Pregnancy Cholestasis - You Need To Know That

definition

Pregnancy cholestasis is a disruption of the outflow of bile from the liver into the gallbladder or duodenum during pregnancy.
This leads to an increased concentration of bile acids in the blood. It usually occurs in the third trimester, i.e. from around the 26th week of pregnancy, in every 500th to 1000th pregnancy.

The risk of a second pregnancy again Pregnancy cholestasis to develop is somewhere between 40 to 60%.
The main symptom is pronounced itching that lasts until the end of pregnancy. The drug ursodeoxycholic acid can alleviate itching by improving the excretion of bile acids.

Causes of pregnancy cholestasis

The cause of pregnancy cholestasis is not yet clearly understood. It is believed that many factors play together to trigger this clinical picture.

It is assumed that genetic and external factors can play a role. It is also discussed that an increased sensitivity to the higher concentration of the pregnancy hormone estrogens during pregnancy can have an influence on the development of pregnancy cholestasis.

Please also read: Pregnancy hormones

At the liver cell level, it was found that a disruption of the transport of bile acid from the liver cells into the bile ducts leads to increased concentrations of bile acids in the blood. In turn, these elevated concentrations trigger the symptoms described below.

Symptoms of pregnancy cholestasis

The leading symptom of pregnancy cholestasis is itching.

If the course is severe, jaundice (med .: Jaundice) train. This is characterized by a yellow coloring first of the dermis of the eye and later also of the skin, which is triggered by the storage of a breakdown product of the red blood pigment. In some cases, nausea and vomiting can also occur.

itching

Itching is the most important symptom of pregnancy cholestasis and is described as distressing by affected women. It is believed that the increased concentration of bile acids in the blood causes them to be deposited in the skin. There they irritate nerve endings and thus trigger the usually severe itching. In many cases this persists during the remainder of the pregnancy and is difficult to treat.

Diagnosis of pregnancy cholestasis

The first step in diagnosing pregnancy cholestasis is to consult a doctor. Here, the doctor who has been consulted confidently will collect the symptoms and, if biliary stasis is suspected, also ask whether similar symptoms have already occurred in previous pregnancies. This is particularly important for further diagnosis, since pregnancy cholestasis recurs in up to 60% of the following pregnancies.

A clear diagnosis is now made via a blood sample with determination of the bile and liver values ​​in the laboratory in conjunction with the symptoms.

Symptoms often vary in severity and there are no early warning signs, so laboratory testing is the most important diagnostic tool.

Laboratory values

A blood test is used to diagnose pregnancy cholestasis Cholestasis parameters certainly. These are the Gamma glutamyl transferase and the Alkaline phosphatase.
They are also greatly increased in other diseases that are associated with biliary obstruction.

In addition, the liver enzyme Alanine aminotransferase measured, which is also often slightly increased. In addition, the direct bilirubin, which is the processed form of a breakdown product of the red blood pigment, is increased. An increased value means that there is a disruption in the removal of the bile acids.

An important differential diagnosis of pregnancy cholestasis is hepatitis, the inflammation of the liver, which is triggered by certain viruses. Therefore, you should also determine in a laboratory whether the pregnant woman has become infected with one of these viruses and whether there is sufficient vaccination protection. Since the laboratory parameters mentioned are usually always determined in conjunction with other liver values, the blood test also provides information here.

Please also read: Liver values

Therapy of cholestasis in pregnancy

If pregnancy cholestasis is diagnosed, close monitoring of the mother and fetus is essential, as the risk of intrauterine fetal death (the child dies in the second half of pregnancy in the womb) and premature birth is increased.

Ursodeoxycholic acid (Ursofalk®), which promotes the excretion of your own bile acids.

Increased excretion can also improve itching.
It is also a very safe drug to use during pregnancy and appears to reduce the rate of deaths and premature births.

Another drug that is used in some cases is colestyramine. It binds the bile acid in the intestine and facilitates elimination.

However, relevant side effects when taking colestyramine can occur due to a lack of fat-soluble vitamins (vitamins E, D, K and A). Therefore, vitamin K should also be given.

A symptom-relieving therapy with various drugs can be initiated against the itching, but the removal of the excess bile acids is in the foreground and is the most effective therapeutic approach against the itching.

An early delivery should also be sought, although the exact time is disputed. In severe cases, however, delivery should take place no later than the 37th week of pregnancy.

Diet in pregnancy cholestasis

As in the normal course of pregnancy, a healthy and balanced diet should be observed.
In addition, it should be eaten with as little fat as possible, as the impaired transport of bile acids into the intestine can impair the digestion of fats.

When using fats and oils, attention should be paid to vegetable origin and high quality. If greasy stools have already occurred, certain digestive enzymes can be taken, which support the breakdown of fats in the intestine.

Some sources also advise against eating heavy meals, hard-boiled eggs, or foods that promote gas.
However, these are only recommendations based on empirical values. An actual improvement in pregnancy cholestasis due to certain diets has not yet been scientifically confirmed.

Please also read: Diet in Pregnancy

How long does pregnancy cholestasis last?

Pregnancy cholestasis occurs more frequently during the last three months of pregnancy. The symptoms, in particular the itching, persist throughout the rest of the pregnancy in most cases.

An improvement can only be expected after the delivery. Sometimes the symptoms can persist for up to four weeks after delivery.

Is there a risk of premature birth?

The risk of premature birth is increased with pregnancy cholestasis.

In 2006, around 20 to 60% of pregnant women with cholestasis had a premature birth, although this rate should have decreased with the targeted therapy with urodeoxycholic acid.

During childbirth, the newborn may experience increased shortness of breath, for which obstetricians and midwives should be prepared so that a quick birth can be possible. If these points are observed, however, this does not mean a greater risk during the birth.

Read more about this under: Premature birth

Is there a risk to the child?

The greatest risk for the child is premature death in the womb during the second half of pregnancy.

Therefore, regular check-ups at close intervals are very important in pregnancy cholestasis. In addition, the risk of inflammation of the inner membrane is increased.

If this clinical picture occurs, the child must be delivered as soon as possible, otherwise the newborn child may become infected or the mother may develop sepsis (colloquially: blood poisoning).

With regular monitoring and consistent treatment of cholestasis, however, these risks can be significantly reduced.