The difference between an itchy pregnant belly and obstetric cholestasis

It’s perfectly normal and common for pregnant women to experience some sort of itching as their bellies—and other body parts—expand, but not all pregnancy itchiness is created equal.

I remember the first time I said to my husband, “I feel itchy.” It was a weeknight, and I felt a strange and distinct urge to scratch at the palms of my hands for most of the day. The same sensation returned the following morning and, within days, had spread to my legs and feet.

I made an appointment with my OB/GYN. She ordered blood tests and, within days, we had a diagnosis: I was suffering from obstetric cholestasis. I was seven months pregnant and had weeks of constant scratching ahead.

Sleep was hard to come by. I found myself taking cold showers several times a day and using cream to cool off the itchiness. It felt like I was being bitten by a swarm of mosquitoes in the dead of summer.

What is obstetric cholestasis?

Obstetric cholestasis is a pregnancy-specific liver disorder, explains Nancy Kent, associate head of maternal fetal medicine at BC Women’s Hospital and Health Centre. This rare condition occurs in only 0.1 to two percent of pregnancies worldwide. It typically develops later in pregnancy, but in rare cases, it can present as early as the first trimester. In genetically predisposed women, the increase in hormones during pregnancy triggers a problem where bile acid transfers from the liver to the blood.

The problem is likely exacerbated because the liver is working extra hard to serve two people. A liver that isn’t functioning as effectively allows for a build-up of bile, which is then secreted into the bloodstream, causing itchy hands and feet. In some cases, the irritation is present all over the body, as it was in my case.

What are the risks of obstetric cholestasis to mother and baby?

While the biggest issue for moms suffering from obstetric cholestasis is itching, there are other risks for babies, such as higher rates of stillbirth and preterm birth, fetal heart rate complications during labour, and lung problems caused by increased meconium in the amniotic fluid.

“The risk [of] increases with higher bile acid levels,” explains Greg Athaide, an OB/GYN at Lakeridge Health in Oshawa, Ont. He says that experts think this happens because bile acids accumulate in the placenta, amniotic fluid and fetus. Because stillbirths often happen around the 37- to 39-week mark, women with obstetric cholestasis are typically induced around 37 weeks.

How is a woman diagnosed with obstetric cholestasis?

The only way to conclusively diagnose obstetric cholestasis is by performing a blood test. “The test looks at levels of bile acids in the bloodstream,” says Kent. “For an official diagnosis, the bile acid must measure greater than 10 micromoles per litre.”

“We often repeat the blood testing to see how the levels of bile acids are behaving,” adds Athaide. “Depending on the results, further tests to monitor the pregnancy may be arranged.”

Who is at risk of getting obstetric cholestasis?

Obstetric cholestasis appears to run in families, according to Kent. “It is also more common in women with multiple pregnancies [twins], in vitro fertilization pregnancies or underlying liver disease, as well as women of Chilean descent and Indigenous women in North America,” she says.

Women who develop obstetric cholestasis are also more at risk of getting it again. Recent research suggests a 90 percent chance of the condition reoccurring in subsequent pregnancies, while more conservative numbers peg that figure at between 30 and 50 percent.

How is obstetric cholestasis treated?

A pregnant woman with obstetric cholestasis will need to be monitored more closely. Depending on her symptoms and the level of bile acids in her system, the condition and itching can be treated with a medication called ursodeoxycholic acid (or Urso, for short), which was still not widely prescribed when I was pregnant five years ago. Kent says it can be taken up to three times a day, usually starting at 250 milligrams per dose. “There is good evidence that Urso can take away the itch and lower the abnormal liver function tests and bile acid levels in the blood,” she says.

The medication is taken until the baby is delivered and then stopped. Doctors say that the woman’s liver function will likely return to normal soon after delivery, and that’s when the itchiness dissipates, too.

I was induced at 38 weeks. I was wheeled into the operating room for an emergency C-section because doctors were concerned about my son’s fetal heart rate—one of the potential complications of obstetric cholestasis. But I gave birth to a healthy baby boy who is now five. And, like my doctor promised, the severe itching went away almost immediately.

Read more: Third trimester pregnancy aches and pains—and how to treat them
This is why you shouldn't take too many antacids during pregnancy