When you’re pregnant, it’s normal to experience a few (or a lot) of new and odd symptoms. But if you have redness and itching on your hands and feet, be sure to see your doctor. Cholestasis — a rare but serious liver disorder — might be the cause.
Here’s what you need to know about the condition, from symptoms to treatment.
What is cholestasis?
Cholestasis is a liver disorder that most often occurs late in pregnancy, typically during the third trimester. It's also known as intrahepatic cholestasis (ICP) or obstetric cholestasis.
Cholestasis occurs in just one to two pregnancies in 1,000, but the incidence can vary worldwide for unknown reasons. It's more common in people of Hispanic and Scandinavian background.[1]
The condition can cause serious complications in your newborn — which is why it’s important to recognize the symptoms and talk to your doctor if you think it might be affecting you. Fortunately, early diagnosis and active management by your doctor can help ensure you and your baby have a safe and healthy pregnancy and delivery.
What causes cholestasis in pregnancy?
A quick biology lesson: Bile, excreted by the liver and stored in the gallbladder, helps your body break down fats into fatty acids that your intestines can absorb. Cholestasis is a condition that slows down the normal flow of bile from the liver to the intestines, resulting in a buildup of bile acids in the liver — which in turn spills into the bloodstream, leading to intense itching.
Possible causes of cholestasis include:[2]
- Hormonal changes: Increased estrogen levels during pregnancy (especially in the third trimester) can slow the flow of bile.
- Genetic disposition: If an immediate family member has had cholestasis during pregnancy, be sure to tell your doctor.
- Gallstones: A collection of small stone masses in the gallbladder caused by imbalances of bile could be the culprit (pregnant women are also more at risk of gallstones due to increased estrogen levels).
Cholestasis is also more common in women carrying multiples and in those who have had previous liver damage. And if you've had cholestasis in a previous pregnancy, you're also at a greater risk of having the condition in subsequent ones.
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Since your chances of developing the condition can be hard to identify early in pregnancy, it's important to check in with your doctor if you have risk factors so they can keep a close eye on you.
What are the symptoms of cholestasis in pregnancy?
Besides redness and intense itching on your feet and hands, less common symptoms can include:
- Yellowing of the skin and eyes (jaundice)
- Nausea
- Vomiting
- Dark urine
- Itching in other areas of the body
- Liver enlargement and abdominal distension (an outward belly extension that's noticeably beyond your normal baby bump)
Discomfort and itching on the palms and soles of the feet tends to be especially noticeable at night.
If the palms of your hands and soles of your feet are a bit red but not itchy, there's no need for concern — that's usually caused by extra estrogen and blood flow during pregnancy.
How is cholestasis diagnosed during pregnancy?
If your doctor suspects you have cholestasis, she’ll want to run a diagnostic test — usually a blood test known as a fractionated bile acid test, but sometimes a liver function test (though the results of the latter alone may not be enough to diagnose the condition).
Since the results may take 10 to 14 days to get back, it’s very important to talk to your doctor as soon as you think you may be experiencing symptoms of cholestasis.
How is cholestasis treated in pregnancy?
While it isn't possible to prevent cholestasis during pregnancy, your doctor may prescribe treatments such as topical lotions, and oral medication like ursodiol to help the liver function properly and reduce its bile acid levels.
Your practitioner will closely monitor your baby's health and development with additional tests, such as nonstress testing (NST) and a fetal biophysical profile (BPP).
Your doctor will also likely recommend that you visit a high-risk obstetrician who practices maternal-fetal medicine, so you can deliver in a special hospital where you and your little one can be monitored and managed closely. You will most likely also have to be induced a bit early.
What are the risks associated with cholestasis?
With regular prenatal care and monitoring, your baby will likely not be affected by cholestasis during pregnancy and after delivery. Studies have found little increased risk to babies when their mothers have only mild cholestasis and low amounts of bile acids.
In cases when maternal bile acids are higher, cholestasis can increase baby's risk of a low birth weight, a slightly lower Apgar score, lung immaturity and preterm delivery — which is why early diagnosis and treatment are so important.
In extremely rare cases, stillbirth is a risk, though it can be prevented if labor is induced early. The risk of stillbirth goes up after 36 to 37 weeks, which is why getting diagnosed as soon as possible is so important.
The good news is that the condition is very treatable if it's caught early, and all the symptoms of cholestasis usually disappear on their own within 48 hours after birth. Until then — with early diagnosis and proper treatment to manage your condition — you'll stay healthy during pregnancy and can look forward to a happy, healthy life with your baby.
For more information on cholestasis, visit ICPCare.org.
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