Cholestasis in pregnancy: a serious problem or a normal condition?

During pregnancy, a woman's body becomes more sensitive and susceptible to various pathological processes. One such condition is intrahepatic cholestasis of pregnancy.

Intrahepatic cholestasis of pregnancy – is a benign disease of the liver, which is manifested by itching of the skin and jaundice, while the primary lesion – rash – no. Liver enzymes are activated and the concentration of bile acids in the blood increases.

Cholestasis of pregnancy. Process Development Mechanisms

The pathogenesis of cholestasis of pregnancy is not fully understood. But such a theory is supposed that an increased concentration of endogenous sex hormones, which is characteristic of the period of pregnancy, has a stimulating effect on the processes of bile formation.

At the same time, an inhibitory effect is exerted on bile secretion. This promotes the reabsorption of bilirubin into the blood. This syndrome is quite common and occurs in 80% of women in the second half of pregnancy.

The relationship between pregnancy and intrahepatic cholestasis of pregnant women is proved by the rise in estrogen levels, which correlates with the development of pruritus in them. A genetic defect in the metabolism of sex hormones, which manifests itself only during pregnancy, plays a certain role. In most women, cholestasis appears on the background of long-term use of hormonal contraceptives.

At the moment, defects in liver transport systems that are inherited (deficiency of the MDR-3 gene) have been identified. They lead to the development of intrahepatic cholestasis of pregnant women.

Skin itch – the main complaint of pregnant women with cholestasis

The main complaint of the woman is intense itching of the skin, which intensifies at night. The cause of skin itching is an increase in the concentration of bile acids in the blood by 10-100 times. Itching of the skin is present on the palms, feet and extremities. There is itching on the face and neck. As a rule, jaundice appears a month after the onset of skin itching.

This jaundice is not severe, accompanied by dark urine and/or discoloration of the stool. The general condition of women does not particularly suffer.  In the biochemical analysis of blood, the level of alanine and aspartic transaminases, alkaline phosphatase increases. Only some women have an increase in bilirubin due to the direct fraction.

The indicators of blood coagulability often decrease – II, IV, IX.  There may also be signs of a deficiency of fat-soluble vitamins (A, D, E, K) with pronounced cholestasis. The main feature of cholestasis of pregnancy is the increase in symptoms by the period of childbirth and their complete disappearance after childbirth.

Do I need to treat intrahepatic cholestasis of pregnancy?

In most cases, uncomplicated intrahepatic cholestasis of pregnancy is not life threatening. However, it is not worth considering cholestasis of pregnant women as a pathology requiring only observation.

In 60-70% of cases with repeated pregnancies, cholestasis recurs, and with a protracted course, it can turn into primary biliary cirrhosis, steatohepatosis and cholelithiasis. It is also important to be aware of the worse prognosis for the fetus.

 Bile acids in the blood penetrate the feto-placental barrier and cause intoxication in the fetus. This can provoke hypoxia and fetal hypotrophy. Starting from the 35th week of pregnancy, the risk of fetal loss increases in proportion to the increase in the amount of hormones.

In addition, it has been established that maternal bile acids have a toxic effect on the child's liver and inhibit the development of his adrenal glands.

Cholestasis of pregnancy can lead to preterm labor and postpartum hemorrhage.

How to treat intrahepatic cholestasis of pregnancy?

In the treatment of cholestasis of pregnancy, it is important to distinguish between intrahepatic and subhepatic cholestasis.

When a risk to the fetus and mother is identified, ursodeoxycholic acid preparations are used to treat cholestasis of pregnancy. It is an integral part of the bile acid pool, a natural and non-toxic hydrophilic bile acid.

Its main action is associated with cytoprotective and anti-cholestatic effects. UDCA displaces more toxic bile acids. Previously used cholestyramine relieved skin itching but did not prevent fetal complications.

Therefore, at the first suspicion of cholestasis of pregnancy, a woman should immediately consult a doctor.