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Gravidic cholestasis: when to worry?
Gravidial cholestasis is a disease that only affects pregnant women in the third trimester of pregnancy. It is mainly characterised by itching. A dysfunction in the liver is responsible. Are you wondering when you should be concerned, especially if you experience itching, pimples, a rash or diarrhoea during pregnancy? We answer all your questions about gestational cholestasis.
What is gestational cholestasis?
Gravidic cholestasis is a disease that only occurs in pregnant women. It is characterised by itching and an increase in the concentration of bile acid in the blood on an empty stomach.
As soon as the pregnancy stops, the disease disappears without any treatment. However, it is necessary to start treatment as soon as possible before the birth because this disease can be dangerous for the foetus.
How common is gestational cholestasis in pregnant women?
Gestational cholestasis occurs more or less frequently in different countries of the world. For example, in South America, up to 27% of pregnant women can contract it. In Europe and France, however, it occurs much less frequently. It affects less than 1% of French pregnant women.
In the absence of characteristic signs, there is therefore no reason to worry during a pregnancy: the pregnant woman has little risk of contracting this disease, or of not realising that she has it.
What are the symptoms of gestational cholestasis?
The only criterion of gestational cholestasis that is easily detected by the pregnant woman is pruritus: itching of the whole body is possible. However, the skin does not change in appearance. There is no associated jaundice, rash or pimples that appear. The only skin lesions that may occur are those related to intense scratching caused by pruritus.
The other characteristic symptom is seen on a blood test. In this case, the liver balance is abnormal: the transaminases are too high in the blood.
Other rarer symptoms may be related to gestational cholestasis, but this is not systematic:
- threat of premature delivery;
- acute fetal distress;
- unexplained in utero death.
What are the consequences of gestational cholestasis?
The consequences of untreated gestational cholestasis are more dangerous for the fetus than for the mother.
For the mother
The main risk for the mother is directly related to pruritus. If it is very intense, it can lead to skin lesions due to scratching. It can also cause insomnia. Sometimes the pregnancy is terminated because of the intensity of the pruritus.
However, gestational cholestasis disappears after the birth of the child without leaving any after-effects. Women who have had gestational cholestasis are slightly more at risk of developing certain liver diseases: biliary lithiasis, hepatitis C, non-alcoholic cirrhosis, non-alcoholic pancreatitis and biliary diseases.
For the fetus
The main risk for the fetus of a mother with gestational cholestasis is premature birth. Between 12 and 60% of babies are born before 37 weeks' gestation if their mother has gestational cholestasis.
There is also a slightly higher risk of the foetus dying in utero. However, this is very rare, especially if the gestational cholestasis is treated effectively and quickly.
When should you be concerned about gestational cholestasis?
If you have itching that appears during the third trimester of pregnancy, consult the health professional who is monitoring your pregnancy as soon as possible. The same applies if they appear at the end of the second trimester.
The health professional will be able to prescribe additional tests if he or she considers it necessary. There is no need to be overly concerned because cholestasis is well known. The health professionals who follow you know about this condition, how to diagnose it and how to treat it. They will also know how to refer you to other professionals or to hospital if necessary.
The appearance of red patches or pimples that are not associated with itching should not lead you to think that you have gestational cholestasis. Simply consult your GP who will also be able to refer you.
What causes gestational cholestasis?
Gravidic cholestasis is partly genetic in origin. It is the hormonal changes that take place during pregnancy that are responsible. This is why it only occurs in the last trimester of pregnancy, when the concentrations of certain hormones are highest.
What is the treatment for gestational cholestasis?
The treatment is based on 3 axes:
- taking a drug, ursodeoxycholic acid;
- monitoring the health of the mother and the foetus, possibly with hospitalisation
- the possible induction of labour.
Monitoring is mainly done by taking blood samples once or twice a week. This is why hospitalisation is far from being systematic.
Is there a natural treatment for gestational cholestasis?
There is no natural treatment such as a herbal, essential oil or herbal tea that has been proven to be effective. Gravidic cholestasis can be serious for the foetus. It is therefore important to :
- to be followed by a health professional used to treating pregnant women;
- to discuss with your health professional any treatment or substance you are taking, even natural ones, as there are possible interactions that can be harmful and reduce the effectiveness of the main treatment.
Is it necessary to adapt one's diet in the case of gravidic cholestasis?
Although cholestasis affects the liver, diet has no impact on it. It is therefore not necessary to adopt a special diet or to reduce food intake. There are no foods that can be eaten to reduce the intensity of cholestasis.
In which trimester of pregnancy does cholestasis occur?
Cholestasis occurs in the majority of cases in the third trimester. Exceptionally, it can occur in the second trimester, at the end of it. But never in the first trimester.
Itching that occurs in the first trimester of pregnancy should therefore be interpreted as an allergy or another pathology.
Does one have gestational cholestasis in every pregnancy?
As gestational cholestasis is largely genetic, it does occur quite often in subsequent pregnancies. 42% of women who have had gestational cholestasis will also suffer from it in a subsequent pregnancy.
You now know more about this disease in the third trimester of pregnancy. If you experience itching during the third trimester of pregnancy, make an appointment with your pregnancy consultant as soon as possible.