Internal itch during pregnancy increases risk of stillbirth
July 28, 2014 at 2:28 a.m.
Updated July 29, 2014 at 2:29 a.m.
• Itching is often the only symptom noticed. The itching will typically increase in severity until either treatment is implemented or delivery takes place. The itching can be on the palms of hands, soles of feet, arms, legs or all over the body. The itching can be recurrent or constant. It can be a life-hindering problem. Loss of sleep, loss of appetite and an inability to perform normal daily tasks can result from the intense itching.
• Some itching is normal in pregnancy. If a woman finds herself itching more than normal, it is important to request a fractionated bile acid blood test.
• Some women with ICP will develop other symptoms, including dark urine, pale stools, right upper quadrant pain, jaundice, fatigue, preterm labor, nausea and mild depression.
Shirley Odell, 58, of Edna, could not scratch her itches when she became pregnant for the first time in 1980. The intense itching was internal.
The summer was one of the hottest on record, and her mobile home did not have air conditioning. Clothing was torture to her body. Her father-in-law bought her an old, used window air conditioning unit, and she soaked in cold oatmeal baths during her daily lunch breaks.
"You do not know the misery - my feet itched so bad," Odell said. "My family thought I was imagining things."
More than 20 years later, Odell realized that the condition that tormented her during two pregnancies was intrahepatic cholestasis of pregnancy.
Her daughter, Sheri Biggers, 33, was diagnosed with the condition when she sought help during her second pregnancy for the same unbearable internal itchiness Odell had experienced.
Intrahepatic cholestasis of pregnancy is a condition unique to pregnancy that typically occurs during the third trimester, said Dr. Manju Monga, a maternal-fetal medicine specialist at Houston's Texas Children's Pavilion for Women. There is no long-term risk for mothers with the condition, unless related to another disease. However, there is an increased risk of stillbirth.
"We see scratch marks because it becomes so itchy that women can't contain the urge to scratch," Monga said. "It can be so significant that they cannot sleep."
Biggers experienced intrahepatic cholestasis of pregnancy during the third trimester of all three of her pregnancies. She covered her body with menthol lotion, wore nothing but cotton maxi dresses and kept the air conditioner cranked down to 68 degrees.
Biggers knew within five minutes when one of her children turned the temperature up to 69 degrees. Her husband knew better.
"Who changed the air?" Biggers would yell.
"Mom, we're cold," her children would respond.
"Get a blanket and put some clothes on," Biggers would snap from the center of her bed, where she was sprawled.
Her hands, feet, arms, legs, face and even her earlobes itched.
"It was a crawling itch that felt like a million fire ants biting me," Biggers said. "I scratched until I bled."
In women with intrahepatic cholestasis of pregnancy, the serum bile acid levels are elevated as are the liver enzyme and bilirubin levels, though more moderately, Monga said.
Jaundice, a yellowish pigmentation of the skin and eyes, is sometimes a consequence of the condition. The most severe symptom is an internal itching that often begins on the palms of the hands and soles of the feet but can move throughout the body.
Women with a family history of intrahepatic cholestasis of pregnancy are more likely to get it, and those who get it are likely to have it again during subsequent pregnancies, Monga said. No one knows exactly what causes the condition, but it likely involves a genetic predisposition, among other factors such as increased production of hormones.
For an isolated population, intrahepatic cholestasis of pregnancy might be related to liver and gastrointestinal tract diseases.
"We have theories, but specific etiology is not known yet," Monga said.
Women with the condition have a 1 percent chance of delivering their children stillborn, so doctors perform fetal testing throughout their pregnancies, Monga said. Doctors also recommend early delivery at 37 weeks to reduce the risk of stillbirth.
However, other potential risks for fetuses, such as respiratory distress syndrome, come with early delivery.
The condition is mainly treated with ursodeoxycholic acid, a medication that lowers the level of bile acid in the bloodstream.
Often, the mother's itchiness lessens as a result of the medication.
Intrahepatic cholestasis of pregnancy affects 1 percent of pregnant women in the U.S. The condition is more prevalent in South American countries such as Chile and Bolivia, where it strikes 10 to 15 percent of pregnant women, Monga said. Other populations, including Southeast Asians and Scandinavians, also experience higher incidences.
The discomfort may be enough for Biggers to not want to have additional children.
But her children are also hoping the family is complete.
"Mom, please don't have anymore kids," said Haley Biggers, 9, Sheri Biggers' oldest daughter.