The pregnancy itch that should not be ignored: Cholestasis of Pregnancy

When we are pregnant we get bloodwork done to test for abnormalities that can happen to our babies. We are told to watch out for certain symptoms such as the ones for preeclampsia, any abnormal fetal movement, kick counts, etc. However, there are some symptoms that are somewhat overlooked many times because they might be insignificant or they might get confused with typical pregnancy ailments. I am talking about back pain, being super tired, maybe some nausea, darker than normal urine, and/or some mild or moderate itchiness. All those are some symptoms of Intrahepatic Cholestasis of pregnancy. Other symptoms are light-colored bowel movements and jaundice.

Intrahepatic Cholestasis of Pregnancy, also commonly known as Cholestasis of Pregnancy, is a liver disorder during pregnancy. It is characterized by intense itchiness (usually on hands and or feet) which is caused by bile acids that build up in the blood. This itch should not be ignored because it can lead to unfortunate complications for the unborn baby and for the mother.

The symptoms are most likely to appear during the last trimester of pregnancy. I had the first five symptoms but did not think of going to the doctor about them. The doctor never asked me if I was ever itchy (that is the main symptom that alerts doctors of Cholestasis of Pregnancy in a patient) during my past 2 pregnancies. I would have asked why and be alert like anyone would be alert if they have super swollen feet because it might indicate preeclampsia. I got very mild itching on my big toes and sometimes my hands, only at night and not every day. I did not think of anything serious about it. I now know I should have talked to my doctor but since our bodies change when we are pregnant and no pregnancy is the same, I just brushed those symptoms off.

My symptoms were so mild that I did not think of talking to my doctor about them. It was not until I was 3-4 weeks postpartum that I started to wake up in the middle of the night with pain in the middle of my ribs and towards the right side under my rib. It was a pain that would make me desperate and anxious. It would go away after about 2 hours. I had some mild itchiness but once again did not think of anything. A week passed and my pain was starting to feel worse and more often. The pain spread to my upper right back and felt like I could not lay down on either side to relax and ride it out because none of the painkillers would work. I googled my symptoms and Cholestasis of pregnancy came up. I read and read several articles and was baffled! I had all the symptoms, even the light-colored bowel movement (sometimes), the only thing was that I was not pregnant anymore! I made an appointment to be seen on the same day.

I mentioned Cholestasis of pregnancy to my doctor but since I was not pregnant anymore, she did not pay attention to that. To my surprise, she told me I had heartburn! I was like “no way!” She prescribed some pills for that and ordered a urine test to see if I had some sort of postpartum infection. And about the pain, she said that it was most likely my posture when nursing my baby. I left the doctor’s office hoping she was right but deep inside of me I knew she was not. I know what heartburn feels like and that was not it.

Three days later I went back again because the pain had lasted around 12 hours (6 hours of anxious bad pain and 6 hours of mild pain) and my pee was yellow-brownish-orange. I told her that the heartburn pills did not work. Yes, I lied, I never took them because why would I take them if I knew I didn’t have heartburn? I also told her again what I found about Cholestasis and that I wanted her to please order some bloodwork to see how my liver was functioning (my husband’s idea after I told him my pee was yellow-orange). She reluctantly ordered the bloodwork saying that she did not think something was wrong with my liver. I went to have my bloodwork done immediately after I saw her.

Later that evening, she called me to tell me she was sorry but that she had never seen liver enzymes as elevated as mine. They were in the 500s and 600s. She recommended me to go to the ER right away to see what was going on. I did and they found gallstones. Also, my liver was somewhat enlarged. They recommended a cholecystectomy but I refused to have it! I mean, I wanted to know why this happened and if there were other ways to go about it. 

Usually, Cholestasis of Pregnancy goes away a few days after you give birth. I guess mine stuck around. I gave birth on April 12, 2019, and finally got the cholecystectomy in August that same year. I really delayed it as much as I could. I got choline and some digestive enzymes that I would religiously take every day. They only worked for 2 months and then the pain and other symptoms came back worse. I would get the pain and throw up even if I had not eaten anything greasy or heavy. The last time, I had just had a late breakfast and by 2 pm the pain was starting. At 8 pm I threw up water or whatever I had drunk. I went to sleep with pain. I don’t think I slept 2 hours straight. Morning came, the pain still there, threw up again and that is when I decided to go to the ER. This time they kept me there until I had the surgery. My liver enzymes were in the 1,300s!

As I read about Cholestasis of Pregnancy now, I have found horrible stories about pregnant women who brushed off the symptoms as I did and sadly had stillbirths even though the risk is only 15%. That is not the only risk, the other risks are pre-term labor, fetal distress, meconium passage, respiratory distress syndrome, maternal hemorrhage, among others. I was shocked when I read that because I remember a week before my baby was born, I noticed a sudden lack of movement from her part. She was always moving, day and night, and that day she barely moved. I rushed to the hospital and thank God everything seemed fine: no fetal distress and a normal heartbeat. However, I also read that sometimes the fetal distress test comes back negative and stillbirth happens after a day or so. At that time I did not have the mild symptoms I had 2-3 weeks before so I did not mention anything. Had I been informed, I would have said something way before that. I think more doctors should make pregnant women aware of these symptoms. Maybe clarify the difference between “normal” pregnancy itchiness and not normal and on which body parts to look for. That way, the mom is informed and knows what to look for. They do it with other conditions, why not with Cholestasis of Pregnancy?