During pregnancy, huge changes occur in the female body at the hormonal level. Often these processes provoke the onset or worsening of cholestasis in pregnant women. How dangerous is intrahepatic cholestasis of pregnancy and how to deal with the disease?
Essence of the Disease
The development of intrahepatic cholestasis of pregnancy is usually caused by an increase in the content of estrogens (female sex hormones) during pregnancy. The hereditary factor also plays a very important role in the development of the disease. It is based on genetically determined sensitivity to estrogens. And since by the 40 weeks of pregnancy the estrogen content increases approximately 1000 times, pregnancy itself is the factor provoking the disease.
Intrahepatic cholestasis of pregnancy affects primarily the liver, as it is the most sensitive to pregnancy hormones organ. One of the functions of the liver is the production of bile, which is then excreted through the bile ducts into the intestines and participates in the digestive processes. With the development of intrahepatic cholestasis of pregnancy, this function is disrupted, the outflow of bile to the intestine decreases, and bile salts begin to accumulate in the blood.
Varieties of Cholestasis
Cholestasis is a disease of the liver that occurs when the bile secretion either stops or decreases. The disease also occurs due to release of the bile into the duodenum. Bile is produced by the liver and, getting into the intestines, promotes digestion. Sometimes this mechanism fails.
This ailment can occur not only because of hormonal changes in women. Diseases of the genitourinary system, such as adenoma, tumors, inflammations, urolithiasis, stimulate the development of cholestasis. Genetic predisposition to liver disease also serves as a sign.
There are two main types of cholestasis:
Intrahepatic cholestasis of pregnancy, i.e., the processes occur in the liver at the cellular level. Often it is a consequence of hepatitis, cirrhosis, the liver damage because of alcohol, hormonal changes or reaction to medications. Depending on the symptomatology, doctors distinguish the following forms of cholestasis: functional – decrease in the level of bile in the channels, lowering of bile acids; morphological – accumulation of bile components in liver ducts and cells (hepatocytes); clinical – determining the delay of components in the blood.
Extrahepatic, i.e. clogging of the biliary tracts outside the liver.
During the hormonal reconstruction of the body, the liver in some women weakens. Due to this intrahepatic cholestasis of pregnant women may occur. Hypersensitivity to estrogen (female sex hormones) affects the development of the disease, which is explained genetically.
By the end of pregnancy, the level of estrogen in a future mother increases many times. This is the main cause of cholestasis in pregnant women, since estrogens lower the formation and secretion of bile.
Signs and Diagnosis of Intrahepatic Cholestasis of Pregnancy
Intrahepatic cholestasis of pregnancy is a liver disease in which the bile flow in the bile ducts is disturbed and the concentration of bile acids in the blood increases. It is believed that cholestasis during pregnancy develops due to the action of pregnancy hormones and heredity. The risk of developing the disease is higher if there were cases of intrahepatic cholestasis of pregnancy in the woman’s family, if she had previously experienced liver disease, with multiple pregnancies, or if intrahepatic cholestasis occurred in previous pregnancies.
Cholestasis is accompanied by the following symptoms:
- dry skin, itchy limbs (palms, feet) or whole body;
- violation of sleep, as a result – fatigue, poor health, stress;
- jaundice of a mild form of manifestation can be observed, yellowness of the eyes;
- with the advanced stage of the disease, the color of urine darkens, and the stool, on the contrary, can become lighter.
Because of the characteristic itching, redness of cholestasis is sometimes confused with an allergic reaction or skin diseases.
The big problem is that it is not possible to diagnose the disease at once, but only after 2-3 weeks after the appearance of the first symptomatology. To do this, the doctor appoints to pass a clinical blood analysis and biochemistry blood test or to determine the amount of bile acids, components – bilirubin and transaminase. The results of the tests make it possible to judge about the development of cholestasis in a pregnant woman.
In some cases, the woman will have to make the ultrasound of the liver. In the presence of intrahepatic cholestasis of pregnancy, the size of the liver increases, as well as the volume of the gallbladder.
Risk Group Include Women:
- with multiple pregnancies;
- with a genetic predisposition to the disease (if there were cases of cholestasis in the family);
- who previously had a disorder of the liver and the gall bladder.
Diet for Intrahepatic Cholestasis of Pregnancy
- Eat often but in small quantities. Drink a lot of liquids.
- Eat more fresh vegetables and fruits, vegetable products rich in fiber, vitamin C and calcium: spinach, lettuce, broccoli, green peas, low-fat dairy products, fish, oranges, bread.
- Reduce the number of animal fats (fatty meat, dairy products, butter), avoid fatty fried foods, mayonnaise, sauces.
- Control the amounts of easily consumed vegetable oil or margarine (fats are necessary for the development of the baby).
- Drink transparent juices, berries and fruits decoctions, and herbal teas. Freshly squeezed grapefruit juice and rose hip tea are especially useful.
- Avoid eggs, cauliflower, Brussels sprouts, melon, radishes, dried peas, lentils, beans, olives, pickled products, avocados.
- Do not drink coffee, green tea, bile-expelling teas.
Itching and caused by itching discomfort can be reduced in the following ways:
- Compresses with ice for the palms and feet (because of the cold, the blood flow slows down and the itching calms down as well).
- Sleep in a cool room. Control air humidification in the room.
- Moistening and soothing the skin. You can try compresses from oat flakes and chamomile. Use a moisturizing lotion.
Developmental Dangers and Prevention of Intrahepatic Cholestasis of Pregnancy
For the future mother, such a disease is not risky. As a rule, all the symptoms disappear in a few days after labor, when the work of the liver and gall bladder is normalized. At the same time, there is a high probability of recurrence of the disease in subsequent pregnancies. The most terrible consequence after the birth of a child is heavy bleeding.
Intrahepatic cholestasis of pregnancy has dangerous consequences for the child. Since before birth the mother’s liver is responsible for the secretion of bile in the fetus, there may be violations of the development of the liver in the baby after childbirth. There is also a risk of premature birth. With advanced stages of cholestasis, the disease can provoke intrauterine fetal death after 38 weeks.
Therefore, when the first signs of cholestasis appear, the pregnant woman should immediately consult a doctor.
To prevent liver disease during pregnancy, it is recommended:
- to lead a healthy, active lifestyle, to maintain proper nutrition;
- it is important to observe the water balance, i.e., abundant drinking, as dehydration can also cause stagnation of bile;
- to go in for sport under the special program made for pregnant women;
- women who experienced genetic abnormalities in liver function should be especially careful and constantly observed by a specialist;
- to pass the general analyzes appointed by the doctor in time.
Be sure to consult a specialist if you notice the first symptoms of liver disease.