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Cholestasis of PregnancyColestasis del Embarazo

Cholestasis of Pregnancy

What is cholestasis of pregnancy?

Cholestasis of pregnancy is a condition that causes the normal flow of bile in the gallbladder to be slowed or stopped. This causes itching and jaundice (yellowing of the skin, eyes, and mucous membranes). Cholestasis sometimes begins in early pregnancy but is more common in the last trimester of pregnancy. It usually goes away within a few days after delivery. About 1 out of 1,000 women will get cholestasis of pregnancy. Women of Swedish or Chilean heritage are more likely to get it. You are also more likely to get it if you are pregnant with two or more babies. If you've had cholestasis of pregnancy once, you are more likely to get it again. 

Cholestasis of pregnancy is also sometimes called intrahepatic (in the liver) cholestasis of pregnancy and pruritus gravidarum.

What causes cholestasis of pregnancy?

The gallbladder is an organ attached to the lower part of your liver. It stores bile. Bile is a fluid that is made in the liver. Bile acids helps your body breakdown fats during digestion. Waste products in the blood are turned into called bilirubin which is found in bile.

Doctors think that the hormones your body releases during pregnancy change the way the gallbladder works. When bile slows or stops flowing, bile acids can build up in the liver and spill into the bloodstream. This is what causes the itching. Jaundice may also happen when bilirubin levels build up.

Why is cholestasis of pregnancy a concern?

Cholestasis may increase the risks for problems during pregnancy. Some of those problems are: 

  • Fetal distress

  • Preterm birth

  • Stillbirth

  • Severe bleeding after delivery (Postpartum hemorrhage)

Cholestasis of pregnancy can also lead to vitamin K deficiency. This will need to be treated before you give birth as it can cause you to bleed more than is safe.

What are the symptoms of cholestasis of pregnancy?

Symptoms of cholestasis of pregnancy may be different for each person. The most common symptoms are:

  • Overall itching, especially the palms of the hands and soles of the feet

  • Mild nausea and pain in the upper right part of your belly

  • Dark urine color

  • Light coloring of stools (bowel movements)

  • Jaundice (yellow coloring of skin, eyes, and mucous membranes)

The symptoms of cholestasis sometimes look like other medical conditions. Always see your health care provider for a diagnosis.

How is cholestasis of pregnancy diagnosed?

Your health care provider will check your medical history and give you a physical examination. Certain symptoms, such as generalized severe itching without a rash, may be enough for your health care provider to know that you have cholestasis of pregnancy. He or she may also order blood tests to check your liver function, bile acids, and bilirubin. If the tests show changes, they may help your health care provider make a diagnosis.

Treatment for cholestasis of pregnancy

Your health care provider will figure out the best treatment for you based on:

  • Your pregnancy

  • Your overall health and medical history

  • How sick you are

  • How well you can handle specific medications, procedures, or therapies

  • How long the disease is expected to last

  • Your opinion or preference

The goals of treating cholestasis of pregnancy are to relieve the itching and prevent complications. Itching may be treated with topical anti-itch medications or with corticosteroids. Medication is sometimes used to help lower the amount of bile acids.  Fetal monitoring tests may be used to check the well-being of your fetus. Babies of women with cholestasis are often delivered early (usually around 37 weeks) because of the risk to the baby.