How to manage Cholestasis- itching in Pregnancy

How to manage Cholestasis – a condition that usually occurs during late pregnancy in which the pregnancy hormones obstruct the flow of bile juices in the gallbladder causing the bile salts to accumulate in the liver and later be released in the bloodstream.

Each pregnancy is unique and it comes with its own fair share of mood swings, nausea, health and emotional challenges. So was mine. The first trimester was a cool breeze except for occasional throw-ups in the evening. Oh yes! Luckily I never had morning sickness and my share of vomits came in the evenings.

This way I could attend my office easily and working hours never bothered me much. The second trimester was the most beautiful. I had started gaining weight, and my skin and hair too grew healthy. I didn’t experience any cravings also and I regret it because I could not bother my husband with those midnight chocolates or ice creams or those khatte golgappe. I was eating fresh, healthy, homemade food with occasional treats.

Time kept rolling and soon it was the third trimester and in the eighth month of my pregnancy something cumbersome had started. To be precise it was the onset of the 32nd week. I had come to my mum's place a few weeks back with the intention of delivery being done in Delhi. The cold winds had already started to bother my usually dry skin.

After a week of reaching home, suddenly this itchy dry skin condition worsened. A frustrating phase of becoming a Monkey Mom had set in. Yes, I could be found scratching myself like a monkey, all the time. It started with an itch on my palms and soles and then slowly it was all over my body. I used to scratch my limbs, tummy, and back 24*7. I could not sleep at night, it was so uncomfortable. I resorted to using back brushes, and combs to soothe it but it helped only for a while.

Everybody told me that itching is normal in pregnancy and I kept exploring all sorts of moisturizers, and body butter to soothe the itch and shrugging it off to be a usual dryness issue. Even after trying so many remedies to treat the itching, it kept increasing and sometimes I felt my internal organs to be itching too.

After 10 days of a futile fight with this itch, I decided to consult my Gynae about it. Luckily, she took my itching issue seriously and advised me to go for a round of LFT (Liver Function Test). She counselled me and my husband about this condition and the possible course of action henceforth. She told us that I might be suffering from Cholestasis.

How to manage Cholestasis

What is Cholestasis

Cholestasis is a condition that usually occurs during late pregnancy in which the pregnancy hormones obstruct the flow of bile juices in the gallbladder causing the bile salts to accumulate in the liver and later be released in the bloodstream. It is also termed Intrahepatic Cholestasis of pregnancy (IHCP) or Obstetric Cholestasis (OC) and it occurs only during pregnancy. It was a cause of concern because it might lead to a stillborn baby or pre-mature one or a baby could gulp the meconium if the condition is left unattended. Also, there is no medication to treat this condition.

Listening to such horrifying explanations, my hale and hearty pregnancy journey turned into a fearful, anxious one. The results of my tests came and my liver parameters were not satisfactory at all. Negativity, fear and anxiety hovered in my mind but my Gynae took care of them. With continuous monitoring of fetal health through LFTs, KFTs, CTGs, sonographies and taking a healthy diet, she helped me steer through this situation.

Cause, Symptom of Cholestasis

The causes of Cholestasis or Intra Hepatic Cholestasis are still not clear and are believed to be linked with either your genetic makeup or the hormonal imbalance. There is no definite way to prevent IHCP from occurring but certainly, early diagnosis and treatment can help bring it under control and deliver safely.

Here are a few early symptoms that you should watch out for –

1. It usually manifests in the last trimester of Pregnancy

2. Itching: It is the primary symptom and often starts with the palms and soles of feet but may spread to the whole body. The itching because of cholestasis will be worse at night though there may be no rash.

3. Jaundice: This is a rare symptom of OC. Your eyes and skin might turn yellow which is an indication of jaundice.

4. Dark urine: Urine passed by a pregnant woman suffering from cholestasis will be dark in colour

5. Light-coloured stools: Stools will be lighter in colour than normal/regular stools.

6. Tiredness: Cholestasis can leave you feeling drained out of energy.

7. Loss of appetite: Cholestasis affects hunger and eating schedule.

Seeing any of the signs above, you should immediately consult your doctor because there might be complications of cholestasis for both the mother and the baby.

As explained by my Gynae, the complications can be summed up as –

Complications for Mother

The effect of cholestasis on the mother is usually non-life threatening. The condition can temporarily affect how the body absorbs fat-soluble vitamins though this will hardly affect her nutrition. The itching usually resolves itself within a few days after delivery and the condition does not cause any long-term effects on the liver.

Complications for the unborn baby

Obstetric cholestasis can cause complications for the baby to be born. The foetus has a liquid known as meconium that could leak into the amniotic fluid. If the foetus then inhales the meconium during delivery, she will have complications with her breathing. The condition could also cause foetal demise in late pregnancy. Due to the high chances of stillbirth due to obstetric cholestasis, your doctor might want to induce labour by the 37th week.

How to Deal with Cholestasis

With so much said about Cholestasis, I am sure you want to know how to manage this complication. Let me share things which helped me sail through this demon called Obstetric Cholestasis and helped me to deliver a full-term healthy 3.2 kg baby.

Foods to Avoid

1. Processed food in all forms. Means NO JUNK AT ALL.

2. Artificial sugar.

3. Fatty items like full cream dairy products, excess of ghee, cheese etc

4. Spicy food.

5. Aerated drinks are high in sugar.

Foods to Embrace

1. Whole fruits and vegetables.

2. Carrots, beets and leafy greens are a must.

3. Proteinaceous legumes- kidney beans, chickpeas, lentils.

4. Healthy fats from dry fruits, flaxseeds, pumpkin seeds, walnuts etc.

5. Whole grains like millet, buckwheat, and amaranth.

Other Useful Tips:

1. Soothe your itch by applying coconut oil mixed with pure camphor. Alternatively, you can try some good body butter also.

2. If possible, use cold baths or ice packs to comfort your itchy areas.

3. Wear comfortable, pure cotton garments.

4. Drink 10-12 glasses of water to flush out toxins.

5. Drink half or whole lemon squeezed in warm water on an empty stomach to detoxify the liver.

6. I also used to have a Liver tonic as advised by my Doctor. (Please consult your doctor before taking any medication)

This article is an attempt to inform you about the possible demon behind your itching which you might ignore as just another dryness issue. It needs medical intervention to be warded off, so please consult your doctor before you make any dietary changes yourself. I hope this article helps you to identify the real reason behind itching and prepares you to rule out any unfortunate possibilities in your pregnancy journey.