What is gestational cholestasis? Learn about its causes, symptoms and treatments.

Cholestasis – what is it?

Gestational cholestasis is a complication of pregnancy that is most dangerous to the fetus. We speak of this disease when there is a stagnation of bile, which is necessary for digestion of food and absorption of fat-soluble vitamins (A, D, E, K). This phenomenon is associated with both abnormalities in the transport of bile into the bile duct and its accumulation inside the liver cells. The affliction is the so-called. Intrahepatic cholestasis, which is caused by disorders of bile excretion at the level of hepatocytes. It occurs in about 4% of all pregnant women. Typically, symptoms of cholestasis appear around the 30th week of pregnancy. The most common complaint is persistent itching of the skin without a rash. If you notice such a symptom, report it to your doctor immediately.

Causes of gestational cholestasis

Already knowing what pregnancy cholestasis is, it is worth learning about its causes and the pathogenesis of its formation. The direct cause of the development of this disease is bile stasis in the hepatocytes, resulting in high concentrations of bile acids in the blood serum.

Cholestasis occurs in moms-to-be because liver cells become more susceptible to sex hormones (estrogen and progesterone) during pregnancy. The discomfort worsens around the 30th week of pregnancy, which is related to the highest concentration of hormones during this period. Disorders of secretion in intrahepatic bile ducts may be diet-related or genetically determined. However, the most important factor, leading to cholestasis, is that hepatocytes are too susceptible to sex hormones, whose greatest activity occurs during the third trimester of pregnancy.

Cholestasis – what risk factors do we distinguish?

There are some indications that may influence the development of this condition in mothers-to-be. These include, but are not limited to:

• multiple pregnancy,
• older age,
• Cholestasis in previous pregnancies,
• damage to liver cells and a history of diseases of this organ (especially previous inflammation),
• A history of kidney and biliary tract diseases (such as primary cholangitis);
• genetic burdens,
• The use of certain drugs,
• Eating heavy and fatty food.

Cholestasis – symptoms

As a rule, cholestasis has a mild course and its symptoms are usually not dangerous for the mother, although they significantly worsen her well-being. The most characteristic symptom is itching of the skin, which is not accompanied by a rash. It initially involves the hands and feet, then other areas of the body as well. Due to persistent itching and scratching, the skin develops so-called laxity, or linear abrasions with epithelial damage. The ailment is often accompanied by, among other things:

• irritability,
• anxiety,
• sleep disorders.

Approximately 1-4 weeks after the onset of pruritus , jaundice, which is a yellow coloration of the skin, eye whites and mucous membranes, appears . In addition, symptoms may include nausea, vomiting, discoloration of the stool and enlargement of the liver. Symptoms of cholestasis gradually disappear after delivery and usually resolve within three weeks after the baby is born.

Diagnosis of gestational cholestasis – test results

The most important to confirm the disease are the results of blood tests, which include the so-called “blood test”. liver tests. AspAT, AIAT, bilirubin and alkaline phosphatase should be tested. These parameters tell the doctor what the condition of the hepatocytes is and how significant the disease is. Based on these, the doctor decides on treatment and possible hospitalization.

Also important in the diagnosis is the level of bile acids in the blood. Taking this parameter into account, we can divide gestational cholestasis into:

• 10µmol/l to 39µmol/l – mild,
• 40µmol/l to 99µmol/l – moderate,
• More than 100µmol/l – severe.

However, regardless of the severity of the disease, every mother-to-be must be under close control of the attending physician and perform the laboratory tests mentioned above regularly. Their results, the clinical condition of the pregnant woman and the assessment of fetal well-being determine further management.

Cholestasis of pregnancy – what should the diet of the future mother look like?

Since the underlying cause of the disease is the dysfunction of liver cells, additional stress on them should be prevented. Such stresses are caused primarily by foods high in fat. The diet for cholestasis in pregnancy should be based on cooked and baked dishes, with a high content of vegetables and fruits . Highly processed foods, containing a large amount of sugars and sweetened carbonated drinks should also be excluded from the menu. It is worth remembering to properly replace, among other things. Vitamin A, which is a fat-soluble compound. An alternative then is β-carotene, which occurs naturally in carrots, tomatoes, pumpkin and green peas. In addition, supplementation of vitamin E, as well as K, may be necessary.

How is the treatment going? – gestational cholestasis

Diagnosis of this disease is generally associated with hospitalization in a pregnancy pathology department and the selection of appropriate pharmacotherapy. Treatment of gestational cholestasis involves the use of preparations, primarily designed to relieve bothersome discomfort and prevent complications of the disease. The most common symptom is pruritus, which is treated with cholestyramine and antihistamines.

In addition, the drug of choice is often the one with ursodeoxycholic acid (UDCA), a substance tolerated by pregnant patients. The goal of this treatment track is to reduce bile acids and the severity of pruritus. In experimental studies, it has been found to have a positive effect on generating bile acid transporters in the placenta and thus reducing the concentration of bile acids in fetal serum.

Cholestasis is the cause of abnormal liver function, resulting in impaired synthesis of blood clotting factors. This can cause bleeding from: the nose, the mouth after a tooth extraction, a wound after a cut, but also (in extreme cases) internal bleeding, including into the brain. To minimize the effects and prevent bleeding, vitamin K is used.

Although unpleasant discomforts significantly make life miserable for the mother-to-be, the disease (detected and treated early enough) poses little threat to her. The greatest dangers, including the possibility of malformations and even intrauterine death, involve the fetus. Because of this , it is important to pay attention to characteristic symptoms, as this allows early detection of the disease, appropriate treatment, monitoring of the baby and choice of pregnancy termination.

FAQ:

• What is gestational cholestasis?

The disease takes two forms: extrahepatic and intrahepatic. The first arises when the flow of bile through the external bile ducts is impaired, with causes including. pancreatic diseases. The second, on the other hand, occurs through problems with bile excretion at the level of hepatocytes – and this is the one that affects pregnant women.

• What are the symptoms of gestational cholestasis?

Symptoms that accompany moms-to-be at that time include:

• Persistent itching of the skin,
• nausea,
• Yellow coloration of the skin, eye whites and mucous membranes;
• stool discoloration,
• irritability.

• How is bile stasis treated in pregnancy?

Therapy consists of giving cholestyramine and antihistamines to the mother-to-be to relieve itchy skin. In addition, ursodeoxycholic acid is used in the treatment. This substance reduces the concentration of bile acids and also leads to the elimination of itching.