Cholestasis of Pregnancy: Causes & Cure

Pregnancy is not easy for all expecting moms. There are several conditions that may affect a woman while she is pregnant and pose complications. One such condition is cholestasis. Cholestasis is a condition in which the liver cannot excrete the bile properly. This condition can cause severe itching to a pregnant woman and can pose complications for the baby.

What Is Cholestasis?

Also known as obstetric cholestasis, it is an uncommon condition that occurs during pregnancy and affects the liver, causing itching during pregnancy. This condition is seen in 1 in 70 pregnant Indian women. This condition causes the blockage of the normal flow of bile in the body. Medical practitioners now prefer to call it intrahepatic cholestasis of pregnancy or ICP.

Because the flow of bile is blocked, the bile builds up in the liver. The bile, particularly the bile salts, then begin to leak into the bloodstream. When this happens, it makes the skin extremely itchy, especially of the hands and feet. It usually manifests in the last trimester of the pregnancy. While this condition does not seem to have any long term effects on the mother’s health, it can cause severe complications for the infant.

What Are the Causes of Obstetric Cholestasis (OC)?

There aren’t any clear reasons as to why cholestasis of pregnancy occurs. However, there are hypotheses that hormonal and genetic factors might play a role.

1. Hormonal Factors

Some women might be highly sensitive to the changes in hormonal levels caused due to their pregnancy. The increase in oestrogen and progesterone affects the liver in a way that slows down the bile as it flows through the tiny ducts.

2. Genetic Factors

Women who have obstetric cholestasis in their family history have more chances of developing the condition themselves. This is because it seems to be inherited, though it is known to skip generations. These women may have inherited a problem in the way the bile is produced and moved through the body. While this problem does not manifest otherwise, a change in the hormone levels during pregnancy could cause the condition to flare up.

Other reasons for the development of this condition include disease, infection and certain medicines.

What Are the Symptoms of Obstetric Cholestasis in Pregnancy?

The following cholestasis liver disease symptoms may be present if you are suffering from OC during your pregnancy:

• Itching: This is the primary symptom of the condition and often affects the palms of your hands and the soles of your feet. The itching because of cholestasis itching will be worse at night though there will be no rash.
• Jaundice: This is a rare symptom of OC. Your eyes and skin might turn yellow which is an indication of jaundice.
• Dark urine: Urine passed by a pregnant woman suffering from cholestasis will be dark in colour.
• Light coloured stools: Stools will be lighter in colour than normal/regular stools.
• Tiredness: Cholestasis can leave a pregnant woman feeling drained and out of energy.
• Loss of appetite: Cholestasis affects hunger and eating schedule.

If you experience intense itching around your feet and palms, do talk to your doctor immediately. Obstetric cholestasis can cause severe complications to the health of your baby and if you have this condition, then you and your baby will be monitored closely.

Risk Factors for Obstetric Cholestasis

There are many factors that can increase the risk of the condition manifesting in pregnant women. These include:

• If a woman has multiple pregnancies, she will have higher chances of developing OC.
• Any previous history of liver disease or injury could increase the chances of the manifestation of OC.
• Family history can be an indicator of the condition.

What Are the Complications of Cholestasis of Pregnancy?

Cholestasis of pregnancy affects both the mother and baby, though it affects the health of the baby more so. Here are some of the ways in which cholestasis of pregnancy can cause complications.

1. Complications for the Mother

The effects of cholestasis on the mother are usually non-life-threatening. The condition can temporarily affect how the body absorbs fat-soluble vitamins though this will hardly affect her nutrition. The itching usually resolves itself within a few days after delivery and the condition does not cause any long term effects on the liver.

2. Complications to the unborn baby

Obstetric cholestasis causes the baby to be born prematurely though the exact reason why is unknown. The foetus has a liquid known as meconium that could leak into the amniotic fluid. If the foetus then inhales the meconium during delivery, she will have complications with her breathing. The condition could also cause foetal demise in late pregnancy. Due to the high chances of stillbirth due to obstetric cholestasis, your doctor might want to induce labour by the 37^th week.

Diagnosis and Test for Cholestasis in Pregnancy

Your doctor will suggest a blood test for detecting obstetric cholestasis called liver function test or LFT. Apart from this, she could also ask for a fasting serum bile acid test. If tests are negative, but the itching continues, they must be repeated.

Your doctor might also suggest an ultrasound to detect obstetric cholestasis. This could rule out gallbladder stones. Other tests to rule out abnormal liver functions like viral hepatitis, Epstein Barr virus, and cytomegalovirus are conducted before a diagnosis of OC can be made.

While all these tests may seem intimidating, you must remember that they are not complicated and are extremely useful for helping maintain the health of your baby.

What Are the Treatments for Obstetric Cholestasis?

Your doctor will recommend treatments that will reduce the itching and spread of the condition and avoid the risk of stillbirth. The treatments include the following methods:

• Ursodeoxycholic acid is generally administered for the itching and to restore the liver back to normal functioning.
• In cases of extreme cholestasis, the doctor will administer steroids.
• The leaking bile salts will cause a loss of Vitamin K which is required for blood clotting. Thus, Vitamin K supplements can be prescribed.

• As soon as the baby develops lungs, your doctor will be ready to induce labour to avoid stillbirth. This is usually between week 35 and 38.

Are There Any Natural Remedies for Obstetric Cholestasis?

Many women find that relaxing provides relief. You can use the following methods, particularly at night, so that you can fall asleep easier.

• Lower the temperature of the room by cranking up the air-conditioning.
• Do not use a blanket and stay uncovered while you sleep as heat can worsen the itching.
• Take a cool shower or bath right before bedtime as cholestasis itching worsens at night due to circadian fluctuations in pregnancy hormones, and taking a bath with cold water can provide you temporary relief and help you sleep better.
• Soak your hands and feet in ice water for a while to get relief from the itching

• Some women have also found that using a mild moisturising lotion has provided them with some relief. Using a lotion with menthol in it has helped others. Before you do use any lotion, check with your doctor first.
• Eat a healthy and balanced diet with minimal oily and fatty food to reduce the pressure on your liver.

• Use only mild soaps so as to not further irritate your skin.
• Wear loose clothing to let your skin breathe.

How Can You Prevent Potential Complications of Obstetric Cholestasis?

Due to the complications posed by obstetric cholestasis, your doctor might recommend close monitoring of your baby. These measures may include:

1. Non-stress Tests and Biophysical Profile Scores

Through this test, your medical practitioner will monitor how much your baby moves at certain times and how much her heart rate increases with the movement. The scores of the biophysical profile will give your doctor information about the volume of amniotic fluid as well as fetal muscle tone and activity.

2. Inducing Early Labor

Even if all the prenatal tests offer normal results, your doctor will recommend that she induce early labour by the 37^th week. Since it is near impossible to predict when foetal death can occur, it is best to opt for early delivery.

FAQs

1. Will the mother get Obstetric Cholestasis in another pregnancy?

The chances of a pregnancy with obstetric cholestasis occurring after a previous pregnancy with the condition are very high. If the condition occurs in your family, you too could have a pregnancy with this condition.

2. Will my baby get delivered early if I have Obstetric Cholestasis?

Since the chances of stillbirth in this condition are very high, your doctor will recommend inducing labour between the 35^th and 38^th week. This is usually done around the 37^th week.

3. What happens after labour & childbirth?

Your doctor will take the following measures to ensure that your health as well your little one’s health stays uncompromised after childbirth.

• A vitamin K injection will be administered to your baby to ensure that the baby doesn’t bleed.
• You will have a follow-up liver test after six to 12 weeks to check the health of your liver and rule out the presence of OC.
• An ultrasound will be done to rule out gall stone formation.
• You will not be given birth control pills that have estrogen in them. Talk to your doctor about other options for contraception.

Obstetric cholestasis can be an uncomfortable condition for you and can cause serious complications for your baby. Keep a note of all your symptoms and keep your medical practitioner in the loop. Maintain all appointments with her to ensure the safe delivery of your baby. Talk to your doctor about solutions for the itching and make sure you keep yourself stress-free to relieve discomfort.