What Causes Itching During Pregnancy?

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Cholestasis of Pregnancy

The most common cause severe itching during later pregnancy is cholestasis, which is a common liver disease that only happens in pregnancy. It is a condition in which the normal flow of bile in the gallbladder is affected by the high amounts of pregnancy hormones. This is more common in the last trimester of pregnancy since the hormones are at their peak at this stage, but normally goes away within a few days after delivery. Studies show that cholestasis occurs in about 1 out of 1,000 pregnancies and is more common in Swedish and Chilean ethnic groups. Sometimes referred to as ‘extrahepatic cholestasis’ when it occurs outside the liver and ‘intrahepatic cholestasis’ which occurs inside the liver, or ‘obstetric cholestasis’.

What causes cholestasis of pregnancy?

The gallbladder function is affected by the pregnancy hormones, resulting in slowing or stopping the flow of bile. The gallbladder holds bile, which is necessary in the breakdown of fats during digestion and is produced in the liver. When the bile flow is stopped or slowed down, this may result in the build up of bile acids in the liver, which can spill into the bloodstream.

Symptoms of cholestasis of pregnancy

The most common symptoms of pregnancy include

  • Itching, particularly on the hands and feet
  • Dark urine color
  • Fatigue or exhaustion
  • Light coloring of bowel movements
  • Depression
  • Loss of appetite

Less common symptoms include:

  • Jaundice
  • Nausea
  • Upper-Right Quadrant Pain

Who is at risk for cholestasis of pregnancy?

The following are at a high risk of getting cholestasis during pregnancy:

  • Women carrying multiples
  • Women whose mother or sisters had Cholestasis
  • Women who have previous liver damage

How is cholestasis of pregnancy diagnosed?

A diagnosis of cholestasis can be done by obtaining a complete medical history and physical examination and blood tests that evaluate liver function, bile acids, and bilirubin.

How will the baby be affected?

There may be an increased risk for fetal distress, stillbirth or preterm birth if affected by cholestasis. The elevated levels of maternal bile cause stress on the baby’s liver as the developing baby relies on the mother’s liver to remove bile acids from the blood. Women with cholestasis should be monitored closely and serious consideration must be given while inducing labor.

Treatment for cholestasis of pregnancy

The treatment for cholestasis is mainly done to relieve itching.

Some treatment options include:

  • Topical anti-itch medications or medication with corticosteroids
  • Cold baths and ice water slow down the flow of blood in the body by decreasing the temperature
  • The steroid that increases the maturity of the baby’s lungs such as Dexamethansone.
  • Medication to decrease the concentration of bile acids.
  • Vitamin K supplements administered to the mother before delivery and again once the baby is born in order to prevent intracranial hemorrhaging
  • The natural substances that are beneficial to the liver including Dandelion Root and Milk Thistle.
  • Bi-weekly non-stress tests which involve contraction recordings and fetal heart monitoring
  • Regular blood tests monitoring both liver function and bile serum levels.

Treatment for cholestasis of pregnancy takes the following criteria into consideration:

  • The extent of the disease
  • Your pregnancy, overall health, and medical history
  • Expectations for the course of the disease
  • Tolerance of specific medications, therapies or procedures.
  • Your opinion or preference

Treatments that should not be used for cholestasis include:

  • Antihistamines
  • Aveeno and Oatmeal Bath

In the past, the medication Cholestyramine was readily used to treat cholestasis, but some studies have shown that Cholestyramine has some adverse side effects such as blocking essential vitamins like Vitamin K.

What are the chances of the mother getting cholestasis in another pregnancy?

Some sources claim that women who have had cholestasis have up to a 90% chance of having this in future pregnancies, but since the research is not conclusive, it is impossible to confirm whether a woman will experience cholestasis in future pregnancies.