From Low-Risk to High-Risk Overnight
Some of you may have seen on Instagram that I have been dealing with a serious health concern with my pregnancy. I have decided to write about it here to not only help me to deal with some of the emotions around my diagnosis, but also to give you some more information. I tend to be an open book, and while this is painful to talk about, I think it is important to bring more awareness to the disorder.
About two weeks ago I started mildly itching, and then as the days went on it got worse. I had read that itching was a normal part of pregnancy, but something did not feel quite normal. So I started googling and discovered that there was a rare liver condition that can occur during pregnancy where the main symptom is itching. This condition is especially recognizable when you start itching on the palms of your hands and the soles of your feet. One night I started to feel the terrible itch on the soles of my feet and knew it was time to contact my OB. I have had liver disease in the past - so I knew I could be a likely candidate for this disorder.
I messaged my OB and she immediately sent me to the lab to get a blood test. I got the results that evening and it was clear something was up, my liver enzymes were very high. My OB called and told me to go to the labor and delivery section of the hospital to get some more tests and to also get an ultrasound on my liver. The OB told me it was likely that I had a disorder called Intrahepatic Cholestasis of Pregnancy (ICP). Josh and I did some quick research and discovered that this condition was very serious for the health of your baby. On the way over to the Hospital I had a major breakdown, everything was happening so fast - I couldn't believe that my body might be toxic for my baby.
The next day Josh and I both spent a lot of time researching ICP and talking to his sister, a NICU nurse, about the disorder. ICP is a liver disorder that affects the normal flow of bile. Bile acids are chemicals in the bile of the liver that help with digestion. With ICP the bile flow begins to slow down and the bile acids build up in the blood. It is thought to be caused by an increase in hormones. The build up of bile acids in the blood results in itching for women, it can vary in severity and most often is worse at night. The itching can be so severe that women often have trouble sleeping for weeks to months on end. Usually people are diagnosed with ICP in their third trimester, so I am very early to be diagnosed at only 20 weeks.
ICP poses several major risks for the baby. It is associated with an increased risk of stillbirth (intrauterine fetal demise), preterm labor, fetal distress, respiratory distress, maternal hemorrhaging and meconium passage in utero. Despite the possible outcomes of ICP, proper treatment provides a great degree of reduction in both fetal risk and maternal symptoms. With active management that include the two most important factors in the treatment are reducing the bile acids in the bloodstream with the medicine Ursodeoxycholic Acid and delivering the mother as early as lung maturity will allow, often by 37 weeks gestation. In cases where bile acids do not respond to treatment, it may be necessary to deliver earlier than lung maturity to protect the child from the possibility of stillbirth. Unfortunately there is no cure for ICP, and most treatments are aimed at relieving the itch (source).
Reading about this disorder was scary to say the least. I felt absolute despair when I saw how high of a risk I am for a stillbirth. No expecting mother would want to receive news like this, that your own body is literally toxic for your baby. You feel so defeated and powerless to do anything. Before this diagnosis I was finally feeling like I was no longer the "sick girl", the baby was so healthy and all my initial tests had come back as perfect. For once, I felt like everything was going to be totally normal - it is devastating how wrong I was.
After researching more, starting on the medication, and talking with my OB I am feeling a bit more positive. I have an appointment tomorrow with an excellent high-risk specialist, and I am going to be frequently monitored to make sure the baby is ok. I will most likely be induced and delivering our baby at 36 weeks (instead of the normal 40). That moves my due date up a full month to early August. As a way to cope with this terrible news, I am at least excited that we will get to meet our little guy earlier.
So far my itching is not severe (though certainly annoying!!) and I have not had any side effects so far from the medication. I am really hoping that my symptoms do not get much worse, that my levels go down, and of course that my baby is safe and sound up to the 36th week delivery. My entire perspective has changed, I no longer care what sex the baby is or how my body looks, I just want our baby to be alive and healthy.
Needless to say - this blog is probably going to take a back seat as I focus on my health and on completing the client projects I have in the works. Thanks to everyone for your incredible support, all of your comments on instagram touched my heart and I read them daily to help me get through this hard time.
If you want to learn more about ICP, this site is really incredible.