Cholestasis of pregnancy is a condition during which bile cannot flow from a pregnant woman’s liver to her duodenum, or the first section of the small intestine. It is also referred to as intrahepatic cholestasis of pregnancy or obstetric cholestasis. Cholestasis of pregnancy often occurs during the third trimester, but can develop at any point of pregnancy. Cholestasis of pregnancy is the second most prevalent cause of jaundice during pregnancy.
Cholestasis of Pregnancy Risk Factors
While the exact causes are unknown, evidence suggests that hormones and genetic factors play a key role in cholestasis of pregnancy. Cholestasis of pregnancy most commonly occurs during the third trimester when hormone levels are highest. Additionally, cholestasis of pregnancy is more common in twin and triplet pregnancies as they cause heightened hormone levels.
Other risk factors for cholestasis of pregnancy may involve:
- A history of liver damage
- Treatment with progesterone
- Pregnancy from in vitro fertilization (IVF)
- Estrogens that reduce the uptake of bile acid
- Genetic mutations that affect bile salt transport
Cholestasis of Pregnancy Symptoms
Cholestasis of pregnancy is primarily manifested in the mother as severe itchiness, or pruritus on the palms of hands and soles of feet. This itchiness is typically not accompanied by a rash. It tends to increase in the evening and does not respond well to anti-histamines or other remedies for itchiness caused by external stimuli.
Other symptoms that may indicate cholestasis of pregnancy include:
- Darker urine
- Lighter stools
- Heightened nausea
- Decrease in appetite
- Increased blood clotting time
- Pain in the upper right quadrant
- Jaundice, or yellowing of the eyes, membranes, and skin
Diagnosis and Treatment
There are two primary tests performed to diagnose cholestasis of pregnancy: a liver function test (LFT) and a serum bile acid test. LFTs are simple blood tests that can indicate elevated levels of alanine transaminase (ALT). ALT is an enzyme that is most commonly affiliated with the liver. ALT elevation coupled with pruritus of the palms and feet are commonly treated as cholestasis of pregnancy.
Serum bile tests measure the amount of bile salts in the body’s serum. Serum is the component of the blood. Serum does not contain clotting factors or blood cells. It can be separated using a centrifuge and naturally separates when blood coagulates. Bile salt concentration is a helpful indicator to cholestasis of pregnancy, as the condition causes bile buildup in the blood.
Cholestasis of Pregnancy Complications
For the mother, cholestasis of pregnancy typically does not pose serious health risks. Cholestasis of pregnancy in the mother typically resolves itself after childbirth. However, the fetus may experience potentially fatal complications if the condition is not treated. Cholestasis of pregnancy is associated with premature birth and stillbirth. It is recommended to deliver the fetus no later than the 38th week of pregnancy to avoid cholestasis of pregnancy complications. After this point, the lungs of the fetus have typically matured.
If cholestasis of pregnancy diagnosis and treatment are delayed or improperly executed, the fetus may experiences distress in the womb. This can result in meconium ingestion or aspiration. Meconium is a newborn’s first stool that is typically passed after birth. However, fetal distress often causes meconium expulsion into the womb’s amniotic fluid. If the meconium is ingested or inhaled into the lungs, the fetus may develop respiratory distress syndrome. In severe cases, death may occur.