Pregnancy brings excitement and anticipation, but it can also introduce unique health challenges. One of these is cholestasis of pregnancy, a liver condition affecting bile flow, particularly during the third trimester. Understanding cholestasis and knowing how to support liver health naturally can make a positive difference for both mother and baby.

What is Cholestasis in Pregnancy?

Intrahepatic cholestasis of pregnancy (ICP), commonly called cholestasis, occurs when bile acids don’t flow properly from the liver to the intestines, causing bile acids to build up in the bloodstream. This results in intense itching, typically on the hands and feet, and can affect liver function.

Who Does Cholestasis Affect?

While cholestasis can impact any pregnant woman, certain factors may increase the risk, including:

• A history of liver issues or bile duct problems.

• Previous pregnancies with cholestasis.

• Family history of the condition.

• Twin or multiple pregnancies.

• Specific ethnic backgrounds, including South Asian, Scandinavian, and Native American descent.

• Previous gallbladder removal surgery, as altered bile flow may increase the likelihood of developing cholestasis.

This condition affects approximately 1-2% of pregnancies, and it’s crucial to address as it poses risks to both mother and baby.

The Importance of Diagnosing Cholestasis

Detecting and monitoring cholestasis early is essential to minimise risks. Research indicates that when bile acid levels reach 100 μmol/L or higher, there’s an increased risk of stillbirth. However, many women with cholestasis have lower bile acid levels, meaning their stillbirth risk is similar to the general pregnant population, provided that bile acid levels are tested regularly until delivery.

Key Tests for Diagnosing Cholestasis

1. ALT Test

High serum levels of alanine aminotransferase (ALT) can suggest liver problems. Although this test alone won’t confirm cholestasis, it helps your doctor understand liver health.

2. Total Bile Salts Test

This test measures serum bile salts. High bile salt levels are a key indicator for diagnosing cholestasis of pregnancy.

3. Vitamin K Deficiency Test

In rare cases, cholestasis can cause vitamin K deficiency, potentially impacting blood clotting. Testing prothrombin time (the time blood takes to clot) can reveal if vitamin K supplementation is necessary.

Then you've got a medical questionnaire discussing any itch, stool consistency and colour, jaundice and malice. There may even be a liver ultrasound if you have discussed with with your GP, Midwife and/or Obstetrician.

Risks Associated with Cholestasis in Pregnancy

Cholestasis of pregnancy also increases the risk of:

• Gestational diabetes

• Preeclampsia

• Preterm labour

• Postpartum haemorrhage

• Pregnancy-related hypertension

Since baby relies on mother’s liver function, elevated bile acid levels from cholestasis can also impact baby’s health. Here’s how:

• Liver Function and Bile Acid Transfer

High maternal bile acid levels can cross the placenta, affecting baby’s organs, including the liver. This may damage the placenta, which is essential for delivering oxygen and nutrients to baby.

• Respiratory Health

High bile acid levels in the baby may lead to structural damage in the placenta and higher rates of respiratory distress at birth.

• Birth Weight

Studies indicate that babies of mothers with cholestasis often have lower birth weights. Early-onset cholestasis (occurring in the first trimester) is associated with even lower birth weights than late-onset cases.

• Heart Function

Excessive maternal bile acid levels can affect fetal heart function, increasing the risk of intrauterine death. Research has shown significant differences in heart valve function and increased respiratory distress for babies of mothers with severe cholestasis.

• Fetal Distress and Meconium Staining

Cholestasis often leads to fetal distress, causing babies to pass their first bowel movement (meconium) in utero. Although meconium aspiration is rare, it’s a serious concern and can require medical intervention.

• Premature Birth

Early-onset cholestasis, though uncommon, presents more severe risks, including a higher likelihood of preterm birth. Studies reveal that adverse outcomes are more common in mothers with early-onset cholestasis compared to those with later onset.

How Naturopathy Can Support You Through Cholestasis

While medical management is crucial, naturopathy can provide supportive care that complements conventional treatments. Here’s how a naturopath can help you manage symptoms naturally:

1. Liver Support

Herbal remedies like milk thistle and dandelion can gently support liver function and detoxification processes. It’s essential to use these under professional guidance to ensure safety during pregnancy.

2. N-Acetyl Cysteine (NAC)

NAC is naturally produced by the body and supports glutathione production, an antioxidant crucial for liver detoxification. NAC won’t treat cholestasis directly, but it can support overall liver health. I find NAC beneficial for my clients; however, please avoid self-prescribing if you have cholestasis. It’s best to seek professional and personalised care.

3. Nutritional Guidance

A diet focused on reducing inflammation and supporting liver health can make a significant difference. Avoiding processed foods and consuming a balanced diet rich in fibre, leafy greens, and antioxidant-rich vegetables can support liver health and reduce bile acid buildup.

4. Itch Relief

Natural options for relieving itch include soothing oatmeal baths. Simply place raw oats in a sock or cloth, tie it up, and leave it in the bath to release soothing compounds. Nettle tea, a natural antihistamine, may also help reduce itchiness.

5. Stress Management

Cholestasis can bring extra worry, making stress management essential. Practices like mindfulness, gentle yoga, and breathwork can help reduce stress, benefiting both your liver health and overall well-being.

If you’re experiencing symptoms of cholestasis, such as intense itching (which could be PUPPS) or other unusual changes, don’t wait to reach out. Early support can make a difference. Book a consultation today to develop a personalised, holistic approach to managing your symptoms and supporting your health naturally throughout pregnancy and if you are not sure if you should see me or a medical practitioner, please email or just book in to the GP - don’t put up with it.

Disclaimer: This information is for educational purposes only and does not replace professional medical advice. If you suspect you have cholestasis or another health concern, consult your healthcare provider or a qualified health professional for diagnosis and treatment.