Cholestasis of pregnancy

Overview

often without a visible rash. This itching typically occurs on the hands and feet, although it can also manifest on other parts of the body.

ICP can temporarily reduce liver function in some pregnant individuals. This results in an accumulation of bile in the liver and bloodstream. Bile, produced by the liver and stored in the gallbladder, plays a crucial role in breaking down fats during digestion. As bile levels in the blood reach a certain threshold, it can trigger itching.

The discomfort caused by pregnancy-related cholestasis can be significant. However, of greater concern are the potential risks it poses, particularly for the baby. Due to these potential complications, healthcare providers may advise considering an early delivery around the 37-week mark of the pregnancy.

Symptoms

The primary symptom of cholestasis of pregnancy is intense itching (pruritus), which occurs without the presence of a rash. Typically, this itching sensation is felt on the palms of the hands or the soles of the feet, although it can be experienced throughout the body. The itchiness is often more pronounced at night and can become so bothersome that it interferes with sleep.

While this itching mainly arises during the third trimester of pregnancy, it can occasionally start earlier. It may feel worse as your due date approaches. However, once the baby is born, the itching usually subsides within a few days.

Less commonly observed signs and symptoms of cholestasis of pregnancy may include:

• Yellowing of the skin and the whites of the eyes, known as jaundice
• Nausea
• Reduced appetite
• Stools with an oily and unpleasant odor
• Darkened urine
• Light gray or pale brown stool
• Fatigue
• Discomfort in the upper right abdomen.

Causes

The cause of pregnancy-related cholestasis remains uncertain. It involves a disruption in bile flow, which is a digestive fluid produced by the liver to break down fats. Instead of progressing to the small intestine, bile accumulates in the liver, allowing bile acids to enter the bloodstream. Elevated bile acid levels seem to contribute to the symptoms and complications of pregnancy-related cholestasis.

The factors that play a role in pregnancy-related cholestasis include:

• Hormones: Pregnancy hormones increase as your due date approaches, potentially leading to a slowdown in bile flow.
• Genetics: Occasionally, the condition is familial, with specific gene variations associated with pregnancy-related cholestasis.
• Environment: While the exact environmental factors aren’t well-defined, the risk fluctuates based on geography and season.

Risk factors

Several factors that could elevate your susceptibility to cholestasis of pregnancy are:

• Personal or familial background of cholestasis during pregnancy.
• Previous liver damage or disorders, including hepatitis C and gallbladder stones.
• Carrying multiple pregnancies concurrently.
• Pregnancy at an advanced age, specifically 35 years or older.

If you have previously experienced cholestasis in a past pregnancy, your likelihood of developing it again during another pregnancy is considerable.