Pregnancy

What is Cholestasis in Pregnancy?

Cholestasis is a common liver disorder that occurs in pregnancy when the normal flow of bile is affected in the gallbladder due to very high amounts of pregnancy hormones. Cholestasis is more common during the last trimester. According to the Cincinnati Children’s Hospital Medical Center, this disorder of the gallbladder occurs in about one out of 1000 pregnancies.

Causes of Cholestasis in pregnancy

Pregnancy hormones affect the gallbladder, which results in stopping or slowing the normal flow of bile. The gallbladder holds the bile that is being produced by the liver. This helps in the breakdown of fatty acids and aids in digestion as well. When this flow of bile is stopped or slowed, this results in building of the bile acids, which are then spilled into the bloodstream.

Symptoms of Cholestasis in Pregnancy

Here are a list of signs and symptoms of cholestasis during pregnancy:

  • Depression
  • Loss of appetite
  • Exhaustion or fatigue
  • Light colored bowel movements
  • Dark colored urine
  • Itching, especially over the hands and feet, which is often the only symptom noticed.
  • Nausea
  • Pain in the upper right area
  • Jaundice

Less common symptoms include:

Risk Factors for Cholestasis

Around one to two pregnancies in 1,000 are affected by cholestasis. Here are some of the conditions that put a woman at a great risk of suffering from cholestasis during pregnancy:

  • Women whose mother or sisters had cholestasis
  • Those who had previous liver disorders
  • Women carrying multiples

Diagnosis of Cholestasis

Diagnosis of cholestasis is made by taking the complete medical history, blood tests, and a physical examination that evaluates bile acids, bilirubin, and liver function.

How Does Cholestasis in Pregnancy Affect the Mother?

Cholestasis increases the risk for preterm birth, fetal distress, or still birth. A baby in the womb relies completely on the mother for proper liver function. The mother’s liver removes the bile juices from the blood, but if the maternal bile levels are elevated, then this automatically causes stress on the baby’s liver. A woman with cholestasis during pregnancy must be monitored strictly. Once the baby’s lungs reach maturity, labor must be induced.

Treatment for Cholestasis of Pregnancy

The main goal of treatment for cholestasis is to relieve itching. Some of the treatment options are:

  • Regular blood tests of both the liver function and bile serum levels
  • Bi-weekly non-stress tests that involve contraction recordings and fetal heart monitoring
  • Milk thistle and dandelion root are natural herbs that are beneficial for liver function. Consult your doctor before taking these herbs.
  • According to the American Pregnancy Association, vitamin K supplements are given to the mother just before the delivery, which is mainly to prevent intra-cranial hemorrhage.
  • Steroidal medicines are given to increase the lung maturity of the fetus.
  • Ice water or cold baths can slow down the blood flow in the body by reducing body temperature.
  • Medications can be taken to reduce the bile acid concentration.
  • Topical anti-itch medications can be taken along with corticosteroids.

Treatment for Cholestasis

Treatment of cholestasis during pregnancy must be determined by a physician who will take care of the following:

  • Pregnancy, overall health, and medical history
  • Expectations for the course of the disease
  • The tolerance of certain procedures, medications, and therapies
  • The extent of the disease

Treatments Not Used for Cholestasis

Some of the treatments that are not given for cholestasis patients are:

  • Oatmeal bath
  • Antihistamines

There are conflicting views on the use of the medication called Cholestyramine. This medicine was used in the past, but some studies have stated that this drug can cause adverse effects like blocking vitamin K, which is already found to be deficient in pregnant women. Therefore, keep a note of these signs and symptoms. If you suffer from the above symptoms, consult a physician for further treatment before any complications arise.

 

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