About 1% of the women in the US suffer from cholestasis during the second or last trimester of pregnancy, and in rare cases, it can also be the cause of stillbirth.
The term “cholestasis,” derived from the Greek words “chole” meaning “bile” and “stasis,” meaning “still” is also referred to as obstetric cholestasis or intrahepatic cholestasis of pregnancy.
Cholestasis happens when the liver cannot excrete bile properly, leading to its buildup. Bile is something that a human body produces to help digest food in the blood. Various conditions can lead to cholestasis, pregnancy being one of them. In the absence of proper and timely treatment, cholestasis of pregnancy can pose a severe risk to the fetus.
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I know this image will always be shocking for others to see but this is my reality, holding my child’s body with no breaths making that chest rise and fall. No whimpers or grunts. No warmth to her skin. I see joy on my face because i am finally meeting my sweet girl and I know, simultaneously, there is pain in my heart – more pain than I’ve ever felt in my life. June is intrahepatic cholestasis of pregnancy awareness month. A mouthful, I know, but one of the most important awareness months I’m aware of. I share my experience with losing Indi so that her death is not in vain. Her death has a purpose and that purpose is me sharing with anyone that will read this, what cholestasis is, how to care for yourself and your baby if diagnosed with it, how your doctor should care for you, and how to advocate for yourself. I posted a series of stories today detailing my story and how to handle it in honor of Indi and this awareness month. PLEASE share this post, this info, my stories, however you want to get this information to your friends and family. Chances are you’ll know someone who is or will be pregnant or you yourself may be pregnant, you’ll want to know what this is to help each other. Thank you, as always, for your support in spreading this knowledge. I always wish someone had been there to do the same for me. 💕 #cholestasisofpregnancy #cholestasis #stillborn #stillbornstillloved #angelbaby #fighttheitch #icpcare #icpawareness #highriskpregnancy #mfm
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The following factors increase the chances of cholestasis that affects 1 out of every 100 pregnancies in the US.
- Demographic: Parents of South American and Scandinavian origin may be at higher risk.
- Carrying multiple babies: Studies indicate that one cause may be, higher levels of estrogen and progesterone, which result from carrying more than one baby and IVF pregnancies.
- Medical history: If a woman has suffered from cholestasis in any of her previous pregnancies, her chances of having the same in future may increase somewhere between 45% to 90%.
- Family history: Because of its genetic component, the risk for an expectant woman increases if someone in her family has had it.
- Timing: Though there aren’t many scientific records to prove it, it tends to occur more frequently in the winter.
- Liver ailments: A history of liver damage can also put a woman at the risk of cholestasis of pregnancy.
The symptoms come on very gradually with itching of palms of the hands and soles of the feet, which then spreads to other parts of the body. The itching mostly becomes severe during the third trimester. Jaundice or yellowing of the skin and eyes may also be a symptom of the same.
I was one of the 1%. I woke up in the middle of the night with itching hands and feet. I called my OB’s office first thing in the morning. As soon as I mentioned hands and feet, the receptionist said, “You got yourself an appointment today.” https://t.co/90HiIcENpk
— Megan Griffiths (@meggiedoodah) January 14, 2020
Dr. Devin Smith, MD, a maternal and fetal medicine fellow at the Ohio State University Wexner Medical Center, explains the difference between the itching caused due to cholestasis and other factors. Smith says that rashes can make women feel itchy, but when itching occurs without rashes, it can be cholestasis.
Since the itching comes on gradually, in case of any mild itching on hands and feet also, it’s essential to speak about to it the OB-GYN.
Barring the fact that it may occur in future pregnancies too, cholestasis doesn’t have any long-term adverse effect on the mother’s health. Smith says it goes away when hormone levels return to normal after childbirth.
However, it can be dangerous for the fetus as it increases the risk of impulsive preterm birth. If the bile concentration is exceptionally high i.e., 100 μmol/L or, it can also increase the propensity of stillbirth.
Johanna Quist-Nelson, MD, a maternal and fetal medicine fellow at Thomas Jefferson University, says, “Most women with cholestasis of pregnancy will have a healthy, uncomplicated outcome, and that’s our hope for our patients.”