Cholestasis of pregnancy is a common condition that affects the liver during pregnancy, causing severe itching in the hands and feet due to the accumulation of bile in the blood. This stagnation occurs when the liver is unable to secrete bile properly, and usually appears in the late second trimester or during the third trimester of pregnancy. Cholestasis can lead to serious complications for the fetus, so it is recommended to give birth early, usually in the 38th week of pregnancy. There is no specific treatment for this condition, but symptoms such as itching can be relieved and potential risks to the fetus can be reduced by taking some medications according to the doctor's instructions. In the following paragraphs, we will review  Dalili Medical,   how to treat cholestasis and the causes of its occurrence.

What is cholestasis during pregnancy?

 

Cholestasis of pregnancy is a condition that affects the liver and obstructs the flow of bile, which is the digestive fluid produced by the liver, from the liver to the intestines. This defect leads to the accumulation of bile acids in the blood, causing various symptoms and potential complications.

How can I know if I have cholestasis?

 

Severe itching is the main symptom of cholestasis during pregnancy, and it often occurs without a rash. You usually feel itching on the palms of your hands or soles of your feet, but it can occur anywhere on your body. The itching is most severe at night, and it can be so annoying that it keeps you awake.

Can cholestasis occur during pregnancy without a gallbladder?

 

Cholestasis during pregnancy is a disorder that affects the liver, not the gallbladder, so removing or not having the gallbladder will not affect the likelihood of cholestasis.

What is the effect of cholestasis on the fetus?

 

Cholestasis during pregnancy is a major risk to the health of the fetus, as the bile acids that accumulate in the mother's blood can pass to the fetus and negatively affect it. Potential risks to the health of the fetus include fetal distress, premature birth, fetal death before birth, and meconium aspiration.

Liver function, bile levels in the mother's blood, and the health of the fetus are monitored through blood tests and ultrasound examinations.

Labor is usually induced at 38 weeks of pregnancy to reduce the risk, but may be induced earlier if the cholestasis is severe. Delivery can be done vaginally using medication to induce labor, or by cesarean section.

What happens if you have cholestasis during pregnancy?

 

During pregnancy, your baby relies on your mother’s liver to get rid of waste products in your blood. If your liver isn’t working properly, bile levels can rise to unsafe levels, which can put a strain on your baby’s liver. Your liver is a vital organ in removing toxins and waste products from your body, so any malfunction can lead to complications. Your doctor will monitor you carefully to make sure your cholestasis isn’t harming you or your baby.

How common is cholestasis during pregnancy?

 

Cholestasis affects about 1 to 2 in every 1,000 pregnant women. Cholestasis is more common during the winter than at any other time of the year, but researchers aren’t sure why. Data suggests that this condition is more common among people of Spanish and Swedish origin.

Causes of cholestasis of pregnancy:

Cholestasis during pregnancy usually occurs as a result of hormonal changes that affect liver function. The most prominent causes are:

Hormonal changes: During pregnancy, levels of hormones such as estrogen and progesterone increase, which affects the flow of bile. These changes may reduce the liver's ability to secrete bile normally.

**Increased estrogen levels:**It is believed that estrogen can contribute to increased bile production. When the liver is unable to handle this increase, bile may accumulate in the blood.

**Genetic problems:**Some women may be genetically predisposed to developing cholestasis during pregnancy, as they have a family history of the condition.

**Pressure on the liver:**As the fetus grows in the womb, this may put pressure on the liver, which impedes the flow of bile and contributes to cholestasis.

**Environmental or health factors:**Some other health conditions, such as liver disease or gallbladder problems, may increase the likelihood of cholestasis during pregnancy.

**Types of cholestasis after pregnancy**

Two main types of cholestasis can occur after pregnancy:

. **Intrahepatic cholestasis of pregnancy (ICP)**

. **Obstetric cholestasis (OC)**

Intrahepatic cholestasis of pregnancy occurs when the flow of bile from the liver slows or stops due to a hormonal imbalance during pregnancy. This type is most common in the third trimester of pregnancy and can cause symptoms such as itching, jaundice, and dark urine. If left untreated, ICP can lead to serious complications such as premature birth, stillbirth, and other health problems.

Obstetric cholestasis of pregnancy is a rare condition that occurs when the flow of bile slows or stops due to a blockage in the bile ducts. This type can also cause symptoms such as itching, jaundice, gallstone formation, and dark urine. If left untreated, it can lead to similar complications such as premature birth and stillbirth.

Both types of cholestasis can be treated with medications, which help relieve itching and improve bile flow, as well as careful monitoring of the pregnancy. In some cases, early delivery may be necessary to protect the health of the mother and baby.

**Symptoms of cholestasis during pregnancy**

Recognizing the symptoms of cholestasis during pregnancy is crucial for early diagnosis and appropriate treatment. Prominent symptoms that may appear are itching or severe swelling.Itching is often accompanied by the absence of a rash, and usually begins on the palms of the hands and soles of the feet, and may then spread to other areas of the body.

**Hormonal changes** The functions of the digestive system and liver are greatly affected during pregnancy due to hormonal changes. Increased levels of some hormones, such as estrogen and progesterone, can lead to increased bile secretion and changes in the process of digesting food, which increases the likelihood of cholestasis.

**Increased size of the uterus** During pregnancy, the uterus expands to accommodate the growth of the fetus, which can put pressure on surrounding organs, including the gallbladder. This pressure can impede the flow of bile and increase the likelihood of gallstones.

**Digestive system changes** Women experience changes in their digestive system during pregnancy, the most prominent of which is slow bowel movements, which can lead to the accumulation of bile and the formation of gallstones.

**Pressure on blood vessels** The increase in size and weight during pregnancy puts additional pressure on the blood vessels, especially those that supply the liver and gallbladder. This pressure can lead to increased blood pressure in these vessels, which negatively affects this area.

**Dietary changes** Some changes in eating patterns during pregnancy, such as eating large meals at once, can increase the risk of gallstones. The increased secretions and hormonal effects may contribute to the formation of bile.

**High cholesterol levels** Cholesterol levels rise during pregnancy, which may increase the likelihood of gallstones and lead to the appearance of this problem.

**Genetic factors** Genetic factors play a role in determining the body's predisposition to gallstones. If there is a family history of cholestasis problems, there may be a greater chance of developing this condition during pregnancy.

- Jaundice: This is a yellowing of the skin and eyes, although it is considered less common.

- Dark urine: indicates an increase in the percentage of bile pigment.

- Pale stool: occurs as a result of the bile juice not reaching the intestines.

- Fatigue: a general feeling of tiredness and weakness.

Less common symptoms are:

- Nausea: feeling sick with the desire to vomit.

- Loss of appetite: decreased desire to eat.

- Pain in the upper right abdomen: a feeling of discomfort or pain in the upper right quadrant of the abdomen

**Diagnosis of cholestasis during pregnancy**

Accurate diagnosis is vital to effectively managing cholestasis during pregnancy. The diagnostic process usually involves several key steps:

**Clinical assessment** The initial assessment involves a comprehensive review of the patient's symptoms and medical history. A characteristic itching that occurs without a rash is an important sign.

**Laboratory tests** Blood tests are necessary to confirm the diagnosis, and include:

- **Liver function tests (LFTs)**: to measure liver enzyme levels.

- **Serum bile acid test**: Elevated levels of bile acids indicate the presence of the condition.

- **Bilirubin levels**: To check for jaundice.

**Imaging studies** In some cases, imaging studies such as ultrasound may be used to rule out other causes of liver dysfunction, such as gallstones.

What are the complications associated with cholestasis during pregnancy?

 

Cholestasis during pregnancy can lead to a range of complications if not treated appropriately. These complications include:

- **Preterm labor**: Cholestasis can increase the risk of premature birth, which occurs before the 37th week of pregnancy. Preterm birth is dangerous for both mother and baby, as the baby may not have fully developed, making it more vulnerable to health problems.

- **Stillbirth**: Cholestasis is associated with an increased risk of stillbirth, which means the baby dies before or during the birth process.

Additional complications: Cholestasis can lead to other complications, such as:

- Fetal distress (health problems for the baby during labor and delivery).

- Placental abruption (separation of the placenta from the uterus before birth).

- Newborn respiratory distress (difficulty breathing after birth).

Early diagnosis and treatment can help reduce the risk of these complications. There are also other tests, such as anomaly scans, that can help identify abnormalities in the fetus's structure.

Can you have liver problems after pregnancy?

 

Postpartum cholestasis usually does not lead to permanent liver damage. Except in future pregnancies, most women do not experience further liver problems after this condition.

However, if cholestasis is not treated, it can cause complications such as premature birth or stillbirth, which can negatively affect the health of the mother and baby. Infection with the hepatitis E virus during pregnancy can also lead to cholestasis. Treatment may include medications to relieve itching, improve bile flow, and closely monitor the pregnancy. In some cases, early delivery may be necessary to protect the health of the mother and baby.

Can cholestasis cause long-term damage?

 

Cholestasis that occurs during pregnancy usually resolves after delivery. However, it is important to discuss any ongoing symptoms or concerns you may have with your health care provider.

Cholestasis is a temporary condition that occurs during pregnancy and usually resolves within a few weeks after delivery. However, some women may experience symptoms such as itching for longer periods. In rare cases, cholestasis can also occur after pregnancy. Cholestasis is rare when the flow of bile from the liver slows or stops due to a blockage in the bile ducts. This problem usually resolves afterBirth, but it may recur in future pregnancies

What are the effects of cholestasis on the baby after birth?

 

If cholestasis is not treated, it can affect the baby's health after birth. The baby may be more susceptible to health problems such as difficulty breathing and low blood sugar levels. In rare cases, oral contraceptives may increase the risk of stillbirth. In some cases, early delivery may be necessary to protect the health of the mother and baby. After birth, the health care team will carefully monitor the baby to ensure his or her health and well-being.

**Treatment of cholestasis during pregnancy**

Management of cholestasis during pregnancy focuses on relieving symptoms and reducing potential risks to the fetus. Treatment strategies include:

- **Milk thistle**: Contains silymarin, which helps protect liver cells and promote liver health.

- **Peppermint**: It can help improve digestion and increase bile production, which may be helpful in cases of cholestasis.

- **Dandelion root**: Dandelion is believed to support liver health and stimulate bile flow, but should be used with caution during pregnancy.

- **Artichoke**: Helps to promote bile secretion from the liver.

- **Ginger**: Ginger is an anti-inflammatory and may help improve digestion and increase bile flow.

**Medications**

- **Ursodeoxycholic acid (UDCA)**: This is the most common medication used to reduce bile acid levels and relieve itching.

- **Antihistamines**: Used to help control itching, although their effectiveness may be limited.

- **Vitamin K supplements**: Given to address potential deficiency and reduce the risk of bleeding.

**Monitoring and delivery planning**Regular monitoring of liver function and bile acid levels is essential. Non-stress tests and biophysical profiles can be used to assess fetal health. In many cases, early delivery, usually at 37-38 weeks, is recommended to reduce the risk of stillbirth.

**Relieving itching in pregnant women**

To relieve itching, doctors recommend the following steps:

- Using a medication known as Ursodiol to reduce the level of bile in the blood.

- Applying topical anti-itch medications that may contain cortisone.

- Taking other medications to relieve itching in some cases.

- Soaking the itchy areas in cold or lukewarm water.

**Monitoring the child's health**Cholestasis can lead to complications during pregnancy, so the doctor pays special attention to monitoring the child's health during this period. He may recommend the following tests and procedures:

1. **Non-stress test**: The doctor uses this test to monitor the child's heartbeat and how increased activity or movement affects the fetal heart rate.

2. **Fetal vital signs examination**: This examination includes a set of tests that aim to evaluate the health of the fetus, as it provides comprehensive information about its movement and muscle strength, in addition to examining its breathing strength and the amount of amniotic fluid surrounding it.

3. **Early induction of labor**: Even if your pre-pregnancy tests are normal, your doctor may suggest inducing labor early if there is a risk to your baby, such as a possible stillbirth. Doctors usually resort to early induction of labor between weeks 37 and 38 to avoid complications of cholestasis.

**Lifestyle and home remedies**

Avoid using synthetic fabrics and replace them with natural fabrics such as cotton.

Use moisturizers and creams to relieve itching.

Take a cool shower and avoid scented soaps.

You can take an oatmeal bath, as oatmeal helps relieve sores, especially those caused by chickenpox, fever, or sunburn.

Avoid stress, as stress can increase the severity of itching. You can practice relaxation exercises to help reduce stress.

Avoid sudden movements between places with different temperatures.

Follow a proper diet after consulting your doctor, as modifying your diet can help relieve the symptoms of cholestasis during pregnancy. This includes:

Eating fresh fruits and vegetables is the best way to get the vitamins, minerals, and fiber your body needs.

Choosing organic produce that has not been sprayed with pesticides to reduce exposure to toxins.

Make sure canned produce is preserved in its water when used, and avoid foods that contain added sugar.

Be sure to drink enough water daily, equivalent to 8-12 cups.

Stay away from foods that contain soy products and high-fat dairy products.

Avoid processed foods such as processed meats.

**Can cholestasis be prevented after pregnancy?**

 

There is no guaranteed way to prevent cholestasis of pregnancy, also known as intestinal cholestasis of pregnancy (ICP) or gestational cholestasis (OC). However, there are some steps you can take to reduce your risk:

- **Get medical care early:** If you are pregnant and have any symptoms that suggest cholestasis, such as itching or jaundice, it is important to contact your health care provider as soon as possible.

- **Eating a healthy diet:** Eating a balanced diet that includes a variety of fruits, vegetables, and whole grains can help support liver health. It is also best to avoid high-fat foods and consume moderate amounts of fat.

- **Avoid certain medications:** Some medications, such as cholesterol-lowering medications and some pain relievers, may increase your risk of cholestasis.

- **Managing underlying health conditions:** If you have liver disease or other health conditions, it is important to manage them well. This may include following a special diet, taking medications as prescribed, and following your health care provider’s recommendations.