Ep 300: The Silent Danger Behind Pregnancy Itching with Donna Benavides, Founder of ICP Care

Dr. Nicole:
Intense pregnancy itching might be a sign of a serious condition called coli stasis of pregnancy. In this episode, I'm joined by Donna Benavides, founder of the nonprofit ICP Care, to talk about her personal journey after tragically losing her first son due to coli stasis of pregnancy. Donna shares critical insights about symptoms to watch for, the importance of self-advocacy, and how to get the right care.

If you or someone you love is pregnant, this is an episode you absolutely need to hear.

Dr. Nicole (00:41.494)
Welcome to the Birth with Power podcast, where knowledge is power and power transforms birth. I'm Dr. Nicole Callaway-Rankins, mom of two and practicing board certified OB-GYN with over 20 years of experience and nearly 2,000 births attended. I've seen firsthand how the hospital system can leave women feeling unheard and uncertain, but that doesn't have to be your story. Here, you'll get the knowledge, support and strategies to take charge of your birth experience.

so you can walk into the hospital feeling calm, confident, and empowered. Note, this podcast is for educational purposes only and it's not a substitute for medical advice. See the full disclaimer at drnaclomaragans.com forward slash disclaimer. Now let's get to it.

Hello there, welcome to another episode of the podcast. This is episode number 300. Whether this is your first time listening or you've been here before, I'm so glad you're spending a bit of your time with me today. This episode is a deeply personal and powerful one. I'm joined by Donna Benavidez, a mother, advocate and founder of ICPCare.

a nonprofit dedicated to raising awareness about intrahepatic holy stasis of pregnancy or ICP. After experiencing this condition and the heartbreaking loss of her first son, Jordan, Donna has spent more than a decade empowering families with information, resources, and community. In honor of ICP Awareness Month, which happens in June, Donna is here to share what everyone should know about this rare

but potentially dangerous pregnancy complication. You'll learn the signs and symptoms, what testing and treatment involve, how to advocate for yourself, and how ICP can affect future pregnancies. If you're pregnant, planning to be, this is must know information to help you protect your baby and your peace of mind. Let's get into the conversation with Donna.

Dr. Nicole (02:50.766)
Thank you so much, Donna, for agreeing to come on to the podcast. I'm really excited to have you talk about this topic of coli stasis and pregnancy as we were chatting before we started. haven't talked about it before.

really excited to be able to share with you and also to all your audience and listeners. It's so very important. It's and is rather rare, not really as you know, awareness is key.

Agree, agree, agree. So why don't you start off by telling us about yourself and your family and what led you to this work.

Yeah, so I'm a mother who experienced intracardic ulcerative colitis pregnancy and I've been blessed thankfully with two healthy teens. My sons Brandon and Evan. And I have an angel baby, his name is Jordan. I'm a passionate advocate helping those affected with intracardic colitis pregnancy. It is so important to spread the word, share evidence-based information.

and to provide emotional support to all those affected and to know they're not alone in this experience because it's quite anxiety and emotional just to know the risks that are involved with the cold season pregnancy. And I'm the founder of ICP Care, a 501c non-profit celebrating our 11th year actually as a 501c status.

Dr. Nicole (04:11.246)
nice. That's wonderful. That's wonderful. So yes, and people will hear in the intro that you did create this nonprofit. was it your experience? Let me back up and say, can you share a little bit about your experience with Coley Stasis? And then what about it led you to start this nonprofit? Because a lot of times people have experiences, but they don't necessarily start an organization afterwards. So what was your experience and then what led you to start the nonprofit?

Well, my story is one that is, to have an angel baby so you can kind of already gather what occurred. So in my story, I was pregnant with my first son in 2002. And what led me to start the nonprofit was to help other families from experience the loss of a baby from stillbirth risks of colostrum pregnancy that I lived. My firstborn son Jordan passed away due to ICP 21 years ago.

It's 21 years ago, I can't believe it. Time has really gone by so fast, but not really. And so I began to, know, as in my experience, I was always a healthy person, very healthy, but I began to feel an intense itch at 33 weeks of pregnancy and I was diagnosed somewhat late at 36 weeks because, you know, pregnancy itch is rather normal, but this isn't. And my doctor,

35 weeks had suggested a blood work just to kind of rule out this high risk pregnancy condition that again is rather rare. And this was 21 years ago. And I was, I had the bile acid blood test and my levels were quite high, they were severe. And he unfortunately had passed away at 37 weeks on June 10th of 2003. Just a little bit to give you little bit of background on me being just healthy and.

this is just being pregnant and having this kind of thrown on me. was just, and we were just like, what? So, you know, based on the research that was available in that time and what I found online and based on, you know, past experience and the expertise of my doctors, you know, I was going to really well-known, you doctor group. I was like convinced and I, you a very positive person. I was just like, okay, know, everything's going to be fine, we're good, you know, we're diagnosed.

Donna Benavides (06:31.854)
You're doing things right. So I continued monitoring pregnancy. We had decided early delivery was going to be occurring at 38 weeks. There was medicine that was available, but I wasn't offered it. And again, this was 21 years ago. Things are quite different now. so I soon learned the untimely truth of everything that although you're diagnosed, although you feel like your doctor may know and you feel like you've researched some.

know, some healthcare providers aren't completely educated, even to this day, you know, or up to date, or aware of, you know, the proper treatment and management of colostasia pregnancy. And a lot of times we have to advocate for ourselves. And, you know, this is really why just really having the nonprofit exists to help families prevent, you know, losing their baby like I did. And...

and to really have them feel supported and heard and be able to advocate for themselves.

Yeah, absolutely. Definitely. Definitely. So why don't we talk about some some basics of what is intra hepatic coli stasis of pregnancy? And I'm going to shorten it just to coli stasis just for simplicity sake. But what what is it? And it's kind of hard to describe. So

Yes, So ICP is just the shorter version of what it's called, the cholestases of pregnancy, cholestases exactly. So it's a family of liver disorders that occur only during pregnancy and it's characterized by elevated bile acids tests. So it's blood tests in patients. And ICP can pose a risk to the one more baby and the worst case scenario risk is stillbirth, which is what I experienced. And so ICP is...

Donna Benavides (08:14.798)
caused by the genetic predisposition paired with hormonal and environmental, so it's multifactorial. But it is genetic, does have pre-genetic predisposition.

Yeah, definitely, definitely. then what are some, you've described one of the most common symptoms that people have, but what are some of the symptoms of ICP that people need to be aware of who are listening?

The primary symptom and often only the only symptom that women have in cholestasis or pregnancy is moderate to intense itching and it can vary. And often itching is mainly in the hands, wrists, ankles, However, it can actually occur all over the body. And one of the things that some of our community members have really expressed is just...

really unusual places that they may feel itching, which you'd think is uncommon, like the scalp, their inner ear, their tongue. So again, it could just be anywhere. And many people experience worsening of the itching at night. And so other symptoms that may be present, but not necessarily, is right upper quadrangle pain. So pain in the area where the gallbladder and the liver is, also dark urine can be a symptom.

hailstool and very rarely with jaundice.

Dr. Nicole (09:38.654)
Yeah, yeah, exactly. But the itching is going to be the thing that that tips people off. So I want to quickly answer how common is it? And then I want to get to if someone starts to have itching, what do you what would you recommend that they do? So first, why don't we talk about how common is is colostasis?

Well, based on research that's currently available, it's anywhere from one to two pregnancies in a thousand that are affected in the US. And Latinas are 5.6 % more prevalent to have colostasis. And that's kind of where I'm from, because I'm Latina. And so it is higher. And of course, in the UK, there's a different percentage that's out there. However, is somewhat uncommon.

But it is something that itching during pregnancy, like I said before, is common. But this itching is quite different because it can be really intense, especially at night. And it's just something that is very unusual. You think maybe you have something wrong with the products you're using on your skin or maybe there's bed bugs. That's how unusual it is. It's just very unusual.

Right, yeah, yeah. It's hard to describe. I mean, I didn't have colostasis with either one of my pregnancies, but having taken care of people with it and hearing them describe how intense the itching is, it's not just like, you know, a little something and it's almost overwhelming in a way. Like it's a very intense itching for sure.

It's so intense. can actually make you feel like you're like you're losing your mind in a sense. You know, it's just really, really, it can be really.

Dr. Nicole (11:22.614)
Yeah. So if someone is, yeah, if someone said, okay, they're at a certain point in pregnancy and it's like, my goodness, this itching was going on. What do you recommend that folks do?

I definitely recommend for them to speak to their doctor or just communication overall with your health care provider is just so critical. then being heard and just having a health care provider that's receptive and really open. And the first thing is to allow them to know that you're itching and this itching is just really unusual and it's intense. And they will more than likely be aware of colostrum pregnancy and

and have blood tests drawn. And the two blood tests that are important are bile acids and liver functions. And if indeed they may not request blood tests, then you're able to research on your own and be your own advocate for your inner baby and request the blood test. And then from there, once a blood test does come back with the results, you have more answers and then you can talk more with your health care provider. And then if indeed, because we do find this in our community and this does happen.

If indeed your blood results come back normal and you still have the intentogen, that's a red flag. So you have to have another blood test and just request it and you have to just be again on top of your health and advocate for yourself. Because sometimes it can take a few blood tests to show as diagnosable levels within the bile acids in your bloodstream.

Thank you, that's a really important point that I want people to make sure that they hear is that you can have colestasis and have normal blood work. It may take some time for the results to reflect what's going on. And sometimes it may take like three or four days for the results to come back, things like that. So sometimes we have to treat it or diagnose it based on symptoms and just like the persistence of it. But this is not like a one and done.

Dr. Nicole (13:20.664)
kind of thing. we checked it. It's fine. If it continues, then we really need to continue to re-evaluate. So that's just a really important point that everybody should take from this conversation. Yeah. Yeah. So you talked about the big risk for baby, which is still birth potentially. Are there any particular risk for mom?

Absolutely.

Donna Benavides (13:45.326)
For a month there there

If you indeed have colostasis of pregnancy, your pregnancies complicated by colostasis of pregnancy are also at risk for preeclampsia and gestational diabetes. So there is a connection there. Doesn't mean you won't get either of these, but there is a higher chance that you may. Prior studies have shown an increased risk of bleeding around the time of delivery.

But recent studies have really shown this risk is very low with treatment of intramedical lysis. So in other words, in the past, there's been hemorrhaging as a potential risk for moms with ICP.

Yeah, definitely. I often, or not infrequently, I would say preeclampsia for sure of those things is what I've seen in my career the most, but it can absolutely be associated with other conditions that we have to be on the lookout for. And then yes, unfortunately that risk of stillbirth is there, which kind of leads us into the discussion of what do we do when it's diagnosed and how do we manage it?

Yeah, so just the risks for baby are obviously quite different. But, so colostacean pregnancy is treated, um, so the treatment for it includes medication. It's bursar deoxycholic acid. Um, and in the US it's...

Dr. Nicole (15:03.992)
Yeah, or style.

called and early delivery are quite critical for managing depending on the bile acid level. And it all depends on the bile acid level. So the risks increase as the bile acids increase. just the medicine itself has been proven safe for both parent and baby and it improves symptoms and for the majority of patients, not everybody. But however, there is, you know, therapeutic and benefits for the baby. And, you know, want to kind of have that opportunity to be able to cook the baby as long as you

I'm sorry.

You know, early delivery again typically occurs in weeks between 36 and 39 weeks depending on the severity of the interopatical disease or pregnancy. And again, really working with your doctor, really having the blood test retaken to be able monitor your bile acid levels to really make a decision. also we've already talked about this, this is a really sore spot in regards to just the blood test, how long it takes to receive insulin.

for some patients, it's really frustrating. And healthcare providers have actually communicated that to us when we've gone to conferences. And again, it's just something that we've been working on and there's also another organization that's working with Yale University to see if, you know, can be done in-house.

Dr. Nicole (16:21.326)
I'm coming with a faster test. Yeah, really, it definitely takes like three or four days for the test to come back, which can be very, very frustrating when you're looking for answers. So for sure that.

Exactly, because time has up the essence, Especially when the risk is still worth its critical.

Definitely. And you know, we will say that the risk of stillbirth is it's it's it's not high, but it's certainly higher. Obviously, that's why we're concerned. And obviously, as we know from Donna's story, it's not zero and it does happen. So it is something that we absolutely have to be aware of and take seriously. I'm curious, do you mind sharing like, are there any particular stories and you have a community of folks that have had this that

resonate or come from the story that you feel like other people should know or learn from? I'm kind of throwing this one. This is one of the questions I was thinking about, but as you mentioned community, what are some things that you've seen throughout the years that have just been like, my goodness, or I'm glad that person advocated for themselves or anything that has stood out over the time of your nonprofit?

The stories in our support group that I've heard throughout the years, not only me, just our team of support group volunteers that are there really helping other moms. I've heard so many stories, but throughout the years it's just, it's been consistently improving, I would say, in regards to having moms advocate for themselves, you know, with the help of just the resources and, you know, the internet has the vast amount of information, but just really being connected to the nonprofit.

Donna Benavides (18:01.664)
support group and having the community and being able to ask questions, being able to get answers and just encouraging and being given evidence-based information is so amazing because this way they can have that information to give to their health care provider and communicate and make a best decision. But just there's been so many stories, know, some very, very heart wrenching stories that I can tell you during COVID that happened and

You know, that just, again, because of the lack of communication and being able to be in the setting, a normal setting, sort of just tell the house. You know, just babies passing away, unfortunately, and just things like that. But again, there's so many stories, but advocacy is critical and just finding your community, finding the support. And guess what?

I'm gonna say it.

Donna Benavides (18:58.786)
Just having your mom, your husband or family member be there with you on the appointment, to be your support group, to be your cheerleader in case the doctors, you know, just maybe you feel like you need just more support and then you feel a little more courageous and more able to advocate for yourself. Or they can speak for you, you know. I think when you're pregnant, you're in such a delicate state. I remember myself being pregnant for the first time.

You know, and just being in such a delicate state and you're, want to protect your baby. It's just like, and then your body, you have this Irish pregnancy and just like, what? But having a support group of family and just, it's just amazing.

Exactly.

Dr. Nicole (19:38.37)
For sure, for sure. You always want to have somebody who can help advocate for you if need be. Or just a second ear, because sometimes you may not hear everything. All of those things are really, really important. Really, really important. So how likely is cholestasis, how likely is it to recur?

It varies. So the information that's out there, it varies in regards to anywhere from 60 to 90 % recurrence rate. It is known that women who have ICP in one pregnancy are very likely to develop it again in the subsequent pregnancy. That doesn't mean that it's to definitely happen 100%. But for example, in my case, I've had severe colostacean pregnancy.

and I've had it in all my pregnancies, so all three. Really? Yeah, and the norm within our community from stories and everybody that's shared, know, those times that I see those posts are like, we had an ICP pregnancy. I'm just like, I'm just like cheering them on. I said, I'm like, sometimes when I'm in the group and I see it, I'll put a message and I'm like, I'm so happy that, you you got to experience the ICP free pregnancy. You know, we're so happy for you.

Right, right.

But it's just amazing when that does happen. it does. interestingly enough, we had a volunteer in our group years back. She had four pregnancies and she had all cholestases. And then her fifth one, ICP-free. was like, wow. Amazing.

Dr. Nicole (21:15.238)
That just tells you we don't know what I mean we can guess but we don't always know what's going to happen. Yeah. Now what was your experience like with it with your second two? Did it develop around the same time or was it any worse or anything like that?

pregnancy to pregnancy.

Donna Benavides (21:30.978)
For me, it was interesting because with my second son, I was monitored with blood tests earlier on. I already knew if I had a little bit of tingling of an itch or anywhere, I was like, okay, was just like my intent was not just to get really tested and to make sure that I was diagnosed earlier. But that I was able to get diagnosed earlier with him because I already knew. And with him, I would say that

being diagnosed earlier and then just getting the medicine, which I hadn't gotten my first, was definitely different and I felt, I would say, safer for him. I felt it was safer. And he was actually born at 35 weeks and five days. And what my second, I honestly,

My third, excuse me, my son Evan, he actually, I thought that because I wasn't itching right away or early on, I was just like, maybe I'm not gonna get this, maybe it's gonna skip. But interestingly enough with him, because one of the risks of Colistis is preterm labor, and actually when I was 30 weeks pregnant with him, I was having contractions and I went to the hospital.

Right.

Donna Benavides (22:54.862)
They gave me an IV to stop in, help me stop the labor. And it actually happened again at 31 weeks. So with him, I hadn't experienced the itching early on, but I did end up having this preterm labor, which is again, one of the risks or symptoms, whatever you want to put it together. But I did end up having itching with him. It did kind of show up during my 30, I want to say 30.

35 weeks, I quite late and again, I didn't finish a lot and then he was born.

Okay, okay. Yeah. Definitely, definitely. Okay. All right. Yeah. Every pregnancy is, is, is different. It sounds like you experienced the whole gamut. Yeah, for sure. For sure. Yeah. Yeah. So, is there anything that can be done to prevent, let's have this discussion, prevent ICP at all or prevent it from happening again?

So that was a different

Donna Benavides (23:57.23)
Well, there's no research to really show that it can be prevented. However, there are community members that have shared just their experiences and how they feel, that what they did that helped them possibly, you know, kind of improve their odds in regards to their health and their pregnancy. So some of those include just eating healthier.

you know, taking some herbs or again, working with somebody that knows about all that stuff, natural path or whatnot, and just doing other things that, again, that may help. but no, there is no research to show it can't be.

Yeah. Is there any research being done? I'm not aware of any, or much, maybe you know, that is done to better understand and treat this condition.

Yeah, so the research that's happening now, it's interesting because there is a new actually drug therapy that's kind of out there to see if it can help in a different way than Urso does. And again, more research is needed in this case, but they're looking into IPAT inhibitors. So it's a class of drug that block the reabsorption.

Donna Benavides (25:25.866)
of bile acids in the small intestine. So in other words, what happens is it's kind of redirected and then you're able to kind of like excrete the extra bile acids through your stool. Interesting. But that's the research that's happening in that regard. And I know that what I had mentioned earlier regarding the bile acid blood test.

that again, the source brought the results coming back so late. This isn't necessarily research, research on cholestasis, but it's research on just having sooner available bile acid blood tests. And that can happen within the hospital setting. If you have a kit, it just has the machine, the machines that most hospitals have, can just be recalibrated and there's a little kit to be able to get results pretty much.

you know, within the 24 hours. So I know that that's something that's worked, that's been done in hospitals in North Carolina, believe, or South Carolina, I which one it was. And I think that Yale is, Yale is working on kind of like pushing to see if that can happen again. Made a reality because it makes such

you can get faster results.

Absolutely, yeah. Time makes a big difference in this condition, so definitely important. And then, what can partners do to support someone who has ICP?

Donna Benavides (26:49.838)
Yeah, so partners could definitely be such a wonderful, amazing support system. Just going to the doctors with your spouse is amazing a partner. Help them relieve the itch as much as you can. Offer to put on some of that lotion that is helpful to relieve the itch. And again, it's not going to get rid of the itch, but at least it relieves it. Place a humidifier in the room.

know, refill their ice bags to help alleviate the itching. Because a lot of times, some of you may think like, what is she talking about?

Thanks.

Let me tell you what it is to be a Coliseum pregnancy mom. Pretty much, you know, to relieve and kind of dull out the itching, what we end up doing is we get ice. We either can put our little feet or little hands in, you know, into cold ice buckets or, you know, little portable ice packs. We can put them on our hands and our feet. I actually did that in my pregnancy. My pregnancy is...

And so it just, again, it just, it alleviates. so, yeah, for sure. Just, you know, partners can help to maybe hire somebody to come to clean, to take care of you. If they already have kids, take care of the other kids. Allow them to take a nap because unfortunately it does disrupt your sleep at night because of the itching. And then if indeed you have to go to work the next day, you know, or, or, you know, take just work.

Dr. Nicole (28:21.126)
Yeah. Absolutely. And even though it's something that you can't necessarily, I guess, see physically that something is happening, that it's a real thing and that it's not like a, you know, crazy pregnancy brain or anything like that. It's a real condition that needs to be taken seriously. Yeah. Yes. Yeah. So then as we wrap up, what would you say is the most frustrating part of

just knowing their needs.

Dr. Nicole (28:49.57)
this work you do with your nonprofit.

I'm just going bring it back to the same thing as before. The bile acid blood test, the length of time to receive the results because time is of the essence, like I mentioned. And it's really frustrating. And just to see within our support group community, how the moms just worry. then they mentioned the same thing about having the blood results take so long and then just being concerned about the decisions and not knowing just the real time.

Yeah.

results and how they are at that time because, you know, decisions need to be made, especially if you're further along because, you know, if the bile acids are in data in the severe range, if they weren't before, then management needs to, you know, to be changed. You need to decide to induce sooner, make decisions again to keep the baby

Yeah, definitely, definitely. Then on the flip side, what would you say is the most rewarding part of your work?

Donna Benavides (29:52.43)
So the most rewarding is like there's so many, but our mission is to definitely save lives, know, save the lives of innocent Prussian's beautiful babies. You know, this is why this is my why. And just working with an amazing team of passionate board members, volunteers and ambassadors are, you know, we're all such powerful advocates for the cause and we're helping so many families and you know, in the world. And it's just so rewarding, honestly.

Amazing. sure. So then what is your favorite piece of advice that you would like to give to an expectant mom or family so that they can best use their power during their pregnancy and their birth?

Yeah. Yeah, it's just good.

Donna Benavides (30:38.99)
So definitely, you know your body. I always say this. You know your body the best. There's nobody else that can say, you know, this is how you're feeling. This is what's normal for you because you know your body the best. And that's something you need to honor and really validate in yourself. And so we must be advocates for our baby. You your intuition as a mom, as a parent, is always there to guide you. And, you know, never allowing anybody to just

talk you out of something that you genuinely feel in your gut. And if you're itching during pregnancy, it may be cool to see some pregnancy if somebody's out there and itching. A simple blood test can be requested. And if symptoms persist, like we talked about before, it's so critical and important. Ask for another blood test. Second one, a third one, a fourth one, do it. if indeed, I always like to just say this because

Definitely.

Donna Benavides (31:38.638)
know, healthcare providers are amazing. There are different levels of healthcare providers to our specialists or high risk pregnancy doctors, maternal, fetal medicine specialists. You can always get a consultation or consult with another one. Get a second opinion. Don't ever feel that you can't and that you're trapped and you're powerless because you're not. There's tons of other doctors out there that can take your case on or you can't get a consultation.

You know, put your mind at ease.

Yep. So important. Great point. Great point. Great point. So then where can people find you and find more information about you and your organization?

Definitely a website, icbcare.org. We have amazing evidence-based resources. We have support groups. We have free downloadable information brochures. We also have a new program that we started, which are free pamphlets, brochures that can be actually mailed to you. know, we can be found on Facebook, on Instagram, Twitter.

We have an amazing YouTube channel that has stories that can really allow you just to connect in a different way. And our support groups are the main really area that I always love pointing everybody to because that's where you're going to find your community, find other moms where you can relate to. Other moms that are pregnant can't really relate to Colostase is a pregnancy mom because of just the dynamics of everything that's involved.

Donna Benavides (33:17.467)
We are on TikTok.

You are everywhere.

Pretty much, I see PK.

You are everywhere. Great, great, great. Well, thank you so much, Donna, for agreeing to come onto the podcast. This is just such an important topic that people need to know about. So I appreciate your time.

Thank you so much. appreciate you Nicole and all you're doing and just so excited to have your community receive all this information on colostasis pregnancy to spread awareness to really allow other moms just to understand that itching and pregnancy is normal, but hey, it could very well be a higher pregnancy condition that you need to bring to the attention to your doctor and talk about your symptoms.

Dr. Nicole (33:59.468)
Yep, exactly, exactly.

Dr. Nicole (34:08.525)
That was a really informative episode. So appreciate Donna coming on. And you know, after every episode, when I have a guest on, I do something called Dr. Nicole's notes, which are my top takeaways from the conversation. Here are my Dr. Nicole's notes from my conversation with Donna. Number one, definitely pay attention to unusual itching, intense, persistent itching, especially on the palms of your hands or the soles of your feet.

or unusual places like really bad in your scalp or your inner ears, that could be a red flag for coli stasis. So do not ignore it. Always bring that up with your doctor or midwife. Okay, number two, trust your intuition and advocate hard if you need to. Donna reminds us, you know your body best. I have always said, I am an expert in obstetrics, hands down.

Period, full stop. But you are an expert on you. Also hands down, period, full stop. So if something feels off, speak up. You may need to ask for a blood test. And if results come back normal, but symptoms persist, you may need to get blood tests again. Self advocacy, not just in this condition, but in general, whether you're pregnant or not.

can literally be life-saving. So trust your intuition always and advocate hard if you need to, to get those answers. Okay, number four, early delivery is important. I know that there can be a lot of anxiety or concern about induction and having a delivery early, but please know that this is really a standard treatment that can significantly reduce the risk.

Those medications like ursodial can reduce symptoms, but early delivery and often between 36 to 37 weeks, depending on the severity of the cholestasis can really be life-saving. The risk of stillbirth can be as high as 3%, especially if the bio-acids are really high. And that may not seem like a huge number, but that could be anywhere from 100 to 200 stillbirths a year in the U.S. that would be avoided by induction. So.

Dr. Nicole (36:27.086)
This is not something to take lightly. Early delivery really is a evidence-based approach to treating colostasis of pregnancy and making sure you decrease that higher risk of stillbirth. And then the final thing I want to talk about, and this may sound a little bit out of place or weird, but let's just talk about it. And I'm talking about those portal lab results. You're like, what? What are you talking about portal lab results? Well, because of a law passed a few years ago, you can now get immediate access to your lab results.

through your patient portal, whether it's your LabCorp patient portal or your doctor's office's patient portal. And sometimes those results will show up at weird times. It's after hours or even on weekends, and it may be before your doctor sees them. Now, in most cases, I recommend that you wait to contact your doctor during normal business hours if you see lab results that pop up in your portal in an off time that are concerning to you.

However, in this instance, a very elevated bioasset is different. If you're 36 weeks pregnant or later and you see that you get this lab result and your bioassets are really high, go ahead and call the on-call doctor, maybe even head to the hospital if you can't get ahold of the on-call doctor, because if you are 36 weeks or later, they are probably going to want to recommend and appropriately recommend labor induction. So in general, no.

You don't have to call on nights, weekends when you see those things pop up. But in this case with that bile acid level, go ahead and call the on-call doctor or midwife when you see those results. Okay, that's it for this episode. If this show has helped you feel more calm, more confident, more empowered, the best way to show your love is to subscribe, leave that quick review and share it with a friend.

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Dr. Nicole (38:48.854)
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