Cholestasis of pregnancy causes severe itching and sometimes jaundice. Most frequently occurring in late pregnancy, cholestasis affects 1 or 2 women out of 1000. Women carrying multiples, who have a family history of cholestasis, getting pregnant through the use of in-vitro fertilization (IVF) or who have suffered previous damage to their liver are most at risk. While the itching can be so severe it disrupts a woman’s life, most of the issues with this condition revolves around the baby. This condition is also known as obstetric cholestasis and intrahepatic cholestasis of pregnancy.
What Causes Cholestasis?
Cholestasis is a liver disease. It only occurs in pregnancy, and while the cause is unknown, it is thought that the flow of bile from the gallbladder may be affected by the hormones of pregnancy. It is most common for women to suffer from this condition during the last trimester when these hormones are at their highest levels. Bile is required to help break down fats during digestion, and when it is slowed or stopped, the collected acids in the liver may overflow into the bloodstream.
Problems Caused by Cholestasis
Women affected with cholestasis of pregnancy may suffer from itching that ranges from annoying to severe. Itching may increase at night. The itching may be all over the body or focus on the palms of the hands and the soles of the feet. Exhaustion, loss of appetite, nausea and depression may also occur. Any time itching may cause a scrape or cut in the skin, infection may occur. She may also have problems absorbing fat-soluble vitamins like A, D, E and K. The biggest risk for the mother is the recurrence of the condition in a future pregnancy. Hemorrhage is a concern for both mother and baby.
Cholestasis of pregnancy can affect the baby by increasing the risks of stillbirth, preterm birth or fetal distress. The baby’s liver may get stressed since the mother’s liver is not removing bile acids efficiently. Due to the stress on the baby’s system, they may release meconium (their first bowel movement) before they are born and inhale it. This may cause breathing problems.
Treatment
Bile acids need to be reduced to get the best results for both pregnant women and their babies. Ursodeoxycholic acid is often prescribed to improve liver function. Studies have shown that it can reduce the bile acid levels in the amniotic fluid and umbilical cord blood as well.
Vitamin K is often deficient in women suffering from cholestasis of pregnancy. Supplements can increase the levels and help prevent hemorrhaging in both mom and baby. It is recommended that babies born in these circumstances should receive an injection of vitamin K to make sure their levels are adequate.
Steroids are often given to help the baby’s lungs mature so labor can be induced. Induction of labor around 36 to 37 weeks gestation is routine. The baby will usually be born before the condition affects it too severely by following this protocol. The itching will resolve a few days after birth.
Things that mothers can do to help themselves include lowering their fat intake. This may help with the itching, since bile acids are produced when digesting fat. They should drink lots of water to help flush any toxins from the body. An herbal remedy of dandelion root and milk thistle can strengthen the liver. This can be a tincture or a tea. If stress levels can be lowered, it may help the other remedies to function more efficiently. She should keep her skin well moisturized to reduce external irritation. Comfortable clothing, low temperatures, ice packs and cool baths may help. Soothing skin lotions may help relieve some of the itching.
Mothers with this condition will be monitored with blood tests to keep an eye on liver function and bile acid levels. Ultrasounds will be done to monitor the baby’s well-being, as well as frequent non-stress tests to measure the baby’s heart rate. If a mother thinks she has this condition, she should request testing. It is better to have a negative test result than to end up with a compromised baby due to undiagnosed cholestasis. Sometimes this request needs to be made several times to get the needed tests.
