Intrahepatic Cholestasis of Pregnancy: What Is It and What to Do About It

Obstetric Cholestasis

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Intrahepatic cholestasis is a condition that happens to some women during pregnancy. There’s no cure for the condition, which can cause severe itching in expectant mothers, but there are ways to treat the symptoms, and, once pregnancy is over, the symptoms always subside.

A diagnosis of intrahepatic cholestasis of pregnancy (ICP) may require extra monitoring, in the form of additional blood tests, as part of prenatal care. While most women with this condition have healthy babies, monitoring is essential since the condition does carry some risks for the developing baby.

Which women are at risk?

Environmental, genetic and hormonal factors all contribute to this pregnancy condition. Genetics are likely implicated since the condition is rare in some populations, but has a higher incidence in others. Intrahepatic cholestasis occurs in as few as 0.1 percent of all pregnancies in Europe but up to 15.6 percent of pregnancies in South American countries such as Bolivia and Chile. The incidence is also slightly higher in South Asian and Scandinavian populations. If your mother or sister had cholestasis, you are also likely to develop it.

Women at a higher risk also include those with:

  • A history of liver disease.
  • A history of gallstones.
  • A multiple pregnancy
  • A history of itchy skin while taking oral contraceptives.

What is it?

Normally the liver makes bile, which it uses to break down foods. In the process the bile passes through tiny bile ducts.  Some women may have inherited a slight lag in processing bile, which is not noticeable and does not prompt any symptoms until they are pregnant. During pregnancy the surge in estrogen and progesterone can affect liver functions, slowing down the way bile passes through bile ducts. This delay can lead to a bile buildup that leaks into the bloodstream and makes skin very itchy. The severe itch usually starts after the 24th week of pregnancy when hormone levels are at their highest.

What are the symptoms?

While some itchiness or skin sensitivity is normal during pregnancy, it’s important to discuss any severe or persistent itchiness with your healthcare provider, since itchiness is the most prominent symptom of obstetric cholestasis. Other symptoms may include: fatigue, depression, loss of appetite,  jaundice, pain, darker urine and lighter bowel movements.

A blood test can measure bile acids and liver enzymes to determine if you have this condition. Once it is diagnosed you will need to have blood tests every week or two during your pregnancy and one around 10 days after the baby is born to be sure everything is back to normal.

How is it treated?

There is no cure for the condition but there are a few ways to treat the symptoms:

  1. Topical anti-itch medications
  2. Medications such as ursodeoxycholic acid, a bile acid produced naturally by the body, to decrease the concentration of bile acids.
  3. Taking cool showers and soaking hands and feet in ice water can decrease blood flow and relieve symptoms.

Most women with obstetric cholestasis deliver healthy babies but it is important to monitor the condition to decrease risks. Since elevated levels of maternal bile can stress a baby’s liver, cholestasis may increase the risk for fetal distress or stillbirth. Your healthcare provider can monitor the pregnancy and determine if there is a risk. A perceived risk may result in an early induction of labor as soon as baby’s lungs are sufficiently developed, usually around the 37th week.

For most expectant mothers, intrahepatic cholestasis is merely an uncomfortable condition, but monitoring can minimize risks.

Joan MacDonald
Joan Vos MacDonald has written about health and fitness for newspapers, magazines and websites. She is a member of the National Association of Science Writers and the author of two books on health-related topics, "Tobacco and Nicotine Dangers," for young adults, and "High Fit Home," a design book about fitness and architecture. She lives in upstate New York near her children and grandchildren.

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