Rise in Intrahepatic Cholestasis of Pregnancy cases in women above 35: Doctors

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The rate at which liver diseases are increasing in pregnant women is alarmingly high, and becoming a matter of concern. Intrahepatic cholestasis is seen in a majority of pregnant women.

Remember, monitoring of liver functions, appropriate diet, treatment of obstructive cholestasis, and monitoring of foetal well-being is important as it makes pregnant women high-risk mothers. It is the need of the hour for pregnant women to go for regular health check-ups, follow treatment plans, and take medication prescribed by the doctor only.

Pregnancy brings about various changes in a woman's body, among them being significant shifts in liver function. Many liver diseases can be detected during this period and some may be mild and others potentially life-threatening.

There are a large number of women who may have Intrahepatic Cholestasis of Pregnancy (ICP). "Cholestasis is seen in 3 per cent of the population. There is a sharp rise of 20 per cent in the advanced maternal age group or addicts or those having prior liver diseases. So, mothers above 35 are known to mainly suffer from this condition due to underlying health conditions. This condition is seen in all age groups. Usually, pregnant mothers can be symptom-free, and in most, liver derangements are detected accidentally during the screening of liver functions that are planned during pregnancy. However, when cholestasis progresses, the mothers may face itching all over the body especially in the palms and the feet to begin with. They may also have a rash all over the body leading to itching, right-sided upper abdominal pain, and in advanced and untreated cases, there will be obstructing jaundice and yellowness of the face," says Dr Swati Gaikwad, consultant obstetrician and gynaecologist, Motherhood Hospital, Pune

Gaikwad adds, "This condition is also seen in some women with prior medical history or liver illness or pancreas and bile duct, advanced maternal age, late marriages, late conception, and fertility issues. The cause of this condition mainly in pregnancy is the progesterone hormone (normally produced during pregnancy). It makes the bile secretion a little thicker making liver disease common in women. Prior liver diseases and bile duct diseases, gallstone issues, alcohol, addiction, medication, and pancreatic problems are already present in some mothers. So, some prior diseases may worsen the behaviour of this condition or liver problems in pregnancy."

Adding to this Dr Nitin Gupte, gynaecologist, Apollo Spectra Pune, says, "Pregnancy-related liver condition known as Intrahepatic Cholestasis of Pregnancy (ICP) arises due to a mix of genetic and hormonal factors, leading to symptoms that can impact the health of both the mother and the baby. Expectant mothers should be vigilant about recognising the signs and potential dangers that are linked to this condition. Treatment primarily revolves around symptom management and minimising complications, often involving medication to decrease bile acid levels or expedited delivery in severe instances."

Gaikwad says, "Screening for liver functions in pregnancy at least three times (beginning, seven months and the ninth month) is imperative even if the mother is symptom-free to identify any derangement after which the woman will be put on proper monitoring and preventive medicine. Cholestasis is treated in two different ways. The milder cholestasis will receive Ursodiol to fix that bile chemical and make it easier for the bile to excrete from the body as it is the waste product that needs to be taken out of the blood. Liver enzyme support and itching support medication, skin applications can be used to reduce skin itchiness, vitamins (D, K), and even calcium may help in liver blood clotting."

If left untreated, pregnant mothers will not have any complications but the baby will suffer from premature delivery, c-sections, respiratory distress syndrome, foetal distress, and unexplained intrauterine deaths. Thus, mothers having this condition are delivered around 37 weeks and are not allowed to reach 40 weeks. C-section rates in obstructive Cholestasis are on the higher side.

Disclaimer: This information does not replace professional medical advice. Consult a qualified specialist or your physician for personalised guidance.