Cholestasis in Pregnancy

Cholestasis is a condition in which bile, a substance that normally flows from the liver, is blocked. This condition occurs most often in the last trimester of pregnancy and usually goes away within a few days of giving birth. Cholestasis occurs in about 1-2 pregnancies out of every 1,000.

Causes
After the liver produces bile, it is held in the gallbladder. Hormonal changes during pregnancy can affect the function of the gallbladder and cause it to slow or stop the flow of bile. The result is that the bile backs up into the liver and overflows to the bloodstream.

Symptoms
Often, the only indication of cholestasis in pregnancy is itching on the hands and feet. However, other symptoms may be present such as dark urine, depression, loss of appetite, fatigue and light colored bowel movements. Less common symptoms are jaundice (yellowing of the eyes and skin), pain, and nausea.

Diagnosis
To diagnose cholestasis in pregnancy, the doctor will take a blood sample to measure the amount of bile in the mother's blood. Also, an ultrasound may be performed to look for abnormalities in the liver.

Treatment
Cholestasis in pregnancy is multi faceted. To relieve itching, anti-itch medications or corti-costeriods can be used. To help decrease the amount of bile in the system, medications such as ursodeoxycholic acid are given. The mother may also be advised to take cold baths to slow the flow of blood.

A mother with cholestasis in pregnancy will need extra monitoring such as non-stress tests to determine whether the baby is in distress and also regular blood tests to monitor bile levels and liver function.

To decrease the risk of harm to the baby, dexamethansone is often given to help the baby's lung reach maturity because in some cases of cholestasis in pregnancy, it may be necessary to deliver the baby early.

The website www.itchymoms.com recommends following a diet that will help reduce the effects of cholestasis in pregnancy. It is advised to follow this diet along with, not in place of, medical treatment. The diet includes drinking at least 8-12 glasses of water a day, drinking warm water with the juice from half a lemon, eating an organic diet, getting plenty of fiber, fruits and vegetables with deep pigments, and avoiding sugar and artificial sweeteners.

Complications
Cholestasis in pregnancy increases the risk of stillbirth, fetal distress and preterm birth. For the mother, there is a risk of postpartum hemorrhage.

Risk Factors
Although the general risk of cholestasis in pregnancy is low, women who have prior liver damage, have had a sister or mother with cholestasis during pregnancy, and women who are carrying twins have a higher risk of developing this condition.

Sources:

http://www.americanpregnancy.org/pregnancycomplications/cholestasispregnancy.html

http://www.healthsystem.virginia.edu/UVAHealth/peds_hrpregnant/cholesta.cfm

http://www.mayoclinic.com/health/cholestasis-of-pregnancy/DS01033

http://www.itchymoms.com/diet.html