Intrahepatic Cholestasis – Have you heard of it?

My friend has been suffering really badly with her first pregnancy

So when I saw her phone number on my ph I just new it was time to forget all my own worries and be a friend, a compassionate and understanding friend. For the next 15 mins or so I had to focus on her alone. . 

I answered the phone in my most compassionate voice and immediately there were tears and an “oh thank god you are home, I really need to talk to someone who will just listen”

So I listened and for 20 minutes my poor friend just let it all out, she paused and cried then talked some more and some more. . . There was little that I could say as I had never heard of “Cholestasis” and had nothing I could advise her on. So when she was ready I said “remember mate, no matter what time of day or night I am hear for you even if its just so hear you cry” . .

We ended the call and I knew I needed to find out about this condition if I was to be a good and supportive friend. So here is what I have learned, I thought I’d share it with you all just in case as you never know who or what is around the corner.

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Cholestasis is basically a condition which involves your liver. Basically this means that there is a dramatically reduced flow of bile (bile salts) down the bile ducts in the liver, this then causes some bile to leak into the bloodstream.

As you know our bloodstreams travel all around our body delivering all the goodies that our bodies need. Our blood stream however is not meant to carry bile. This condition can happen when you are not pregnant and in this case it is known as simply as “Cholestasis” but if is occurs during pregnancy then it is known as “Intrahepatic Cholestasis of Pregnancy” (aka Obstetric Cholestasis)

So who gets Intrahepatic Cholestasis of Pregnancy?

Basically obstetric Cholestasis seems fairly random and it only works out that it occurs in around 1 in every 100 pregnancies. It is also more common in pregnancies with multiple babies (i.e. twins, triplets). If your mother, sister or grandmother suffered from this condition when they were pregnant then you also stand a higher risk of developing obstetric Cholestasis so it’s important that you mention this condition to your GP or obstetrician.

Sadly in some parts of the world this condition has a higher rate equating to around 1 in 20 pregnancies so sadly if you live in or are from Chile, Bolivia or South America then the risks are higher. This leads many to believe that your genes may also play a huge role.

Another important issue to remember that is that if you suffered from obstetric Cholestasis in one pregnancy then you also stand a high chance that it will occur in any future pregnancies.

So do the Dr’s know what causes it?

In a nutshell the answer is NO the exact cause is basically unknown but there are a few suggestions made by the scientific community:

Hormones – We all know that pregnancy results in an increase of two major hormones; oestrogen and progestogen. What many don’t know is that these hormones also play a huge role in how the liver works.

Genes – It is known that this condition tends to run in families although for the lucky ones it is known to skip generations. It is thought by some that a woman may inherit a slight problem in their livers that is not noticeable until they become pregnant with all those extras hormones.

There is also some thought that environmental factors may also contribute but as of yet this is not proven. Whatever the case may be it is clear that once the pregnant women gives birth all the symptoms of the condition disappear with no long term problems left over within the liver.

So what are the symptoms?

The good news is that almost all symptoms do not occur until the last third of a woman’s pregnancy as this in when hormones are at their peak. Sometimes however as with most medical conditions there are some that do get the symptoms earlier on.

The most common symptom is an ITCH. . .  This itch can be all over the body but is more common of the pregnant mum’s hands and feet. This itch can become so severe that often the affected mum to be is unable to sleep, concentrate and often ends up moody as a result. . . . ** Remember though that mild itching is a normal part of pregnancy so just because you have a mild itch this does not mean you have Cholestasis.

There are also some less common symptoms and they are:

A poor appetite and  a general feeling of being ill
• Tiredness
• Mild Jaundice (you may go yellow and have pale pooh.)

So how serious is it?

Although it all sounds bad in reality this condition whilst pregnant is not considered life threatening or extremely serious. This condition is more unpleasant for the mum to be rather than life threatening.

There also seems to be a debate among Dr’s and scientists as to whether this condition is dangerous to the unborn baby but so far the majority feel that there seems to be a minor risk and therefore a delivery can usually be expected early and is recommended at 37 weeks.

So how is it diagnosed?

Well this is the easiest part as this condition is easily diagnosed through a simple blood test. This test detects raised levels of bile or liver enzymes in the blood. Many Dr’s also check for viral hepatitis as hepatitis can sometimes also raise liver levels. If there is an itch present and the result comes back as normal then often a second test is done a week later.

I have it so what are the treatments?

There is no cure for this condition, as I mentioned above this condition is more annoying and not life threatening. Remember that the symptoms will go once you have delivered your baby.

There are however some things that may help. Some women with this condition recommend the following:

• Keeping cool – lower your thermostat a few degree’s, sleep naked or uncovered at night, take cool showers and baths and also soaking your feet and hands in icy water.
• Moisturizers - Using a very bland moisturizer during the day may also give you temporary relief from the itching.

Then there are the measures that your doctor may offer such as:

• Vitamin K supplements
• More frequent anti-natal visits
• Discussions on when to deliver your baby

In summing up I personally think this condition whilst not life threatening is still very important especially for my friend. As a diabetic I suffer from many different forms of itching so this gives me a little bit of an idea what my friend is going to be going through towards the end. I may not have this condition and neither do you BUT you and I now both have an understanding which should help us to help our friends or relatives.

Thanks for taking the time to read this and I hope that this has helped someone out there in the community . . ..

Cheers Kellz