Cholestasis of pregnancy is a condition that causes generalised itching of the skin.
It usually appears in the third trimester of pregnancy and disappears after birth. The incidence is also higher in South American pregnant women, multiple pregnancies, in vitro fertilisation and pregnant women who have had cholestasis in a previous pregnancy.
It is characterised by pruritus, typically affecting the palms and soles. The itching usually occurs at night and can be so intense that it is difficult to sleep. It doesn't pose a health risk to pregnant women, but it can be dangerous for the foetus, causing premature birth, meconium and foetal death.
The diagnosis is based on an interview and physical examination. Blood and urine tests can show an increase in bile acids.
Ursodeoxycholic acid is the treatment of choice and is associated with a marked improvement in both symptoms and blood test changes. In more severe cases, abortion may be necessary.
- Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet 2019
- Kong X et al. Evaluating the effectiveness and safety of ursodeoxycholic acid in treatment of intrahepatic cholestasis of pregnancy: A meta-analysis (a prisma-compliant study). Medicine 2016
- Puljic, A et al. The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy by gestational age. AJOG 2015 C
