Intrahepatic Cholestasis of Pregnancy

From ICP Care:

What is Intrahepatic Cholestasis of Pregnancy (ICP)?

ICP is a group of liver disorders specific to pregnancy which interfere with the flow of bile. Bile is a substance produced by the cells of the liver to aid in digestion of fats. During normal liver function, the bile which is produced is transported out of the cells and into the bile duct by special pumps. During Intrahepatic Cholestasis of Pregnancy, the cells are unable to transport the bile out of the cells normally, which leads to bile acids building up in the blood. Elevated bile acids in the blood are associated with increased risk to the unborn baby. It is important to note that Intrahepatic Cholestasis of Pregnancy is not a single disorder, but a heterogeneous group of many different disorders which all lead to elevated bile acids. This means that the disorder presents very differently in different affected women. 80% of cases are diagnosed in the third trimester, about 10% in the second trimester, and about 10% in the first trimester, with documented cases as early as 8 weeks pregnant.

What are the symptoms of Intrahepatic Cholestasis of Pregnancy (ICP)?

• Itching – The most commonly noticed symptom of ICP is itching which can be moderate to severe. Itching due to Intrahepatic Cholestasis of Pregnancy does not typically respond to antihistamines. The itching is usually not associated with a rash, but a rash can, in some cases, develop as a result of scratching. The severity and location of itching can vary greatly. The most common location of itching is hands and feet, but some women experience itching on the arms and legs, the scalp, or all-over itching. Some women with the disorder itch everywhere except the hands and feet. In the majority of cases, itching is the only symptom reported.
• Dark urine
• Pale Stool
• Right upper quadrant pain
• Fatigue/Malaise
• Mild depression
• Pre-term labor
• Nausea/lack of appetite
• Rarely jaundice

What causes Intrahepatic Cholestasis of Pregnancy (ICP)?

Intrahepatic Cholestasis of Pregnancy is caused by a combination of factors including:

• Genetics – Research has identified several genetic mutations which are associated with ICP. Not all genes have been identified. Many of these mutations cause defects in the bile salt export protein (BSEP), which is responsible for moving bile out of liver cells. Intrahepatic Cholestasis of Pregnancy can be considered a genetic disorder, even when there is no family history of the disorder. Mothers, sisters, and daughters of women affected by Intrahepatic Cholestasis of Pregnancy are at higher risk of developing the disorder, though it is not guaranteed.
• Hormones – The initiation of ICP during pregnancy is influenced by the high levels of the hormones estrogen and progesterone, which are responsible for maintaining the pregnancy. The high levels of hormones further interfere with the liver’s ability to transport bile acids.
• Environmental Factor– Intrahepatic Cholestasis of Pregnancy recurs in future pregnancies in 60-90% of cases, which indicates that environmental factors also play a role. It is not entirely understood why ICP sometimes does not recur, but research has found evidence that seasonal influences as well as improved nutrition may play a role. More women are diagnosed with Intrahepatic Cholestasis of Pregnancy in winter months, and selenium deficiency has been linked to the disorder, though it is not known if this is a cause or effect of ICP.

Take a closer look at these causes.

What is the treatment for Intrahepatic Cholestasis of Pregnancy (ICP)?

• Early Delivery – Active management of Intrahepatic Cholestasis of Pregnancy reduces the risks associated with the disorder to that of an uncomplicated pregnancy, but there is no cure for ICP except delivery. Active management includes, most importantly, the medicine Ursodeoxycholic Acid (also known as UDCA, Actigall, Ursodiol, or Ursofalk), and early delivery, typically by 36-37 weeks gestation. In some cases, where medication is not controlling bile acid levels, delivery may occur even earlier.
• Medication (Medical Option ~ Natural Options listed below) – Ursodeoxycholic Acid is considered the frontline treatment for the disorder. It has been proven safe in meta-analysis for both mother and baby, and research has identified many ways in which it potentially can provide a safer environment and protect the baby against harmful effects of bile acids until delivery can occur. It is a naturally occurring substance in the body, and has been proven to reduce the total bile acids in the bloodstream of women affected by Intrahepatic Cholestasis of Pregnancy. Sometimes other treatments will be used in conjunction with Ursodeoxycholic Acid with the aim of reducing maternal symptoms.

What are the risks associated with Intrahepatic Cholestasis of Pregnancy (ICP)?

Intrahepatic Cholestasis of Pregnancy puts affected pregnancies at higher risk for several complications. With active management it is believed that the risk of stillbirth is similar to that of an uncomplicated pregnancy (less than 1%).

• Pre-term labor/delivery
• Fetal Distress
• Meconium Passage
• Respiratory distress syndrome (RDS)
• Failure to establish breathing (sometimes called fetal asphyxia)
• Maternal hemorrhage
• Stillbirth (Intrauterine Fetal Demise/IUFD)

Natural Options for the Treatment of Cholestasis

The idea here is to maintain a balance within the body, whereby keeping cholestasis at bay for as long as possible. Supporting the liver through dietary intake, supplements and herbs, keeping the bile acid levels lower for a greater duration of time.

As with anything I recommend to my clients, this is meant as a foundational guide to get you off and running in the right direction, with lots of options. Please do your own research from this foundation. Trust your body and your instincts, go with what feels right to you and listen to how your body responds.

Also, remember that any protocol works best when providing full support to the body. We tend to support one or two areas, leaving other areas of the body to make up the slack, whereby creating an unintended imbalance. The recommendations listed below are meant to be used for complete support for all areas in need during this time. Daily consistency and diligence are necessary.

Always discuss your options with your care provider.

 Weston A. Price Pregnancy Diet

     – Ensuring low fat intake, with complete removal of all saturated fats.

     – Ensuring that minimal fat intake is from healthy forms of fat. You may need to adjust some of the brewer’s diet recommendations to extremely cut fat intake. Focus on Fish, fruit and vegetables.

     – Aim for 8 – 10 Liters of water/day. Think of flushing the toxins out.

     – Foods high in Vitamin K, especially K2

     – Foods high in Selenium

     – Natto – Fermented Beans – Very high in K2

    – Get rid of all processed foods; digesting them makes your liver work harder.
– Foods that especially support the liver are apples, blackberries, dark grapes, plums raspberries, beets, asparagus, carrots, celery, leafy greens, onions, tomatoes and watercress. (some of those combined would be a great smoothie!)

1) Vitamin K2, Jarrow Brand – This brand is specifically derived from Natto.

     – If you feel you need to supplement from your diet.

     – Acid levels need to be in balance for proper vitamin K absorption

2) Selenium

     – Again, if you feel you need to supplement from your diet.

     – Selenium deficiency is one of the leading triggers for an increase in estrogen production, inducing bile flow impairment.

     – Lecithin is a type of unsaturated fat that is also referred to as a phospholipid. Your body produces some lecithin naturally, storing it in the bile in your liver to help metabolize fats.

     – It works as an internal lubricant within the body (also great while breastfeeding – prevention and treatment of blocked milk ducts and mastitis.)

4) SAM-e

      – Vitacost & Thrive Market are great places to purchase discounted, quality supplements!

     – S-Adenosyl-L-Methionine (SAMe) is a chemical that’s found naturally in your body that plays a role in liver and brain function. It’s also sold as a dietary supplement to treat a variety of conditions. According to the National Center for Complementary and Integrated Health, there is supporting research to suggest that SAMe is a safe and effective treatment for cholestasis.

     – You want 800mg per day. It is commonly sold as 400mg, so you would need double the dose.

     – Nutritionally supports the liver’s ability to maintain normal liver function. It has shown positive effects in treating nearly every known form of liver disease. Milk thistle works due to its ability to inhibit the factors responsible for liver damage, coupled with the fact it stimulates production of new liver cells to replace old damaged ones.

     – Liver, spleen and pancreatic tonic, kidney tonic, helps dissolve kidney and bladder stones, stimulates liver, good for hepatitis, jaundice, anemia, acne and skin conditions. Fresh dandelion greens are highly nutritious and the flowers are edible, too.

Some of the herbs studies also talk about the benefits of artichoke herb, in combination with milk thistle and dandelion, for liver health and function. However, artichoke should not be used, when a blockage in the liver exists, which is what happens during cholestasis.

Tinctures & Tea

     – Liver Tincture – Liver Glow

     – Persephone’s Tea This counts as water intake! 😉

          – Steeping this in the correct manner is of the utmost importance.

               – Steep 1oz in 1 quart boiling water

               – Let sit for 2 hours

               – Drink 2 – 4 cups daily

For additional information about ICP please go to icpcare.org.

Download a helpful infographic with embedded links at icpcare.org/images/ICPinfographic.pdf.

References:

AASLD
Medical Articles & References