What is Cholestasis of Pregnancy? Causes and Treatment

Written by Medicover Team and Medically Reviewed by Dr Vineela Medapati , Gynecologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Cholestasis of pregnancy, also known as intrahepatic cholestasis of pregnancy (ICP), is a liver disorder that occurs during pregnancy and can have serious implications for both the mother and the fetus. It typically manifests in the third trimester and is characterized by intense itching and elevated bile acid levels in the blood. Understanding this condition is crucial for expecting mothers and healthcare providers to manage and mitigate its risks effectively.

What are the Types of Cholestasis of Pregnancy?

There are primarily two types of cholestasis relevant to pregnancy:

Intrahepatic Cholestasis of Pregnancy (ICP): This is the most common type and occurs within the liver. It is usually a temporary condition that resolves after delivery.
Extrahepatic Cholestasis: This type is less common and occurs outside the liver, typically due to bile duct obstructions. It requires different diagnostic and treatment approaches.

What are the Symptoms of Cholestasis of Pregnancy?

Recognizing the symptoms of cholestasis of pregnancy is critical for early diagnosis and management. The hallmark symptom is pruritus, or severe itching, often without a rash. This itching usually begins on the palms of the hands and soles of the feet and can spread to other parts of the body.

Other Common Symptoms

Jaundice: Yellowing of the skin and eyes, although this is less common.
Dark urine: Indicative of elevated bile pigments.
Pale stools: Due to a lack of bile reaching the intestines.
Fatigue: Generalized tiredness and weakness.

Less Common Symptoms

Nausea: Feeling of sickness with an inclination to vomit.
Loss of appetite: Decreased desire to eat.
Upper right abdominal pain: Discomfort or pain in the upper right quadrant of the abdomen.

What are the Causes of Cholestasis of Pregnancy?

The exact cause of cholestasis of pregnancy is not well understood, but several factors may contribute to its development.

Genetic Factors

A family history of cholestasis can increase the risk, suggesting a genetic predisposition. Specific gene mutations related to bile acid transport may play a role.

Hormonal Changes

Pregnancy-related hormonal changes, particularly elevated estrogen levels, are thought to impair bile flow, leading to cholestasis.

When to see a Doctor for Cholestasis of Pregnancy?

If you develop symptoms of cholestasis of pregnancy, consult a Gynecologist promptly. Early diagnosis and treatment can help reduce pregnancy-related complications, relieve symptoms, and protect the health of both the mother and baby.

If you experience severe itching, especially on the palms of your hands or soles of your feet, without a skin rash.
If you notice yellowing of the skin or eyes (jaundice).
If you develop dark-colored urine, pale stools, or persistent fatigue.
If you have nausea, loss of appetite, or pain in the upper right side of your abdomen.
If you notice reduced fetal movements or any changes in your baby's activity.
If you have abnormal liver function tests or elevated bile acid levels during pregnancy.
If you have a personal or family history of cholestasis of pregnancy and develop similar symptoms.
If your symptoms persist or worsen, consult a Gynecologist promptly for comprehensive evaluation, monitoring, and appropriate treatment.

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How is Cholestasis of Pregnancy Diagnosed?

Accurate diagnosis is essential for the effective management of cholestasis of pregnancy. The diagnostic process typically involves several steps.

Clinical Evaluation

The initial evaluation includes a thorough review of symptoms and medical history. The characteristic itching without a rash is a significant indicator.

Laboratory Tests

Blood tests are crucial for diagnosis and include:

Liver function tests (LFTs): To measure levels of liver enzymes.
Serum bile acid test: Elevated bile acids confirm the diagnosis.
Bilirubin levels: To check for jaundice.

Imaging Studies

In some cases, imaging studies such as ultrasound may be performed to rule out other causes of liver dysfunction, including gallstones.

How is Cholestasis of Pregnancy Treated?

Managing cholestasis of pregnancy focuses on relieving symptoms and minimizing risks to the fetus. Treatment strategies include:

Medications

Ursodeoxycholic acid (UDCA): The most commonly prescribed medication to reduce bile acid levels and relieve itching.
Antihistamines: May help relieve itching, although their effectiveness is limited.
Vitamin K supplements: Help address potential deficiencies and reduce the risk of bleeding.

Monitoring and Delivery Planning

Frequent monitoring of liver function and bile acid levels is essential. Non-stress tests and biophysical profiles may be used to assess fetal well-being. In many cases, early delivery around 37 to 38 weeks is recommended to reduce the risk of stillbirth.

Lifestyle and Home Remedies

While medical treatment is essential, some lifestyle adjustments may help relieve symptoms.

Avoid hot showers: Hot water may worsen itching.
Use moisturizers: Applying unscented moisturizers may help soothe the skin.
Wear comfortable clothing: Loose, breathable clothing can reduce irritation and discomfort.

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How can Cholestasis of Pregnancy be Prevented?

There is no guaranteed way to prevent cholestasis of pregnancy, but awareness and early medical intervention can improve outcomes. Regular prenatal care is essential for early detection and timely management.

Prognosis for Mothers

For most women, cholestasis resolves after delivery, and liver function returns to normal. However, there is an increased risk of recurrence in future pregnancies and possible long-term liver problems.

Prognosis for Babies

Babies born to mothers with cholestasis may have complications such as preterm birth, respiratory distress, and stillbirth. Close monitoring and timely delivery significantly reduce these risks.

What are the Risk Factors for Cholestasis of Pregnancy?

Several factors can increase the likelihood of developing cholestasis of pregnancy.

Multiple pregnancies: Women carrying twins or triplets are at higher risk.
Previous history: Women who have experienced cholestasis in a previous pregnancy are more likely to develop it again.
Liver conditions: Pre-existing liver diseases can increase susceptibility.