Should I change my diet?
There are no special foods to eat or to avoid. As with all pregnant women, it is important that you eat a well-balanced diet which includes lots of vegetables, fruit and whole wheat cereals, including bread. As the flow of bile into the gut is reduced, you may find you cannot tolerate the same amount of fat as normal. You may therefore find that it helps to lower your fat intake1.
What can I do to relieve itching?
To help with itching you may find the following suggestions from other mothers helpful.
- Have frequent tepid baths.
- Try not to get too hot.
- Use lotions such as calamine and aqueous cream with menthol
- Wear loose cotton clothing.
- Gently scratch your skin with a baby’s hairbrush.
Can I drink alcohol?
OC is not caused or made worse by alcohol. However, the Department of Health recommends that if you are pregnant or are planning a pregnancy, you should avoid drinking alcohol to minimise harm to your baby.
When you drink, the alcohol passes across the placenta to the baby. A baby cannot process alcohol in the same way that you can and this can seriously affect the baby’s development.
If you do choose to drink, in order to minimise the risk to your baby you should limit this to no more than one or two units of alcohol once or twice a week. You should avoid getting drunk. Additionally, it is recommended to avoid alcohol completely in the first three months of pregnancy as it increases the risk of miscarriage20.
Will OC damage my liver?
OC is not thought to cause any lasting liver damage in the majority of cases. However, it may leave your liver more sensitive to normal changes in the level of your hormones, and a few women report what is known as ‘cyclical itching’ during the menstrual cycle. This can happen just before ovulation or just prior to a period.
This type of itching is usually only mild and stops either when ovulation has taken place or your period has started.
Can I breast feed?
OC should not influence your ability to breastfeed.
What about future pregnancies?
It is highly possible that you may have OC in future pregnancies. The risk is generally estimated to be greater than one in two (50%)4,10. If OC does recur, it may not necessarily follow the same pattern.
It is important that any future pregnancies are carefully managed by a consultant obstetrician who is familiar with the condition. This may involve checking your bile salt levels and LFTs early in pregnancy and then at 28 weeks. If itching occurs, blood tests should be checked sooner.
If you are worried that you may have OC, you must contact your doctor or midwife.
As OC can run in families, it is important to make family members aware of the increased risk.
Can I use the contraceptive pill?
Until it is proven that the hormones oestrogen and progesterone do not have an effect on the liver in OC, it would seem sensible to approach hormonal contraception (the ‘pill’) with caution or avoid it completely1.
However, this may not be realistic or practical for all women and it may be best to discuss the options with your doctor or a suitable healthcare professional. Use of contraception after OC is still a new area and may involve some trial and error in choosing what is right for you.
There is anecdotal evidence that a number of women can tolerate the mini pill and that others are also able to use a low dose combined oral contraceptive pill.
You might also consider intrauterine contraceptive devices (IUCDs). Some IUDs release a lower dose of hormones which avoid the liver by going directly into the womb rather than into the bloodstream. Some women are unable to tolerate even low doses of localised hormones from the IUD.
If you do proceed with hormonal contraception, an LFT should be undertaken beforehand to establish that your liver function is normal. You should have the test repeated six weeks later.
If you have concerns, there are other forms of contraception available.
Can I take antibiotics?
Because they have the potential to cause cholestasis, it may be advisable to avoid the antibiotics erythromycin and augmentin following an OC pregnancy21. Other antibiotic treatments are likely to prove just as effective and should be used if possible. Your doctor should be able to determine which antibiotics the organism causing your infection is sensitive to and prescribe accordingly.
How can friends and family help?
It goes without saying that the anxiety of an OC pregnancy can be extreme. It is important that concerns are acknowledged by both healthcare professionals and friends and family. Being told everything will be okay can be counter productive and can often make women feel more anxious.
Family and partners can reduce anxiety by reading up on the condition so that they understand concerns and provide support during hospital appointments and GP visits (further copies of this leaflet are available from the Trust).
Some women experience bouts of severe itching which could be dangerous while driving, so support with transport may be valuable.
Partners need to be aware that the effects of sleep deprivation can add to an already delicate emotional state and be sympathetic to the resultant fatigue. They need to be prepared for being woken up a lot in the night when itching is often at its worst. Offering to get up and make a hot drink in the middle of the night can be very helpful. It is not helpful to tell someone to 'stop scratching'. It is impossible!
You may wish to participate in a research project into the condition. This may require family members to be involved and to provide blood samples or mouth swabs.
Where else can I get emotional support?
Many women say that they often feel very isolated with OC. It is important not to push friends and family away. Let people know how you are feeling and ask for support.
You may find it helpful to get in touch with others who have experience of OC via online support groups, so that you can discuss your fears and worries in a safe and confidential environment. You may also access counselling services through your GP or via the British Association for Counselling & Psychotherapy (BACP), see the ‘Who else can help?’ section.