Cholestasis during pregnancy

Some women experience very intense itching at the end of pregnancy. The most common cause is cholestasis, a common liver disease that only occurs during pregnancy. Intrahepatic cholestasis of pregnancy is a condition in which the normal flow of bile is affected by increased amounts of pregnancy hormones.

Cholestasis most often occurs in the last trimester of pregnancy when hormone levels are at their peak, but usually resolves within a few days after delivery.

Cholestasis occurs in about 1 in 1,000 pregnancies, but is more common in Swedish and Chilean ethnic groups. Cholestasis is sometimes referred to as extrahepatic cholestasis occurring outside the liver, intrahepatic cholestasis occurring within the liver, or obstetric cholestasis.

What causes cholestasis of pregnancy?

Pregnancy hormones affect liver function, which slows or stops the flow of bile. The gallbladder contains bile produced in the liver, which is needed to break down fats during digestion. When the flow of bile in the liver itself stops or slows down, it causes a buildup of bile acids in the liver that can enter the bloodstream.

Intrahepatic cholestasis of pregnancy is diagnosed when the content of total bile acids or bile acids in the blood serum is 10 µmol/l and above. Research initially showed that this increase in bile acids was solely due to estrogen, but recent research has shown that progesterone may contribute to this reserve to the same extent.

What are the symptoms?

Itching, particularly on the hands and feet (often is the only symptom noticed)
Dark urine color
Pain in the right upper quadrant, without gallstones
Pale/Light coloring of bowel movements
Fatigue or exhaustion
Loss of appetite
Depression

Less common symptoms include:

Jaundice (yellow coloring of skin, eyes, and mucous membranes)
Upper-Right Quadrant Pain
Nausea

Who is at risk?

Between 1 and 2 out of 1000 pregnancies suffer from cholestasis.

The following women are at higher risk of developing cholestasis during pregnancy:

Women wearing multiple
Women who already have liver damage
Women whose mother or sisters had cholestasis or intrahepatic cholestasis of pregnancy

How is it diagnosed?

The diagnosis of cholestasis can be made by taking a complete history, physical examination, and blood tests that evaluate liver function, bile acids, and bilirubin.

Intrahepatic cholestasis of pregnancy should be diagnosed when the content of total bile acids or bile acids in the blood serum is 10 µmol/l and above.

How will it affect the child if the mother is diagnosed with cholestasis?

Cholestasis can increase the risk of fetal distress, preterm birth, or stillbirth. The developing child depends on the mother's liver to remove bile acids from the blood; consequently, high maternal bile levels cause stress on the baby's liver. Women with cholestasis should be closely monitored and serious consideration should be given to inducing labor after the baby's lungs have matured.

How to treat cholestasis of pregnancy?

The goals of treatment for cholestasis of pregnancy are to relieve itching. Be sure to talk to your doctor before taking any medications or supplements.

Some treatment options include:

Topical antipruritics or drugs containing corticosteroids.
Bile acid lowering medicines such as ursodeoxycholic acid
Cold baths and ice water slow down the circulation of blood in the body, lowering the temperature.
Dexamethasone is a steroid that increases the maturity of a child's lungs.
Vitamin K supplements given to mothers before childbirth and again after childbirth to prevent intracranial hemorrhages.
Biweekly non-stress tests that include monitoring of the fetal heart and recording beats.
Regular blood tests monitoring both serum bile levels and liver function

Treatment of cholestasis of pregnancy should be determined by the attending physician, who will take into account the following criteria:

Your pregnancy, overall health, and medical history
The extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference

There are different opinions about the use of the drug cholestyramine for the treatment of cholestasis. This drug has been readily used in the past to treat this condition, but some studies have shown that cholestyramine may not be as effective as other treatments and has potentially unwanted side effects such as blocking essential vitamins such as vitamin K (a vitamin that already in short supply). women with cholestasis).

What is the probability that the mother will get cholestasis in the next pregnancy?

It is almost impossible to know if a woman will suffer from cholestasis in future pregnancies. Some sources claim that women who have had cholestasis of pregnancy have up to 90% chance of having the condition again in future pregnancies, but research is inconclusive.