What is Cholestasis of Pregnancy (IHCP)?
IHCP complicates between 1-15% of pregnancies and is a condition that is characterised by abnormalities in liver function and an intense itching, most commonly involving the palms of the hands and soles of the feet and often worse at night.
What causes IHCP?
The cause is not fully understood, but is likely due to a combination of genetic, environmental and pregnancy factors (increased levels of estrogen and progesterone).
How is IHCP diagnosed?
Typically, a combination of symptoms (which most typically commence in the later part of pregnancy) and blood tests (elevated liver function tests or bile acids) are used to make the diagnosis. There are rarely any physical signs of cholestasis, so the presence of a rash or other signs means other conditions should be investigated.
Are there any complications for mothers with IHCP?
Generally (unless there is severe cholestasis impairing the body’s ability to absorb fats from the diet) the main issue is the intense itch and possible secondary skin infections from scratching. Occasionally supplementation with vitamin K may be needed if there’s any evidence of deficiency to correct clotting abnormalities.
Are there any problems for babies of mothers with IHCP?
There are higher rates of a number of complications for babies
- Prematurity (either due to induction of labour or spontaneous preterm labour)
- Meconium stained liquor
- Respiratory distress after delivery
- This is most strongly associated with significantly elevated bile acid levels after 38 weeks
How is IHCP managed?
The symptoms of itch can be helped by medication (ursodeoxycholic acid). The timing of delivery will depend on the timing of diagnosis and the severity of symptoms and bile acid elevation. The current general recommendation would be for delivery by 37-38 weeks or on diagnosis if the pregnancy has progressed beyond this already, but specific management decisions should always be on a case by case basis in consultation with your obstetrician. Oral vitamin K supplementation may be required if there is evidence of changes in clotting ability.
Are there any long term consequences?
It may be best to avoid estrogen containing contraceptives due to the increased risk of developing cholestasis while on these medications.
The recurrence rate in subsequent pregnancies is up to 60-70%, so close surveillance in subsequent pregnancies is recommended.
The above information doesn’t take the place of a medical consultation so please seek further advice if you have further concerns.