Cholestasis of pregnancy: when itching in pregnancy should never be ignored

#HIGHRISKPREGNANCY #itchinginpregnancy #gynecologistinmumbai #Cholestasiaofpregnancy #safemotherhood #jaundiceinpregnancy #liverprobleminpregnancy

BOOK AN APPOINTMENT

Cholestasis of Pregnancy: When Itching in Pregnancy Should Never Be Ignored

By Dr. Anuradha Narayanan

Consultant Obstetrician & Gynaecologist

Anurag Women Health Care, Chembur, Mumbai

Pregnancy brings many changes to a woman’s body, and mild itching due to stretching of the skin is common. However, intense itching—especially on the palms of the hands and soles of the feet—can sometimes indicate a condition called Intrahepatic Cholestasis of Pregnancy (ICP).

Although uncommon, cholestasis of pregnancy requires prompt medical attention because it can affect both the mother and the baby.

What is Cholestasis of Pregnancy?

Intrahepatic Cholestasis of Pregnancy is a liver disorder that usually develops in the second or third trimester. During pregnancy, hormonal changes can slow the normal flow of bile from the liver. As a result, bile acids accumulate in the bloodstream, causing intense itching and potentially increasing the risk of complications for the baby.

The good news is that the condition usually resolves completely after delivery.

What Causes Cholestasis of Pregnancy?

The exact cause is not fully understood, but several factors are believed to contribute:

• Pregnancy hormones (especially estrogen)

• Genetic predisposition

• Family history of cholestasis

• Twin or multiple pregnancies

• Previous history of cholestasis

• Underlying liver disorders

  
  

Women who have had cholestasis in one pregnancy have a 45–90% chance of recurrence in future pregnancies.

Symptoms to Watch For

The hallmark symptom is severe itching without a rash.

Common symptoms include:

• Intense itching on the palms and soles

• Itching that is worse at night

• Generalized itching over the body

• Sleep disturbance due to itching

• Dark urine

• Pale stools

• Yellowing of the eyes or skin (rare)

Remember, itching without a visible rash should never be ignored during pregnancy.

How is Cholestasis Diagnosed?

Your doctor may recommend:

• Liver Function Tests (LFTs)

• Serum Bile Acid Levels (the most important test)

• Complete blood tests

• Viral hepatitis screening if indicated

• Ultrasound to exclude other liver or gallbladder diseases

• 
  

A fasting or non-fasting serum bile acid level ≥19 µmol/L supports the diagnosis, depending on the laboratory reference range and clinical setting.

Why is Cholestasis Important?

While mothers usually recover completely after delivery, the condition can pose risks to the baby.

Possible fetal complications include:

• Preterm labour

• Passage of meconium before birth

• Fetal distress

• Meconium aspiration syndrome

• Stillbirth (particularly with very high bile acid levels)

The risk increases as bile acid levels rise, especially when they are 100 µmol/L or higher.

Treatment

Treatment focuses on relieving symptoms and reducing fetal risks.

Your obstetrician may recommend:

Ursodeoxycholic Acid (UDCA)

UDCA is the most commonly prescribed medication. It helps improve bile flow and often reduces itching. Although it improves maternal symptoms and liver tests, evidence for reducing stillbirth is limited, so careful fetal surveillance remains essential.

Symptom Relief

• Moisturizers and emollients

• Cool baths

• Loose cotton clothing

• Keeping the bedroom cool

• Antihistamines may help improve sleep but usually do not relieve the itching itself.

  
  

Monitoring During Pregnancy

Women diagnosed with cholestasis require close monitoring, which may include:

• Regular bile acid testing

• Liver function tests

• Blood pressure monitoring

• Monitoring fetal movements

• Ultrasound assessment of fetal growth

• Non-stress tests (NST) or biophysical profile (BPP) when clinically indicated

  
  

It is important to note that normal fetal monitoring cannot completely predict or prevent sudden fetal complications in severe cholestasis.

When Will My Baby Be Delivered?

Timing of delivery depends mainly on bile acid levels and the overall clinical picture.

General recommendations are:

• Mild disease: Delivery around 38–39 weeks

• Moderate disease: Individualized planning

• Severe disease (bile acids ≥100 µmol/L): Delivery around 36 weeks is often recommended after balancing the benefits and risks.

Your obstetrician will discuss the safest timing for your pregnancy.

What Happens After Delivery?

The itching usually improves within a few days after birth.

Blood tests generally return to normal within 4–8 weeks.

A repeat liver function test and bile acid level are usually advised approximately 6 weeks postpartum to confirm complete recovery. Persistent abnormalities require evaluation for other liver diseases.

Can Cholestasis Be Prevented?

There is currently no proven way to prevent cholestasis of pregnancy. However:

• Attend all antenatal appointments.

• Report itching early.

• Do not self-medicate.

• Follow your doctor’s advice regarding blood tests and monitoring.

  
  

Early diagnosis significantly improves pregnancy management.

When Should You Contact Your Doctor Immediately?

Seek medical attention if you experience:

• Severe itching, especially on the palms and soles

• Reduced fetal movements

• Yellowing of the eyes or skin

• Dark urine

• Severe abdominal pain

• Vaginal bleeding

• Leaking of fluid

• Regular contractions before term

  
  

Frequently Asked Questions

Is cholestasis dangerous for the mother?

Most mothers recover completely after delivery. The primary concern is the increased risk to the baby during pregnancy.

Will the itching disappear?

Yes. In most women, itching resolves within days after childbirth.

Can I breastfeed?

Yes. Cholestasis of pregnancy is not a contraindication to breastfeeding, and UDCA is considered compatible with breastfeeding.

Will I get cholestasis again?

There is a high chance of recurrence in future pregnancies, so early monitoring is recommended.

Severe itching during pregnancy is not always normal. If you notice persistent itching—particularly on your palms and soles—consult your obstetrician without delay. Early diagnosis, appropriate treatment, and close monitoring help ensure the safest possible outcome for both mother and baby.

At Anurag Women Health Care, we provide evidence-based, compassionate care throughout pregnancy, including the diagnosis and management of high-risk conditions such as cholestasis of pregnancy. If you have concerns about itching or any other pregnancy symptom, schedule a consultation promptly.

Call 8850911046 for appointment https://wa.me/918850911046

Healthy mothers. Healthy babies. Safe pregnancies.