Cholestasis of pregnancy

Symptoms and causes

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

Cholestasis of pregnancy can make you very uncomfortable. But more worrisome are the potential complications, especially for your baby. Because of the risk of complications, your pregnancy care provider may recommend early term delivery around 37 weeks.

Intense itching is the main symptom of cholestasis of pregnancy. But there is no rash. Typically, you feel itchy on the palms of your hands or the soles of your feet, but you may feel itchy everywhere. The itching is often worse at night and may bother you so much 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 gets near. But once your baby arrives, 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, called jaundice
• Nausea
• Loss of appetite
• Oily, foul-smelling stools

The exact cause of cholestasis of pregnancy is unclear. Cholestasis is reduced or stopped bile flow. Bile is the digestive fluid made in the liver that helps break down fats. Instead of leaving the liver for the small intestine, bile builds up in the liver. As a result, bile acids eventually enter the bloodstream. High levels of bile acids appear to cause the symptoms and complications of cholestasis of pregnancy.

Pregnancy hormones, genetics and the environment may all play a role.

• Hormones. Pregnancy hormones rise the closer you get to your due date. This may slow the flow of bile.
• Genes. Sometimes, the condition runs in families. Certain gene changes have been identified that may be linked to cholestasis of pregnancy.
• Environment. Although the exact environmental factors aren't clear, risk varies by geographic location and season.

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, including hepatitis C and gallbladder stones
• Being pregnant with multiple babies
• Pregnancy at an older age, such as 35 years or older

If you have a history of cholestasis in a prior pregnancy, your risk of developing it during another pregnancy is high. About 60% to 70% of females have it happen again. This is called a recurrence. In severe cases, the risk of recurrence may be as high as 90%.

Complications from cholestasis of pregnancy appear to be due to high bile acid levels in the blood. Complications may occur in the mom, but the developing baby is especially at risk.

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. Future liver problems may occur but are uncommon.

Also, cholestasis of pregnancy increases the risk of complications during pregnancy such as preeclampsia and gestational diabetes.

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

• Being born too early, also called preterm birth.
• Lung problems from breathing in meconium. Meconium is the sticky, green substance that typically collects in the developing baby's intestines. Meconium may pass into the amniotic fluid if a mom has cholestasis.
• Death of the baby late in pregnancy before delivery, also called stillbirth.

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

There is no known way to prevent cholestasis of pregnancy.