Cholestasis of Pregnancy – Diagnosis and Treatment
Diagnosis
Doctors begin by collecting detailed information about symptoms, such as persistent itching—particularly on the hands and feet—and signs like jaundice. A physical examination may reveal yellowing of the skin or eyes, which can indicate liver involvement.
To confirm the diagnosis and rule out other conditions, providers typically perform several laboratory and imaging tests, including:
- Liver function tests (LFTs) to measure enzymes such as ALT and AST.
- Serum bile acid levels, which are often elevated in cholestasis.
- Bilirubin levels to assess liver and bile duct function.
- Hepatitis panel to rule out viral hepatitis.
- Complete blood count (CBC) and coagulation studies to monitor for complications.
- Ultrasound imaging of the liver and gallbladder to check for gallstones or bile duct obstruction.
Doctors also consider other pregnancy-related liver conditions with overlapping symptoms, such as HELLP syndrome, acute fatty liver of pregnancy, and pre-eclampsia, which require different treatment approaches.
Treatment
Ways to Relieve Itching
Many people with cholestasis of pregnancy experience strong itching, known as pruritus. Providers often prescribe a bile acid therapy agent to reduce bile acid levels in the blood and help relieve symptoms such as itching and discomfort.
Other anti-itch medicines might be used, but their effectiveness can vary. Simple steps such as cool baths or lukewarm water soaks may also give some relief from itching.
| Method | Details |
|---|---|
| Bile acid therapy agent | Lowers bile acids, eases itching |
| Cool/lukewarm water baths | Soothes skin, provides temporary relief |
| Other medications | For itch, with varying results |
Watching the Baby During Pregnancy
Providers use special tests like nonstress tests to track the baby’s heart rate. Biophysical profiles (BPPs) check for movement, muscle tone, breathing, and amniotic fluid levels.
These tests help detect signs of fetal distress or poor fetal outcome, but they can’t predict every problem. Ongoing fetal surveillance helps guide treatment decisions.
Planning for an Earlier Birth
Providers often suggest delivery before the usual due date to reduce the risk of stillbirth or other serious complications.
Inducing labor around 37 weeks is a common choice if cholestasis is present, unless other issues require a different plan.
Early delivery helps manage risks from conditions such as coagulopathy, vitamin K deficiency, or meconium in the amniotic fluid.
Birth Control Options After Pregnancy
Past cholestasis can return with birth control methods containing estrogen. Because of this risk, providers suggest other birth control options. Choices include progestin-only pills, intrauterine devices (IUDs), or barrier methods like condoms or diaphragms.
These options lower the chance of liver-related symptoms in future pregnancies. In some cases, providers may advise women to take extra vitamin K to prevent vitamin K deficiency and blood clotting problems.
Ways to Manage at Home
Many women try simple steps to lessen itchiness or discomfort. They use cool or oatmeal baths, soothing creams, or lotions to calm the skin. Placing an ice pack on itchy spots might help for a short time.
Wearing soft, loose clothes, eating healthy foods, and keeping stress low can also support comfort during pregnancy.
| Symptom | Helpful Tip |
|---|---|
| Itching | Cool or oatmeal baths |
| Nausea | Eat small, frequent meals |
| Abdominal pain | Rest and wear loose clothing |
| Vomiting | Stay hydrated, avoid strong smells |
| Anorexia | Choose light, easy-to-digest foods |
Complementary Therapies
Some people explore complementary therapies for help with symptoms of rare bile duct disorders during pregnancy, such as cholestasis.
Researchers have studied the supplement S-adenosyl-L-methionine (SAMe) for its effects on itching. Results from different studies do not always agree, and early research shows it may not work as well as standard medications like ursodiol.
Key Points:
- The use of SAMe may be safe for a short time in late pregnancy, but long-term risks are unclear.
- Other alternative methods, including certain herbs and supplements, have not been shown to be safe or effective.
- Anyone with a genetic predisposition or rare liver disorder should talk to a healthcare provider before using complementary therapies.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Getting organized before the appointment helps make the most of the time with the healthcare provider.
Bringing a full list of current symptoms is very helpful—even those that seem minor or unrelated, especially in the second or third trimester. It’s best to write them down to avoid forgetting anything.
Recording all medicines, supplements, vitamins, and herbal products taken is important. Patients should include the names, doses, and how often each one is taken.
This gives the provider a clear view of what might be affecting health or the baby. If possible, bringing someone, like a family member or friend, can be helpful.
They can listen, ask questions, and take notes. It is also a good idea to bring a notebook or a note-taking app for keeping track of new information, recommendations, or next steps.
Preparing a list of important questions makes the meeting more useful. Here are sample questions a patient may want to consider:
| Question Idea | Topic |
|---|---|
| What might be causing these symptoms? | Diagnosing causes |
| Is this mild or severe? | Assessing seriousness |
| How could this affect the baby? | Baby’s well-being |
| What are the next steps in care? | Treatment planning |
| What tests are needed now? | Testing |
| Are there other treatment options? | Alternatives |
| Is early delivery needed? | Labor timing |
| Any activities I should avoid? | Restrictions |
| Are there resources for more information? | Educational support |
It’s also okay to ask for more information or for explanations if something isn’t clear during the visit.
What Your Health Provider Might Ask You
The provider will likely ask about symptoms and health history to better understand the situation. Common topics include:
- What symptoms are you experiencing?
- How long have the symptoms lasted?
- How intense or frequent are the symptoms?
- Have you noticed any change in the baby’s movements?
- Does anything make the symptoms better or worse?
- Have you had cholestasis in a past pregnancy?
If you answer with as much detail as possible, the provider can figure out what is happening and how to manage it. This becomes especially important in the second or third trimester, when close monitoring may be more urgent.
