Experts at Mediclinic Welcare Hospital in Dubai shine light on why pregnant women have regular itching...
25 August 2019| Last updated on 25 August 2019
Mild itching is common with pregnancy. It might be caused by the hormonal changes, increased blood supply to the skin or skin stretched by the growing baby.
Most cases of itching with pregnancy are mild and benign and can be alleviated by simple measures like wearing loose clothes made of cotton and avoiding synthetic fabrics, strong perfumes, spicy food, alcohol and caffeine.
Cool baths and the use of moisturising creams can improve the itching. In case those measures do not improve the symptoms your doctor might prescribe local medications that are safe with pregnancy.
But not all cases of itching with pregnancy are benign, as severe itching might be the presenting symptom of a serious condition that affects the liver of a small percentage of pregnant women called Intrahepatic Cholestasis of Pregnancy (ICP) or Obstetric Cholestasis (OC).
What is Obstetric Cholestasis?
Normally bile acids flow from the liver to the gut to help you digest fat. In OC they do not flow properly, instead they build up in your body.
The main presenting symptom of this condition is itching that typically starts in the second half of pregnancy. It is characteristically not associated with a rash and can involve the whole body, even the palms and soles, and worsens at night.
The patient might also notice dark urine and pale stools.
Why is Obstetric Cholestasis serious?
Obstetric cholestasis might have harmful effects on your baby, including preterm labour, lung problems because of breathing meconium during delivery, or stillbirth. That is why if you start experiencing severe itching that starts in the second half of your pregnancy you should consult your doctor, who will exclude other causes of itching with pregnancy and order some blood tests (liver functions and bile acids).
Once OC is diagnosed, you will be prescribed oral tablets and soothing creams and your liver functions will be checked regularly to help monitor the disease progress.
Unfortunately, to date, no ideal method of fetal surveillance has been determined for OC, and fetal antenatal testing has had limited predictability in the setting of this disorder. However, you might be offered a non-stress test (a test that measures fetal heart rate and response to movement in the third trimester) to ensure the baby is doing well and getting enough oxygen.
If your itching is severe and/or your liver functions continue to rise, your doctor will offer you induction of labour on completing 37 weeks (sometimes even earlier if clinical condition necessitates).
Obstetric cholestasis is not an indication for a caesarean section and is not a contraindication for breastfeeding. After delivery, itching will disappear and your liver functions will continue to be monitored until they are back to normal.
It is worth noting that OC tends to run in families, though it can occur with no family history. Also if you have it in one pregnancy you are more likely to have it in subsequent ones.
With all my best wishes for a safe pregnancy, easy delivery and a healthy baby.
Authored by Dr. Mona Abouseif
Specialist Obstetrician and Gynaecologist