Cholestasis Of Pregnancy: 6 Things To Know About This Liver Problem

Pregnancy throws many curveballs at moms-to-be. And sensitive, itchy skin is just one of them. Usually, this is because of an increase in hormones or the stretching of the abdominal skin as the baby grows. But if the itching is intensive, uncontrollable, and persistent, it is a red flag – one that may point to a condition called intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis. Here’s what you should know about this problem that affects pregnant women.¹

ICP Is A Liver Disorder

Your liver produces bile, a digestive juice that helps digest fat. Once produced by the liver, the bile moves to the gallbladder and is stored there. When you have ICP, pregnancy hormones may impair this liver function, causing bile flow to become sluggish. Bile acids consequently tend to build up in the liver and move into the bloodstream. This may not cause any serious harm to the mother but the bile can cross the placenta and reach the baby.

ICP commonly begins in the third trimester when your hormone levels are at their peak but it has been known to occur as early as 8 weeks in some women. There is also a higher risk of recurrence in subsequent pregnancies if you’ve already experienced it before – estimates suggest a 60 to 90% chance of it occurring again.^{2 3}

Symptoms Include Itching, Dark Urine, Pale Stools, And Abdominal Pain

[pullquote]Do see a doctor immediately if you experience persistent itching during pregnancy. A simple blood test can help you confirm or rule out ICP. ⁴[/pullquote]

There are some clear signs that point toward ICP that you should watch out for.

• Intensive itching or pruritus is often the first and, often, the only sign of ICP. It can occur in any part of the body but it’s usually more noticeable and severe on the soles of your feet and your palms. It may also start with these areas and then move on to the rest of the body. The itching also tends to worsen at night and may disturb your sleep.
• You can have dark urine and pale or grayish stools.
• You can experience pain or a dull ache on the right side just below the rib cage.
• You may also experience symptoms like fatigue and loss of appetite and generally feel unwell.^{5 6}

Hormones, Genetics, And Environment Can Contribute to ICP

It’s not clear what exactly causes ICP in some pregnancies but a combination of genetic, hormonal, and environmental factors may be responsible.

• Hormones: All hormones are broken down by your liver. It has been suggested that increased levels of hormones such as is seen during pregnancy can overload the liver and affect its capacity to remove bile salts. This theory is supported by the fact that ICP is more common when the mother is carrying triplets or twins where you tend to see higher hormone levels. Also, this condition has been observed in women who take oral contraceptives which contain hormones as well as women treated with progesterone.
• Genes: Genetic factors may play a part in the development of ICP as it appears to run in families. This may also explain why it occurs more commonly in certain ethnic groups. ICP occurs in 0.4–1% of pregnancies in North America and Central and Western Europe while South American countries like Chile and Bolivia see 5–15% cases. It affects 0.7% of pregnancies in the UK overall but occurs more commonly in women of Pakistani or Indian descent in the UK (1.2–1.5%). Do note, however, that you can get ICP even if you don’t have a family or genetic history of the condition.⁷
• Environment: Some environmental factors may also play a part in the development of ICP. For instance, it may be more common during winter. The incidence of ICP has also been found to decrease with better nutrition in some countries.⁸

ICP Can Lead To Complications During Pregnancy

ICP can pose several risks to your pregnancy if you don’t take measures to control it.

• Fetal distress: Fetal distress is a term used to indicate that your unborn baby is not doing well. For instance, he or she might not be getting enough oxygen. Decreased movement and a low or high heart rate can be some indications of fetal distress.
• Preterm birth: ICP can increase your risk of delivering the baby too early.
• Meconium passage: Meconium is the fecal matter which is usually stored in your baby’s intestines till birth. But sometimes it can be released into the amniotic fluid before the baby is born. This can cause serious respiratory problems if the baby inhales the tainted fluid.
• Maternal haemorrhaging: Cholestasis can impair your ability to absorb vitamin K which is fat soluble. Vitamin K plays a critical role in blood clotting and a deficiency in this vitamin can cause you to bleed excessively.
• Stillbirth: It is not completely understood why ICP increases your risk of stillbirth but bile acids can cause harm to your unborn baby in many ways, including causing abnormal heart rhythms or abnormal contraction of veins which supply your baby with nutrients. Actively managing the condition can bring your risk for stillbirth down to normal levels.
• Breathing problems: ICP can cause your newborn baby to have respiratory issues.^{9 10}

Medication, Supplementation, And Early Delivery May Be Used To Manage ICP

[pullquote]ICP is diagnosed when a blood test shows that the total bile acids (TBA) or serum bile acids are 10 micromol/L and above.[/pullquote]

There is no cure for ICP. Your doctor will monitor the functioning of your liver and may advise medication for managing the condition.

• Calamine lotion or aqueous creams containing menthol can be used to ease itching temporarily. Taking cool or even cold baths may help ease symptoms.
• Your doctor may also advise medicines that decrease bile acid levels and itching.
• In some cases, your doctor may recommend inducing delivery early at 37 or 38 weeks.
• If you have an issue with blood clotting, your doctor may recommend taking a vitamin K supplement.^{11 12}

ICP Resolves On Its Own After Delivery

ICP usually resolves on its own after the baby is born. But you need to get a checkup done about 6–12 weeks after delivery to confirm that your symptoms have resolved. ICP doesn’t typically cause developmental issues for the baby or damage to the mother’s liver though women who have had ICP may be at a slightly higher risk for developing gallstones or autoimmune liver conditions. Some women with a history of ICP have also been known to get cholestasis after taking the contraceptive pill or certain antibiotics.¹³