For pregnant women, cholestasis is a common and potentially dangerous condition that requires medical attention and may even lead to a recommendation for early delivery. Due to the delicate nature of the body during pregnancy, and at the time of birth, this is a condition that cannot be ignored.
What is Cholestasis of Pregnancy (ICP)?
Cholestasis is a condition that affects the flow of bile from the liver. Bile is a critical digestive juice, but it can also cause problems in the body when it builds up or is unable to move freely between systems where it is required. Basically, the bile is unable to reach the gallbladder, so it ends up being released into the bloodstream, resulting in a number of symptoms. This amount of bile in the blood can be dangerous to the mother, as well as the child. [1] [2]
While cholestasis is almost exclusively seen during pregnancy, there can be other causes as well like a physical blockage in the duct where bile is transported. The symptoms of this condition are quite obvious, so an early diagnosis is simple and an appropriate treatment strategy can be developed.
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As mentioned, the root cause of cholestasis is the blockage of bile after it is produced in the liver. However, there can be other causes of this blockage, including the extreme increase of hormones in the body during pregnancy, namely estrogen and progesterone. [3]
When these hormones build up in the body, they can wreak havoc on normal systems and metabolic processes, including those that allow for the flow of different compounds and gastric juices. In some rare cases, there may be a mechanical blockage of the bile in a pregnant patient but this is rarely the case.
Risk Factors for Cholestasis
There are a few risk factors for cholestasis of pregnancy, including late pregnancy, previous liver problems, a family history of the condition and carrying multiple children in the same pregnancy.
Liver Problems – If you already have problems with your liver or gallbladder, cholestasis is a much greater risk, as the liver is likely not producing bile at the right levels. [4]
Family History – This particular liver condition does appear to run in families and it has a genetic connection, so if this condition runs in your family, see the doctor early in your pregnancy. [5]
Multiples – With more tiny lives in your womb, your hormone levels will be even more extreme and imbalanced. If you are planning on twins, triplets or more, your chances of developing cholestasis are much higher. [6]
Late in Your Term – This condition typically affects women who are late in their term, during the third trimester, although it can appear during the second trimester. [7]
Symptoms of Cholestasis
Some of the most common symptoms of cholestasis include itching on the hands and feet, nausea, yellow skin and loss of appetite.
Itching – The most common and recognizable symptom is itching on the hands and feet, although it can appear at any part of the body. This may be accompanied by a rash, which can be treated in various ways. [8]
Nausea – A less common symptom of this condition, you may experience gastrointestinal distress when the bile salt levels in your blood exceed a certain level. [9]
Yellow Skin – Looking jaundiced can often happen when your bile salts build up in the blood, making this another easily recognizable symptom. [10]
Appetite – Some women may experience loss of appetite if they are suffering from cholestasis of pregnancy, although the chemical pathway causing that is still unknown.
Diagnosis of Cholestasis
Diagnosing cholestasis can be done in a number of ways, including a physical exam and discussion of symptoms, coupled with a blood test for bile levels in the blood.
Exam and Discussion – A physical exam and a thorough discussion of all symptoms can often clue a doctor into what is going on in your body, even without a formal or quantitative test.
Blood Test – A blood test can confirm the cholestasis diagnosis by measuring the amount of bile salts in the blood, which would show that the bile is not being properly diverted to the gallbladder. [11]
Effects of Cholestasis
For mothers, cholestasis is rarely dangerous and typically disappears within a few days of delivery. The symptoms of this condition can be annoying, namely the itching or rash, but besides topical ointments for that, there are few treatment options.
However, for the infant, complications can be far more dangerous, including fetal distress, a low volume of amniotic fluid, premature birth or stillbirth. Birth defects and improper growth and development can also occur as a result of this improper level of bile salts in the blood.
To avoid these negative effects for infants, regular tracking and testing are required throughout pregnancy to ensure that the amniotic fluid is at an appropriate level, measure heart rate and other biophysical profile elements, while ensuring that growth and muscle movement is normal. In some cases, it may be necessary to schedule a controlled early-term birth to protect the fetus, once the infant’s lungs are fully developed. In rare cases, a steroid will be administered to speed up the development of the baby’s lungs. [12]
Treatments for Cholestasis
As mentioned, the treatment for cholestasis symptoms is a basic anti-inflammatory ointment for the mother and regular testing for the infant, but there are also medications for bile levels in the body, vitamin K supplements, cold water baths and herbal remedies.
Bile Medications
There are certain medications that can reduce the production of bile in the liver, which will prevent it from overflowing into the bloodstream and causing the symptoms of this condition. [13]
Vitamin K
Women suffering from this condition are often deficient in vitamin K, as it can’t properly bind without the presence of bile in the stomach, so supplementation is often recommended.
Cold Water Baths
This can slow down blood flow due to the low temperature, thus lessening the deposition of bile salts into the blood.
Lecithin Intake
This specific type of fatty substance has been directly linked to a lower occurrence of this condition, whether you get the animal or vegetable-derived lecithin. [14]
Dietary Restrictions
If you are suffering from cholestasis of pregnancy, there are a number of foods you should avoid, such as high-sodium foods, alcohol, and sugary processed foods.
High Sodium
Avoid high-sodium foods, as they can cause inflammation in the liver, which is already malfunctioning when you are suffering from this condition.
Alcohol
Alcohol consumption must be avoided if you have cholestasis, as it causes liver malfunction and long-term damage that can impact the production and flow of bile. [15]
