Cholestasis of pregnancy: a pregnancy complication

Cholestasis of pregnancy

Liver disease that can occur at the end of pregnancy, cholestasis of pregnancy is a risky situation for the baby. In this article we will focus on this complication of pregnancy.

What is pregnancy cholestasis ?

Cholestasis of pregnancy (gravidarum referring to the term "gravid", or pregnant) is a liver disease that most often occurs in the third trimester of pregnancy . Cholestasis occurs when the hepatocytes (liver cells) no longer do their job well and allow bile acids to pass into the blood instead of being excreted in the bile. The bile acids then accumulate in the blood, with the risk of reaching the fetus via the placenta .

Causes and risk factors of pregnancy cholestasis

Pregnancy cholestasis affects 0.5% to 0.8% of pregnancies. We do not yet know all the mechanisms behind this disease, but we know that hormones come into play, on a favorable genetic background. The risk is increased in the case of twin pregnancy, history of pregnancy cholestasis in the family or during a previous pregnancy. Finally, certain ethnic groups are more at risk, while others are almost protected.

Symptoms of cholestasis of pregnancy

Cholestasis of pregnancy is characterized by severe itching (pruritus) on the palms of the hands, soles of the feet, or the entire body. The itching intensifies over the days and can become so intense that it prevents the mother from sleeping. In the most severe forms and in the absence of treatment, jaundice may appear. A liver test (transaminases, bile acids) can then confirm the diagnosis and assess the degree of cholestasis.

Risks for the baby and the mother

Apart from the discomfort caused by the itching, cholestasis of pregnancy is rarely a cause for concern for the mother-to-be. However, it is for the baby, because the accumulation of bile salts in the blood can be toxic to it. This results in fetal distress and a high risk of premature delivery (spontaneous or decided by the medical team).

Management of pregnancy cholestasis 

There is no cure for cholestasis of pregnancy, but there are effective treatments to combat the symptoms. Treatment with ursodeoxycholic acid can help to counteract the accumulation of bile salts in the blood and reduce pruritus. The mother-to-be, hospitalized for the most serious forms, is closely monitored with regular liver tests, as is the baby with frequent ultrasounds and monitoring. In some cases, labor will be induced as soon as the baby's lungs are mature (39 weeks).

After delivery, the itching will gradually disappear and the liver will return to normal activity. But during a subsequent pregnancy, the mother will be closely monitored to avoid any risk of recurrence.