What Is Cholestasis during Pregnancy?

Cholestasis during pregnancy, also known as obstetric cholestasis or intrahepatic pregnancy cholestasis, can cause intense itchiness, especially in the hands and feet.

It usually occurs during the first trimester of pregnancy. Some women can’t identify the symptoms. The doctor is the one who discovers what the cause is, usually with a blood test.  

The condition doesn’t pose any serious long-term health risks for the mother. But it can lead to serious complications for the baby, so it’s important to be well informed.

The term “cholestasis” comes from the Greek words “chole” which means “bile” and “stasis” which means “standing still.”

Cholestasis happens when the liver cannot excrete bile appropriately. Bile is a liquid that helps the body to process fat.

Symptoms of Pregnancy Cholestasis

There are some characteristic symptoms of pregnancy cholestasis that you should be aware of.

Onset is more common during the third trimester of pregnancy, appearing in the hands and feet due to possible fluid retention. But it can also occur earlier.

Symptoms may worsen as your delivery date approaches. Once the baby is born, however, the itching usually goes away in a few days. 

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

• Intense itchiness, especially on the palms of the hands and bottom of the feet
• Dark urine
• Light-colored stool
• Jaundice
• Itchiness may be the only symptom, getting worse at night
• Nausea
• Loss of appetite

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

This illness can lead to fetal distress, premature birth, or fetal death in-utero (due to to the biliary acids travelling to the placenta and poisoning the baby). Additionally, the mother may suffer an internal hemorrhage.

Causes of Cholestasis

It isn’t clear what causes cholestasis in pregnancy. It may be genetic. Pregnancy hormones can play a role as well.

Bile is a digestive fluid produced in the liver that helps the digestive system to process fats.

The increase in hormones due to pregnancy may increase the normal flow of bile outside the liver. 

This possible accumulation of bile in the liver allows biliary acids to enter the blood stream. The biliary acids deposited in the mother’s tissue can cause itchiness.

Bile is a yellow-green liquid that helps digest fat. It’s composed mostly of cholesterol, biliary salts, and pigmentary bilirubin. It’s produced by the liver and stored in the biliary vesicle.

From the biliary vesicle it passes through the common biliary duct to the duodenum.

Ocassionally, an obstruction outside the liver keeps the bile from leaving the liver, which leads to a condition known as extrahepatic cholestasis. 

Intrahepatic cholestasis occurs when there is a problem with the elimination of the biliary salts from the liver. This is the type of cholestasis that happens during pregnancy.

It’s thought that pregnancy hormones, especially the additional estrogen, may affect the normal function of the biliary vesicle and the liver.

Risk Factors

Risk factors that increase the probability of developing cholestasis during pregnancy are:

• A personal or family history of pregnancy cholestasis. In other words, that there are similar cases in the family passed down genetically.
• History of liver disease
• Pregnancy with twins, triplets, or more
• In Vitro fertilization

Some of these factors have to do with heredity, and all are probably related to the increase in hormone levels during pregnancy.

After having had the condition once, the risk of developing it again in a later pregnancy is high. And steps must be taken to avoid complications.

Almost two thirds of women may suffer from cholestasis during pregnancy. 

Your doctor may ask you questions about your symptoms and family history. A blood test can show whether your liver is functioning correctly and will measure the levels of bile in your blood.

Ultrasounds can also detect abnormalities in the mother’s liver, but not in the fetus’s. If the cholestasis is mild, no treatment is necessary, but normally the goal is to alleviate symptoms and prevent complications.