Cholestasis of Pregnancy mombabykids

    Pregnancy cholestasis ( or intrahepatic cholestasis) is a disruption in the production of bile during pregnancy. A rare condition, it occurs in less than 1% of expectant mothers. This liver condition generally occurs during the  third trimester of pregnancy .

    Etymologically, the word cholestasis comes from the Greek khole meaning bile and stasis meaning stoppage. Cholestasis is therefore defined by  an interruption in the flow of bile in the liver .

    Reminder  : Bile is a liquid produced by the liver that aids digestion.

    When you have cholestasis, hepatocytes (liver cells) stop functioning properly. The pathway of bile acids is disrupted: they flow back  into the blood rather than passing through the bile ducts and into the digestive system.

    However, through the umbilical cord, the fetus risks being affected by this abnormally high level of bile acids in the blood of the future mother.

    Not all of the causes of this condition are known. The main hypotheses are hormonal or genetic dysfunction.

    However, it is known that the disease is more common in  multiple pregnancies (around 20% risk in a  twin pregnancy  for example). However, it can also occur in a woman pregnant for the first time .

    Cholestasis of pregnancy is characterized by intense  itching , also called pruritus , which can quickly spread throughout the body. It is the increase in bile acids in the blood that causes this itching. Generalized pruritus is present in 90 to 95% of cases , without necessarily being associated with another symptom.

    Nighttime itching is very common and can lead to insomnia. In severe cases, jaundice may occur .

    Any persistent itching during pregnancy requires medical attention. To diagnose cholestasis of pregnancy, a blood test is required. This will measure transaminases (enzymes responsible for transferring amine molecules) in the blood, as well as bile acids. In addition to confirming or ruling out cholestasis, this test will assess its severity and the impact it could have on the fetus.

    If the  liver function test indicates a serum bile acid level above 10 µmol/L, then cholestasis is present. If this level exceeds 14 µmol/L, the disease requires treatment.

    Aside from the fatigue and itching that this disease causes, it does not pose a real threat to the health of the expectant mother. However, excessive levels of bile acids in the blood pose risks to the fetus. Toxic, they increase the risk of prematurity and fetal death in utero , although it is not yet clear to what extent and by what mechanisms.

    Medical treatment for cholestasis of pregnancy is based on the  prescription of ursodeoxycholic acid . This reduces itching and also reduces the concentration of bile acids in the cord blood and amniotic fluid. It thus limits the toxic effects of bile acids on the fetus, and therefore the risks of prematurity and fetal death. Ursodeoxycholic acid should be administered when cholestasis occurs before the 37th week of amenorrhea , or before the 38th week of pregnancy. Generally, beyond 37 weeks of amenorrhea, doctors prefer to induce labor , because it is from this date that the risk of fetal complications is greatest.

    In the most serious cases, and when taking ursodeoxycholic acid is not sufficient in light of blood tests, hospitalization with regular liver tests and close monitoring of the fetus ( monitoring , ultrasounds ) may be necessary. Finally, if the mother's health improves quickly after giving birth, it will still require monitoring to check that everything is returning to normal at the liver level.

    The next pregnancy should also be closely monitored, as the risk of recurrence of pregnancy cholestasis is high and around 50%.