The most common cause of severe itching late in pregnancy is cholestasis, a common liver disease that only happens in pregnancy. Cholestasis of pregnancy is a condition in which the normal flow of bile in the gallbladder is affected by the high amounts of pregnancy hormones. Other names of cholestasis are extrahepatic cholestasis which occurs outside the liver, intrahepatic cholestasis which occurs inside the liver, or obstetric cholestasis.

Cholestasis can happen anytime in pregnancy but is more common in the last trimester of pregnancy when hormones are at their peak, but it usually goes away within a few days after delivery. Cholestasis occurs in about 1 out of 1,000 pregnancies but is more common in Swedish and Chilean ethnic groups.

Causes of cholestasis of pregnancy

Pregnancy hormones affect gallbladder function, resulting in slowing or stopping the flow of bile. The gallbladder holds bile that is produced in the liver, which is necessary for the breakdown of fats in digestion. When the bile flow is stopped or slowed down, this causes a build-up of bile acids in the liver which can spill into the bloodstream.

Symptoms

• Itching, particularly on the hands and feet (often is the only symptom noticed)
• Dark urine color
• Light coloring of bowel movements
• Fatigue or exhaustion
• Loss of appetite
• Depression
• Jaundice (yellow coloring of skin, eyes, and mucous membranes)
• Upper-right quadrant pain
• Nausea

The following women have a higher risk of getting cholestasis during pregnancy:

• Women carrying multiples
• Women who have previous liver damage
• Women whose mother or sisters had cholestasis

How is cholestasis of pregnancy diagnosed?

A diagnosis of cholestasis can be made by doing a complete medical history, physical examination, and blood tests that evaluate liver function, bile acids, and bilirubin.

How will the baby be affected?

More often than not, cholestasis will have no adverse effect on the pregnancy though it may increase the risks for fetal distress, preterm birth, or stillbirth.  Women with cholestasis should be monitored closely and some doctors like to deliver the baby, especially close to the due date. Many doctors will monitor the pregnancy closely with tests such as regular non-stress tests which involve fetal heart monitoring. In addition, regular blood tests are done to monitor both bile serum levels and liver function

What is the treatment?

The treatment goals for cholestasis of pregnancy are to relieve itching. Some treatment options include:

• Topical anti-itch medications or medication with corticosteroids.
• Medication to decrease the concentration of bile acids such as ursodeoxycholic acid.
• Cold baths and ice water slow down the flow of blood in the body by decreasing its temperature.
• Dexamethasone is a steroid that increases the maturity of the baby’s lungs.
• Vitamin K supplements administered to the mother before delivery and again once the baby is born to prevent intracranial hemorrhaging.
• Cholestyramine has been used to treat this condition, but some studies have shown that Cholestyramine may not be as effective as other treatments and potentially has some adverse side effects such as blocking essential vitamins like Vitamin K (a vitamin that is already deficient in women with cholestasis).

Treatment for cholestasis of pregnancy needs to be determined by your physician who will take the following criteria into consideration:

• Your pregnancy, overall health, and medical history.
• The extent of the disease.
• Your tolerance of specific medications, procedures, or therapies.
• Expectations for the course of the disease.
• Your opinion or preference.

Recurrence in another pregnancy

Some sources claim that women who have had cholestasis of pregnancy have up to a 90% chance of having this repeat in future pregnancies.