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Cholestasis in Pregnancy

Intrahepatic Cholestasis of Pregnancy (ICP) occurs when the normal flow of bile is affected by the increase in hormones during pregnancy. It has been seen in approximately 1 out of every 1000 pregnancies and tends to be more common in Swedish and Chilean ethnic groups. It is also more common in women who are carrying multiples, women who have previous liver damage and women whose mother or sisters had ICP. ICP is more common during the third trimester of pregnancy when your hormones are at their highest. It will also usually go away within a few days following delivery.


What causes this? Pregnancy hormones (estrogen & progesterone) can slow or stop the flow of bile. Bile is produced by the gallbladder and is essential for the breakdown of fat during digestion. When the flow of bile is slowed or stopped, this can cause a buildup of bile acids in the liver, which can eventually spill over into the bloodstream.


Cholestasis may increase the risk for fetal distress, preterm birth or stillbirth. A developing baby relies on the mother's liver to remove bile acids from the blood and if levels continue to increase, this will cause stress on the baby's liver. Women are monitored very closely by their care providers and may even be included around 37-38 weeks. 


What are the symptoms?


- Itching, particularly on the hands and feet (often the first and only symptoms noticed)

- Dark urine color

- Pain in the right upper quadrant, without gallstones

- Pale/light colored stool

- Fatigue or exhaustion

- Loss of appetite

- Depression

- Less common symptoms include: jaundice and nausea 


Will I get this again? Some research states that women who were diagnosed with cholestasis during their first pregnancy have a 90% chance of having it again in future pregnancies. However, it is nearly impossible to know for certain.  If you have been experiencing any of the symptoms listed above, please let your care provider know ASAP. If you have any other questions, please do not hesitate to reach out to Dr. Sarah or Dr. Caitlin. 




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