Pregnant – What You Need to Know About Cholestasis of Pregnancy

Cholestasis of pregnancy is a liver condition caused by pregnancy. It is characterized by a high level of bile acid. There is no known treatment for the condition except to induce delivery. Symptoms are intense itching especially in the hands and feet and worse at night than during the day. It is dangerous for both mother and baby and should be monitored closely.

I developed this towards the end of my first pregnancy. It started with intense belly itching. The itching spread all over my body and quickly developed into a rash. The rash was what took my doctor a while to diagnose it properly because cholestasis itching doesn’t often have a visible rash. PUPPS, another rash condition that is harmless but annoying, will be visible. She thought I had PUPPS at first but as the itching got worse, she tested me for cholestasis. By this time, I was already scheduled to be induced because my son was at 41 weeks so I didn’t get treatment for cholestasis. I was also told that if you get cholestasis in one pregnancy, you are likely to get it again. I still remember scratching all night and only getting  hours of sleep during the last week. It was a type of misery I dread repeating.

This picture was taken during the last few weeks of my first pregnancy. It’s the only “proof” I have of the discomfort I dealt with from itching. Remember that cholestasis rash is not visible so this is most likely PUPPS. Imagine all these red spots on both legs, my belly, behind each armpit, and on certain spots of my arms. *side note: PUPPS is harmless but extremely miserable and I had both this and cholestasis. It’s a rash that started within my stretch mark lines on my belly and spread all over my body. There’s a correlation to women who carry boys and especially if it’s a bigger baby although there’s no scientific proof as some women carrying girls can get it and of course not all women carrying boys get it.*

Which leads me to pregnancy #2 with twins. I’ve been watching out for symptoms all pregnancy long. The belly itching started around 5 months. It was moderate and started getting worse. Right when I started feeling itching in my hands, feet, armpits, and my FACE, especially getting worse at night, I told my doctor and she ordered bloodwork. Cholestasis takes a longer time to analyze so it took over a week to get my results and they came back positive. My OB ordered some medication for the itching. If I were having a normal pregnancy with a singleton, the treatment would be to get more ultrasounds and non-stress tests as well as bloodwork to monitor the bile acid levels. And ultimately to induce at 37 weeks. Since I’m having twins, the NST and ultrasounds are already the normal course for mo-di twins so this diagnosis does not change my treatment besides additional medicine.

Because of this new diagnosis, I will be delivering at exactly 35 weeks because the combination of mo-di twins (sharing same placenta), gestational diabetes, and cholestasis – most of which may be monitored til 37 weeks on their own – together now make a risky combination. My doctors don’t feel safe going past 35 weeks.

While I’m pretty miserable with the itching, it’s relieving to get diagnosis and some medication. I want to warn everyone that itching on your hands and feet and anywhere else except the belly is not normal. Insist on the test. Cholestasis may not be common, but stillbirth is one of the risks so just be that pushy mom and insist on getting tested if you feel symptoms. Here’s a resource for more information on Cholestasis. I’ve also linked it everywhere in this post where the word “cholestasis” is written. I really want people to learn about.

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