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Obstetric cholestasis during Pregnancy – Causes and Treatment

Cholestasis during pregnancy is a condition which affects the normal flow of bile in the gallbladder because of the large amount of pregnancy hormones. Cholestasis is more common in the last trimester of pregnancy when the hormones are at their peak, but this usually disappears within a few days after birth. Cholestasis means there is a reduction in the flow of bile through the bile ducts in the liver. Some bile then ‘leaks’ into the bloodstream, especially bile salts. They circulate in the bloodstream and can cause symptoms. Obstetric cholestasis is sometimes called intrahepatic cholestasis of pregnancy.

Causes:
Pregnancy hormones affect gallbladder function, resulting in slowing or stopping the flow of bile. The gallbladder produces bile in the liver, which is necessary in the breakdown of fats during digestion. When bile flow is stopped or slowed, it results in an accumulation of bile acids in the liver which can seep into the bloodstream. The exact cause is unclear. Hormonal and genetic factors may be responsible.

Hormonal factors: Pregnancy causes an increase in the hormones estrogen and progestin. These may affect the liver in a way that slows down the bile that passes along the small bile ducts. Some pregnant women may be more sensitive to these effects of the hormone.
Genetic factors: Obstetric cholestasis seems to run in some families (although it can skip several generations). One theory is that women who develop obstetric cholestasis may inherit a small problem with the way bile is made and passes through the bile ducts. It does not matter when one is not pregnant. However, the high level of hormones produced during pregnancy may ‘tip the balance due to a very low flow in the bile.

There may be some other environmental factors contributing to cholestasis. Within a week or so after birth, the symptoms disappear.

Treatment:
The goals of treating cholestasis during pregnancy are to relieve the itching. Some treatment options include:
– Topical anti-itch medications or with corticosteroids.
– Medications to reduce the concentration of bile acids such as ursodeoxycholic acid.
– The cold baths and cold water stop the flow of blood in the body by decreasing the temperature.
– Dexamethansone is a steroid that increases the maturity of the baby’s lungs.
– Vitamin K supplements are given to the mother before delivery and once the baby is born to prevent intracranial hemorrhage.
– Dandelion root and milk thistle are natural substances that are beneficial for the liver.
– Regular blood tests monitoring both the bile and serum liver function and informed about early delivery of the baby.

Ursodeoxycholic Acid
This is a naturally occurring bile acid and is used as a medicine. Strictly speaking, it is not licensed for pregnant women, but often prescribed. The logic is that taking this medication can help improve liver function and helps in reducing the level of bile acids in the blood. However, some doctors believe it helps, some small studies have found that it does not help. A current national standard of obstetric cholestasis states … “There is insufficient data to support the widespread use of ursodeoxycholic acid (UDCA) outside of clinical trials.”Therefore, treatment is being studied and can be used, but more research is needed to clarify whether it is useful or not.

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