Cholestasis of pregnancy is a common liver disease that occurs only during pregnancy. An estimated one to two pregnancies in 1,000 are affected and the chances are higher for women carrying twins. According to Schiff’s “Diseases of the Liver”, the condition presents during the second or third trimester and resolves spontaneously following delivery. Cholestasis results from changes in the normal flow of bile in the gallbladder. The American Pregnancy Association explained that the high levels of pregnancy hormones, specifically estrogen, slow or even stop the flow of bile. This leads to the accumulation of bile acids in the liver which eventually get into the bloodstream.
Itching is the main symptom, most commonly on the palms and soles of the feet. It is more severe at night and disappears within the first few days after delivery. The itching is very uncomfortable The Mayo Clinic lists treatment options such as prescription medications to relieve itching and increase bile flow, corticosteroid creams or lotions, and lukewarm water baths. Other symptoms include dark colored urine, light colored stools, and jaundice or yellow coloring of the eyes and skin.
A health care provider will confirm a diagnosis by obtaining a medical history, performing a physical exam and ordering blood tests to monitor liver function, bile acids, and bilirubin. The elevated maternal bile levels stress the unborn child’s liver. There is an increased risk for fetal distress, premature birth, and stillbirth. Women with cholestasis are very closely monitored with regular blood tests to evaluate bile serum levels and liver functions. Typically, once the fetus’s lungs have matured to sustain life outside the womb, labor is induced early. A woman who experiences cholestasis once has a 70 percent chance of developing it during subsequent pregnancies.
Sources: Schiff’s Diseases of the Liver by Eugene R. Schiff, M.D. eighth edition