Cholestasis of pregnancy is a liver condition that can cause severe itching, especially on the hands and feet.

Cholestasis happens when bile acids build up in a person’s blood. Bile acids are substances that helps the body process fat.

It usually occurs late in the second trimester or during the last trimester of pregnancy.

The condition does not always pose a serious risk to a pregnant person’s long-term health, but it may cause severe complications for the fetus.

The following signs and symptoms may be present in cases of cholestasis of pregnancy:

The itchiness may be the only symptom, and it often becomes worse during the night.

A pregnant person who has any of the signs or symptoms mentioned above should tell a healthcare professional as soon as possible, as they could indicate a risk for the health of the fetus.

To diagnose cholestasis of pregnancy, a doctor will consider an individual’s signs and symptoms, such as itchiness and the color of their urine and stool. The person may also need to tell the doctor about any personal and family medical histories. Next, the doctor will do a physical examination.

If a doctor suspects cholestasis of pregnancy, they will test for the condition by looking at a person’s total serum bile acid. This is determined through a blood test.

There are also some additional blood tests a doctor can order to see how well the liver is functioning. This includes an alanine aminotransferase test, a bilirubin test, and an aspartate aminotransferase test.

Ultrasound scans may be used to look for abnormalities in the individual’s liver. If a person is diagnosed with cholestasis of pregnacy, a doctor may also recommend more frequent ultrasound scans of the fetus. This is to monitor fetal health and development on a regular basis.

The doctor may also request regular “non-stress” tests to check how often the fetus moves in a given period and measure the fetal heartbeat in relation to body movements.

To prevent complications before they occur, a person will also need ongoing blood tests to monitor their liver function and blood bile levels.

Doctors often recommend induced labor before 39 weeks if cholestasis is severe.

Some believe that eating a balanced diet may help a person with cholestasis of pregnancy reduce the condition’s severity, or prevent the condition. However, there is no research to support this.

In general, it is important to follow a healthy, balanced diet with plenty of whole fruits and vegetables to reduce the risk of complications during pregnancy.

While there is little evidence to link dietary choices with the development of cholestasis, eating a health-promoting diet is one of the best ways to help ensure a healthy pregnancy.

Healthy-eating tips from the American College of Obstetricians and Gynecologists include:

  • Fill half of your plate with fruits and vegetables for every meal: Fresh, canned, frozen and dried fruits and vegetables are all good options.
  • Eat a range of protein sources: Choose from foods such as meats, poultry, fish and seafood, eggs, beans and peas, tofu and soy products, nuts, and seeds.
  • Focus on whole grains such as oats, whole wheat, and brown rice: Look for “whole grain” on the label when selecting breads, cereals, and bakery products.
  • Include healthy fats and oils: Try to reduce fats from animal sources. Replace them with liquid oils like olive oil or grapeseed oil, and foods like nuts and avocados.

Some believe that foods that can help the function of the liver may be particularly helpful. Since the condition interferes with nutrient absorption, eating as many nutrient-rich foods as possible is important.

Because they are less likely to contain pesticides, some people choose to eat organic foods during pregnancy. Apples, strawberries, and grapes often contain higher amounts of unwanted chemicals, while avocados, sweetcorn, and pineapple top the “clean” list.

If using canned produce, check that manufacturers have preserved it in its own juice and that there are no added sugars.

When it comes to protein, some people choose certified organic meat during pregnancy. It is important to avoid raw or undercooked seafood. Dried beans and legumes, such as lentils and chickpeas, are good sources of protein.

Consider avoiding the following:

A person should also drink 8-12 cups (64-96 ounces) of water every day and avoid alcoholic drinks and sodas, such as cola.

Drinking alcohol will not cause cholestasis in pregnancy. Still, a person should avoid alcohol during pregnancy, as it can lead to a number of serious complications.

It is important to follow a doctor’s instructions regarding treatment and diet. Certain foods such as unpasteurized dairy should be avoided during pregnancy because they come with risks for the health of the pregnant person and fetus. Also, diet is not an alternative to medication that a doctor prescribes.

It is also a good idea to check that any product with an organic label is 100% organic. In addition, foods with a “natural” label are not necessarily organic or healthy.

Treatment normally aims to relieve symptoms, mainly the itching, and prevent potential complications.

The primary treatment is ursodeoxycholic acid, which relieves itching and increases bile flow. A person will typically start on a dose of 300 milligrams (mg) daily and go up to 300 mg three times daily until delivery.

They will usually experience fewer symptoms within 2 weeks. If not, the dose can increase to a maximum of 21 mg per kilogram a day.

Other treatments that doctors may use to treat cholestasis of pregnancy include:

People with cholestasis will have low levels of vitamin K, increasing the chance of hemorrhage, so a person will often need Vitamin K supplements before and after delivery.

Research also discusses using antihistamines as a treatment. However, these do not appear to help with itching.

Home remedies

In addition, a person can try soaking the affected areas of skin in lukewarm water to get some temporary relief. Dabbing with baking soda or apple cider vinegar may also help, and people may try applying coconut oil after a bath.

Lotion may help with skin itching. Some sources also recommend oatmeal baths. People should speak with a doctor before trying any alternative treatments to check their effects during pregnancy.

Natural remedies that are sometimes suggested for liver health include dandelion root and milk thistle. But there is no evidence that these are safe or effective for cholestasis of pregnancy. Home remedies are not a replacement for medications prescribed by a doctor.

It is very important to check with a doctor beforehand to make sure any natural remedy is safe and to consult a doctor if symptoms get worse.

Bile is a yellow-green fluid that helps digest fat. It mainly consists of cholesterol, bile salts, and the pigment bilirubin.

The liver produces bile and the gallbladder stores it. From the gallbladder, it passes through the common bile duct into the duodenum.

Sometimes, a blockage outside the liver prevents the bile from leaving it, leading to a condition known as extrahepatic cholestasis.

Intrahepatic cholestasis happens when there is a problem with eliminating bile salts from the liver. This is the kind of cholestasis that occurs during pregnancy.

Pregnancy hormones, and especially the additional estrogen, may affect the proper functioning of the gallbladder and the liver.

Factors that may increase a person’s risk of developing cholestasis of pregnancy include:

  • having a close relative who had the condition
  • having had cholestasis of pregnancy before, as the risk of recurrence during subsequent pregnancies is 60–70%
  • a multiple pregnancy, for example, if a person is having twins or triplets
  • a history of liver damage
  • being pregnant as a result of in vitro fertilization

As well as intense itching, a person may have some problems with absorbing fat-soluble vitamins, which are vitamins A, D, E, and K. However, within a few days after giving birth, the problems should resolve. There will not usually be any further liver problems.

The risk of stillbirth is higher in people with cholestasis of pregnancy, and may increase with very elevated bile salt levels in the blood. There is also a significantly higher risk of preterm birth for the fetus if the pregnant person has cholestasis, although the reasons for this are unclear.

An infant born preterm may have breathing difficulties if the lungs are not yet fully developed. The risk of fetal death is also higher.

During gestation, the fetus depends on the pregnant person’s liver to remove bile acids from the blood. If their liver has too much bile acid, they can pass this on to the fetus.

The baby also has a higher risk of inhaling meconium during childbirth, resulting in breathing difficulties.

Doctors often induce labor early if the pregnant person has cholestasis of pregnancy because of the potentially serious complications for the baby.

Research suggests that cholestasis of pregnancy may increase the risk of cardiovascular disorders and metabolic disorders such as obesity when the child reaches adulthood.

Below are answers to some frequently asked questions about the condition.

Is delivery by 37 weeks necessary for cholestasis of pregnancy?

Since most stillbirths occur after 37 weeks of pregnancy, most research recommends delivery by this time for people with cholestasis of pregnancy. This is also the point at which doctors would consider the baby full-term if born.

How common is it?

The prevalence of cholestasis of pregnancy is not known. One estimate suggests that up to 1 in 50–5,000 pregnancies are affected, depending on the population.

How serious is it?

Cases of cholestasis of pregnancy can be mild or severe. In mild cases, a person may just experience some discomfort due to the itching on their skin. However, severe cholestasis of pregnancy can cause more severe itching and other symptoms. It can also lead to serious complications for both the pregnant person and the fetus.

Does it cause liver damage?

Having previous liver damage is a risk factor for developing cholestasis of pregnancy. The condition itself can also lead to liver dysfunction.

When does it start?

Typically cholestasis of pregnancy will present in the second or third semesters of pregnancy. The pruritus rash often develops around the 30th week of pregnancy.

Will I get it for all pregnancies?

A person who has had the condition is highly likely to develop it again in another pregnancy. The recurrence rate is 60–70%.

Cholestasis of pregnancy is the most common liver disorder associated with pregnancy. It happens when a pregnant person’s bile acid levels become elevated.

The main symptom is itching, but there can be other symptoms. Cholestasis of pregnancy can lead to serious complications for both the pregnant person and the fetus. A person should speak with a doctor about any unusual itching or other symptoms they develop during pregnancy.