Signs and symptoms of cholestasis of pregnancy may include:

• Intense itching
• Dark-colored urine
• Light-colored bowel movements
• Yellow eyes or skin

Often, however, intense itching — particularly on the palms of the hands and the soles of the feet — is the only symptom of cholestasis of pregnancy. The itching may be worse, even intolerable, at night. The itching is most common during the third trimester of pregnancy, but sometimes begins earlier.

When to see a doctor
Contact your health care provider if you develop any signs or symptoms of cholestasis of pregnancy.

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The cause of cholestasis of pregnancy is unknown. However, the condition seems to be triggered by pregnancy hormones.

Bile — a digestive fluid that helps the body break down fats — is produced in the liver and stored in the gallbladder. Pregnancy hormones can affect how well the gallbladder functions. Sometimes, pregnancy hormones slow or even stop the flow of bile. Eventually, this excess bile may enter the bloodstream. This is cholestasis of pregnancy.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Estimates of how many women develop cholestasis of pregnancy vary greatly, from less than 1 percent to more than 15 percent of pregnant women worldwide. For unknown reasons, cholestasis of pregnancy seems to be more common during the colder months in Chile and Scandinavia.

Factors that increase the risk of developing cholestasis of pregnancy include:

• A personal or family history of cholestasis of pregnancy
• A history of liver damage
• Being pregnant with twins
• Having become pregnant by in vitro fertilization

In fact, the risk of cholestasis of pregnancy is highest for women who had the condition during a previous pregnancy. After you've had the condition once, the risk of developing it during a subsequent pregnancy may be as high as 70 percent.

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For mothers, cholestasis of pregnancy may temporarily hinder the absorption of fat-soluble vitamins. Itching usually resolves within a few days of delivery, and subsequent liver problems are uncommon — although cholestasis is likely to recur with other pregnancies.

For babies, the complications of cholestasis of pregnancy can be much more severe. For reasons not well understood, cholestasis of pregnancy increases the risk of preterm birth and meconium — a substance that lines the baby's intestines during pregnancy — in the amniotic fluid. If a baby inhales meconium during delivery, he or she may have trouble breathing. There's also a risk of fetal death late in pregnancy. Because of the potentially severe complications, labor is typically induced early.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

It's a good idea to be well prepared for your appointment with your obstetrician. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, even if you think they're normal pregnancy symptoms.
• Make a list of all medications, vitamins and supplements that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor. Preparing a list of questions will help you make the most of your time with your doctor. List your questions from most important to least important.

For cholestasis of pregnancy, some basic questions to ask your doctor include:

• What is likely causing my symptoms?
• Is my condition mild or severe?
• Is it safe to continue the pregnancy?
• What is the best course of action?
• What kinds of tests do I need?
• What are the alternatives to the primary approach that you're suggesting?
• Are there any restrictions that I need to follow?
• Will it be necessary to induce early labor?
• Do you have any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared, don't hesitate to ask questions during your appointment at any time that you don't understand something.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

To diagnose cholestasis of pregnancy, your health care provider may:

• Ask questions about your medical history
• Perform a physical exam
• Send blood samples for laboratory testing to evaluate how well your liver is working and measure the amount of bile in your blood
• Conduct an ultrasound exam — a test that uses high-frequency sound waves to create images of internal organs — to check your liver for abnormalities

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Treatment for cholestasis of pregnancy has two goals: relieve itching and prevent complications.

Relieving itching
To soothe intense itching, your health care provider may recommend:

• Taking a prescription medication, such as ursodeoxycholic acid, to relieve itching and increase bile flow
• Using anti-itch creams or lotions that contain corticosteroids
• Soaking itchy areas in lukewarm water

Preventing complications
To make sure your condition doesn't lead to complications with your pregnancy, your health care provider may recommend:

• Regular blood tests to monitor how well your liver is working and measure the amount of bile in your blood.
• Periodic ultrasounds and nonstress tests to monitor your baby's well-being. During an ultrasound, high-frequency sound waves are translated into a pattern of light and dark areas — creating an image of your baby on a monitor. During a nonstress test, your health care provider will check how often your baby moves in a certain period of time and how much his or her heart rate increases with movement.
• Early induction of labor. Even if the prenatal tests appear normal, your health care provider may suggest inducing labor early — at or near 38 weeks, or even earlier if cholestasis is severe — which is sometimes the best and only way to prevent complications.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

To relieve intense itching, you might try:

• Applying an anti-itch cream, such as an over-the-counter hydrocortisone cream
• Taking a cool bath with cornstarch added to the water

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Research into effective alternative therapies for treating cholestasis of pregnancy is ongoing and not yet complete, so doctors and other health care providers generally aren't recommending any alternative therapies at this time.

One alternative therapy being studied is S-adenosylmethionine (SAMe), a naturally occurring substance. In two small studies, women in their third trimesters who had cholestasis of pregnancy were given SAMe intravenously — through a vein — and experienced relief from intense itching with no adverse effects to them or their babies. These results suggest that SAMe therapy might be safe for short-term use during the third trimester of pregnancy, but more research is needed before doctors can recommend this therapy.

Other alternative therapies that have been or are being studied include guar gum, activated charcoal, milk thistle and dandelion root, but there's no evidence that these therapies work or are safe for pregnant women to take.

Always check with your doctor or health care provider before trying an alternative therapy, especially if you're pregnant.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.