Many mothers experience various discomforts during pregnancy. While it is normal to feel itchy at times, sometimes it can be something to be concerned about. Especially towards the end of your pregnancy, if you find yourself itching uncontrollably, starting with your palms and soles and then all over your body, it could be a symptom of a condition called Cholestasis of Pregnancy. Shall we talk about this in detail today? Don't worry, it is very important to be aware of this.
What exactly is Cholestasis of Pregnancy?
Simply put, cholestasis of pregnancy is a condition that affects the liver . It most often occurs in the third trimester of pregnancy, around 28 weeks. In some people, it can occur earlier. Doctors also call it ``Intrahepatic Cholestasis of Pregnancy (ICP)`` or ``Obstetric Cholestasis``. You may have heard these terms when you see a doctor.
In this condition, some pregnant women experience a temporary decrease in liver function. Then, the substance called bile in our body does not flow properly and starts to accumulate in the liver and blood.
What is bile?
Bile is a fluid produced by our liver and stored in the gallbladder. Every time we eat, this bile helps us digest the fats in the food we eat. So, when this bile level in the blood exceeds the required level, you start to get that terrible itch.
This condition of cholestasis can cause complications for you and your unborn baby. That's why if your doctor suspects you have this condition, you and your baby will be closely monitored throughout the remainder of your pregnancy.
What happens if I have cholestasis during pregnancy?
This is something to understand. During pregnancy, your baby relies on your liver to remove waste products from his body. So, if your liver isn't working properly, that bile level I mentioned earlier can become dangerously high. This can put some pressure on your baby's liver as well. The liver is one of the most important organs in our body. It's the main place where the body gets rid of waste products. So if it's not working properly, there's a chance of complications.
But don't worry . Your doctor will check you and your baby regularly to make sure that cholestasis isn't harming either of you.
How common is cholestasis during pregnancy?
This condition affects one to two out of every 1,000 pregnant women. That means it's not that common. Although researchers still don't know the exact cause, data shows that it's more common in the winter. It's also said that people of Hispanic and Swedish descent are more likely to develop it.
What is the main cause of cholestasis?
As we've discussed before, bile is a substance made by the liver and stored in the gallbladder. It helps break down fats during digestion. During pregnancy, your body's levels of the hormones estrogen and progesterone increase dramatically. These increased levels of these hormones affect the liver's ability to properly transport bile. Simply put, bile doesn't travel throughout the body, but instead accumulates in the liver and then backs up into the bloodstream. When bile builds up in the bloodstream, you get that unbearable itch.
Cholestasis of pregnancy most often occurs in the third trimester, around 28 weeks. This is because pregnancy hormone levels are at their highest during this time. In some cases, it can be genetic . This means that if your parents had cholestasis, you are at risk of developing it too.
What are the symptoms of cholestasis during pregnancy?
The main and most obvious symptom of this condition is severe itching (pruritus) . This itching first begins on the palms and soles of the feet. Then it can gradually spread to other parts of the body. For many people, this itching is worse at night . They scratch so much that they cannot sleep. Unlike other itching conditions, cholestasis does not usually cause a skin rash . This is very important.
In addition to itching, there may be several other symptoms. However, not everyone experiences these:
- Nausea
- Dark urine
- Light gray or pale brown poop
- Extreme tiredness
- Decreased appetite
- Pain in the upper right side of your belly
- Jaundice - This means your skin and the whites of your eyes turn yellow.
If you have one or more of these symptoms, it is best to seek medical advice immediately.
At what week of pregnancy does cholestasis begin?
Cholestasis of pregnancy usually begins after 28 weeks of pregnancy. However, as I mentioned earlier, some people can develop the condition earlier. So it's important to be aware of the itching.
How is cholestasis diagnosed during pregnancy?
Your doctor will diagnose this condition by doing a physical exam and blood tests. These tests can show how your liver is working. They will also do a serum bile acid test to measure the level of bile acids in your blood.
These tests can confirm this condition if the total bile acid level is 10 micromoles per liter (`10 micromoles per liter`) or higher. Micromoles are a unit of measurement used in some medical tests. You may also have regular blood tests to monitor your bile acid levels throughout the rest of your pregnancy.
In addition, your doctor may recommend a prothrombin time test to see how well your blood clots, and an ultrasound to look at your bile ducts and liver.
How is cholestasis treated during pregnancy?
The main medication doctors use to treat this condition is Ursodeoxycholic acid (UDCA) . It is also known as `(ursodiol)` or `(Actigall®)`. This medication helps improve your liver function and reduce the level of bile in your blood.
Additionally, there are treatments to control the symptoms of cholestasis, especially the severe itching:
- Medicine for itching: (But remember, you should definitely ask your doctor before taking any medicine.)
- Wear soft, loose clothing: Wearing tight clothing can make itching worse. Therefore, wear loose-fitting clothing made from soft fabrics like cotton.
- Rest: Getting enough rest is also very important.
- Bathing in lukewarm water: Soaking in lukewarm water for a while can provide some relief from itching.
Sometimes, if medication doesn't reduce your bile levels, your doctor may recommend delivering your baby a little earlier, before your due date. Inducing labor, usually around 37 or 38 weeks, can reduce the risk of complications from cholestasis. Your doctor will also do tests, such as a biophysical profile or nonstress test, to make sure your baby is okay.
If the baby is delivered early, a steroid may be given to help the baby's lungs mature properly and a vitamin K supplement to prevent internal bleeding.
What are the possible complications of cholestasis during pregnancy?
Cholestasis of pregnancy can cause complications. You may have trouble absorbing vitamin K , which increases your risk of excessive internal bleeding. It can also be linked to conditions like preeclampsia (high blood pressure during pregnancy) and gestational diabetes .
Complications that can occur in the baby are:
- Premature birth
- Stillbirth - This is something that many people fear. However, with proper medical supervision, this risk can be greatly reduced.
- Fetal distress - This means that the baby is experiencing discomfort in the womb.
- Meconium aspiration - A baby who has passed stool in the womb and then inhales it.
To reduce the risk of complications like these, your doctor sometimes decides to deliver the baby a little early.
Is it possible to have a healthy baby if you have cholestasis during pregnancy?
Yes, you definitely can! Just because you had cholestasis during pregnancy doesn't mean your baby won't be healthy. With proper medical care and supervision, most mothers give birth to healthy babies. So don't worry unnecessarily.
Are there any things I should avoid eating when I have cholestasis?
Your doctor may advise you to limit certain foods depending on your condition. However, there is no specific diet plan (standard diet) that you must follow if you have cholestasis during pregnancy. The most important thing is to eat a balanced diet during pregnancy. This means eating fruits, vegetables, lean meats or other sources of protein. Talk to your doctor about this and get more advice.
Can cholestasis be prevented during pregnancy?
Unfortunately, there is no way to prevent cholestasis during pregnancy. However, genetic testing can help to understand the risk of passing the condition on to your baby.
What are the risk factors for cholestasis during pregnancy?
You are at higher risk of developing cholestasis during pregnancy if you:
- If someone in your family has had this condition before (Have a family member with the condition).
- If you have had cholestasis (ICP) during a previous pregnancy.
- If you are expecting twins, triplets or more.
- If you have a history of liver disease or hepatitis C.
- If you have a history of liver damage.
- If you have a genetic condition that affects how your body makes and uses bile.
If you have these risk factors, be especially careful about rashes during pregnancy.
What is the prognosis for those with cholestasis of pregnancy?
This is the best news! Cholestasis of pregnancy usually goes away within a few days after the baby is born . Your blood bile levels will return to normal. Once your bile levels return to normal, you can stop taking your medication.
Most people with this condition do not develop any liver problems later on, unless they become pregnant again. If you have cholestasis once, you have a 60% chance of developing it again in subsequent pregnancies . However, if you have a severe case of cholestasis, the chance of developing it again in subsequent pregnancies can increase to 90%.
When should I see my doctor?
If you experience unbearable itching during pregnancy that won't go away, or if your skin or the whites of your eyes appear yellow (signs of jaundice), see your doctor immediately. These symptoms may not necessarily be due to cholestasis, but it's best to get checked out.
What questions should I ask my doctor?
If you are diagnosed with cholestasis of pregnancy, you may want to ask your doctor questions like these:
- How serious is cholestasis of pregnancy?
- What treatment options do I have?
- What can I do to protect myself and my baby?
- If I have had cholestasis (ICP) before, what should I know about future pregnancies?
Don't be afraid to ask questions like these. Your doctor is there to help you and clear up any doubts you may have.
Finally, things to remember (Take-Home Message)
Cholestasis of pregnancy is a condition that causes severe itching during pregnancy. Don't be alarmed by this. Your doctor will monitor you and your baby closely and provide the necessary treatment. This condition resolves completely after delivery and is usually not life-threatening. In some cases, your doctor may decide to deliver your baby a little early for the safety of both of you.
The most important thing is that if you have any questions, doubts, or fears about this, talk to your doctor about them. They are there to listen to you and do what is necessary to keep you and your baby safe. You are not alone, and there are doctors who can help you on this journey.
So, I hope this information is helpful to you. Wishing you a healthy pregnancy and a healthy delivery!
` Cholestasis of pregnancy, itching during pregnancy, liver disease, ICP, pregnancy health, bile accumulation, baby's health
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