Every so often, we’ll hear something like this from a pregnant mom: “My feet itch, especially the bottoms! And my hands itch, too. I just itch, itch, itch! It seems worse at night. Sometimes I wake up just itching—but there’s no rash there!”
What might this be?
While it’s normal to itch during pregnancy—your skin stretches to accommodate the little one growing inside you—the itching we’re talking about here is much more pronounced.
It’s called cholestasis, or intrahepatic cholestasis of pregnancy, a disorder of the liver.
The National Library of Medicine describes it as a condition that impairs the release of bile, a digestive fluid, from liver cells. Consequently, bile builds up in the liver and impairs liver function.
How is this problem relieved? By the birth of your baby.
After your baby is born, the itching will subside and eventually disappear altogether as the flow of bile returns to normal. This typically only takes a few days.
Other symptoms of cholestasis can include nausea, loss of appetite, insomnia, epigastric discomfort and yellowing of the eyes or skin.
Cholestasis is rare. It’s estimated to affect only 1 percent of the population. However, I know of several cases from last year alone.
Risks to mom, baby
How might cholestasis affect mom and baby? The buildup of bile can affect the way mom absorbs fat. This in turn can affect clotting factors, although this is especially rare.
The itching is what drives mom crazy the most. One mom recently told me she woke up at night clawing at her feet. It itched so badly she wished her feet would disappear!
I’ve read some studies that have indicated the chances of this recurring in a mom’s subsequent pregnancies is anywhere from 45-70 percent. Other studies have suggested it could possibly cause mom to eventually develop gallstones.
The risks to the baby, however, are far more serious. Adverse developments can include premature birth, lung issues due to meconium (births with cholestasis have a higher meconium rate), fetal distress and stillbirth.
Diagnosis, treatment
Lab work is very important in suspected instances of cholestasis. The lab results can tell us how the liver is doing and if things are progressing. Non-stress tests are also usually recommended.
While the cause of cholestasis is unknown, it’s suspected that it’s related to pregnancy hormones, genetic factors and even the environment. Seasonal variance has also been noted, with higher cases in the winter—especially January.
Again, delivery is the primary solution.
The American College of Obstetricians and Gynecologists supports active management for cholestasis. The general thought is that delivery should not be delayed past 37 or 38 weeks.
It’s also recommended that each case involve a clear discussion between patient and provider, with the primary aim to determine the best approach for mom and baby.
The drug ursodeoxycholic acid is sometimes prescribed to help with this condition, although antihistamines might also be prescribed to help with the intense itching.
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