(Date of issue: March 2015. Version: 2)
This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.
What is it?
Obstetric cholestasis (OC) is a liver condition that affects about one in every 100 pregnant women in the UK, usually in the third trimester. The main symptom of OC is severe itching, which might particularly affect the palms of the hands and soles of the feet, and is often worse at night. Itching is common in pregnancy, but if your doctor or midwife suspects that you have OC they will carry out tests to check your liver enzyme levels. These will be abnormal in women with OC.
Are there any risks to me or my baby from obstetric cholestasis?
Obstetric cholestasis is not generally life-threatening for the mother, although the severe itching can be very unpleasant and may make it difficult to sleep. Once the baby has been born OC usually resolves quickly of its own accord.
Obstetric cholestasis has however, been linked to an increased risk of stillbirth. Recent studies suggest that for women with OC who are being looked after by a hospital, the risk of stillbirth is probably only slightly above that in the background population. To reduce the risk of stillbirth women with OC may be offered an early planned delivery once they reach their 37th week of pregnancy.
Studies show that women with OC are also more likely to have their baby prematurely (before 37 weeks of pregnancy). It is likely mainly to be due to the fact that women with severe OC, or who have increasing liver enzyme levels, are often induced early to reduce the risk of the problems in the baby as described above.
It is therefore recommended that pregnant women with OC receive consultant-led care and give birth in a hospital unit.
What are the treatments for obstetric cholestasis?
Moisturising skin creams
Moisturising skin creams may reduce the feeling of itching for a short time in some women and are considered safe to use in pregnancy.
Antihistamines that cause drowsiness as a side effect are sometimes prescribed for women who are experiencing severe itching to help them sleep at night. The sedating antihistamine for which there is the most information on use in human pregnancy is chlorphenamine. Use in later pregnancy does not appear to cause problems in the baby before or after birth. If you are prescribed an antihistamine please check to see if we have a bumps leaflet summarising what is known about effects on a baby in the womb.
Ursodeoxycholic acid (UDCA) is currently the most commonly used medicine for women who require treatment for OC. UDCA seems to relieve itching more effectively than other treatments, and the small amount of scientific information that is currently available has not shown it to be harmful to a baby in the womb. Some small studies suggest that treating obstetric cholestasis with UDCA reduces the risk of premature birth and possibly stillbirth, but other studies have shown it to be no more effective than placebo (‘dummy’) treatments and more research is therefore required.
Colestyramine is no longer routinely used in the treatment of OC, although it may still be used for some women for whom other treatments have not worked. Taking colestyramine in pregnancy is not known to cause harm to a baby in the womb, although very few studies have investigated this and more research is required. Colestyramine use can cause vitamin K deficiency which may need to be treated with a supplement (see below).
Although vitamin K does not treat obstetric cholestasis, it may be required because OC can cause vitamin K deficiency (low vitamin K levels). Vitamin K is needed for blood to clot properly and deficiency can therefore lead to bleeding problems in both the mother and the baby. Women with obstetric cholestasis may be offered additional blood tests to check clotting and are likely to be advised to take a vitamin K supplement. This is particularly important for women who are being treated with colestyramine because this can also cause vitamin K deficiency.
For more detailed information on the medicines used to treat OC please read the bumps leaflets on: chlorphenamine, ursodeoxycholic acid and colestyramine.
Will I or my baby need extra monitoring during pregnancy?
As part of their routine antenatal care most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects and to check the baby’s growth.
Women with obstetric cholestasis are likely to be offered extra pregnancy monitoring to check their liver enzyme levels and blood clotting. It is recommended that pregnant women with OC receive consultant-led care and that they give birth in a hospital unit.
If you received treatment with colestyramine it is very important that your baby receives vitamin K after birth.
Who can I talk to if I have questions?
If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.
Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks. They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.
Medicines use in pregnancy
Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby. There are, however, some medicines that can harm a baby’s normal development. How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.
If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.
When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.
Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.