Gestational cholestasis is a liver disease that can occur late in pregnancy. The main symptom of this common condition is severe itching. Pregnancy cholestasis typically goes away after the baby is born. You can find more information below.
What is pregnancy cholestasis?
Gestational cholestasis is a common liver disease that causes severe itching in late pregnancy. It is also known as intrahepatic pregnancy cholestasis or obstetric cholestasis.
Gestational cholestasis temporarily impairs liver function in some pregnant women. This liver disorder causes bile (a substance made by the liver that aids digestion) to build up in the liver and bloodstream. When bile levels in the blood reach a certain point, it causes itching.
Pregnancy cholestasis can cause complications for both the expectant mother and the baby.
How common is it?
Cholestasis is a common liver disease during pregnancy. About 1 to 2 in 1,000 pregnant women develop this condition. Women of Scandinavian, Indian, Pakistani, or Chilean descent are more likely to develop it.
What causes pregnancy cholestasis?
Bile is a substance made by the liver. It helps break down fats during digestion. In some people, when hormone levels such as estrogen increase during pregnancy, the flow of bile in the liver stops or slows. This slowdown can cause bile to build up in the liver and enter the bloodstream.
Pregnancy cholestasis typically develops during the third trimester, when pregnancy hormone levels are highest. In some cases it is genetic, meaning it is passed between family members.
Who is at risk?
Women with the following health conditions have a higher risk of developing pregnancy cholestasis:
- Having a family member experiencing the same thing
- giving birth to two or more babies
- Previous IVF attempts
- History of liver damage
- Chronic hepatitis C
What are the symptoms of pregnancy cholestasis?
The main symptom of pregnancy cholestasis is severe itching. This itching starts on the hands and feet and spreads to other parts of the body. Itching is usually worse at night. Does not contain redness.
Less common symptoms of cholestasis may include:
- dark urine
- light colored stool
- decreased appetite
- Pain in the upper right part of the abdomen
- Jaundice (yellowing of the skin and eyes)
When should you see a doctor?
You should see your doctor if you develop intense itching that does not go away during pregnancy.
How is pregnancy cholestasis diagnosed?
The doctor diagnoses pregnancy cholestasis with a physical exam and blood tests. These tests tell the doctor how the liver is working. They also measure the level of bile acids in the blood.
Tests confirm the diagnosis when total bile acids measure 10 micromoles per liter and above. (A micromole is a measure of small amounts for some medical tests.)
Your doctor may test your blood regularly during your pregnancy to monitor the levels of bile in the blood.
How is pregnancy cholestasis treated?
Doctors use a medicine containing ursodeoxycholic acid to treat gestational cholestasis. This medicine may increase the liver’s ability to work and reduce bile levels in the blood.
Treatments to manage the symptoms of pregnancy cholestasis include:
- anti-itch medications
- wearing soft and loose clothing
If the medication does not lower bile levels, your doctor may recommend that the baby be born prematurely. It can reduce the risk of serious complications such as premature birth, miscarriage and stillbirth. Doctors usually initiate labor around 37 or 38 weeks of pregnancy to reduce the risk of pregnancy complications of cholestasis.
Remember, your doctor will decide which medicine to take and how.
Can pregnancy cholestasis be prevented?
You cannot prevent pregnancy cholestasis. Genetic testing can help you understand the chances of passing this disorder on to your child.
What are the complications of pregnancy cholestasis?
Pregnancy cholestasis can involve complications for the expectant mother and baby. Problems in the absorption of vitamin K in the mother can increase the risk of bleeding.
Infant complications related to pregnancy cholestasis include:
- Premature birth: A baby born before his organs are fully developed.
- Stillbirth: A baby who dies before birth.
- Fetal distress : Abnormal heart rate or decreased movement.
- Respiratory issues: Meconium (a baby’s first stool) can enter the amniotic fluid before birth. If the baby inhales this thick substance, it can cause respiratory problems.
Your doctor may deliver your baby early to reduce the risk of these complications.
Outlook / Prognosis
Gestational cholestasis goes away as soon as the baby is born. Bile levels return to normal after birth. At this point, women can stop taking their medication under the guidance of their doctor.
Most women with the disorder do not experience further liver problems unless they become pregnant again. Women who develop gestational cholestasis during one pregnancy are more likely to develop it in subsequent pregnancies.