Cholestasis of pregnancy

Diagnosis

To diagnose cholestasis of pregnancy, your pregnancy care provider usually will:

• Ask questions about your symptoms and medical history
• Do a physical exam
• Order blood tests to measure the level of bile acids in your blood and to check how well your liver is working

Treatment

The goals of treatment for cholestasis of pregnancy are to ease itching and prevent complications in your baby.

Ease itching

To soothe intense itching, your pregnancy care provider may recommend:

• Taking a prescription medicine called ursodiol (Actigall, Urso, Urso Forte). This medicine helps to lower the level of bile acids in your blood. Other medicines to relieve itching also may be an option.
• Soaking itchy areas in cool or lukewarm water.

It's best to talk to your pregnancy care provider before you start any medicines for treating itching.

Monitoring your baby's health

Cholestasis of pregnancy can potentially cause complications to your pregnancy. Your pregnancy care provider may recommend close monitoring of your baby while you're pregnant.

Monitoring may include:

• Nonstress testing. During a nonstress test, your pregnancy care provider will check your baby's heart rate, and how much the heart rate increases with activity.
• Fetal biophysical profile (BPP). This series of tests helps monitor your baby's well-being. It provides information about your baby's heart rate, movement, muscle tone, breathing movements and amount of amniotic fluid.

While the results of these tests can be reassuring, they can't predict the risk of preterm birth or other complications associated with cholestasis of pregnancy.

Early delivery

Even if prenatal tests are within standard limits, your pregnancy care provider may suggest inducing labor before your due date. Early term delivery, around 37 weeks, may lower the risk of stillbirth. Vaginal delivery is recommended by induction of labor unless there are other reasons a cesarean section is needed.

Future birth control

A history of cholestasis of pregnancy may increase the risk of symptoms returning with contraceptives that contain estrogen, so other methods of birth control are generally recommended. These include progestin-containing contraceptives, intrauterine devices (IUDs) or barrier methods, such as condoms or diaphragms.

Lifestyle and home remedies

Home remedies may not offer much relief for itching due to cholestasis of pregnancy. But it doesn't hurt to try these soothing tips:

• Cool baths, which may make the itching feel less intense
• Oatmeal baths, creams or lotions, which may soothe the skin
• Icing a particularly itchy patch of skin, which may briefly reduce the itch

Alternative medicine

Research into effective alternative therapies for treating cholestasis of pregnancy is lacking, so pregnancy care providers generally don't recommend them for this condition.

Several studies have looked at whether the supplement S-adenosyl-L-methionine (SAMe) might ease itching related to cholestasis of pregnancy. But data are conflicting. When compared with ursodiol in early trials, SAMe didn't work as well. It may be safe when used for a short time during the third trimester. But the risks to mother and baby aren't well known. Often, this medicine isn't recommended.

The safety of other alternative therapies hasn't been confirmed. Always check with your health care provider before trying an alternative therapy, especially if you're pregnant.

Preparing for your appointment

It's a good idea to be prepared for your appointment with your obstetrician or pregnancy care provider. Here's some information to help you get ready for your appointment, and what to expect.

What you can do

To prepare for your appointment:

• Make a list of any symptoms you have. Include all of your symptoms, even if you don't think they're related.
• Make a list of any medicines, vitamins, herbs and other supplements you take. Make note of doses and how often you take them.
• Have a family member or close friend go with you, if possible. You may be given a lot of information at your visit.
• Take a notebook with you. Use it to make notes of important information during your visit.
• Make a list of questions you'll ask. This can help you remember important points you want to cover.

Some questions to ask may include:

• What is likely causing my symptoms?
• Is my condition mild or severe?
• How does my condition affect my baby?
• What is the best course of action?
• What kinds of tests do I need?
• Are there any alternatives to the treatment that you're suggesting?
• Are there any restrictions that I need to follow?
• Will I need to have labor induced early?
• Do you have any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment or if you don't understand something.

What to expect from your doctor

To better understand your condition, your pregnancy care provider might ask questions, such as:

• What symptoms do you have?
• How long have you had symptoms?
• How bad are your symptoms?
• Can you feel your baby moving?
• Does anything seem to improve your symptoms?
• What makes your symptoms worse?
• Have you been diagnosed with cholestasis during any previous pregnancies?

Cholestasis of pregnancy can be a worrisome diagnosis. Work with your pregnancy care provider to make sure that you and your baby receive the best possible care for this condition.