Cholestasis of pregnancy: Symptoms, causes, and effects

Cholestasis of pregnancy, also known as obstetric cholestasis or intrahepatic cholestasis of pregnancy, can cause severe itching, especially on the hands and feet.

It usually occurs late in the second trimester or during the last trimester of pregnancy.

The condition does not usually pose a serious risk for the mother’s long-term health, but it may cause severe complications for the infant.

The term “cholestasis” comes from the Greek words “chole” meaning “bile” and “stasis,” meaning “still.”

Cholestasis happens when the liver cannot excrete bile properly. Bile is a fluid that helps the body process fat.

Symptoms

[woman scratching]
Itchy hands and feet are the most common symptom.

The following signs and symptoms may be present in cases of cholestasis of pregnancy:

intense itching, especially on the palms of the hands and soles of the feet

dark urine

light-colored feces

jaundice, giving the whites of the eyes, skin and tongue a yellowish or orangey tinge

The itchiness may be the only symptom, and it often becomes worse during the night.

A pregnant woman who has any of the signs or symptoms mentioned above should tell a health care professional as soon as possible, because they could indicate a risk for her unborn baby.

Treatment

Treatment may not be necessary if cholestasis is mild and occurs late in pregnancy. Treatment normally aims to relieve symptoms, mainly the itching, and to prevent potential complications.

The following medications may be prescribed:

ursodeoxycholic acid, to relieve itching and increase bile flow

menthol creams, to help soothe the itching, as there is no evidence that they cause harm during pregnancy

Soaking the affected areas of skin in lukewarm water may provide some temporary relief. Dabbing the affected areas with baking soda or apple cider vinegar may help, or applying coconut oil after a bath.

Patients with cholestasis will have low levels of vitamin K, increasing the chance of hemorrhage, so a mother will often need Vitamin K supplements before and after delivery.

According to the American Pregnancy Association, natural remedies for liver health include and dandelion root and milk thistle, and calamine lotion may help with itching, but any supplements or alternative treatments should be discussed first with a physician, as the effects during pregnancy may be unknown.

Some sources recommend oatmeal baths, but the American Pregnancy Association says the use of Aveeno or oatmeal baths should be avoided. They also warn against the use of antihistamines.

Many women choose to take herbs, creams, baths, and tinctures instead of medication. Some herbs are difficult to break down, especially when the liver is already compromised.

It is very important to check with the doctor beforehand, to make sure a natural remedy is safe, and to consult the doctor if symptoms get worse.

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Diagnosis

The doctor will consider the patient’s signs and symptoms, such as urine and stool color, and itchiness. The mother will also be asked about her personal and family medical histories, and there will be a physical examination.

Blood tests may reveal how well the patient’s liver is functioning. Blood levels of bile will also be measured.

Ultrasound scans can detect abnormalities in the mother’s liver, but not in the fetus.

Diet

To reduce the risk of cholestasis and other problems during pregnancy, it is important to follow a healthful, balanced diet with plenty of fresh fruit and vegetables.

Organic produce is less likely to be affected by pesticides and other toxins. Apples, strawberries, and grapes often contain higher amounts of unwanted chemicals, while avocados, sweetcorn, and pineapple top the “clean” list.

If canned produce is used, check that it is preserved in its own juice and that there are no added sugars.

Choose certified organic meat and avoid fried fish and raw seafood. Dried beans and legumes, such as lentils and chickpeas, are a good source of protein.

Focus on whole foods, such as whole-grain bread.

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