Cholestasis of pregnancy
Cholestasis of pregnancy
Cholestasis of pregnancy occurs in late pregnancy and triggers intense itching, usually on the hands and feet but sometimes on other parts of the body. Cholestasis of pregnancy can be intensely uncomfortable but poses no long-term risk to the mother. Cholestasis of pregnancy can be dangerous for a developing baby, however. Early delivery is usually recommended.
The term "cholestasis" refers to any condition in which the flow of bile, a digestive fluid from the liver, slows or stops. Pregnancy is one of many possible causes of cholestasis. Other names for cholestasis of pregnancy include obstetric cholestasis and intrahepatic cholestasis of pregnancy.
Signs and symptoms of cholestasis of pregnancy may include:
Often, however, intense itching — particularly on the palms of the hands and the soles of the feet — is the only symptom of cholestasis of pregnancy. The itching may be worse, even intolerable, at night. The itching is most common during the third trimester of pregnancy, but sometimes begins earlier.
When to see a doctor
The cause of cholestasis of pregnancy is unknown. However, the condition may be related to pregnancy hormones.
Bile — a digestive fluid that helps the body break down fats — is produced in the liver and stored in the gallbladder. Pregnancy hormones can affect how well the gallbladder functions. Sometimes, pregnancy hormones slow or even stop the flow of bile. Eventually, this excess bile may enter the bloodstream. This is cholestasis of pregnancy.
Factors that increase the risk of developing cholestasis of pregnancy include:
After you've had the condition once, the risk of developing it during a subsequent pregnancy may be as high as 70 percent.
For mothers, cholestasis of pregnancy may temporarily hinder the absorption of fat-soluble vitamins. Itching usually resolves within a few days of delivery, and subsequent liver problems are uncommon — although cholestasis is likely to recur with other pregnancies.
For babies, the complications of cholestasis of pregnancy can be much more severe. For reasons not well understood, cholestasis of pregnancy increases the risk of preterm birth and meconium — a substance that lines the baby's intestines during pregnancy — in the amniotic fluid. If a baby inhales meconium during delivery, he or she may have trouble breathing. There's also a risk of fetal death late in pregnancy. Because of the potentially severe complications, labor is typically induced early.
Preparing for your appointment
It's a good idea to be well prepared for your appointment with your obstetrician or pregnancy care provider. Here's some information to help you get ready for your appointment, and what to expect from your pregnancy care provider.
What you can do
For cholestasis of pregnancy, some basic questions to ask your doctor or pregnancy care provider include:
In addition to the questions that you've prepared, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Tests and diagnosis
To diagnose cholestasis of pregnancy, your health care provider may:
Rarely, an ultrasound exam may be done. This test uses high-frequency sound waves to create images of your internal organs. For cholestasis of pregnancy, your doctor might use ultrasound to check your liver for abnormalities.
Treatments and drugs
Treatment for cholestasis of pregnancy has two goals: relieve itching and prevent complications.
Using too much corticosteroid cream — as you might be tempted to do to relieve the intense itching associated with this condition — may pose a risk to your developing baby. Follow your doctor's instructions for using over-the-counter anti-itch creams, if he or she recommends that you use them.
Lifestyle and home remedies
To relieve intense itching, you might try:
If you have extensive itching, check with your doctor before applying anti-itch cream or any other over-the-counter product to large portions of your body.
Research into effective alternative therapies for treating cholestasis of pregnancy is lacking, so doctors and other health care providers generally don't recommend alternative therapies.
One alternative therapy being studied as a treatment for cholestasis of pregnancy is S-adenosylmethionine (SAMe), a naturally occurring substance. In two small studies, women in their third trimesters who had cholestasis of pregnancy were given SAMe intravenously — through a vein — and experienced relief from intense itching with no adverse effects to them or their babies. These results suggest that SAMe therapy might be safe for short-term use during the third trimester of pregnancy, but more research is needed before doctors can recommend this therapy.
Other alternative therapies, including guar gum, activated charcoal, milk thistle and dandelion root, are also being studied, but there's no evidence that these therapies work or are safe for pregnant women to take.
Always check with your doctor or health care provider before trying an alternative therapy, especially if you're pregnant.
Last Updated: 2011-10-12
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