Cholestasis of Pregnancy

What is cholestasis of pregnancy?

Cholestasis of pregnancy is a liver problem. It slows or stops the normal flow of bile from the gallbladder. This causes itching and yellowing of your skin, eyes, and mucous membranes (jaundice). Cholestasis sometimes starts in early pregnancy. But it is more common in the second and third trimesters. It most often goes away within a few days after delivery. The high levels of bile may cause serious problems for your developing baby (fetus).

What causes cholestasis of pregnancy?

Healthcare providers don't know what causes cholestasis of pregnancy. They do know that this happens:

• Your liver makes bile. Bile helps break down fats during digestion.

• The gallbladder stores the bile.

• The hormones your body releases during pregnancy change the way the gallbladder works. This may cause bile to slow or stop flowing.

• Bile builds up in the liver and spills into the bloodstream.

What are the symptoms of cholestasis of pregnancy?

The main symptom of cholestasis of pregnancy is severe itching. This is sometimes called pruritus. It may be all over the body. But it is more common on the palms of the hands and soles of the feet. It may also be worse at night. Other symptoms may include:

• Pain in the belly (abdomen), although this is not common

• Light color of stool (bowel movements)

• Yellow color of skin, eyes, and mucous membranes (jaundice), although this is not common

The symptoms of cholestasis sometimes look like other health conditions. Always see your healthcare provider for a diagnosis.

How is cholestasis of pregnancy diagnosed?

Your healthcare provider is likely to think you have cholestasis of pregnancy if you have severe itching. Lab tests will help to confirm the diagnosis. You may have these tests:

• Liver function tests, including the amount of bile acid in the blood. This test result is high in cholestasis of pregnancy.

• Other lab tests, including prothrombin time. This checks how well your blood clots.

You may also have other tests, such as an ultrasound exam of the tubes that carry bile (bile ducts). 

How is cholestasis of pregnancy treated?

You and your healthcare provider will discuss the best treatment for you based on:

• Your pregnancy

• Your overall health and health history

• How sick you are

• How well you can handle certain medicines, procedures, or therapies

The goals of treating cholestasis of pregnancy are to relieve the itching and prevent complications. Treatment may include:

• Medicine. To help relieve itching and help lower the level of bile.  

• Measuring serum total bile acid. The level of bile in your blood may be checked. This helps your healthcare provider figure out treatment.

• Fetal monitoring. The healthcare provider may check your developing baby for any problems.

• Early delivery. You may deliver your baby early, between 37 to 38 weeks of pregnancy. This will lessen the risk to your baby. This may be by vaginal delivery with medicine to start labor. Or you may have a cesarean delivery. Your healthcare provider may decide that you should deliver even earlier, depending on your symptoms, test results, and pregnancy history.

What are possible complications of cholestasis of pregnancy?

There is a serious risk of complications in your developing baby if you have cholestasis of pregnancy. The complications include:

• Fetal distress. This means your developing baby is not doing well. For example, the baby may not be getting enough oxygen.

• Preterm birth. You may be at greater risk for giving birth too early.

• Meconium in amniotic fluid. This means your baby has a bowel movement before birth. This may cause very serious breathing problems.

• Breathing (respiratory) problems. Your baby may have breathing problems as a newborn.

Cholestasis of pregnancy can also lead to vitamin K deficiency. This will need to be treated before you give birth, because it can cause you to bleed too much.

When should I call my healthcare provider?

Call your healthcare provider if you have:

• Severe itching

• Yellow coloring of your eyes, skin, or mucous membranes (jaundice)

Key points about cholestasis of pregnancy

• Cholestasis of pregnancy is a condition that slows or stops the normal flow of bile in the gallbladder.

• It can cause severe itching. This is the most common symptom.

• The goals of treating cholestasis of pregnancy are to relieve itching and prevent complications for your developing baby.

• Babies of women with cholestasis are often delivered early (usually around 37 weeks) because of the risks.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.