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As the name suggests, the gestational cholestasis is cholestasis that occurs during pregnancy. Etymologically, the word cholestasis comes from the Greek khole meaning bile and stasis designating the stop. Cholestasis thus defines interruption of bile flow inside the bile ducts located in the liver. Cholestasis of pregnancy is intrahepatic: hepatocytes, specialized cells of the liver, stop functioning properly, which causes a passage of bile acids in the blood rather than in the bile. And through the umbilical cord, the fetus may be affected by this abnormally high level of bile acids.
The origin of this affection remains unknown. The main hypotheses would be hormonal or genetic dysfunction.
The frequency of cholestasis of pregnancy differs between countries and ethnicities. The prevalence of this disease is between 0,1 and 1,5% in Europe, against 6 to 27% in South America, especially in Chile and Bolivia among women of Mapuche ethnicity.
Cholestasis of pregnancy is multifactorial origin (hormonal, genetic or even environmental) and is more frequent during multiple pregnancies (around 20% risk in a twin pregnancy for example). However, it can just as well take place in a woman who is a mother for the first time (primipara) as in a multiparous woman.
Usually, this liver disease occurs during third trimester of pregnancy.
What are the symptoms of Cholestasis of pregnancy?
Cholestasis of pregnancy is manifested by a phenomenon of itching, also called pruritus, which can quickly spread to the whole body. It is the increase in bile acids in the blood that causes this itching. Generalized pruritus is present in 90 to 95% of cases, without necessarily being associated with another symptom. The nocturnal itching are very common and can lead to insomnia. In the most severe cases, a jaundice ( jaundice) may occur.
Diagnosis of pregnancy cholestasis:
To diagnose cholestasis of pregnancy, a hepatic check is needed. It will be a question of measuring the transaminases (enzymes responsible for the transfer of amino molecules) in the blood, as well as the bile acids. In addition to confirming or not a cholestasis, this test will assess its degree of severity and the impact it could have on the fetus. A study has shown that when the fasting bile acid concentration did not exceed 40 mmol / L, fetal complications were not greater than those of the control group, consisting of unaffected pregnant women. On the other hand, when the concentration of bile acids exceeds this rate, complications are more frequent.
Pregnancy cholestasis and babies, what risk?
Apart from the fatigue and itching caused by this disease, it does not constitute a real threat to the health of the mother-to-be. On the other hand, too high levels of bile acids in the blood have harmful effects on the fetus. Toxic, they increase the risk of prematurity and fetal death in utero, although we do not yet really know in what proportion and by what mechanisms.
Treatment of Cholestasis of Pregnancy:
The medical treatment of cholestasis of pregnancy is based on prescription of ursodeoxycholic acid. The latter makes it possible to reduce itching, but also to decrease the concentrations of bile acids in the cord blood and in the amniotic fluid. It thus limits the toxic effects of bile acids on the fetus, and therefore the risks of prematurity and fetal death. Marketed under the names Délursan® and Ursolvan®, ursodeoxycholic acid should be administered when cholestasis occurs before 37e week of amenorrhea, i.e. before the 38th week of pregnancy. Generally, beyond 37 weeks of gestation, doctors prefer induce childbirth, because it is from this date that the risk of complications is the most significant.
In the most serious cases, and when taking ursodeoxycholic acid is not sufficient for blood tests, hospitalization with regular liver tests and close monitoring of the fetus (monitoring, ultrasound) may be necessary. Finally, if the maternal situation improves quickly after childbirth, it will still require follow-up to check that everything is back to normal at the hepatic level. A new pregnancy should also be closely monitored, as the risk of recurrence of cholestasis of pregnancy is significant and is around 50%.
Sources: Revue du Syndicat national des gynecologues obstétriciens de France.