Have You Heard of Cholestasis? Me Neither.

When I was pregnant the first time, I was a reader. I read books about baby development and my body’s changes, but I never read about cholestasis. Then, the other day, a pregnant friend of mine told me she was going to have her baby 4 weeks early because she developed cholestasis.

I had no idea what she was talking about, so I figured I should do some research. Here’s more about this disease that shows up late in pregnancy.

Overview

Cholestasis is also known as Intrahepatic Cholestasis of Pregnancy (ICP). It is a liver disease that occurs in late pregnancy. For someone with cholestasis, as her pregnancy hormones increase, the hormones slow or stop the flow of bile. Bile breaks down fats in the digestion process, allowing the body to absorb certain important fats like Vitamin K. Vitamin K is necessary for blood clotting, so it’s really crucial to have the correct amount of this vitamin in your body.

Symptoms

For my friend, her main symptom was that she itched all over. Particularly, her palms of her hands and the soles of her feet itched, yet there was no rash. The absence of rash is a key factor to diagnose cholestasis.

For some women, the itching can be so intense that it prevents them from sleeping at night, as itching does normally increase in the evening. Also, as you near your due date, the intensity of the itch may increase.

Itching isn’t the only symptom of this disease. Here are some others:

• Yellowing of the skin and whites of the eyes (jaundice)
• Nausea
• Loss of appetite
• Dark urine color
• Pain in the right upper quadrant (RUQ), without gallstones
• Pale/Light coloring of bowel movements
• Fatigue or exhaustion
• Depression

Occurrence

This disease is relatively rare. According to the American Pregnancy Association, there is a 1 or 2 in 1,000 chance of this occurring. However, the disease is more prevalent in Swedish and Chilean ethnic groups.

Causes

According to the Mayo Clinic, the cause of cholestasis is unclear. It seems to be more likely in women who:

• are carrying multiples,
• have a history of liver damage or disease, or
• have a sister or mother who has also experienced cholestasis during pregnancy.

Since so much is unknown about cholestasis, there is no real advice for prevention.

Diagnosis

To determine whether you have cholestasis, contact your doctor. The doctor will perform an exam and order blood work to check your liver function, bile, and bilirubin levels.

When to See a Doctor

Contact your doctor immediately if you believe you may have cholestasis. The good news is that, for most pregnant women, the symptoms of cholestasis greatly reduce after child birth. In fact, many women live without any liver damage or disease once the body readjusts.

Unfortunately, this disease puts your baby at risk. According to the Mayo Clinic, some complications from cholestasis include:

• “Being born too early (preterm birth)
• Lung problems from breathing in meconium — the sticky, green substance that normally collects in the developing baby’s intestines but which may pass into the amniotic fluid if a mom has cholestasis
• Death of the baby late in pregnancy before delivery (stillbirth)”

Because of the high risk of complications for your baby, your doctor may suggest induction.

Outcome

There is nothing that will correctly predict whether you will have this disease, and there’s nothing you can do to prevent it. In situations like this, the best advice is to be your own advocate. If something feels odd or if you suspect something is wrong, please discuss your feelings with your doctor.

Pay attention to how you feel, and don’t assume that everything you experience is a normal part of pregnancy. Be your best advocate, and speak up for yourself if something seems odd.

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