Some women experience a very severe itching in late pregnancy. The most common cause of this is
cholestasis, a common liver disease that only happens in pregnancy. Cholestasis of pregnancy is a condition in
which the normal flow of bile in the gallbladder is affected by the high amounts of pregnancy hormones. Cholestasis
is more common in the last trimester of pregnancy when hormones are at their peak, but it usually goes away within
a few days after delivery. According to Cincinnati Children’s Hospital Medical Center, Cholestasis occurs in about
1 out of 1,000 pregnancies but is more common in Swedish and Chilean ethnic groups. Cholestasis is sometimes
referred to as extrahepatic cholestasis which occurs outside the liver, intrahepatic cholestasis
which occurs inside the liver, or obstetric cholestasis.
What causes Cholestasis of pregnancy?
Pregnancy hormones affect gallbladder function, resulting in slowing or stopping the flow of
bile. The gallbladder holds bile that is produced in the liver, which is necessary in the breakdown of fats in
digestion. When the bile flow is stopped or slowed down, this causes a build up of bile acids in the liver which
can spill into the bloodstream.
What are the symptoms of Cholestasis of pregnancy?
Itching, particularly on the hands and feet (often is the only symptom noticed)
Dark urine color
Light coloring of bowel movements
Fatigue or exhaustion
Loss of appetite
Less common symptoms include:
Jaundice (yellow coloring of skin, eyes, and mucous membranes)
Upper-Right Quadrant Pain
Who is at risk for Cholestasis of pregnancy?
1 to 2 pregnancies in 1000 are affected by cholestasis. The following women have a higher risk
of getting cholestasis during pregnancy:
How is Cholestasis of pregnancy diagnosed?
A diagnosis of cholestasis can be made by doing a complete medical history, physical
examination, and blood tests that evaluate liver function, bile acids, and bilirubin.
How will the baby be affected if the mother is diagnosed with
Cholestasis may increase the risks for fetal distress, preterm birth, or stillbirth. A
developing baby relies on the mother’s liver to remove bile acids from the blood; therefore, the elevated levels of
maternal bile cause stress on the baby’s liver. Women with cholestasis should be monitored closely and serious
consideration should be given to inducing labor once the baby’s lungs have reached maturity.
What is the treatment for Cholestasis of pregnancy?
The treatment goals for cholestasis of pregnancy are to relieve itching. Some treatment options
Topical anti-itch medications or medication with corticosteroids
Medication to decrease the concentration of bile acids such as ursodeoxycholic acid
Cold baths and ice water slow down the flow of blood in the body by decreasing it’s temperature
Dexamethansone is a steroid that increases the maturity of the baby’s lungs
Vitamin K supplements administered to the mother before delivery and again once the baby is born to
prevent intracranial hemorrhaging
Dandelion Root and Milk Thistle are natural substances that are beneficial to the liver
Bi-weekly non-stress tests which involve fetal heart monitoring and contraction recordings
Regular blood tests monitoring both bile serum levels and liver function
Treatment for cholestasis of pregnancy needs to be determined by your physician who will take
the following criteria into consideration:
Your pregnancy, overall health, and medical history
The extent of the disease
Your tolerance of specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Treatments that should not be used for Cholestasis include:
Aveeno and Oatmeal Bath
*There are conflicting views on using the medication Cholestyramine for treatment of
cholestasis. In the past, this medication was readily used to treat this condition, but some studies have shown
that Cholestyramine may not be as effective as other treatments and potentially has some adverse side effects such
as blocking essential vitamins like Vitamin K (A vitamin that is already deficient in women with cholestasis).
What are the chances of the mother getting Cholestasis in another
Whether or not a woman will get cholestasis in future pregnancies is debatable. However, some
sources claim that women who have had cholestasis of pregnancy have up to a 90% chance of having this repeat in