Cholestasis of Pregnancy: My Journey and the Promise of Precision Medicine

Asraa Hawli-Bazzi
January 19, 2024
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At just 24 weeks into my pregnancy, I woke up in the middle of the night with an intense itching sensation on the palms of my hands and soles of my feet. Initially, I thought it was some sort of allergic reaction. However, when the symptoms persisted, I turned to the internet for answers. A simple Google search led me to a term I had never heard before: Cholestasis of Pregnancy. Little did I know that this condition would become the focal point of my pregnancy journey, causing not only physical discomfort but also mental distress.

Cholestasis of Pregnancy, also known as intrahepatic cholestasis of pregnancy (ICP), is a relatively rare condition. Its prevalence can vary depending on geographical location and ethnic background. In general, it is estimated to affect approximately 1-2pregnancies per 1,000 in the United States and Europe. However, in certain populations with a higher genetic predisposition, such as women of South American, Indian, Pakistani, or Scandinavian descent, the prevalence can be higher, reaching up to 5-15 pregnancies per 1,000.

The author with her daughter.

When I contacted the triage line and described my symptoms, they ordered the necessary tests that confirmed my diagnosis. Suddenly, the itching became the least of my worries. I found myself consumed by concerns about the health of my unborn child and the potential outcomes. As an expectant mother, I had hoped for a simple solution—a cure or medication that could alleviate the itching and ensure the well-being of my baby. However, the reality was far from that. The uncertainty surrounding this condition amplifies the mental and emotional toll it takes on women like myself.

Pregnancy is typically a time filled with joy and anticipation. As the third trimester approached, I should have been looking forward to baby showers and preparing the nursery. However, ICP stole those moments of excitement away from me. The intense itching made it difficult to fall asleep at night, leaving me mentally drained. The constant itch served as a cruel reminder that something was not right within my body.

My doctors diligently monitored my condition as my liver enzymes and bile acids continued to rise. Every appointment was accompanied by anxiety and a relentless countdown of the days until the next check-up. Living my pregnancy day by day became the new norm, overshadowing any semblance of long-term planning or excitement and the lack of definitive answers about the causes and treatments for ICP only adds to the frustration.

In this era of advancing medical knowledge, it is disheartening to witness the limited research dedicated to understanding and addressing ICP. However, Precision medicine holds immense promise for improving our understanding of certain health conditions and pregnancy complications like ICP. By analyzing individual genetic data, environmental factors, and clinical information, we can uncover the intricate mechanisms underlying many conditions.

It is imperative that we also prioritize the inclusion of more diverse populations, including those from the Middle East and North Africa (MENA) region, in genetic studies to ensure that precision medicine benefits all communities and provides comprehensive insights into conditions like ICP.

The NIH All of Us Research Program stands as a beacon of progress in the realm of health research.

It distinguishes itself as the first federal research initiative to incorporate a dedicated category for individuals of MENA descent, among several other subcategories, aimed at ensuring the accurate representation of diverse communities. The potential of this program lies in its capacity to offer invaluable insights into conditions such as ICP. By amassing comprehensive data, it equips researchers with the tools needed to craft personalized approaches, ultimately enhancing healthcare outcomes for both women and their babies.

My experience with ICP has been a challenging and isolating journey. The uncertainty surrounding my child's well-being, and the lack of answers have taken a toll on my mental health. But by sharing my story, I hope to raise awareness about the importance of initiatives like the NIH All of Us Research Program, which can bridge the gaps in knowledge and pave the way for a future where everyone can receive the care and support they deserve, regardless of their background or ethnicity.