Overview

Intrahepatic cholestasis of pregnancy, commonly known as cholestasis of pregnancy, is a liver condition that occurs in late pregnancy. The condition triggers intense itching, but without a rash. Itching usually occurs on the hands and feet but can also affect other parts of the body.

Cholestasis of pregnancy can make you extremely uncomfortable. But, more worrisome are the potential complications for you and your baby. Because of the risk of complications, your doctor may recommend early delivery.

Symptoms

Intense itching is the main symptom of cholestasis of pregnancy. There is no rash. Most women feel itchy on the palms of their hands or the soles of their feet, but some women feel itchy everywhere. The itching is often worse at night and may be so bothersome that you can't sleep.

The itching is most common during the third trimester of pregnancy but sometimes begins earlier. It may feel worse as your due date approaches. Once your baby arrives, however, the itchiness usually goes away within a few days.

Other less common signs and symptoms of cholestasis of pregnancy may include:

  • Yellowing of the skin and whites of the eyes (jaundice)
  • Nausea
  • Loss of appetite

When to see a doctor

Contact your pregnancy care provider immediately if you begin to feel persistent or extreme itchiness.

Causes

The cause of cholestasis of pregnancy is unclear. Your genes may play a role. Sometimes, the condition runs in families. Certain genetic variants have also been identified.

Pregnancy hormones also may be involved. Pregnancy hormones rise the closer you get to your due date. Doctors think this may slow the normal flow of bile — the digestive fluid made in the liver that helps your digestive system break down fats. Instead of leaving the liver, bile builds up in the organ. As a result, bile salts eventually enter the bloodstream, which can make you feel itchy.

Risk factors

Some factors that may increase your risk of developing cholestasis of pregnancy include:

  • Personal or family history of cholestasis of pregnancy
  • History of liver damage or disease
  • Being pregnant with twins or more

If you have a history of cholestasis in a prior pregnancy, your risk of developing it during a future pregnancy is high. About 60 to 75 percent of women have a recurrence.

Complications

Complications from cholestasis of pregnancy may occur in the mom or the developing baby.

In moms, the condition may temporarily affect the way the body absorbs fat. Poor absorption of fat could result in decreased levels of vitamin K-dependent factors involved with blood clotting. But this complication is rare, and future liver problems are uncommon.

In babies, the complications of cholestasis of pregnancy can be severe. They may include:

  • Being born too early (preterm birth)
  • Lung problems from breathing in meconium — the sticky, green substance that normally collects in the developing baby's intestines but which may pass into the amniotic fluid if a mom has cholestasis
  • Death of the baby late in pregnancy before delivery (stillbirth)

Because complications can be very dangerous for your baby, your doctor may consider inducing labor before your due date.

Prevention

There is no known way to prevent cholestasis of pregnancy.

Oct. 17, 2017
References
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Cholestasis of pregnancy