Pregnancy cholestasis – causes, symptoms, treatment. Diet in gestational cholestasis

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Gestational cholestasis is a rare liver disease that develops in some women during the third trimester of pregnancy. Its symptoms should not be taken lightly – if cholestasis in pregnancy is not properly treated, its complications can seriously threaten the health and life of the fetus. What is the characteristic of gestational cholestasis and what are its causes? How can this condition be treated and why is a proper diet so important in cholestasis?

Pregnancy cholestasis – characteristics and causes of the disease

Gestational cholestasis, or actually intrahepatic cholestasis of pregnancy (WCC for short) is a rare disease that affects approximately 4% of pregnant women in the Polish population. Its direct cause is the body’s hypersensitivity to the increasing concentration of sex hormones – especially progesterone and estrogens. Cholestasis in pregnancy is often genetic – liver hypersensitivity to sex hormones is usually hereditary.

The occurrence of gestational cholestasis can also be caused by improper diet and unhealthy habits that weaken the overall health of the liver, such as alcohol abuse and drug use. Previous infections or infections, digestive system diseases (e.g. gall bladder stones or pancreatitis) and long-term use of strong medications may also increase the risk of cholestasis in pregnancy.

Usually, the concentration of sex hormones increases significantly at the beginning of the third trimester of pregnancy – around the 30th week. High levels of these substances can cause problems with the functioning of the liver and bile ducts. There are problems in transporting bile to the bile duct, which causes it to accumulate inside the liver. Then, bile stagnation occurs in liver cells – hepatocytes – and thus increases the concentration of bile acids in the blood serum.

Cholestasis in pregnancy is also associated with disturbances in protein metabolism – because blood tests also increase the level bilirubin and alkaline phosphatase that take part in it.

Pregnancy cholestasis is mild and does not pose a threat to the mother, although it may negatively affect her well-being. However, this disease should not be left without intervention for the sake of the child’s best interests. If left untreated, pregnancy cholestasis can lead to:

1. premature birth;
2. fetal stress;
3. slow fetal heartbeat (bradycardia);
4. staining the amniotic fluid with meconium;
5. in extreme cases – even to the death of the fetus.

In many cases, however, the body of a pregnant woman responds well to the treatment and manages to protect the child from the risk of complications. For mother and child safety reasons, women diagnosed with gestational cholestasis are usually recommended to induce labor or by caesarean section between 36 and 38 weeks of gestation. This decision is always made by the attending physician after a careful assessment of the patient’s individual characteristics and predispositions.

If you are diagnosed with gestational cholestasis for the first time, there is a high risk – 60-70% – that the patient will also develop it in subsequent pregnancies. Interestingly, the likelihood of this disease increases additionally in the case of a twin pregnancy.

Find out more: What should worry me in the third trimester of pregnancy?

Pregnancy cholestasis – symptoms

Pregnancy cholestasis, although it is not dangerous for the expectant mother, is characterized by unpleasant and bothersome symptoms. The most common symptom that occurs in almost 75% of patients is persistent itching of the skin, covering either its entire surface or specific areas, such as the abdomen, hands or feet. The pruritus usually worsens in the evenings when the body is warm. It can appear as early as around the 25th week of pregnancy and usually its intensity increases over time. As a result of scratching, sometimes skin changes called cross-cuts appear on the surface of the skin.

Another common symptom associated with cholestasis in pregnancy is the so-called cholestatic jaundice. We are talking about it when both the skin and the surface of the mucous membranes (e.g. in the whites of the eyeballs) turn yellow. This is due to abnormalities in the levels of bile acids in the blood. In rare cases, it can also be accompanied by the so-called Yellow tufts or yellows, i.e. skin changes appearing around the eyes.

Among other common symptoms of gestational cholestasis, specialists indicate, among others:

1. nausea and vomiting;
2. diarrhea with a specific fatty stool of a white or whitish shade;
3. eating disorders;
4. clearly darker color of urine;
5. pain located under the right rib, associated with an enlarged liver;
6. problems with falling asleep and insomnia caused by other bothersome symptoms.

All symptoms of cholestasis usually go away on their own a few days after the baby is born.

Pregnancy cholestasis – diagnosis

If the patient develops these symptoms – especially persistent itching – she should immediately consult the doctor in charge of the pregnancy. After a medical interview, he will certainly order a wider diagnosis: pregnancy cholestasis gives symptoms similar to many other liver diseases. For the treatment to be effective, it is extremely important to accurately identify the problem.

Therefore, in order to find out whether the patient actually developed cholestasis in pregnancy, a series of laboratory tests should be performed. The so-called liver tests, which determine the concentration of bile acids in the blood (usually labeled M53). If their concentration is over 10 micromol / L, the patient is probably suffering from cholestasis. At a value greater than 40 micromol / L, it is said to be a severe form of gestational cholestasis.

The diagnostics also includes the determination of the concentration of substances such as:

1. asparagine aminotransferase (AspAT, AST, GOT);
2. aminotransferase alanine (ALT, ALAT, AIAT, GPT);
3. gamma-glutamylotranspeptydaza (GGTP);
4. alkaline phosphatase (ALP);
5. bilirubin (BIL).

The results of these tests allow to assess the general condition of the liver and hepatocytes and, on this basis, select the appropriate treatment.

If maternal cholestasis is confirmed in pregnancy, constant monitoring of the condition of the fetus is very important. For this purpose, regular ultrasound examinations are performed, on the basis of which the so-called cerebroplacental ratio (CPR). This is the relationship between the umbilical artery pulsation index and the middle cerebral artery pulsation index. A CTG (cardiotocography) examination is also performed, and the mother is advised to observe the number of movements of the baby.

Also check: Liver disease – how to protect yourself? Preventive examinations and vaccinations

Pregnancy cholestasis – treatment

Treatment of gestational cholestasis is symptomatic. Its aim is to improve the general well-being of a pregnant woman by neutralizing bothersome symptoms – especially skin pruritus – as well as normalizing blood biochemical parameters. The most commonly used drug in this disease is ursodeoxycholic acid, or UDCA (ursodeoxycholic acid). It is a substance that is part of bile in nature and requires supplementation in pregnant cholestasis.

How does UDCA work? First of all, it is able to displace toxic bile acids from the total content of bile, which protects hepatocytes and allows them to function efficiently. It also contributes to the regulation of cholesterol levels. All this significantly improves the clinical condition of most patients: itching is reduced and the results of biochemical tests are much better. The adjuvant in such therapy is usually ornithine aspartate.

Gestational cholestasis can also be treated with other measures if the patient has a poor tolerance to ursodeoxycholic acid – these are usually:

1. cholestyramina;
2. hydroxyzine;
3. dexamethasone;
4. S-adenosyl L-metionina.

In more severe cases of gestational cholestasis, the pregnant woman may need to be hospitalized in the pathology department of pregnancy. It is worth knowing, however, that cholestasis in pregnant women – with prompt treatment and compliance with all doctor’s recommendations in the context of pharmacotherapy, diet and rest – should not leave any permanent changes and consequences for the health of the mother and the child after delivery.

Pregnancy cholestasis – diet

In addition to pharmacological treatment pregnancy cholestasis also requires significant changes in the diet of the patient, which will help regulate the work of the liver. What are the most important recommendations in this regard?

1. Eat 5-6 smaller meals a day approximately every 3 hours. This will allow better and more effective absorption of nutrients from food without overburdening the digestive system.
2. It is best to choose products that are easily digestible and those that do not burden the digestive tract: lean meat, lean dairy products, lean fish. Avoid foods that are heavy to digest and those that contain a lot of fiber, spicy spices or bloating substances. Also cut down on fats.
3. When preparing meals, choose steaming and water cooking, baking in parchment or foil, and stewing without browning. However, exclude fried and raw foods (also vegetables and fruits – it is better to cook them).
4. Give up sweets and sweetened and carbonated drinks.
5. Try to never eat in a hurry – keep your meal in a relaxed atmosphere.

Also read: Five symptoms to tell you if your liver is overloaded

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