Cholestasis of Pregnancy

Cholestasis is a condition in which the bile ducts do not function properly, resulting in the accumulation of waste products in the body. These substances can cause problems with your skin, eyes, urine, and stools. Bilirubin, a waste product produced by red blood cells, escapes the liver throug7h bile ducts and flows to the duodenum, which is eliminated in urine and stools.

Symptoms

If you experience a fever, itching, and rash during your pregnancy, you may have cholestasis of pregnancy. Your healthcare provider will monitor your condition carefully. This condition typically clears up after delivery. While it is not life-threatening, your doctor may recommend you seek early delivery to protect your unborn child. Your doctor will also perform blood tests to monitor bile and liver function.

The most common cholestasis symptoms are intense itching, particularly of the hands and feet. The itching may occur day and night and may be very uncomfortable. Itching can also cause daytime irritability and insomnia. The itching is due to the absorption of bile acid through the skin.

When diagnosed early, cholestasis of pregnancy may be reversible, although future complications for mom and baby can be more severe. The risks to the fetus increase as the bile acid concentrations in the blood rise. In some cases, doctors may induce labor earlier than expected to reduce the risk to the baby. Symptoms of cholestasis of pregnancy usually go away within a few days of delivery. Depending on the severity of the condition, your healthcare provider may prescribe medications to treat the itching or help the baby’s lungs mature. Some will also prescribe vitamin K to help prevent internal bleeding.

Causes

Cholestasis is a condition that causes bile to build up in the gallbladder. This condition can be inherited or acquired. Pregnant women are more prone to develop it during pregnancy due to the hormones they produce, including estrogen. Women who have previous liver damage are also at higher risk. Cholestasis is difficult to detect during the first pregnancy, so seeking medical advice and treatment as early as possible is essential.

Cholestasis is often accompanied by jaundice. This symptom occurs because there are abnormal deposits of yellow pigment in the bile. While this symptom is rare in intrahepatic cholestasis, it is common in obstructive cholestasis. Additionally, patients with chronic cholestasis may also experience fatigue. Defects may cause fatigue in the corticotrophin hormone axis or abnormal neurotransmission. Another symptom is an enlarged gallbladder, which can be felt during physical examination or detected during imaging studies. Some patients with cholestasis experience weight loss and nausea.

In most cases, cholestasis is a result of a liver disorder. There are two primary types of cholestasis. One type is caused by liver disease, while the other occurs outside the liver. Although it is uncommon in adults, it can be fatal.

Treatment

Cholestasis treatment is a multi-step process that starts with self-care measures. This includes reducing dietary fat and ensuring cardiovascular health. Next, medications are administered to decrease the amount of harmful cholesterol in the blood and increase good cholesterol levels. These medications are typically taken orally. Surgery may also be necessary in severe cases.

During pregnancy, women with a Scandinavian or Indian background may be at higher risk of developing cholestasis. If the condition affects a woman’s uterus, it can lead to premature labor and complications during childbirth. A woman may experience excessive bleeding during labor, which can be treated with medications.

Cholestasis during pregnancy is caused by changes in hormone levels that slow the passage of bile through the bile ducts. In pregnant women, high estrogen and progesterone levels can increase the likelihood of developing cholestasis. Other risk factors include carrying twins and taking drugs that damage the liver. Pregnant women can reduce their risk by having a hepatitis B vaccination. Physical examinations detect cholestasis, including abdominal pain, tenderness, and high bilirubin levels.

Prevalence

The prevalence of intrahepatic cholestasis during pregnancy varies widely. In some populations, it is as high as 40%. But for others, the prevalence ranges from 2% to 25%. There is no effective preventative therapy, and the risk of recurrence is 50 to 60% in subsequent pregnancies. Consider antepartum fetal monitoring if you suspect you may have cholestasis during pregnancy. Though most management strategies advocate delivery between 37 and 38 weeks, there are no clear-cut guidelines for this. But before deciding on any antenatal testing, remember to document the gestation and the maternal obstetric history.

In a recent study, Swiss Inflammatory Bowel Disease Cohort researchers studied cholestasis prevalence. The researchers compared the characteristics of patients with cholestasis with those without the disorder. They studied the bile acid profiles of 80 patients with high and low total bile acids and compared them to those with healthy controls. They also assessed bile acid levels in patients with different clinical conditions, such as ileal versus colonic disease and inflammatory vs. non-inflammatory disease.