The time before having a baby is definitely an , nerve-racking experience. I wouldn’t know this, being a guy and a college undergraduate, but I can infer. Occasionally, however, the itchiness isn’t just anticipation but can actually be caused by something called intrahepatic cholestasis of pregnancy. This condition sounds daunting, but fortunately recent research has provided successful intervention.
What is Cholestasis?
Cholestasis is a general condition, common among many diseases associated with the liver, which happens when something goes wrong in bile production. Normally when a person ingests fats, the body uses bile as a catalyst in fat digestion and absorption. Cholestasis is caused by a disruption in the synthesis of bile in the liver that produces unwanted compounds in the blood circulation1. Intrahepatic cholestasis of pregnancy (ICP) is a milder, subtype of cholestasis, the most common symptom of which is pruritus, or itch.
We have known for a long time that the itch associated with cholestasis is caused by a byproduct of bile synthesis. The culprit blamed for the condition has been the improper transport of the components of bile into the liver. Previously it was thought that compounds, which activated a type of receptor called a mu-opioid receptor, were capable of eliciting itch. Some of the support for this claim came from test trials that prescribed to patients certain drugs that blocked the mu-opioid receptors and inhibited itch2. Unfortunately, these drugs often produce undesirable effects similar to opium or morphine withdrawal. Recent studies have shown that elevated levels of compounds that act on mu receptors are not correlated with itch, although they are correlated with cholestasis2. Thus the search continued for what was causing itch in pregnant women with cholestasis.
This figure shows some of the receptors (circles) involved in
bile metabolites into and out of hepatic cells8.
Intrahepatic cholestasis of pregnancy presents a number of interesting features and puzzles. The disease occurs in about 1-2% of pregnant women, but in northern latitudes the rate of prevalence increases significantly during the colder, winter months. Among pregnant women with this condition, is the most common symptom, but the itch isn’t everywhere—hands and feet itch the most. The itch tends to get worse at nighttime, as if the disease runs its course in accordance with a circadian rhythm. fluctuations in symptoms of itch could be caused variations in estrogen release. Women who have twins or triplets produce much more estrogen than do mothers of singletons and as many as 20% of mothers of twins or triplets are during their pregnancy.