skin and whites of the eyes (jaundice), nausea, loss of appetite, or oily, foul-smelling stools, you should also seek medical attention. Early diagnosis and intervention are crucial to manage the potential complications of cholestasis of pregnancy, especially for the well-being of your baby.
Diagnosis
To diagnose cholestasis of pregnancy, your pregnancy care provider will typically:
- Ask questions about your symptoms and medical history
- Perform a physical exam
- Order blood tests to measure the level of bile acids in your blood and assess your liver function. These tests are used to diagnose cholestasis of pregnancy. It's important to work closely with your pregnancy care provider to manage this condition and ensure the best possible care for both you and your baby.
Management and Treatment
Complications
The potential complications of cholestasis of pregnancy include:
- Preterm birth: Being born too early.
- Lung problems: Lung issues from breathing in meconium, the sticky, green substance that collects in the baby's intestines.
- Stillbirth: Death of the baby late in pregnancy before delivery.
- Complications for the mother: Temporary affect on the body's ability to absorb fat, resulting in decreased levels of vitamin K-dependent factors involved with blood clotting. However, this complication is rare. Future liver problems may occur but are uncommon. These complications can be severe for the baby, which is why your pregnancy care provider may consider inducing labor before the due date.
Home Remedies
Currently, there is no known way to prevent cholestasis of pregnancy. It is important to consult with a healthcare provider for proper diagnosis and treatment. If you experience symptoms of cholestasis of pregnancy, such as intense itching, yellowing of the skin and eyes, nausea, loss of appetite, or oily, foul-smelling stools, contact your pregnancy care provider right away for medical advice and guidance.
Treatment
To treat cholestasis of pregnancy, the goals are to ease itching and prevent complications in the baby. Your pregnancy care provider may recommend taking a prescription medicine called ursodiol, which helps to lower the level of bile acids in your blood. Other medicines to relieve itching may also be an option. Soaking itchy areas in cool or lukewarm water can provide some relief. Early delivery, around 37 weeks, may lower the risk of stillbirth, and other methods of birth control are generally recommended due to the increased risk of symptoms returning with contraceptives that contain estrogen. Home remedies may not offer much relief for itching, but trying cool baths, oatmeal baths, and other soothing tips may help. It's essential to work closely with your pregnancy care provider to ensure the best possible care for both you and your baby.
Preparing for medical consultation
To prepare for an appointment for cholestasis of pregnancy, you should:
- Make a list of your symptoms: Include any symptoms you've experienced, even if they seem unrelated to cholestasis.
- Write down key personal information: Note any major stresses, recent life changes, or family medical history that may be relevant.
- Bring a list of medications, vitamins, or supplements you are taking: Including doses and how often you take them.
- Bring a family member or friend along: Having someone with you can help you remember important information and provide support.
- Prepare questions to ask your healthcare provider: Examples include:
- What is the likely cause of my cholestasis?
- What are the potential risks to my pregnancy?
- Are there any specific treatments or medications for cholestasis of pregnancy?
- What changes in my diet or lifestyle can help alleviate my symptoms and reduce the risk to my baby?
- How often should I have check-ups or testing to monitor the condition and my baby's health? Remember to discuss any concerns or questions you have with your healthcare provider during the appointment.