Approximately 2% of all pregnant women experience itching and elevated liver enzymes due to liver impairment in the last part of pregnancy. We will provide more information about this in this pamphlet.

The itching is uncomfortable but harmless for the mother. If left untreated, the liver impairment can affect the unborn child. The cause is pregnancy-related liver overload. This overload resolves on its own after childbirth.

Danish Treatment Program
In Denmark, we have had good results with an examination and treatment program for many years.

Examinations
We recommend that you come for an examination at Rigshospitalet once a week. Each week, blood tests (liver function tests) are performed in section 5001 on the ground floor. Most of the time, the test should be taken while fasting, meaning you should not eat after 10 PM. You can drink 1-2 glasses of water in total. Avoid smoking or chewing gum during the last two hours before the blood test. Additionally, every week, you’ll also be offered an examination for the baby:

You’ll have the option to undergo a fetal heart rate monitoring (CTG) for approximately half an hour. This takes place at Rigshospitalet, Delivery Ward 4023.

If you have elevated levels of bile salts in your blood, you’ll also receive weekly ultrasound scans. This procedure also occurs at Rigshospitalet.

Medical Treatment
You’ll be offered treatment with Ursofalk (Ursochol or Proursan) tablets, which should be taken three times a day. These tablets work by increasing the elimination of some substances that can affect the unborn child (bile acids). Ursofalk also alleviates the mother’s itching.

No side effects have been described for children receiving this treatment. Mothers may experience mild diarrhea from the medication.

Induction of Labor
It is known that prolonged exposure to high levels of bile salts can affect the unborn child. Some studies show a slightly increased mortality rate among fetuses in late pregnancy when the mother has liver impairment. Therefore, all pregnant women with liver impairment are recommended to have labor induced no later than the due date (approximately 40+0 weeks). The timing depends on blood tests and the condition of both the baby and the mother.

Many women with liver impairment will be offered induction of labor 2 weeks before the due date (approximately 38+0 weeks). A very small number of women may be recommended induction of labor 6 weeks before the due date (approximately 34+0 weeks).

You can obtain information about labor induction from your midwife.

Self-Care Recommendations
Many women experience significant itching and difficulty sleeping due to this condition. Here are some suggestions that may help:

• Avoid becoming too warm on the skin. Sleep in cool rooms with a lightweight duvet.
• Keep a damp cloth nearby to cool your skin during the night.
• Use a good moisturizer after bathing to prevent dry skin.
• Some find relief by applying zinc ointment to the skin, which can be purchased over the counter.
• Others may benefit from antihistamine tablets, which should be prescribed by a doctor.

After Giving Birth
There are no specific precautions after giving birth. You can breastfeed, and if everything has proceeded normally, you can have an outpatient birth.

However, there are a few things that may be helpful to know:

• It is recommended that all newborns in Denmark receive a vitamin K injection immediately after birth, although some parents choose to decline this offer. There may be minor disturbances in the mother’s vitamin K levels due to liver impairment, so the baby may have a special need for this injection.
• You should stop taking Ursofalk after giving birth.
• Liver impairment resolves on its own.
• You can have a blood test through your own doctor 6-8 weeks after giving birth to check that liver values have normalized. You need to request this if you wish.
• There is a high likelihood that you will experience liver impairment again in subsequent pregnancies. If you later decide to take birth control pills, it’s a good idea to mention to the doctor that you had liver impairment during pregnancy.
• If you have any questions about this pamphlet or the overall process, feel free to reach out to your midwife.