Obstetric cholestasis in pregnancy
Itching in pregnancy is common especially in the later stages, when the skin of you abdomen is pulled tight over your growing baby. But not all itching is harmless – in some cases it can signal a potentially dangerous condition called obstetric cholestasis (OC), which is thought to affect one to two in every 1,000 moms-to-be in the US.
What are the symptoms?
OC isn’t actually a condition of the skin – it’s a condition of the liver that develops when the normal flow of bile (a fluid that aids our digestive process) is impaired by pregnancy hormones. It results in a buildup of bile acids in the blood and this results in severe itching which most commonly occurs on the palms of the hands and soles of the feet, but can be felt all over the body. It is often so severe that it interferes with your daily activities. It’s often worse at night and may wake you.
Around 10-20% of women with OC also develop jaundice, resulting in a yellowish tinge to the skin and the whites of the eyes. Other symptoms include dark urine, light-colored bowel movements, excessive tiredness and loss of appetite. You’re more likely to develop OC if you’re carrying twins or multiples, and if a close family member, such as your mom or sister, has had it.
While OC isn’t dangerous to you, it can be for your baby as elevated levels of bile in your blood can strain his liver. OC can lead to preterm delivery (it’s thought that up to 60% of moms-to-be with the condition deliver early), hemorrhaging, fetal distress and stillbirth. That’s why it’s so important to report excessive itching, especially if you’re getting it on your hands and feet, to your OB-GYN or midwife. They can refer you for tests that will confirm whether or not you have OC.
Treatment
If the diagnosis is positive you’ll be closely monitored for any signs of preterm labor and given regular blood tests to check the level of bile salts in your blood and evaluate your liver function. You may be given steroids to help mature your baby’s lungs as a safeguard, as well as medication to improve your liver function and help reduce the risk of stillbirth. If there is any indication your baby is suffering any ill effects from OC, he’ll be delivered early.
Coping with itching
Your caregiver may prescribe anti-itch creams or corticosteroids to help ease the itching. Applying cooling, soothing calamine lotion, aloe vera gel (store it in the refrigerator for added cooling powers) or creams containing chamomile also can help. Choose lightweight cotton clothes too: the baggier the better, to allow air to circulate next to your skin.
OC usually clears up spontaneously after the baby is born – you’ll be given a liver function test around six weeks after the birth to check all is well. In rare cases, however, symptoms continue and may even worsen, so you’ll be closely monitored. In addition, you can expect close monitoring in any future pregnancies as the risk of developing OC is 40-60% higher once you’ve already had it.
The information in this feature is intended for educational purposes only. If you have any concerns about your health, the health of your child or the health of someone you know, please consult with a doctor or other healthcare professional.