About 70 percent of all pregnant women suffer from an itchy skin condition at some point during pregnancy. Most cases of itching happen due to trivial reasons like very dry and scaly skin, eczema, and certain types of skin allergies.

However sometimes it can be due to certain conditions that might be detrimental to the health of the growing baby, intra-hepatic cholestasis or cholestasis is such a condition which is mostly experienced by expecting mothers, it is an illness where the liver of the mother starts to function in an abnormal manner due to which the secretion of bile- a digestive juice produced by the liver is either blocked or reduced in amount. This reduction in its flow or blockage causes bilirubin, a compound produced by the liver to build up.

Usually, bilirubin is excreted from the body along with the bile, but during cholestasis, it accumulates in the body and results in extreme itching along with fatigue, nausea, abdominal pain, and it might also prove to be fatal for the fetus if can also cause certain birth complications like early delivery, stillbirth, etc.

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Symptoms of Cholestasis

The first sign of Cholestasis during pregnancy is itching on the soles of the feet and the palms, which then proceeds to spread to the other body parts of the body, mainly the stomach. Initially, the itch might not be that intense, but slowly, it becomes extremely uncomfortable with some women even scratching their bellies till they bled.

Due to the intense itching, some women are also not able to sleep properly. Quick relief from the itching medicines like diphenhydramine or hydrocortisone ointment might help, but the symptoms return as soon as these medicines are worn off. In some cases, women also develop conditions like jaundice and severe abdominal pain. 

A pregnant woman that experiences this, however, does not always mean that they have cholestasis. Some symptoms that are not related to cholestasis are:

  • Rash

Cholestasis does not cause a rash, although there might be marks on the skin, which is basically because of scratching.

  • Short term itching

Cholestasis itching does not resolve on its own, over the counter medicines and creams might provide some relief, but the itching is back and is more intense as soon as the effect of the creams wears off. However, if a pregnant woman experiences itching for some time, and then it goes away on its own, it might be due to some other reasons and not cholestasis. The itching associated with cholestasis goes away within a few days after delivery.

  • Before twenty weeks

Cholestasis mostly occurs in late pregnancy, and sometimes it occurs in the second trimester as well however it never occurs before completing 20 weeks.

Risk factors associated with cholestasis

The risk of cholestasis in pregnancy is although very low at 1 percent; however, there are some risk factors associated with it, which can increase a woman’s chances of getting it. The risk factors of cholestasis are:

  • If a woman is expecting twins
  • If a woman suffered from cholestasis in previous pregnancy as well
  • someone in the family suffered from cholestasis
  • If a woman is Hispanic and specifically belongs to Chile
  • a woman suffered from Hepatitis C
  • If the age of the woman is more than 35 years

Complications

Complications associated with cholestasis affects both the mother and the baby. For the mother, because of the malfunctioning of the liver and the altered bile production, there might be reduced absorption of fat in the body as bile helps in the breaking down and absorption of fat in the body. Due to this, the mother’s body is deficient in the level of vitamin-k, which is essential in blood clotting. These are, however, very rarely experienced.

In babies, the effects of cholestasis might be more severe, which can include:

  • early delivery
  • breathing problems due to breathing meconium or the sticky substance that usually is found in the intestines of fetuses, which can get transferred and mixed with the amniotic fluid in case the mother is suffering from cholestasis.
  • stillbirth

Since the complications mostly affect the baby more seriously, the only way to put a stop to it would be to induce labor before the actual delivery date.

How is Cholestasis diagnosed and treated?

If a pregnant woman is suffering from itching for some days that does not seem to resolve with creams and lotions, they should immediately consult a doctor. For the diagnosis of Cholestasis, a blood test is done, the test helps in measuring the level of bile and to check the overall functioning of the liver. Sometimes, the symptoms show up before the illness itself, in which case the test needs to be done again in about two weeks. 

Cholestasis is a life-threatening condition that can cause severe pregnancy complications like stillbirth. Unfortunately, stillbirths due to cholestasis cannot be prevented even with constant monitoring of the baby via ultrasound or with the help of medications.

The biggest challenge associated with cholestasis is deciding on the right time to deliver the baby, the baby needs to be fully developed at the time of the delivery because if the baby is delivered too early, there might be some serious issues, but then again the baby cannot be left to be exposed to the built-up bile acid which can result in a stillbirth.

The risk of still births depends on how much the bile acid level is in the mother’s body. If the level of the bile acid is more than 100, which 10x more than the normal amount, there is an increased risk of stillbirth, but in cases where the acid level is not much, there is no such risk. Even then, cholestasis is a very serious condition that should not be taken lightly; therefore, early diagnosis can help a great deal in avoiding the complications associated with it. 

Experiencing itching while being pregnant is not something to be extremely worried about as it can be due to reasons other than cholestasis. But if the itching gets severe with each passing day and does not resolve even after applying creams and lotions, a doctor should be immediately consulted. 

References

Reference taken from Mayoclinic.org and nct.org.uk