Obstetric cholestasis

What are the symptoms?

Symptoms of cholestasis usually start 30 weeks into pregnancy, but can appear as early as eight weeks. The most prominent symptom is intense itching, particularly on your palms and the soles of your feet – but it can spread up your arms and legs. Suffers of cholestasis don’t tend to develop a rash, but may in some cases. You might also experience dark urine, pale stools, and jaundice – this presents as a general feeling of being unwell and a yellowing of the skin and whites of the eyes.

For many women, the itching is pretty unbearable, and gets even worse at night; others experience only a mild discomfort.

How do I get tested for it?

I was diagnosed with obstetric cholestasis at 37 weeks. There are two tests: liver function and bile acids. The bile test is the important one – your other liver functions can be normal when the bile is raised, so getting the bile one done is important.

Some itching in pregnancy is perfectly normal, but it's very important to report it to your doctor or midwife, so they can monitor you and perform tests if necessary. Cholestasis is determined by excluding other causes of the itching, and by taking blood tests to determine your liver functionality (LFT) and bile acid levels (BA). Your doctor will also ask you about your medical and family history.

Who gets cholestasis?

The condition often runs in families, so if you’ve got relatives who’ve had it, you’re more likely to suffer too, alas. Your chances of cholestasis are also upped if you’ve got South American, Indian or Pakistani heritage, or have hepatitis C. If you’re expecting twins or more, or had it in a previous pregnancy you’re also more at risk – but do remember that it can develop in any woman at any point during pregnancy, and you should let your doctor or midwife know if you notice any of these symptoms.

Can cholestasis harm my baby?

If you are diagnosed with ICP, it’s likely you will be advised to give birth in hospital under the care of a maternity team, and you may be offered induction at around 37-38 weeks. This is because cholestasis can increase the risk of foetal distress and premature birth. Cholestasis has also been linked in some studies to an increased risk of stillbirth, (particularly severe ICP) but try not to worry – with careful monitoring of the condition, most mothers go on to give birth to perfectly healthy babies.

Does cholestasis cause liver damage?

Don’t worry – there’s no evidence that cholestasis can damage your baby’s liver. It’s unlikely to damage yours, either – though it might make it more sensitive to hormonal changes, so you may experience some mild itching before your period in future. A small proportion of sufferers may go on to develop a liver impairment like gallstones or autoimmune forms of liver disease – so if yours is not back to normal around 12 weeks after you’ve given birth, you’re likely to be referred to a liver specialist to check for any underlying conditions.

What is the treatment for cholestasis?

The only cure for cholestasis is to have your baby. My itching stopped the same day I had my son.

There’s no cure for cholestasis apart from giving birth to your baby – but thankfully, the uncomfortable symptoms can be managed. Topical treatment such as calamine lotion and aqueous cream with menthol are safe to use in pregnancy and should help with the itching. It's also worth giving some of the more traditional methods of tackling itching a whirl – wearing loose-fitting cotton clothing and taking tepid baths can reduce the urge to scratch. Your doctor may also prescribe antihistamines or steroids, or medication to reduce your bile acids.

If you’ve reported pale stools or had severe ICP from early pregnancy, you may also be prescribed a Vitamin K supplement, as cholestasis inhibits its absorption (it’s important for healthy blood clotting).

You’ll also be monitored closely by doctors during the rest of your pregnancy, so that doctors can ensure your liver functionality and the health of your baby – it’s likely you’ll be tested every week until you give birth – a bit of a pain, but well worth it for the peace of mind.

If your doctor has ruled out cholestasis, but you are still suffering with itchiness during pregnancy, there may be other causes.

“I had ICP that developed in my 31st week and had to be very closely monitored (daily hospital visits in the end). It can be serious if left undetected, but with medical monitoring things should be fine. I had my baby five weeks early in the end because things started to get worse, so it was safer to get him out. From personal experience, I cannot stress enough the importance of getting any itching checked out.”

Will cholestasis continue after pregnancy?

Mercifully, the condition should stop once you give birth, and you’ll be monitored following your pregnancy to ensure your liver functionality returns to normal. Unfortunately once you develop cholestasis, you are likely to develop it again in any subsequent pregnancies, so it’s important to make your doctor aware of this should you become pregnant again.

It’s also worth noting that women who have had OC/ICP may develop cholestasis outside of pregnancy when taking medications such as antibiotics or the contraceptive pill.

Where can I get ICP support?

ICP Support is a charity dedicated to helping women with the condition, as well as their partners, midwives, and anyone else affected. You can also visit our birth clubs forum, and chat to other mothers who have experience of cholestasis.