Third Trimester

The Reason behind the itch during pregnancy!

January 28 , 2020
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By: Ayah Al-Nazer, a nurse 

Some pregnant women may experience certain symptoms during their pregnancies that are annoying and frustrating and may point into serious problems they need to consider.

One of these symptoms is itching during pregnancy, which is a serious  issue known as  Obstetric Cholestasis (OC), which takes place in the liver of a pregnant woman..

What is Obstetric Cholestasis?

It is a disorder that affects your liver during pregnancy. This causes a build-up of bile acids in your body which normally goes from your liver to your gut to help digest food.

Obstetric cholestasis appears to run in families, but you could still have OC even if there was no family history.

And if you have OC in your previous pregnancy, there is a chance it will occur again in the next one.

Symptoms

The main symptom is itching of the skin but without skin rash. This symptom can start as early as 8 weeks, but it usually starts between 28-30 weeks, some people call it “The pregnancy itch” as it goes away once the baby is delivered.

Even though it often starts on the palms of your hands and soles of your feet, it could spread into your arms and legs, and sometimes, although less common it could occur on your face, back and breasts.

Itching in OC tends to get worse at night and some women might need to scratch till they break their skins.

Keep in mind, that mild itching is normal in pregnancy and thought to be caused by changes in some chemicals in the blood such as hormones.

It is not harmful to you or your baby, but you should tell your doctor about it, so he can make sure there is no other reason for it.

Other symptoms of Obstetric Cholestasis

  1. Jaundice: some women develop jaundice (which results in yellowing of the skin).
  2. dark urine.
  3. pale poop (2 and 3 are caused by jaundice).

Diagnosis

In the beginning, your doctor might suspect OC if you have unexplained itching. Since itching is usually the first sign of it.

And then, he will inspect your skin for any rashes or changes, to check that your itching is not related to a skin condition such as eczema.

And he might order you the following tests:

  • Liver function test (LFT) to check how the liver is working.
  • Bile acid test: to show the level of bile acids in the blood. This test could be abnormal even if your liver function test was normal.
  • An ultrasound might be performed to check for liver abnormalities and gallstones.

Some women will have normal LFT and bile acid test but still continue to have persistent unexplained itching; in that case their blood tests should be repeated every week to 2 weeks.

Treatment of the itch in pregnancy

There is no cure for OC but to deliver the baby, you can use one of the following tips that can help you relieve the symptoms:

  1. Avoiding tight clothes and opting for loose wear instead, as tight clothes tend to rub against your skin and cause irritation which promotes itching.
  2. Avoid wearing synthetic materials and opt for natural ones such as cotton instead, since these are breathable and allow for air to circulate near your skin.
  3. Cool baths help to alleviate some of the itching
  4. Unscented moisturizers and lotions can help but try avoiding strong perfumes and scented lotions or soaps, they tend to irritate the skin in some women.
  5. The use of antihistamines that might help you sleep better at night but don’t work so well on the itching.
  6. You doctor might prescribe Ursodeoxycholic Acid (UDCA), which reduces the level of bile acid in the blood and could help improve the LFTs.

Some moms might be prescribed vitamin k, since OC might affect your body’s ability to absorb vitamins, which plays a role in the clotting mechanism in your blood.

There is a small risk of stillbirth and premature delivery in women with OC, that is why your doctor might offer an induction of labor around week 37 to 38. 

In some severe cases where bile acids are over 40µmol/L, labor induction might be offered earlier.