++INTHAHEPATIC CHOLESTASIS
GOT ITCH??? WHAT I MEAN BY THAT IS…
ARE YOU PREGNANT…and…ITCHY, ESPECIALLY ON THE PALMS OF YOUR HANDS AND THE SOLES OF YOUR FEET, ARE YOU IN THE THIRD TRIMESTER OF YOUR PREGNANCY… Then you may have something called ICP…
Have you ever heard of ICP…and not relating to Intracranial Pressure, but specifically, INTRAHEPATIC CHOLESTASIS OF PREGNANCY, which is also known as cholestasis of pregnancy.
So what is Intrahepatic cholestasis of pregnancy or ICP?
First let’s put some understanding to the terms
Intrahepatic cholestasis of Pregnancy.
Intra refers to within, or inside; Hepatic refers to the liver; Chole refers to bile or bile ducts; and Stasis refers to stopping, or a stoppage of flow;
And pregnancy refers to pregnancy!
So cholestasis would describe a condition where bile, which is a fluid that helps in the digestion process, and is released from cells within the liver, is then stored in the gall bladder, becomes obstructed and “builds-up” in the liver, which can then impair the function of the liver.
Bile acids occur as part of a normal breakdown of cholesterol within the liver.
It is thought that as bile acids increase in the liver, they then enter the circulation through the bloodstream and these bile acids then cause the symptoms of itching for the mother, but these bile acids can also affect the baby.
It is a condition of pregnancy that is not quite understood why it occurs, but it is thought to occur due to the elevated estrogen levels associated with Pregnancy. As pregnancy progresses, estrogen levels become increasingly elevated, and it is this elevation of estrogen that results in ICP.
ICP is not very common, but it can be very problematic.
This information is to bring awareness to this disorder of pregnancy, that many people, especially pregnant women, may not be aware of. If ICP is not very common, why even talk about it?
That is because it can be very serious and cause harm to the unborn baby. The more it is known about, the more You know about it, the better. This can occur in someone you know, if not you, maybe a sister, a friend, a cousin, an aunt, a neighbor, or even a stranger. Maybe it is overheard about someone talking about this “ITCHING THEY HAVE”, and them being pregnant, it can be shared and brought to their attention. It may make the difference in saving their baby’s life.
Although ICP is not as well known of as other disorders of pregnancy, such as Preeclampsia, or HELLP Syndrome, it does have its own special day…June 10. June 10 is designated ICP AWARENESS DAY… which is a movement to bring awareness to this disorder of pregnancy.
Statistically, in the United States, ICP affects approximately less than 1% of pregnant women, that’s about 1 to 2 women in 1000. In pregnant women of Latin descent, statistics are greater, whereas approximately 5% of pregnancies are affected (or about 5 out of every 100 women).
ICP is most common during the third trimester, but for some women, itching can begin to occur in the second trimester of pregnancy.
The reason it is thought to occur is due to elevated estrogen levels in Pregnancy. So as pregnancy progresses from trimester to trimester, estrogen levels become increasingly elevated, and this would be the reason for ICP to occur in the third Trimester. It is thought that this elevation of estrogen is one of the reasons ICP occurs.
And for unknown reasons it is more common in the winter months.
SIGNS & SYMPTOMS OF ICP
The most common symptom of ICP is itching, from mild to Severe; and may occur all over your body, but most commonly begins to occur, starting on the palms of the hands and the soles (or bottom) of the feet. The Itching may be increase and be more severe at night, which may make resting and sleeping difficult.
Other signs & symptoms of ICP include:
Right upper stomach area pain, also known as the Right upper quadrant…which is where the liver is located.
Nausea (which a pregnant woman may have due to the pregnancy itself…however normal pregnancy nausea and vomiting should decrease after the first trimester).
Decreased or No appetite
Fatigue / malaise (which fatigue may be normal due to pregnancy)
Jaundiced or Yellow-colored eyes and skin.
Dark colored urine
Pale colored stool or Feces
HOW IS ICP DIAGNOSED?
To diagnose ICP, your doctor will take your complaints of itching into consideration, and order blood tests to be performed to check the level of bile acids in your blood.
The clinical diagnosis of ICP is based on symptoms of itching, and an elevated Total bile acid test of 10 µmol/L or greater.
Bile acid levels should also be monitored closely even after a diagnosis, as levels may be progressive and increase.
Mild cases of ICP have bile acids below 40 µmol/L.
Severe cases of ICP have bile acids above 40 µmol/L.
Bile acids greater than 100, are more probable to result in pregnancy related complications.
Another type of test called a Fractionated bile acid test, which measures specific bile acids, and can be used to diagnose ICP with lower levels, than that of a “regular bile acid test”.
Also LFT’s or Liver Function Tests, specifically Alanine Aminotransferase or ALT which is the most sensitive in ICP, and Aspartate Aminotransferase or AST.
can be used to assist in the diagnosing of ICP, but are not used definitively.
Normal LFT results do not rule out ICP,
But, LFT’s are elevated in approximately 60% of people with ICP
Keep in mind that Symptoms can present 2 to 4 weeks before lab work or blood work shows any elevation in bile acids. Follow up testing may be needed every 2 weeks as long as symptoms persist, to determine the actual level of bile acids
Also, the intensity of itching does not correlate to the severity of ICP or levels of bile acids present in the blood.
Tests can take from 3 to 10 days to result.
One thing to mention, it is recommended that treatment with medications should not be initiated until a definitive answer or diagnosis is made as medications are made to decrease the bile acids in the blood. Which could make bile acid levels look lower than they really are.
If it is You feeling the itching, ADVOCATE FOR YOURSELF…It is not “IN YOUR HEAD”….
IF YOU ARE HAVING S/S, YOU ARE THE ONLY ONE WHO KNOWS HOW YOU FEEL…AND you be instrumental in SAVING YOUR BABY’S LIFE
Risk factors of ICP:
Some factors that may increase the risk of developing cholestasis of pregnancy include:
ICP in a previous pregnancy
A family history of cholestasis of pregnancy
History of liver damage or disease
Being pregnant with multiple babies (for example twins)
Have a special gene mutation of the ABCB11 or ABCB4 genes which then does not let the body produce and process bile normally.
Complications of ICP:
Preterm delivery (before 37 weeks gestation)
RDS or Respiratory distress syndrome, usually due to immature lungs due to preterm delivery, which do not let babies breathe normally
Meconium aspiration. This is when a baby breathes in amniotic fluid mixed with feces, or stool.
Fetal distress. This can occur when a baby does not get enough oxygen when inside the mother.
And ultimately…Stillbirth.
It does seem that the higher the level of bile acids, the higher the risk of a baby dying.
***Some studies show that although some fetal deaths can occur before 37 weeks (@ 34, 35 weeks) most occur @ 37 weeks or greater depending on the level of bile acids with STILL BIRTH rates being as high as 10-15% in mothers with ICP.
That’s why it’s important SO to know about ICP and share information about it, whether it’s this BLOG, or a video about ICP…get the word out.
One last possible complication, and that is Mother specific, is that ICP can cause Postpartum hemorrhage to occur, which is excessive bleeding after delivery.
TREATMENT...How is ICP treated?
ICP symptom management of itching is treated with medications such as Ursodiol, which helps lower the amount of bile acids in your blood, thus decreasing the itching.
Ursodiol is a commonly prescribed medication for ICP, and although it is beneficial for the treatment of a mother’s symptoms, it does not help the baby.
Anti-itch creams or lotions, or antihistamines are not recommended as they may mask symptoms and or may not provide any actual relief from itching.
Lukewarm bath soaks water may help with the symptoms of itching, but do not cure ICP.
Prior to delivery of the baby, a doctor may monitor the mother and the baby more frequently with Non-Stress testing.
The treatment and cure for ICP is delivery of the baby. Depending on a mother’s symptoms, lab values, and a baby’s overall health, early induction or Cesarean section may be done to prevent complications.
As mentioned, the cure for ICP, and ultimately for the mothers itching, is delivery of the baby, which will then decrease estrogen levels.
POSTPARTUM or after delivery, and generally after a few days, the Itching should stop.
Your provider may recommend follow-up liver tests to ensure the liver is functioning properly.
FYI:::::If a women has ICP in a pregnancy, there is a 45-70% chance of it happening again in subsequent pregnancies.
If you learn one thing from this BLOG, let it be this…
DON’T IGNORE THE ITCH!