While many pregnant women experience annoying itchiness at some point during their pregnancy, the problem is usually superficial. Cholestasis of pregnancy, however, is a type of liver disease that causes severe itching. It only occurs in pregnant women, typically late in the pregnancy.
The hormones associated with pregnancy affect the flow of bile through the gallbladder, slowing or even stopping it. Bile acids then build up in the liver and leak out into the bloodstream. It is estimated that one in 1,000 pregnancies are diagnosed with this condition.
Symptoms of cholestasis of pregnancy include severe itching, most often on the feet and hands. A woman’s urine may be darker in color, while her bowel movements may be lighter than usual. She may experience abnormal fatigue, a drop in appetite, and even depression. Some women exhibit jaundice or nausea as well.
Risk factors for this condition include pregnancies with multiples, previous damage to the liver, and a family history of the condition. Studies have shown that women of Swedish or Chilean descent also have an increased risk of developing the cholestasis of pregnancy. A diagnosis is made by studying the patient's medical history and taking blood tests to assess liver function and the levels of bile acids and bilirubin.
Cholestasis of pregnancy is a potentially serious condition for both mother and child. Pregnancies diagnosed with the condition have higher chances of fetal distress, prematurity, and stillbirth. Because the mother is unable to correctly process the bile, it puts an additional load on the baby’s liver. Birth is usually induced as soon as the baby is full term or otherwise considered safe to deliver. Dexamethansone is usually administered to help the baby’s lungs develop if the baby is preterm.
It is difficult to treat this condition — usually only childbirth will resolve it. It usually resolves on its own within several days after delivery. Treatment during pregnancy usually serves to alleviate the severe itching. Topical ointments may help.
Ursodeoxycholic acid, a drug that helps to decrease bile acids, may be prescribed to a woman with cholestasis of pregnancy. Dandelion is a natural remedy that has been shown to promote liver health. Some studies report that up to 90% of women who have had the condition will suffer relapses with subsequent pregnancies.