Itchy hands and feet during pregnancy can sometimes be a sign of cholestasis, a rare liver condition that most often develops in the third trimester. While the condition is treatable, it can increase the risk of complications for your baby, making early diagnosis, monitoring, and treatment especially important.
Here's what you need to know about cholestasis, from symptoms to treatment.
What is cholestasis?
Cholestasis is a liver disorder that most often occurs late in pregnancy, typically during the third trimester. It's also known as intrahepatic cholestasis (ICP) or obstetric cholestasis.
A quick biology lesson: Bile, which is produced by the liver and stored in the gallbladder, helps your body break down fats into fatty acids that your intestines can absorb. Cholestasis slows the normal flow of bile from the liver to the intestines, resulting in a buildup of bile acids in the liver — which in turn spills into the bloodstream, leading to intense itching.
Cholestasis occurs in just one to two pregnancies in 1,000, though rates vary around the world for unknown reasons. It's more common in people of Hispanic and Scandinavian backgrounds.[1]
The condition can cause serious complications for your newborn, which is why it's important to recognize the symptoms and talk to your practitioner if you think you might have it. Fortunately, early diagnosis and active management can help ensure you and your baby have a safe and healthy pregnancy and delivery.
What causes cholestasis in pregnancy?
Possible causes of cholestasis include:[2]
- Hormonal changes: Increased estrogen levels during pregnancy, especially in the third trimester, can slow the flow of bile.
- Genetic disposition: If an immediate family member has had cholestasis during pregnancy, be sure to tell your doctor.
- Gallstones: These small, stone-like deposits in the gallbladder can develop because of bile imbalances. Pregnant women are also at greater risk of gallstones due to increased estrogen levels.
Cholestasis is also more common in women carrying multiples and in those who have had previous liver damage. And if you've had cholestasis in a previous pregnancy, you're at greater risk of developing it again.
Because it can be difficult to predict who will develop cholestasis, it's important to let your doctor know if you have any risk factors so they can monitor you closely.
Track your symptoms, get more expert advice, and connect with other moms-to-be with similar concerns in the free What to Expect app.
What are the symptoms of cholestasis in pregnancy?
The most common symptom of cholestasis is redness and intense itching on your feet and hands. Less common symptoms can include:
- Yellowing of the skin and eyes (jaundice)
- Nausea
- Vomiting
- Dark urine
- Liver enlargement and abdominal distension (an outward belly extension that's noticeably beyond your normal baby bump)
- Itching in other areas of the body
"A lot of people say itchy hands and feet. But my hands, feet, ears, armpits, stomach, arms, and legs itch like crazy with this condition," says What to Expect Community mom thekoudelkas.
The itching is most often noticeable at night.
If your palms and soles are a bit red but not itchy, there's usually no cause for concern. That's often caused by increased estrogen levels and blood flow during pregnancy.
"Who would think itching could be so serious?" says Community mom thatabymama93.
How is cholestasis diagnosed during pregnancy?
If your doctor suspects you have cholestasis, they’ll order diagnostic testing, usually a blood test called a fractionated bile acid test. They may also order liver function tests, though those results alone may not be enough to confirm a diagnosis.
Because the results may take 10 to 14 days to get back, it’s very important to talk to your doctor as soon as you think you may be experiencing symptoms of cholestasis.
How is cholestasis treated during pregnancy?
While it isn't possible to prevent cholestasis during pregnancy, your practitioner may prescribe treatments such as topical lotions and oral medication like ursodiol to help improve liver function and lower bile acid levels.
"The itch is awful!" says Community mom rodfam2013. "Thankfully the medication helps the itch for me tremendously!"
Your practitioner will closely monitor your baby's health and development with additional tests, such as nonstress testings (NSTs) and biophysical profiles (BPP).
"My only symptom was itchy hands and feet," says Community mom teamgreeeeen. "My levels are slightly higher than normal, so I'll go for weekly NSTs and blood work and be induced at 37 weeks."
Your doctor will also likely recommend that you visit a high-risk obstetrician who practices maternal-fetal medicine, so you can deliver in a special hospital where you and your little one can be monitored and managed closely. You will most likely also have to be induced a bit early.
"I've had it with my first and third babies," says Community mom mamab23babes. "As much as the itching was awful, I had two smooth inductions at 37 ½ and 39 weeks, and both babies were perfectly fine."
What are the risks associated with cholestasis?
With regular prenatal care and monitoring, your baby will likely not be affected by cholestasis during pregnancy or after delivery. Studies have found little increased risk to babies when their mothers have only mild cholestasis and low amounts of bile acids.
In cases when maternal bile acids are higher, cholestasis can increase a baby's risk of:
- Low birth weight
- Slightly lower Apgar score
- Lung immaturity
- Preterm delivery
In very rare cases, stillbirth is a risk, though it can be prevented if labor is induced early. The risk of stillbirth goes up after 36 to 37 weeks, which is why early diagnosis and treatment are so important.
The good news is cholestasis is highly treatable if it's caught early, and symptoms typically disappear on their own within 48 hours after birth. With prompt diagnosis, close monitoring, and appropriate treatment, most people with cholestasis can look forward to a healthy pregnancy and a healthy baby.
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