What is cholestasis of pregnancy?

Cholestasis (pronounced - kow·luh·stay·suhs) of pregnancy is a liver condition that causes severe itching late in pregnancy. It’s also known as intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis.

ICP temporarily lowers liver function in some pregnant people. This causes bile to build up in your liver and bloodstream. Bile is a substance produced by your liver and stored in your gallbladder. Every time you eat, bile breaks down fats so you can digest them properly. When levels of bile in your blood reach a certain level, you may begin to itch.

Cholestasis of pregnancy can cause complications for you and your baby. To lower the risk of complications, your LMC may monitor you and your baby closely for the remainder of your pregnancy.

What happens if I have cholestasis while pregnant?

During pregnancy, your baby relies on your liver to remove waste from it's blood. Your liver is an important organ responsible for removing waste from your body, so when it’s not fully functioning, it can cause complications. If your liver isn’t functioning properly, bile levels may increase to unsafe levels that may stress your baby’s liver.

How common is cholestasis during pregnancy?

Cholestasis affects about 1 - 2 in 1,000 people during pregnancy.

What is the main cause of cholestasis during pregnancy?

Bile is a substance made by your liver and stored in your gallbladder. Your liver helps break down fats during digestion. Increased levels of estrogen and progesterone during pregnancy affect your liver’s ability to transport bile. This means your bile doesn’t move through your body properly, causing it to build up in your liver and enter your bloodstream and this can make you feel extremely itchy.

Cholestasis of pregnancy typically develops in the third trimester (around week 28 gestation) when pregnancy hormone levels are at their highest. In some cases, it’s genetic, meaning you’re at higher risk if your biological parents have cholestasis.

What are the symptoms of cholestasis?

The main symptom of cholestasis is severe itching (pruritus). This itching starts on your hands and feet and spreads to other body parts. The itching is usually worse at night. Unlike other conditions that cause itching, cholestasis doesn’t involve a rash.

Less common signs of cholestasis may include:

• Nausea

• Dark urine

• Light grey or pale brown poop

• Extreme tiredness

• Decreased appetite

• Pain in the upper right of your belly

• Jaundice (yellowing of your skin and whites of your eyes)

How is it diagnosed?

Your LMC will do a physical examination and blood tests. These tests tell your provider how your liver is functioning. They’ll also measure the level of bile acids in your bloodstream using a serum bile acid test.

Tests confirm the diagnosis when total bile acids are 10 micromoles per litre or above. A micromole is a unit of measurement used in some medical tests. You may have blood tests regularly for the remainder of your pregnancy to monitor bile levels in your blood.

Your provider may also order a prothrombin time test to see how well your blood clots or an ultrasound to look at your bile ducts and liver.

How is it managed or treated?

• medication to improve your liver's ability to function and reduce bile levels in your blood

• anti-itch creams or lotions - check with your LMC before using any products

• wearing soft and loose-fitting clothing

• rest

• sitting directly in front of a fan, soaking in a cool bath, and applying ice packs for short periods to affected areas

• applying naturally-cooling substances, such as aloe to affected areas before rinsing off in a shower

• wearing cool, loose, cotton clothing

• using unperfumed lotion or soap

Are there any possible complications?

Cholestasis of pregnancy may cause complications for you and your unborn baby. You may have problems absorbing vitamin K, which increases the risk of hemorrhage (heavy internal bleeding). It’s also associated with pre-eclampsia and gestational diabetes.

Complications for your unborn baby related to cholestasis of pregnancy include:

• Premature birth

• Stillbirth

• Fetal distress

• Meconium aspiration

Your LMC may suggest an induction to deliver your baby early to decrease the risk of these complications.

Pregnancy can be an emotional experience. But if you are diagnosed with a complication such as ICP, this may cause some stress and anxiety.

Tell your midwife or GP if you are finding it hard to cope with these feelings.