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What Is Cholestasis? Call The Midwife’s Helen George Opens Up About The Pregnancy Condition

Call The Midwife actor Helen George has opened up about her experience with cholestasis, a liver condition which causes itching during pregnancy.

Writing on Instagram, the mum of two said she was prompted to share her story after the disorder was featured on the latest episode of the much-loved BBC drama.

“Spreading the word about this sometimes fatal condition is really important to me,” she said. “I was over the moon that Call the Midwife tackled the subject last night.”

George said she was diagnosed with intrahepatic cholestasis of pregnancy (ICP) in 2017 when she gave birth to daughter Wren, and suffered with the disorder again while expecting second daughter, Lark, last year.

“I started getting the itch a lot earlier with this pregnancy and it was infuriating. I tried everything, creams, baths all of it and nothing would work. I would scratch all day and all night, normally on my hands, shoulders, feet but that quickly increased to just bloody everywhere.”

So what do expectant mothers need to know about the condition that, according to the NHS, affects around one in 140 pregnant women in the UK? We asked doctors for their expert advice.

What is cholestasis?

Pregnant woman baby bump
(Alamy/PA)

“Cholestasis means the flow of bile acid – the fluid produced to digest foods – is slow or has stopped,” says Dr Verity Biggs from H3 Health (h3health.co.uk). “When the flow of bile acid slows, it builds up in the liver and blood.”

Cholestasis can occur in many conditions, and gallstones are the most common cause, Dr Biggs explains: “But it is a condition which can occur in pregnancy, known as Cholestasis of Pregnancy, or Obstetric Cholestasis. It occurs in about 1% of pregnancies.”

Dr Sarah Brewer, medical director at Healthspan (healthspan.co.uk), says: “The reason it occurs during pregnancy is unknown, but may be due to the effects of pregnancy hormones (especially progesterone) in slowing bile flow.”

There also seems to be a genetic component, she adds: “The tendency can be hereditary, and is more likely if you are pregnant with twins or more, or if you have a history of liver problems.”

What are the symptoms of cholestasis?

Woman scratching her neck
(Alamy/PA)

“The main symptom is itching of the skin, although itching is very common for other reasons too,” says Dr Biggs. “This will resolve once the baby has been delivered.”

The increase in bile salt can also cause digestive symptoms such as nausea and loss of appetite.

Plus there may be complications for the baby, Dr Brewer says: “Reduced bile flow into the intestines reduces fat digestion, leading to indigestion, bloating and reduced absorption of fat soluble vitamins such as vitamin K, which could lead to bleeding problems in the newborn baby, although all newborns are offered a vitamin K injection to prevent haemorrhagic disease.”

In severe cases, symptoms may be worse, Dr Biggs adds: “Jaundice can occur (yellowing of the skin and eyes), urine can turn very dark and stools pale, women can feel quite unwell with this. The baby may be born premature, and there is an increased risk of being stillborn.”

How is cholestasis treated?

“Diagnosis is made from blood tests and sometimes ultrasound scans,” says Dr. Biggs. Following diagnosis, a pregnant mother will be “closely monitored throughout the rest of pregnancy, and the baby may be monitored more frequently too.

Some may need treatment to reduce the amount of bile acid in the blood, and other common treatments are antihistamines to reduce the skin itching.”

Dr. Brewer says: “Soothing creams can be prescribed to reduce itching. A prescription drug that lowers blood bile levels (ursodiol) may be used, but because of increased risks of preterm birth, lung problems from the baby inhaling meconium and stillbirth, early delivery may be recommended.”

If you’re concerned about cholestasis in pregnancy, speak to your GP or obstetrician, and for more information visit the ICP Support website.