Q: I am due to have my baby in a few weeks and all of sudden my hands are very itchy. It keeps me awake at night. Should I be concerned?
A: You need to tell your doctor or midwife today about your itchy hands. It could be a sign of cholestasis. Other signs of cholestatsis are intense itching of the feet as well as the hands, dark-colored urine, light-colored bowel movements, yellow eyes or skin.
Cholestasis of pregnancy usually develops at the end of the pregnancy. It might not be of harm to you, but it can be very dangerous for a baby. Because cholestasis is usually related to other conditions, the woman who develops it during pregnancy is carefully monitored for pre-eclampsia and gestational diabetes.
Why does it develop? We really do not know, but we do know that mothers who have a family history of cholestasis, a history of liver damage, having a pregnancy that is multiple babies, and who have become pregnant through in vitro fertilization, are at greater risk of developing cholestasis.
Cholestasis is a general term describing a condition where the flow of bile from the liver is interrupted.
Bile is made by the liver and helps the body break down fats. Patients who suffer from this interruption of bile flow need to be aware of their intake of fat-soluble vitamins -- A, D, E and K. They are important for helping our eyes, teeth, bones; and keeping mucous membranes moist and helping blood to clot. When bile is flowing correctly, the body is able to store these vitamins. With cholestasis the body is unable to store these vitamins, which are found in green leafy vegetables, fish, olive oil, nuts, whole grains and fortified cereals.
Mothers with cholestasis should have a consultation with a dietician that can help them plan out their daily food intake. Interestingly, cholestasis is more common in Chile and Finland.
It has also been noted that those particular populations have a lower intake of the mineral selenium. Selenium is found in the same foods that are rich in fat-soluble vitamins.
Delivery of the baby or babies of a mother with cholestasis is important. Typically labor will be induced prior to the due date.
We do not completely understand why, but when a mother has the condition, the baby is at risk for sickness, even death, at the time of delivery. The baby is more likely to pass meconium (what they have been storing in their gut during their development in the womb) into the amniotic fluid before delivery. Babies take breaths while they are still in the womb. If the baby breathes this into their lungs it can begin a cascading of complications for the baby, primarily the baby's lungs, which then affects the heart and brain.
The good news is that with delivery the condition should disappear as it may be related to pregnancy hormones.
The best news is that with careful monitoring your chances of having a healthy baby are good.
Katie Powers, R.N., is a board-certified lactation consultant and perinatal educator at Manatee Memorial Hospital's Family BirthPlace. Her column appears every other week in Health. Contact her at firstname.lastname@example.org.