Understanding Your Risks for Intrahepatic Cholestasis During Pregnancy

In late pregnancy some women may experience a very severe itching. A common cause of this is cholestasis. Cholestasis is a liver disease that only occurs during pregnancy. This condition may trigger intense itching, usually this occurs on the hands and feet. The itching can affect other parts of the body, but is usually without a rash. Intrahepatic Cholestasis of Pregnancy (ICP) is a condition where the normal flow of bile is affected due to the increased amount of pregnancy hormones within the body. Cholestasis of pregnancy can be extremely uncomfortable. Research says that it is most common to occur during the third trimester when pregnancy hormones are at their peak; however, it generally goes away a few days after delivery. But, more worrisome is the potential difficulties for you and your baby.

Causes

The exact cause of cholestasis of pregnancy is uncertain; but, pregnancy hormones may be involved. The closer that a woman gets to her due date the higher pregnancy hormones will rise. Doctors think that this could slow down or stop the normal flow of bile. Bile is the digestive fluid made within the liver that is necessary to help the digestive system break down fats. Due to the slow down of this fluid leaving the liver, bile can build up. Consequently, bile acids would spill into the bloodstream over time. These bile acids are what can cause the itch. Research also says that your genes may play a role. The condition has been known to run in families.

Risk Factors

According to Cincinnati Children’s Hospital Medical Center, this disease can affect one to two pregnancies in 1,000 women.

The following women have a higher risk factor of getting cholestasis during pregnancy:

• Women who have a history liver damage or disease
• Women who are carrying multiples
• Women with personal or family history of cholestasis or Intrahepatic Cholestasis of Pregnancy – If you have a history of cholestasis yourself, the risk of getting it again is high, 60-75 percent of women have recurrence.

Preventative Measures

There is no known way to prevent cholestasis during pregnancy.

Treatment Options

The treatment options are predominantly to help relieve the itch that is caused. It is important to talk to your healthcare provider before taking any medications or supplements. Your doctor be able to find the best treatment for you, as every woman and pregnancy is different. Possible treatment options include:

• Medication to decrease the concentration of bile acids
• Cold baths and ice water may help to slow down the flow of blood within the body
• Medications with corticosteroids or topical anti-itch medications
• Bi-weekly non-stress tests which involve contraction recordings and fetal heart monitoring
• Vitamin K supplements for both the mother before delivery and after to help prevent intracranial hemorrhaging
• Regular blood tests to monitor bile serum levels and liver function
• Dandelion Root and Milk Thistle supplements for liver health
• Dexamethasone – a steroid to help increase the maturity of the baby’s lungs

Research shows that treatments should NOT include:

• Antihistamines
• Aveeno and Oatmeal Bath

Possible Complications 

Complications may occur in the mom or the developing baby from cholestasis of pregnancy.

Within pregnant women, the condition may temporarily affect the way that the body absorbs fat. A poor absorption of fat could result in decreased levels of Vitamin K. Vitamin K is in important nutrient with the blood clotting process. This complication is rare within the disease.

For babies, the complications of cholestasis during pregnancy can be severe. They could include:

• Risks for fetal distress
• Being born too early (preterm birth)
• Lung problems from breathing in meconium- This is the sticky, green substance that normally gathers in the developing baby’s intestines but may pass into the amniotic fluid
• Stress on the baby’s liver – The elevated levels of maternal bile may cause this.
• Death of the baby before delivery (stillbirth)

Due to the dangerous risk of these complications your doctor may recommend an early delivery. It is important for women with cholestasis to be monitored closely by a healthcare provider.