17901 Cholestasis Of Pregnancy

Overview

Cholestasis of pregnancy (also called obstetric cholestasis or intrahepatic cholestasis of pregnancy) is a liver condition that can happen during pregnancy. It slows the flow of bile, a fluid made by the liver that helps digest food. Bile acids build up in the blood, causing severe itching and possibly affecting the baby. With careful monitoring, most women have a healthy pregnancy and baby.

It is not very common. In the UK, it affects about 1 in 140 pregnant women. The number varies by ethnic background, with higher rates in South Asian and Mediterranean women.

Cholestasis of pregnancy affects pregnant women, most often in the later stages. You are more likely to develop it if you have had it before, if it runs in your family, or if you are carrying twins or more.

Symptoms

Common symptoms

• Intense itching without a rash – often worse at night, typically on the palms of the hands and soles of the feet
• Sometimes itching can spread to other areas, such as the arms, legs, and torso
• Dark urine or pale stools
• Yellowing of the skin or eyes (jaundice) – this is less common

Causes

Main causes

• The exact cause is not fully understood, but it is linked to the high levels of pregnancy hormones affecting the liver's ability to move bile.
• Genetics play a role – the condition often runs in families.
• It may be related to a problem in how the body processes bile acids.

Risk factors

• Having had cholestasis of pregnancy before
• A family history of the condition
• Carrying twins or more babies
• A history of liver disease, such as hepatitis C
• South Asian or Mediterranean background

When to see a doctor

See a doctor urgently if:

• If you experience severe itching during pregnancy, especially on your hands and feet, contact your midwife or doctor the same day.
• If you have itching along with jaundice, dark urine, or pale stools, seek urgent medical advice.

Book a routine appointment if:

• If you have persistent itchiness that is new in pregnancy, mention it at your next antenatal visit.
• If you have had cholestasis before, talk to your healthcare team early in your next pregnancy so they can monitor you.

Diagnosis

Your doctor or midwife will discuss your symptoms and arrange blood tests to check your liver function and the level of bile acids in your blood.

Tests that may be done

• Blood tests for liver enzymes and bile acid levels
• An ultrasound of your liver to rule out other conditions, if needed
• Regular checks of your baby's health, such as heart rate and movement

What to expect at your appointment

Your healthcare team will explain the results and what they mean. You may need repeat blood tests, and you will likely have extra antenatal appointments so that both you and your baby are monitored closely.

Treatment

Treatment is focused on relieving your symptoms, keeping bile acid levels as low as possible, and watching your baby closely. Your team will decide together if early delivery is recommended to reduce risks.

Self-care at home

• Take cool baths or use cool compresses on itchy areas
• Wear loose, soft cotton clothing
• Avoid hot baths and overheating, which can make itching worse
• Use unperfumed moisturisers or soothing creams – ask your pharmacist which ones are safe during pregnancy
• Try gentle activities, rest, and stress reduction

Medical treatments

Doctors may offer a medicine that helps lower bile acids in the blood, or a treatment to ease the itching. You may also be given vitamin K to support normal blood clotting, especially if bile acid levels are high. Only take medicines that your healthcare team advises – never use over-the-counter treatments without checking with them first.

When is surgery considered?

Surgery is not used to treat cholestasis of pregnancy. In some situations, your healthcare team may recommend inducing labour early, which is not a surgical procedure.

Living with this condition

Living with cholestasis of pregnancy means staying in close contact with your healthcare team and looking after your skin and comfort. Keep track of your baby's movements and report any changes right away.

Lifestyle tips

• Keep your skin cool and moisturised
• Choose gentle, unscented soap and bath products
• Avoid scratching; instead, press or pat the itchy area
• Rest when you are tired and sleep with cool, light bedding
• Stay in touch with your midwife or doctor for regular check-ups

Diet and exercise

Eat a balanced diet with plenty of fruit, vegetables, and whole grains. Drink enough water and avoid rich, fatty meals if they make you feel unwell. Gentle exercise like walking is usually safe, but check with your healthcare team first.

Mental health and emotional wellbeing

It is normal to feel anxious or low when you are managing a condition in pregnancy. The itch can disturb your sleep and mood. Speak openly with your midwife, doctor, or a counsellor – you are not alone, and help is available.

Prevention

There is no known way to prevent cholestasis of pregnancy. If you have risk factors, you can be monitored more closely. Early detection and regular care help manage the condition and reduce the chance of complications.

Screening programmes

There is no routine screening for this condition for every pregnancy. However, if you have symptoms or a previous history, your healthcare provider will offer blood tests to check your liver and bile acids.

Complications

If left untreated

• Higher risk of premature birth
• Increased chance of the baby being in distress or passing meconium (the baby's first stool) early
• In rare cases, stillbirth
• Poor sleep and significant stress for the mother

Long-term outlook

With careful monitoring and the right care, the outlook is very positive. Most babies are born healthy, and the mother's symptoms usually disappear quickly after birth. Your healthcare team will be by your side to help you through every step.

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