Causes of Intrahepatic Cholestasis of Pregnancy (ICP)

Cholestasis includes any condition where the flow of bile from the liver is blocked. Doctors have identified two types of liver cholestasis that can affect people, extra-hepatic cholestasis and intrahepatic cholestasis. The former occurs outside the liver, whereas intrahepatic cholestasis takes place within the liver.

One of the most common potential causes of intrahepatic cholestasis is pregnancy. This condition is also commonly referred to, as obstetric cholestasis.

Cholestasis during pregnancy is a rare liver disorder, which usually occurs towards the final stages of pregnancy.

Less than 15% of the pregnant women worldwide suffer from it. Certain factors are known to increase the risk of developing intrahepatic cholestasis during pregnancy. These include:

Being pregnant with twins
Severe liver damage in the past
Getting pregnant through In Vitro Fertilization (IVF)
If you have suffered from cholestasis during one pregnancy, your chances of suffering from this condition during subsequent pregnancies are as high as 70%.

In some cases, intrahepatic cholestasis of pregnancy can be quite dangerous, as it poses a problem for the mother, as also the developing baby. This condition hinders the absorption of fat-soluble vitamins on a temporary basis. The complications of cholestasis are a lot more severe in babies. In most instances, when women suffer from intrahepatic cholestasis of pregnancy, a premature delivery is recommended. Severe cases of cholestasis during pregnancy could also result in a stillbirth.

Causes of Intrahepatic Cholestasis of Pregnancy

The intrahepatic cholestasis causes could be many and the exact factors are not known, but it is believed that this condition is set off as a result of pregnancy hormones. Your liver usually produces bile, which is then stored in the gallbladder. Most people are aware of the fact that pregnancy hormones affect the manner in which the gallbladder functions. At times, the hormones could also slow down or stop the flow of bile. Eventually, the surplus bile continues to enter into the bloodstream, which then goes on to cause cholestasis during pregnancy.

Symptoms of Intrahepatic Cholestasis of Pregnancy

The main sign of intrahepatic cholestasis during pregnancy is intense itchiness on the hands as also the feet. Many women claim that the itchiness worsens during the night and can even become intolerable at that time. However, some of the other signs and symptoms that could also warn you about this condition, which include:

Yellow tinge to the skin and the eyes
Light colored bowel movements
Dark colored urine

These symptoms usually appear in the third trimester, but in some cases, they could show up earlier. In many women the only symptom for the condition is severe itching. This itchiness usually disappears within a few days after childbirth.

Diagnosis of Intrahepatic Cholestasis of Pregnancy

The doctor would also perform certain tests on you so as to make sure and confirm the presence of cholestasis of pregnancy. You would require to go through a complete physical exam, an ultrasound test and blood tests to confirm the presence of any abnormalities in the liver and to measure the bile in your blood. During this time, your doctor will also ask you several detailed questions about your medical history.

Treatment of Intrahepatic Cholestasis of Pregnancy

There is no definite cholestasis of pregnancy treatment and therefore, your doctor needs to monitor your health, as also your baby’s health closely. Some of the methods to do so include:

Ultrasound tests: Your doctor will conduct a screening test at regular intervals, to check if the baby is alright. At an ultrasound high-frequency sound waves are used for the purpose of viewing the baby’s image on the monitor. This test helps your doctor check if the baby is moving properly or not.

Non-stress test: In this test, your doctor would check how often your baby moves within a particular period of time. Your baby’s heartbeat rate will also be closely monitored, to check if it increases with movement or not.

Blood test: The purpose of a blood test is to check the quantity bile in your bloodstream, as well as the functioning of your liver.
Another method of treating intrahepatic cholestasis during pregnancy would be by reducing the itchiness and increasing overall comfort. Some of the methods your health care provider may recommend for soothing the itching include:

Soaking the affected areas, mainly the hands and feet, in a basin of lukewarm water.

Applying topical anti-itch lotions and creams that contain corticosteroids.

Sitting in a bathtub filled with cool water, to which cornstarch has been added
Drinking plenty of water, so that the skin remains moist and the itchiness reduces
Some doctors also prescribe medicines like ursodeoxycholic acid, to increase the flow of bile and reduce itchiness. However, never take any medication during pregnancy, unless it has been recommended by a doctor. Alternative healers recommend the use of dandelion root, milk thistle, guar gum and activated charcoal to improve this condition. There is no evidence to prove that these remedies are effective in treating intrahepatic cholestasis during pregnancy. Moreover, these remedies may not be safe for women who are pregnant, which is why they should be avoided.

Intrahepatic cholestasis of pregnancy is quite a serious condition, which should be carefully monitored by your doctor at all times.