You expected some discomfort in your last trimester, but the itching of your hands and feet was more than you could stand. You felt silly calling the doctor, but after she listened to your symptoms, she wanted to see you right away. You had cholestasis of pregnancy.
Washington University maternal-fetal medicine specialist, Ebony Carter, MD, explains, “Some women experience severe itching late in their pregnancy. There are several possible causes, including inflammatory skin rashes that occur exclusively during pregnancy or immediately postpartum.
However, the most concerning cause of itching late in pregnancy is a liver disease, called cholestasis of pregnancy, because it carries an increased risk for poor pregnancy outcomes, such as preterm delivery and stillbirth.
The itching is usually intolerable and can occur all over the body, but is usually greatest on the palms of the hands and soles of the feet — and is worse at night. Unlike rashes associated with pregnancy, cholestasis typically has no skin findings except possible irritation from excessive scratching.
Cholestasis of pregnancy occurs when bile acids are incompletely cleared and build-up in the bloodstream. We do not know why women get this disease, but genes, pregnancy hormones and environmental factors likely play a role. The diagnosis is made when there is itching and abnormal labs, including elevated liver function tests and bile acids, with no other disease present that could explain these findings.
Cholestasis is more common in the last trimester of pregnancy, but it usually goes away within a few days after delivery. One to two pregnancies in 1,000 are affected by cholestasis in the United States.”
Women who are at higher risk of getting cholestasis during pregnancy include those with twins, liver disease or a family/personal history of the disease.
Symptoms
- Itching in the late 2nd or 3rd trimester, particularly on the hands and feet (often is the only symptom noticed)
- Dark urine color
- Light coloring of bowel movements
Management options
- Topical anti-itch medications or medication with corticosteroids
- Medication to decrease the concentration of bile acids such as ursodeoxycholic acid
- Increased fetal monitoring
- Delivery typically 36-37 weeks or at the time of diagnosis — if diagnosed after 37 weeks.
Dr. Carter says, “Women with cholestasis should be monitored closely by their physician and some with severe disease will require hospital admission. Delivery is typically scheduled between 36-37 weeks. Our goal is to relieve the mother’s symptoms and help her give birth to a healthy baby.”
For more information on cholestatis of pregnancy, or to make an appointment with Dr. Carter or any of our Washington University maternal-fetal medicine specialists, please call 314-454-8181.
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