The most common cause of severe itching in late pregnancy is a condition known as cholestasis, a liver disease that only happens during pregnancy.
Officially known as Intrahepatic Cholestasis of Pregnancy (ICP), the normal flow of bile is affected by the increased amounts of pregnancy hormones. According to ICPcare.org, a global non-profit organisation, ICP is common in the last trimester of pregnancy, when hormones are at their peak, but this usually goes away within a few days post-delivery.
Pregnancy hormones affect liver function, resulting in the slowing of the flow of bile. Your gallbladder holds bile that is produced in your liver and is necessary for the breakdown of fats in digestion. When the bile flow is hindered, this can cause a build-up of bile acids in the liver, which can then overflow into the bloodstream. This overflow causes severe itchiness, which starts on the palms of the hands and soles of the feet, before spreading to other parts of your body. In some cases, you may experience jaundice (yellowing of the skin and whites of the eyes). Research reveals that those with ICP have an increased risk of developing gallstones compared to those do not have the condition.
Signs and symptoms
- Itching, in particular, hands and feet. This is often the only symptom.
- Urine may be dark in colour
- Pale or lighter bowel movements
- Loss of appetite
- Low mood or depression.
- Less common symptoms include jaundice, nausea or pain.
Are you at risk?
The Society for Maternal-Fetal Medicine reports that those at risk include:
- Women carrying twins or multiples.
- Women who have had previous liver damage.
- Women who have a family history (mothers or sisters) with ICP.
A diagnosis can be made through a complete medical history, physical examination and blood tests that evaluate liver function, bile acids and bilirubin. The Society for Maternal-Fetal Medicine adds that ICP is diagnosed when the total bile acids or serum bile acids are measured at 10 micormol/L and above.
This depends on the extent of the condition and how well the itchiness is tolerated. If the symptoms are extreme, to the point that it is disrupting everyday life, then treatment will be necessary. However, even if you are able to tolerate the itchiness, close monitoring of your pregnancy and your baby is necessary.
Treatment options include:
- Topical creams to relieve the itching, these may be steroid-based.
- Cool baths or showers and wearing soft cotton or natural fibre garments may help.
- Ursodeoxycholic acid treatment is a medical option. This helps to decrease the concentration of bile salts, which can help reduce itching and improve liver function.
- Vitamin K supplements may be prescribed to assist with normal blood clotting.
- Antihistamines may be prescribed if necessary.
- Close monitoring of mother and baby is essential.
This condition may increase the risk for foetal distress, preterm birth or even stillbirth. As a developing baby relies on the mother’s liver to remove bile acids from the blood, elevated levels may cause stress on the baby’s liver. The pregnancy will need to be closely monitored. The Society for Maternal-Fetal Medicine reports that most management strategies recommend an induced delivery between 37 and 38 weeks, or once the baby’s lungs have reached sufficient maturity. “Prior obstetrical history, antenatal testing and gestational age should be considered.”
Did you know? The risk of recurrence is subsequent pregnancies is between 50 to 60%. In the case of a family history, there may be up to a 92% rate of incidence.