Intrahepatic cholestasis of pregnancy

Disorder in which bile acids are not completely released by the liver of pregnant women during the second and third trimesters of pregnancy, increasing their concentration in blood and amniotic fluid. It occurs in about 0.2-2% of pregnant women, and although it is not serious for the woman and reverses after childbirth, it increases the risk of severe consequences for the fetus.

The exact causes of this alteration in the digestive function of pregnant women are unknown. Pregnancy hormones seem to be involved, as they can slow down the normal flow of bile. Other factors that may favor intrahepatic cholestasis during pregnancy are:

• History of intrahepatic cholestasis in previous pregnancies. About 60%-70% of women experience this condition recurrently in subsequent pregnancies, reaching up to 90% in severe cases.
• Previous personal history of liver damage or disease, including cholelithiasis or infections from Hepatitis C or B.
• Twin or multiple pregnancies.
• Assisted reproduction techniques.

Intense itching, usually at night without a rash, is the main symptom, mostly in the palms of the hands or soles of the feet, or even in some pregnant women all over the body. However, after childbirth, it usually disappears within a few days.

• Other less common signs and symptoms include:
• Jaundice (yellowing of the skin and whites of the eyes).
• Nausea.
• Loss of appetite.

The consequences for the pregnant mother would be limited to fat malabsorption, which could lead to blood clotting problems, but this is a very rare complication. However, for the developing fetus, there could be more serious complications such as fetal distress, meconium inhalation, premature birth, or intrauterine fetal death.

Currently, the available knowledge about intrahepatic cholestasis of pregnancy does not allow for its early prevention. However, as with other pathologies, following a healthy and balanced diet with plenty of fresh fruits and vegetables can help reduce the risk of cholestasis or its severity, as well as other problems during pregnancy.