In order to be able to enjoy this period of bliss, you must prepare yourself for the unusual changes your body might experience – you’ve heard it all from your pregnant friends, how they’ve had crazy food cravings, some had their hair boomingly voluminous, others had hair loss, some had acne, others were sleepy throughout the 9-mo. of awaiting labor. Most of these come and go and don’t indicate that there’s anything wrong with you or your baby – however, we’ll talk here about one symptom that’s not to be ignored and can easily be mistaken for a minor wacky side effect of pregnancy.
It starts as itchiness in your extremities – hands and feet, without any particular cause to it (i.e. there’s no rash, redness, dry skin or any common reason you’d blame for it). Before you know it, it becomes quite severe and you find yourself scratching even in your sleep. Don’t wait for it to reach this stage and at the first sign, do speak to your GP. It is possible that you’re having a condition called Intrahephatic Cholestasis of pregnancy (ICP, also known as obstetric cholestasis) – a liver condition that can happen to anyone, regardless of their age, race or overall health before and during pregnancy.
It can start as early as in the end of the first trimester, but in most cases it appears towards the end of the second and during the third trimester.
This condition affects the normal flow of bile. Bile acids are chemicals in the bile of the liver that help with digestion, and with normal liver function – they get expelled from our body with wee. With ICP the bile flow begins to slow down, causing the bile acids to build up in the blood – and that’s what’s making this condition so unbearable.
Severe itching on palms, hands, feet, chest…well, almost everywhere – and it’s particularly bad at night, making you dread when the sun goes down. ICP can also be blamed for dark urine, fatigue, pale stool, right upper quadrant pain, nausea or even jaundice.
MED TEST TO DETERMINE IF YOU’VE GOT ICP
Currently the most sensitive test available to detect ICP is a blood test to measure the level of bile acids. Bile acids over 10 µmol/L indicate ICP. Be aware! Some doctors who are not specialists may not be familiar with the bile acid test, so it may be necessary to request it by name. These tests are not commonly done, and it may take from 5-10 days to receive results of the bile acid test since it is processed in only a few specialty labs and must be sent out.
Many doctors will not diagnose without elevated bile acids, but some may suspect ICP based on elevated liver functions alone (approximately 60% of women with ICP have elevated liver enzymes, ALT/AST). Test results for liver functions return within hours instead of days, which can provide your doctor with information more promptly.
WHAT ARE THE RISKS?
ICP poses several risks that are of great concern. Although generally harmless for the health of the mother, it is associated with an increased risk of preterm labor, fetal distress, respiratory distress, maternal hemorrhaging, meconium passage in utero and in worst cases (although very rare), it can be blamed for stillbirth (intrauterine fetal demise).
WHAT CAUSES IT?
The exact causes for ICP and its manifestation, are yet to be determined; researchers are currently investigating genetic, hormonal and environmental factors. Statistically, ICP is more common in twin/multiple pregnancies and pregnancies where the fetus is considered of large size. In these cases, ICP can be triggered by your baby’s mechanical pressure on your liver, causing its function to decrease and bile acids to build up in bloodstream.
HOW IT’S TREATED?
Most commonly, you will be prescribed a medication containing Ursodeoxycholic Acid (i.e. URSO), which are proven to have the best effect in improvement of clinical symptoms and liver parameters.
Other than that, you can always add your own contribution to the health of your liver and to ease yourself from the itchiness:
- Consume healthy fats from nut sources and healthy oils such as extra virgin olive oil and seed oils;
- Avoid processed meals, large amounts of refined sugar, soy, white flour, and ofc unhealthy snacks, such as crisps, crackers etc.;
- Consume whey, whole fruits and veggies, leafy greens, use preferably organic sources for protein coming from meat;
- Drink plenty of fluids and wear loose clothes made of pleasant, natural fibers;
- Find a menthol- or aloe-based ointment, it can serve as a temporary relief when applied;
- Showering with luke warm water and covering your hands and feet with cool towels can be of some help too.
MANY GPs DON’T EVEN KNOW ABOUT IT!
ICP is still considered rare – under 2% of pregnant women in the USA experience this condition every year. This is why some doctors may not have a working knowledge of the condition or may even have misconceptions regarding it. In the past, ICP was considered a benign condition, meaning that it does not pose a risk to the baby, and some may still regard it as such. So be prepared to face skepticism or potential resistance of your doctor to hear what you have to say, especially if you state that you’ve read about it online. If he or she is unwilling to run the test for bile acids then it may be time to seek a second opinion, as your baby’s health is in question here!
On the other hand, a well-informed doctor will monitor your condition closely and measure both your bile acid level and the level of your liver enzymes regularly. It is not uncommon, in cases of high bile acids, for the doctor to even suggest inducing early labor, if there are conditions for it, so that your baby is not exposed to bile acids from your bloodstream for way too long.
GET SOME SUPPORT… WE KNOW IT CAN BE HARD.
Being so rare, it’s a high probability you won’t encounter other stories regarding ICP struggle amongst your friends and relatives. That’s why we’ve got the almighty Internet, where thankfully there are many insightful sources about the condition and wonderful groups of support. It’s an unpleasant condition, difficult to go through, and can definitely ruin the pleasure of being pregnant. Strangely, many women said that the itch was less bearable for them than the sensation of pain. Remember – no matter what anyone tells you, how you’re exaggerating and it’s “just an itch” – you’re not. Having day after day, night after night of constant itchiness can drive you darn nuts. This is a disease, it should be treated like one, and remember that in most cases it will go without any consequences for your baby or you – as long as it’s addressed timely.