What is Cholestasis of Pregnancy?
Bile is a fluid made by the liver that helps to digest
fats. Cholestasis of pregnancy is a liver disorder in which the release of
bile from the liver is blocked by high levels of the hormones
estrogen and progesterone during pregnancy. The bile
builds up in the blood causing itching. Cholestasis of pregnancy usually
occurs in the second half of pregnancy, and affects about one in 200 pregnancies. Cholestasis of pregnancy is also called
intrahepatic cholestasis of pregnancy (ICP) and obstetric cholestasis.
Most women complain of itching. The itching usually begins on the palms of the hands and soles of the feet. The itching tends to be worse at night. Although there is no rash as is seen with pruritic urticarial papules and plaques of pregnancy (PUPPP), intense scratching may leave multiple scrapes or abrasions. About 10% of women with cholestasis of pregnancy may also develop jaundice (yellowing of the skin or whites of the eyes). Dark urine and light colored stool (bowel movements) are uncommon symptoms.
If you have any of the following you are at increased risk for cholestasis of pregnancy
Contact your doctor if you develop intense itching or signs of cholestasis of pregnancy.
Cholestasis of pregnancy is diagnosed by physical examination, reviewing your history, and performing blood tests to evaluate how well your liver is working. Some blood tests that might be ordered to evaluate your liver function include serum bile acids, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and prothrombin time (PT) .
There are many medications and health conditions besides cholestasis of pregnancy that can cause itching and abnormal liver function tests. So make sure to take any medication you have been using, and any medical records your doctor may not have to your doctor's appointment.
The diagnosis of cholestasis of pregnancy is usually made if the following are present:
Because some women may have itching for weeks before abnormal liver function tests develop, your doctor will often repeat the tests every 1 to 2 weeks if your tests are normal.
Cholestasis of pregnancy can occur together with other diseases that cause similar symptoms. Your doctor may order more tests if there is chance you might have another disorder of pregnancy such as pre-eclampsia or HELLP syndrome.
Cholestasis of pregnancy increases the risk for premature delivery and stillbirth. Some studies have found an increased chance for having a low birth weight baby if the mother has cholestasis of pregnancy. In addition, bleeding in the mother may occur due to poor absorption of vitamin K from the gut due to the lack of bile. The likelihood of having a complication appears to greatest for women with very high levels of bile acids.