Code Blue and Chill

Cholestasis of pregnancy is a pregnancy-specific liver disorder that causes severe itching most common late in pregnancy, but as early as five weeks gestation. It’s also known as intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis. ICP temporarily lowers liver function in some pregnant women which causes bile to build up in your liver and bloodstream. Cholestasis of pregnancy can cause complications for you and the fetus. During pregnancy, a fetus relies on your liver to remove waste from its blood; If your liver isn’t functioning properly, bile levels may increase to unsafe levels that may stress the fetus's liver.

Increased levels of estrogen and progesterone during pregnancy affect your liver’s ability to transport bile. This means your bile doesn’t move through your body, causing it to build up in your liver and enter your bloodstream. Bile entering your blood can make you feel extremely itchy.

Cholestasis of pregnancy typically develops in the third trimester (around week 28 of pregnancy) when pregnancy hormone levels are at their highest. In some cases, it’s genetic, meaning you’re at higher risk if your biological parents have cholestasis.

The main symptom of cholestasis of pregnancy is severe itching, usually worse at night, but does not involve a rash. Less common signs of cholestasis may include nausea, dark urine, light gray, pale brown or greasy stool, fatigue, decreased appetite, pain in upper right of belly and jaundice.

ICP is diagnosed with a blood test as some fractionated bile acid tests have lower reference ranges so are less reliable. Your provider may also order a liver panel test.

Fetal complications related to cholestasis of pregnancy include premature labor/birth, stillbirth, fetal distress, preeclampsia, gestational diabetes and meconium aspiration. Just because you have cholestasis during pregnancy doesn't mean your baby will be unhealthy! Your pregnancy care provider may recommend limiting certain foods based on your condition, however, there isn’t a standard diet to follow if you have cholestasis of pregnancy. You should eat a balanced diet with an emphasis on fruits, vegetables, lean meat/protein sources during pregnancy. Don't be afraid to ask your provider questions about your symptoms, BETTER TO BE SAFE THAN SORRY!

credit, citing & references:

icpcare.org

Cleveland Clinic

Student Midwife Studygram