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Cholestasis of Pregnancy

Cholestasis of Pregnancy

Pregnancy hormones may be the cause of this problematic itching disorder of pregnancy known as cholestasis, but no one really knows for sure. What do we know about cholestasis of pregnancy and how can mothers find help if they are diagnosed with cholestasis?

Incidence of Cholestasis During Pregnancy

About 1% of mothers in Europe and North America and 2% of mothers in Scandinavian and Baltic regions develop cholestasis. The highest incidence of cholestasis is found among expectant mothers in parts of South America, especially Chile at 9-15%.

Experts do not know why there is such a large disparity in the number of mothers who develop cholestasis during pregnancy in various regions. However, there are a number of other risk factors, in addition to regional ones, that might make it more likely for mothers to suffer from cholestasis.

Risk Factors for Developing Cholestasis of Pregnancy

Risk factors for developing cholestasis include the following:

  1. living in regions such as Chile or Scandinavia
  2. pregnancy that occurs in winter months in the above regions
  3. twin pregnancy or other multiple pregnancy
  4. close relative with cholestasis
  5. pregnancy that occurred as a result of IVF
  6. a previous pregnancy with cholestasis

Itching is Just One Symptom of Cholestasis

If mothers find that their palms and soles of their feet begin to itch toward the end of their pregnancies, this is one of the most noticeable, and often debilitating symptoms of cholestasis. What are some other symptoms of cholestasis to help identify this disorder?

  • mild to severe itching of skin; primarily on palms of hands and soles of feet
  • itching begins at 30 weeks or later
  • itching more severe in the evening
  • jaundice (can be seen with whites of eyes, skin and tongue becoming yellow)
  • light colored stools
  • dark urine

The primary care provider will look at both the physical symptoms present, and take a blood test to measure the amount of bile to diagnose cholestasis during pregnancy. Cholestasis is not simply a nuisance for the mother during pregnancy. It increases complications with the baby including preterm labor, meconium staining and fetal distress during labor.

Treatment for Cholestasis of Pregnancy

There are several treatments that a care provider may recommend or that may be available to provide some relief from cholestasis during pregnancy.

  1. medication such as ursodeoxycholic acid to relieve itching and reduce bile
  2. topical creams such as corticosteroids to reduce itching
  3. soaking in a tub with lukewarm water to reduce itching
  4. sarna lotion for topical relief of itching
  5. wearing loose cotton clothing
  6. lowering intake of fatty foods

It is recommended that mothers talk to their care provider about any treatments available to see which is right for them.

If diagnosed with cholestasis, pregnancy will be monitored closely with additional blood tests, ultrasounds and non-stress tests to check on the baby’s well-being. As soon as the baby’s lungs are mature, the care provider may recommend a labor induction around 38 weeks of pregnancy.

For additional help or information, there are support groups with other mothers who are also suffering from cholestasis or have had it in the past. The good news is that after birth, symptoms of cholestasis will very quickly begin to disappear.

References:

Pus, T. “Intrahepatic cholestasis of pregnancy”, Orphanet Journal of Rare Diseases, May 29, 2007.

Medical News Today, 2009

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