Itching in pregnancy: cholestasis of pregnancy
Itching in pregnancy is a fairly common symptom probably caused by hormones circulating during pregnancy. The skin also stretches as the belly grows, and this stress to which it is subjected can also cause itching.
However, it is not a symptom to be taken lightly because it can be the sign of a condition that affects the liver, called cholestasis of pregnancy, a pathology that requires medical intervention.
Cholestasis of pregnancy
This is a potentially serious disorder that can develop during pregnancy. Under normal conditions, bile acids flow from the liver to the intestines to aid in the digestion of food.
In case of cholestasis of pregnancy, bile acids do not flow properly and accumulate in the woman’s body. This stagnation determines the change in the quantity of some substances in the blood, in particular of the bile salts which can increase up to 100 times, and therefore cause itching.
However, itching is not always due to cholestasis and therefore some checks must be made. The itching could in fact be caused for example by stones, hepatitis, or by some drugs.
To diagnose it, some tests are usually prescribed to mothers who report this discomfort (generally the itching appears between the 24th and 36th week of pregnancy). The tests are related to: transaminases, alkaline phosphatase and bilirubin. If the values are abnormal and there are no other causes, the diagnosis is cholestasis.
It is not yet known what the causes of cholestasis are but it generally affects predisposed women, whose liver is more sensitive to the increase in estrogen levels that occurs during pregnancy.
It appears with a certain familiarity, it is more frequent in women of South American, Indian and Pakistani origin. If you have had cholestasis during one pregnancy, you are more likely to develop it again in your next pregnancy.
The risk to the baby’s health is high when the bile acid concentration exceeds 40μmol/L . When bile acid levels become worrisome, labor is induced.
Cholestasis of pregnancy is usually a condition that disappears with the birth of the baby.
Symptoms of cholestasis of pregnancy
Symptoms usually start from around 30 weeks of pregnancy , but it is possible to develop the condition as early as eight weeks.
The main symptom is itching, usually without a rash. The itching is often more present on the hands and feet, but it can be all over the body as well.
In many women the itching becomes unbearable and worsens at night, preventing sleep.
Other symptoms may include dark urine, pale discharge and, less commonly, yellowing of the skin and eyes (jaundice).
Diagnosis and treatment of cholestasis
Diagnosis is made by ruling out other causes of the itch. The doctor collects family history and orders a series of blood tests.
These include tests to check liver function and measure bile acid levels.
If cholestasis is diagnosed, frequent checkups (usually weekly) are needed to check blood levels of bile acids. Similarly, if the woman has severe itching but the values are normal, she must still keep them monitored according to the doctor’s instructions.
For the management of itching in the case of cholestasis, some creams are prescribed which are safe in pregnancy and which can provide relief. There are also specific drugs ( ursodeoxycholic acid ) which must always be taken under medical prescription and supervision.
Finally, in cases of mild itching, a lukewarm bath may be of relief by adding a little cornstarch to the water . In the itchy area, mentholated talc can be applied, or calendula or aloe-based creams.
Prevention of cholestasis of pregnancy
Prevention is generally done when the expectant mother knows she is at risk, perhaps because she had the same problem in the previous pregnancy and consists of a diet made up of foods that do not further strain the liver.
Fried foods are therefore eliminated, only vegetable fats should be used in the kitchen, few eggs should be consumed, while legumes, dried fruit, chestnuts and alcohol should be avoided.
Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.
Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.