Got that itchy skin? Especially around your hands and feet? Are you pregnant?
While it is common to get itchy skin in pregnancy (up to 20% get some sort of itching), it is important to get it checked out! Majority of the time, it is a benign condition that is easily treated. But in a small percentage of pregnant mothers, it can be a serious condition known as Cholestasis of Pregnancy.
This is something that might be discussed during the second or third trimester of your pregnancy care.
How common is it?
It can occur in about ~1% of pregnancies, with a slightly higher incidence in certain ethnic populations (higher in Asians and up to 5% in Hispanic population). It can also be affected by genetic and environmental factors.
How does it present itself?
Most commonly manifest as itching on hands and feet, it can affect any pregnant women, and usually in the third trimester. In some women, it can be much earlier and the itching can be anywhere! There is usually also no rash seen. If you have any symptoms of itchiness (not just hands and feet), please remember to discuss it with your healthcare provider.
What causes cholestasis?
We are not entirely sure what causes cholestasis, but there seems to be a possible genetic component as it can occur in familial clusters and certain ethnic populations. Pregnant mothers with underlying liver disease may also be more susceptible.
How do we investigate for it?
If you have symptoms suggestive of cholestasis, we would organize for you to have some blood tests. They will need to be done when you are fasted – bile acids and liver function test.
If I am diagnosed with cholestasis, what happens next?
We will have to monitor both mom and baby and it can happen in the following ways:
· For mom, a medication would be started to bring down the levels of the bile acids. This is important can it can act as a toxin to the baby. Then, weekly bloods may be requested to monitor the condition.
· For baby, a CTG may be requested on a weekly or twice weekly basis and an ultrasound as well to check on the baby’s growth and wellbeing.
As the medication is not a cure for the disease, your doctor will discuss the delivery plan for your baby. Usually we would recommend a delivery between 37-39 weeks but it would depend on your clinical situation.
What is the risk with cholestasis?
There is an increased risk of stillbirth compared to the general population of pregnant mothers. It is very important to be aware of your baby’s movements. If there is any change especially if you feel that baby is not as active, you need to let your doctor know immediately.
Due to the difficulty in predicting stillbirth, you may be offered an early delivery of your baby.
Do I need to have a Caesarean Section?
Cholestasis of Pregnancy in itself is not an indication for a Caesarean Section. However, there is a slightly higher incidence of meconium passed in labour and fetal distress which may contribute to having a caesarean section.
Will it happen again?
Yes, cholestasis can occur again in future pregnancy – in up to 50-80% for pregnant mothers who have had them before. So, it is important that we monitor for it in future pregnancies.
A couple of other things to know when you have cholestasis is that :
· There is generally no long-term adverse effects on your or your baby from the cholestasis itself
· Your doctor may also discuss the options for the pill for the future (avoiding estrogen)
Dr Adeline Chan is a female obstetrician in Sydney, serving the Western Sydney and Hills District area.