Cholestasis of Pregnancy

         Lots of people experience uncomfortable aches and pains during pregnancy, but some people experience itching. There are several possible causes of itching during pregnancy but intense itch, especially in the hands and feet may be a sign of Cholestasis of Pregnancy. The itching sensation is most commonly felt in the hands and feet, however it can also be experienced on the scalp, legs and in some cases, the entire body.

        The underlying cause of the itching is bile, the yellow/green liquid that is made by the liver and stored in the gallbladder.  After consuming a fat containing meal, bile is usually transferred from the gallbladder to the intestines to break down the fats. However, with cholestasis that transfer does not occur which causes bile to build up in the gallbladder and eventually overflow into the bloodstream. It typically happens in the third trimester, but can happen earlier in the pregnancy too.  In addition to the itch, other possible symptoms include dark urine, pale bowel movements, pain in the right upper quadrant of the abdomen, serious fatigue and loss of appetite.

        Although the symptoms may be uncomfortable on the expectant parent, the more medically significant concerns about cholestasis are the possible effects on the growing baby. Bile build up in the blood can stress the baby’s liver. Cholestasis increases the risk of fetal distress, preterm birth or stillbirth. It is recommended that individuals with cholestasis receive bi-weekly non-stress tests which involve fetal heart monitoring and contraction recordings, as well as regular blood tests monitoring bile serum levels and liver function.

        Cholestasis is thought to be caused by a combination of several factors. Genetically, there can be a mutation in the Bile Salt Export Protein (BSEP); a protein that transports bile. If your mom or sister had cholestasis during pregnancy then you are more at risk. Another factor is hormones, specifically estrogen and progesterone. During pregnancy estrogen and progesterone are produced in high amounts, especially when having multiples, and this increased production can obstruct the liver’s ability to transport bile acids. Lastly, if you’ve previously had liver damage there is a higher risk for cholestasis.

        Cholestasis is not an allergy, so treating the itching with antihistamines and oatmeal baths will only bring temporary relief. Other forms of holistic self care may include Dandelion Root and Milk Thistle which are natural remedies thought to help strengthen the liver and facilitate the flow of bile. The itchy sensation felt with cholestasis will grab your attention, contact your doctor or midwife if you begin to feel these symptoms.