High bile acid levels @15 weeks pregnant

[Kcrochet]

Hi everyone,

I’m 15 weeks pregnant today and have just found out my serum bile acid levels are very high (>200). I’ve had intense itching especially on my hands at feet at night for almost 2 weeks, initially the gp just ordered liver function tests and I only had bile acids tested a few days ago.

I’m just so worried these levels will be harmful to my baby. Has anyone else experienced high bile acids in second trimester, and were there any effects on baby’s health?

I know this can occur as part of obstetric Cholestasis later in pregnancy and you have to be induced early to avoid risk of still birth. Obviously I can’t be induced now but surely it can’t be good for the fetus to be exposed to all this bile acid 😢

The consultant I saw today said obstetric Cholestasis was unlikely to be the main cause in my case due to early stage of pregnancy. He thinks it might be due to the sertraline I’m taking for my depression as apparently this drug can cause liver problems.

I’m just gutted as I spent so long researching the risk of sertraline to my pregnancy and discussing it with my gp but this thing about harming my liver never came up. Feeling so guilty I might have harmed my baby.

On the Drs advice I’m stopping taking it immediately and starting on a different one without liver liabilities (duloxetine). Really in two minds about taking the new one now.

Also going to see liver specialist and have more follow up bloods next week.

Sorry for long and detailed post. Just reaching out for support really as I just feel overwhelmed with worry.

[Lovefood1984]

Try not to beat yourself up too much, you did your research and did what you thought was right at the time including getting advice. How bad is your depression? I only ask as if you needed meds before pregnancy I certainly wouldn’t consider going cold turkey as you may get even worse as pregnancy sure does mess with your hormones, you need to be physically and mentally fit for your baby’s sake even if this does mean medication (I had to take anti nausea meds for the whole of my pregnancy, I wish I hadn’t of had to but it was better for us both than me being bed bound and not eating or drinking enough) Work with your consultant and GP and try to get on the best balance and type of meds so you both can thrive. As for bile acid, unfortunately I know nothing about that so can’t offer any advice on risks etc, I hope the consultant can help you feel better that it’s not too big a problem and you caught it early x

[Kcrochet in reply to Lovefood1984]

Thanks for your reply. I know you’re right that sometimes medication is the best option for mum and baby, that’s been my thinking too. I’ve had depression for many years and do have some bad bouts. I just feel so wrong-footed by this unexpected side effect having felt pretty confident that the sertraline was not involved in my symptoms. Also it’s always so hard to know how much benefit I actually get from antidepressants, so difficult to weigh risks and benefits.

My GP is very good, thankfully, and has said she will support me whatever I decide. At the moment I’m leaning towards being on nothing and seeing how that goes, with option to start this new antidepressant if my mood drops. But as you say with added stress and hormones in pregnancy I need to go careful.

Thanks again xx

[Lovefood1984 in reply to Kcrochet]

That’s fab you have a great GP, whatever you decide it has to feel right for you so if you want to try med free go for it having the safety net if you need it. Wishing you all the best x

[Kcrochet in reply to Lovefood1984]

Thank you! xx

[must92]

I was on sterline all way threw I got told off midwife and gp to not stop taking it but everyones different , my baby’s 10 days old today and he’s perfectly healthy and iv been on 50mg all way threw xx

[Kcrochet in reply to must92]

Thanks, yes I totally agree that sertraline is a pretty safe drug to take during pregnancy. Guess I’m just unlucky to get rare side effects on me that could affect my baby. So glad to hear all is well with your new little one and hope you are enjoying getting to know him 😊 xx

[must92 in reply to Kcrochet]

It’s the best feeling in the world 😊 he’s been constipated for 2 day so he’s been really unsettled he’s only 10 days old awful feeling helpless for him , hope all goes ok for you and little one x x

[Kcrochet in reply to must92]

Aww sorry he’s constipated, poor mite. I’m sure you just want to do anything to make him feel better. Hmm starting to suspect all this worry I’m feeling now is not going to magically disappear once baby is born 🙈 xx

[EvaK82]

I agree with other’s comments: You did the best you could - it’s not your fault.

Just remember everyone has a baseline risk or around 3-5% to have some form of complication or malformation. You can do everything right and something still happens. Or some people do lots of things “wrong” and still have healthy babies...

The side effect may not have affected your baby, especially as you noted it fast and are now taking action. Do speak about completely going off meds with your doctor though as this could also have a negative impact on your baby. I read that connections are being investigated between e.g. high cortisol levels / stress / anxiety and ADHD / Autism in children.

I’m taking low dose Amytriptiline for neuropathic pain but many women have safely taken this in pregnancy at high doses which treats depression (it might not be the right one for you but there might be others). I understand that you are now reluctant to take anything but best to trust the doctors and take some time to weigh up all pros and cons

I wish you all the best xx

Ps - I was 15w exactly yesterday

[Kcrochet in reply to EvaK82]

Thank you so much for your kind message. My mind has been spinning off down the track of thinking this is definitely going to harm my baby and it’s definitely my fault - so thank you for reminding me that might not be the case!

It’s funny because I work for a medical journal about drug development and I’m usually so in favour of taking a practical, evidence-based approach to treatment decisions, and I agree that there’s some evidence of harm to the brain developing if cortisol levels are high in pregnancy. But since this scare everything feels so turned upside down and all I can think is that I want my liver to be fully recovered before I consider taking new drugs.

As you suggest I’ll keep talking to my gp and consultant to make sure I’m doing the right thing, and I guess just keep seeing how liver and mood are doing.

Sorry I’m going on a bit now... helps to get thoughts out though 🙂

Great you are 15 weeks too! How is it going so far? Sorry to hear about your neuropathic pain ☹️ Really hope your meds are helping to keep on top of it xx

[EvaK82 in reply to Kcrochet]

Maybe there are liver detoxing things that you can do to give yourself some peace of mind?

I had looked forward to this pregnancy for years and certainly had a super healthy image in my mind of the type of mummy I wanted to be. I saw myself sipping green juices but definitely not popping any kind of pills!

But here I am.... some mean twist of faith gave me a disc prolapse just before conception which has become gradually worse. Since Christmas I could barely sleep and since Tuesday this week I am now confined to my bed in a face down position.

I first didn’t even want to take ibuprofen (back in November) as I was afraid for the baby... then Amytriptiline 10mg was introduced just after New Years as doctor’s said not sleeping is far worse for the baby. I agonised over this for days... then cocodemol was added (again researched all published journals for 2days). The dose of both was increased weekly...

On Tuesday this week, I had to make a trip to A&E and they had to give me oral morphin and now I am on oxycodone - the strongest kind of narcotics! But at this point I am just grateful to not have pain every second of the day and that I could stop crying my eyes out (which must be just as terrible for the little one).

I have stopped beating myself up about why this happened. And yes there are friends who tell me I ought to really stop taking these pain killers and whether I had considered massage as this can help... 🙄but I just need to trust that my doctors know what they are doing and that everything will be fine in the end. My research showed me that we are made of much tougher material and that many people have to do or take very many things - and still have healthy babies. I’m just going to trust that it will be me too (and you!). Next week the doctors will either operate my spine under general anaesthesia or inject steroids under radiological load. Neither optimal but both considered safe for baby under the circumstances... a team of doctors will be discussing my case to decide what’s best. And I have stopped googling now and will just trust them 🙏🏼

[Kcrochet in reply to EvaK82]

Oh I’m so sorry for what you’re going through. That sounds pretty horrendous even without the added worry of how it could affect your pregnancy. It sounds like you’re definitely doing the right thing following doctors advice, and if you’ve spent days reading up on the literature too there’s not much else you can do.

I think we all have these ideals of super healthy calm pregnancies but life so often has other ideas!

Hmm it doesn’t sound like massages are going to remotely cut the mustard but maybe when you’re on the mend some complementary approaches like acupuncture could help to boost the effects of the opiates..? I’ve looked up some liver-friendly foods so it’s mung bean soup tonight 🙈 who knows if it will help but feels good to try something.

I did a lot of reading up on liver and bile last week when I didn’t feel like the doctors I was seeing were really listening to me but now I have a good consultant with weekly follow ups I’m hoping I can let go a bit and trust in what he decides.

Will you let me know how you get on and what your teams decides at follow up next week? Really hope things start to improve soon 😘 🙏 xx

[EvaK82 in reply to Kcrochet]

Thanks darling - very sweet of you! I should know more on Thursday next week...

Before I got pregnant I did liver cleanses 1-2 a year and there are lots of veggies, fruits and herbs that are good... but would need to check about pregnancy safety. For example Dandelion (either as a supplement or Romain lettuce if you can’t find it) or juices containing apple and lemon. There was this fresh orange juice mixed with olive oil (sounds gross - but actually tastes quiet nice!) which was part of the cleanse. Oh and parsley and coriander were super detoxifying - mixing them into the juicer isn’t for the faint hearted but you can make a nice quick pesto with pine nuts and Parmesan and have it as quick pasta dish or on sandwiches.

Generally eating more plant based food and less food irritants allowed the body to focus on detoxing... i used to do this as i suffer from IBS as an occasional reboot just helped my system. I also have this liver and gall bladder tea - i think it has dandelion and mint in it...

I’m sure there is lots more that can give a little aiding hand. And a nice mung bean curry is yum 😋There is a new Ayurvedic cook book out by one of the Hemsley sisters and she has a nice Mung bean curry recipe in her East by West recipe book. I can send you a snap of it if you need one 😉 xx

[Kcrochet]

Thanks for the liver detox tips! Yes I’m on dandelion tea (tastes a bit odd but what the hey). I’d love a snap of that mung bean recipe if you have a mo 😊 but otherwise there are lots of tasty ideas online.

Let me know how it goes on Thursday xx

[Barry87 in reply to Kcrochet]

Hi Kcrochet, hope you delivered safely.

Would you mind sharing how the delivery was etc.

My partner was diagnosed with Chloestatis in week 29. Her reading was 119. She's been taking Urso 500mg 3 times a day for the last 4 weeks and thankfully her Bile reading is now much lower. It's reduced from 119, 80, 15 and 8.9. Doctors still want to induce her at week 36 + 4 days. I'm just wondering now that her bile readings have significantly reduced, should we go ahead with week 36 + 4 days or try to get to full term (37 days). We have seen 3 different doctors and they all suggest different induction dates (week 35, week 36, week 37). Partner is currently 33 weeks + 4 days.

[Kcrochet in reply to Barry87]

Hi Barry,

Sorry to hear your wife has had cholestasis but that’s great her bile acid levels have come down so much on the URSO. I can understand your dilemma about early induction versus going to 37 weeks especially when there’s no definitive answers from the doctors.

I was induced at 34 + 4 as my bile acid went really high again in the 3rd trimester despite the urso. All went really well with the induction and my daughter seemed ready to come out! She didn’t need any breathing support or incubation, but we did stay in hospital a couple of weeks to get feeding established and she had some feeds through a nasal tube at first. She’s now a healthy toddler (I can hear her in the next room bossing her dad around!)

I’m no expert and not a doctor but for what it’s worth I would go for induction at 36 + 4. To me it feels like those few extra days in the womb aren’t worth the risk. But that’s just my opinion and I understand the thought of ‘interfering’ to bring baby out early can be daunting.

I was under the care of an excellent team at kings hospital in London. If you like I could send you a couple of email addresses in a private message? But maybe you feel you’ve already got too many opinions!

Hope I’ve been able to help - please do message again if you have any other questions. Otherwise all the best for the rest of the pregnancy and beyond!

Katie

[Barry87 in reply to Kcrochet]

Thanks for your swift response Katie.

I'm so pleased to hear your little one is doing well

I've tried to do research but in all honesty, the articles aren't pleasantly reading for women who have had bile readings of 100 or more at any given time so that is why I'm keen to speak to women who have gone through a similar experience. I exchanged messages with another lady on this site who had readings of 200 at some stage but thankfully delivered a healthy baby at week 38.

We are under the care of Royal London Hospital. My partner was admitted into ICU at Royal London Hospital for 6 weeks with really bad covid. She was incubated and on a ventilator for just over 2 weeks. Thankfully she survived. When my partner woke up, her sugar levels shot up and she started to itch. The ICU consultants said it was due to COVID. After a couple weeks they said it could be pregnancy related. So she's now been told she has gestational diabetes and cholestasis but have not ruled out the liver issue being a side effect of COVID.

As mentioned, urso has really helped control my partner's bile levels. The hepatology team did say her blood improvements could be because her body is healing from covid. We just dont know as so much is unknown about the long term effects of covid.

Partner's itching has passed too since taking urso.

We just want to ensure we get timing right so keen to hear from other people. Oh would the email addresses be from the medical team at Kings Hospital?

Thank you.

[Kcrochet in reply to Barry87]

Hi Barry,

I’m so sorry to hear your partner had severe covid as well. That must have been such a stressful time for you! And then not knowing how these other complications relate to covid and recovery must just add to the worry.

I can’t remember my exact bile acid levels but they were definitely over 200 when it was first diagnosed and I think over 150 in the third trimester. I went insane with the itching and had to take cold showers in the middle of the night for 2 months!

From what I remember reading the dangers to the baby only happen towards the end of the pregnancy (after 36 weeks?). I was still scared that having such high levels at any point would be bad but my daughter hasn’t shown any ill effects 🙏

There probably isn’t an exactly ‘right’ decision in all this but there isn’t a wrong one either. One thing I would say in favour of early induction was we were amazed at how resilient and cool our daughter was! When they’re in the womb we think of them as so vulnerable and helpless but she just took everything in her stride and sort of led the way. Once they’re here you won’t look back!

The person I saw at Kings was Catherine Williamson:

kcl.ac.uk/people/catherine-...

She was amazing and is a real expert, as well as kind and caring. Her email address is there on the page if that’s helpful.

Let me know if you think of anything else.

All the best!

Katie

[Barry87 in reply to Kcrochet]

Haha my partner was going crazy with the itching too for a week or so. I'm so pleased your daughter is doing well and hopefully there are no long term issues.

I agree with you, we do consider the little ones to be delicate and vulnerable. But you're right, they are strong little people.

Thank you for sharing Catherine's details. I guess there's no harm in reaching out to her to get an opinion.

These forums are really helpful as it helps knowing people have been in a similar position and have successfully delivered healthy babies