What is Cholestasis of Pregnancy?

Cholestasis of pregnancy is a liver condition you can develop when you’re expecting a baby. It’s most notable for the extreme itchiness that it causes – especially on the palms of your hands and the soles of your feet.
In more severe cases, cholestasis can result in some problems for your baby, both before and after birth. But with careful monitoring, these risks are greatly reduced.

So, let’s find out more about cholestasis and its causes, symptoms, and treatment.

In this article: 📝

Understanding cholestasis of pregnancy

What is cholestasis of pregnancy? It’s a medical condition that affects your liver – the body’s largest solid organ and one with a vital role in digestion, energy storage, and clearing toxins from your system.

Your liver makes a fluid called bile to support these important bodily functions. In normal times, bile flows out of the liver, where it’s stored in the gallbladder.

But when you have cholestasis of pregnancy, the flow of bile slows down, and it can build up in your liver. The result? Chemicals called bile acids start overflowing into your bloodstream. These are the culprits behind the uncomfortable itching during pregnancy that mamas-to-be with cholestasis often feel.

Cholestasis is also known as “intrahepatic cholestasis of pregnancy” (ICP), or “obstetric cholestasis.”

The condition happens in around 1 to 2 out of 1,000 pregnancies in the US.

What are the symptoms of cholestasis?

You won’t usually notice the symptoms of cholestasis of pregnancy until you’re in your third trimester. But it’s not unknown for them to hit as early as five weeks into your pregnancy.

Cholestasis symptoms can include:

• Itching. Having severely itchy hands and feet while pregnant is a common sign of cholestasis. The itch can spread to other parts of your body too. It’s often irritating enough to keep you awake at night.
• Dark-colored urine.
• Pale-colored bowel movements.
• Jaundice. A rarer symptom of cholestasis, this is where your skin and eyes turn a yellow color. Jaundice can happen when your liver isn’t working as well as it should.
• Nausea, vomiting, and not feeling hungry.

If you spot any of these symptoms and you’re concerned about cholestasis, get in touch with your healthcare provider.

What causes cholestasis in pregnancy?

The causes of cholestasis aren’t fully understood. It’s thought that higher levels of the hormones estrogen and progesterone in pregnancy might slow the flow of bile out of your liver.

Or there could be a genetic cause since cholestasis can run in families and it’s more common in certain ethnic groups. For example, Latina mamas-to-be in the US have a 5% chance of getting cholestasis, according to the pregnancy health website March of Dimes (vs. less than 1% for all pregnancies).

But we do know that you have a higher risk of developing cholestasis in pregnancy if you have:

• A history of liver damage or disease
• Close family members (your mama or sister) who’ve had cholestasis
• A multiple pregnancy (with twins, triplets, or more)

The risk is also higher if you’ve already been diagnosed with cholestasis in a previous pregnancy.

What problems are associated with cholestasis?

When you have mild cholestasis (that is, your levels of bile acids are only low) there’s a good chance that it won’t cause further problems for you or your baby. You might just need treatment to deal with any discomfort from your symptoms.

With more severe cholestasis, there is a risk of complications for your baby. They may show signs of not getting enough oxygen in your uterus (“fetal distress”), breathe in meconium (the material that makes up their first bowel movement), or be born prematurely (before 37 weeks). If they’re premature they might need extra help with their breathing after birth, too.

But all these conditions can be either prevented or managed when your baby is monitored carefully, both before and after birth.

You might have another difficult question on your mind though: How common is stillbirth if you have cholestasis?

Again, it depends on the severity of the condition. Research suggests that cholestasis with low levels of bile acids doesn’t come with an increased risk of stillbirth. But the risk is greater with more severe cholestasis, where you have higher levels of bile acids.

That said, stillbirth as a result of cholestasis is still rare. And it’s possible to prevent it by inducing labor early. You can talk to your doctor about whether this is the right step for you in your pregnancy.

How is cholestasis diagnosed?

If you’re experiencing itching while pregnant (or any of the other symptoms of cholestasis), head down to your doctor’s office. To establish whether or not you have cholestasis, your doctor is likely to:

• Give you a physical exam to rule out other sources of your itching (such as eczema)
• Ask you questions about your medical history and your family’s medical history
• Send you for blood tests, including a fractionated bile acid test and a liver function test

They may also recommend an ultrasound scan to check your liver.

It’s possible that you could become itchy from cholestasis before your bile acid levels are high enough to show up in a blood test. So if your tests are negative but the unexplained itching carries on, you should be retested every 1–2 weeks.

What happens if you have cholestasis during pregnancy?

Once you’re diagnosed with cholestasis, you can receive treatment, and your baby will be closely monitored.

Cholestasis of pregnancy treatments include medications to lower bile acid levels in your blood (often a drug called ursodeoxycholic acid, or UDCA). And there are creams you can apply to your skin to help soothe the itch.

Tip: Wearing loose, breathable clothing and soaking in a lukewarm bath might make you feel more comfortable, too.
There are a few different tests that your healthcare provider might use to monitor your baby’s health. These include:

• Fetal heart rate monitoring (also called a “nonstress test”)
• Ultrasound scans
• Biophysical profile (a nonstress test combined with an ultrasound)
• Amniocentesis (testing a small sample of the amniotic fluid that surrounds your baby in the uterus)

If your doctor is concerned that the cholestasis could impact your baby’s health, they might advise inducing your labor early – potentially before 38 weeks. In that case, your baby might need a little extra care in the hospital during their first few days or weeks of life.

Recovering from cholestasis of pregnancy

After your baby’s birth, you should be saying a swift goodbye to that annoying itch. Your bile acid levels typically reduce quickly after labor, and your liver gets back to normal. You might get a blood test just to make sure that everything is okay again, but you won’t generally need further treatment.

If you’d like any more info or advice about cholestasis, you could check out the nonprofit organization ICP Care.