Apr 19, 2023 • 7 min read

Cholestasis of Pregnancy Diet

Medically Reviewed by Kim Langdon, MD on 4.19.23
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Cholestasis of pregnancy is an uncommon disorder of pregnancy affecting 1 in 150 pregnancies. Cholestasis means that the bile in the liver flows poorly, resulting in low appetite, nausea, and jaundice. Fats in your diet rely on bile for their absorption. Without bile, fats become oils that are expelled in stool, leading to oily, foul-smelling stools.

The causes of cholestasis in pregnancy include hormonal factors, genetics, and possibly the environment you live in. Known risk factors include previous liver disease (including gallstones or hepatitis C), being over 35 years, and having a multiple gestation pregnancy. If you’ve had it before, you have a high likelihood of getting it again in any subsequent pregnancy.

Cholestasis of pregnancy can be risky for you and your baby. Your baby might be born early or stillborn. Meconium staining at the time of birth and the potential for lung problems can also happen to your baby if you have this disorder. No diet or medication can prevent the problem; however, eating right can help a lot.

This guide goes over nutritional recommendations for cholestasis of pregnancy, including the best foods to eat and which to avoid. We will talk about how eating habits can reduce the chances of complications and how a prenatal nutritionist can help you navigate this challenge effectively.

Nutritional recommendations for cholestasis of pregnancy

Pregnancy puts added stress on your liver, which partly explains why cholestasis of pregnancy develops. Your liver performs many tasks, including making your blood proteins, producing enough clotting proteins, detoxifying your body, and balancing hormones.

You can help your liver function better during the stress of pregnancy and cholestasis by following some simple dietary recommendations:

  • Eat plenty of protein. Your liver is responsible for making many blood proteins. You can help by making sure you get key amino acids found in foods high in protein. You can learn more about how much protein to eat during pregnancy here.
  • Eat foods with medium-chain fatty acids (MCFAs). Fats absorb very poorly when the bile flow has slowed or stopped. The only fats that absorb relatively easily are medium-chain fatty acids, found in higher concentrations in coconut oil and palm kernel oil. Other types of fats should be reduced in your diet as they are poorly absorbed and contribute to GI upset.
  • Consume extra fiber. Toxins in your food can be absorbed by the gut and because your liver is sluggish, it can’t break them down as easily. Fiber helps bind toxins so that you aren’t as affected by them.
  • Eat foods high in vitamin K. Vitamin K is a fat-soluble vitamin that needs bile to be absorbed. You need this vitamin for the effective clotting of blood. In order to get enough vitamin K absorbed when you have cholestasis, you should consume more than you normally would. Leafy greens like spinach and collard greens are great choices.
  • Eat extra omega-3 fatty acids. Omega-3 fatty acids will be more challenging to absorb with cholestasis of pregnancy. Do your best by eating foods that have mostly this type of healthy fat. These include fish, nuts, and seeds.
  • Load your diet with vitamins A, C, and E. These are antioxidant vitamins that help your cells heal from stress. Vitamin C will be easily absorbed but because vitamins A and E are fat-soluble, they are harder to get into your system. Nevertheless, when you eat more foods with these vitamins, the chances of some getting in are greater.
  • Make phytonutrients your friend. Phytonutrients are plant-based nutrients known to have antioxidant effects or to help your cells heal in other ways. Highly-colored fruits and vegetables will be your go-to foods for phytonutrients.
  • Consume a diet higher in calcium. Calcium and vitamin D are essential for bone health. Researchers note that, because metabolic bone disease can be partially corrected with high calcium intake in those who have cholestasis outside of pregnancy, it is recommended to get this during pregnancy as well.
  • Remain hydrated. Hydration helps your kidneys flush waste (including toxins). By drinking extra water, you can help your kidneys do their job.
  • Avoid oxalates. People with cholestasis have a higher risk of oxalate-containing kidney stones. By avoiding certain foods, you can reduce your chances of having this complication. Foods to avoid include rhubarb, almonds, miso, rice bran, and buckwheat. Spinach would normally be avoided too but you may need it for its other health benefits. Eat spinach in moderation.
  • Avoid alcohol. Alcohol is not recommended during pregnancy anyway but with cholestasis, you have another reason to avoid it. Alcohol places a huge stress on the liver, so it won’t be advisable to drink even after pregnancy until the cholestasis resolves.
  • Avoid highly-preserved and processed foods. Pesticides and preservatives are chemicals your liver can’t handle when you have cholestasis. Highly processed foods are hard on your system because they contain more of these.
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A note about the Dirty Dozen & Clean Fifteen foods

The Environmental Working Group (EWS) is a global coalition designed to educate people on the use of pesticides in food. The EWS studied foods grown commercially and sold in stores for their pesticide content and developed the concept of the “Dirty Dozen” and “Clean Fifteen” foods.

Foods are included in the Dirty Dozen if they are particularly high in pesticides. If you have cholestasis, your liver will have trouble processing these excess pesticides, and they could harm you or your developing baby. Organic versions of these foods offer you a chance to avoid high levels of pesticides.

The Dirty Dozen foods include:

  1. Strawberries
  2. Spinach
  3. Kale, collard, and mustard greens
  4. Nectarines
  5. Apples
  6. Grapes
  7. Cherries
  8. Peaches
  9. Pears
  10. Bell and hot peppers
  11. Celery
  12. Tomatoes

The Clean Fifteen foods are those that are generally considered to be safe because pesticides are not often a part of growing them commercially. If you can’t afford organic foods or don’t have access to them, you can eat these foods whether they are organically grown or not.

The Clean Fifteen foods include:

  1. Avocado
  2. Sweet corn
  3. Pineapple
  4. Onion
  5. Papaya
  6. Sweet peas (frozen)
  7. Eggplant
  8. Asparagus
  9. Broccoli
  10. Cabbage
  11. Kiwi
  12. Cauliflower
  13. Mushrooms
  14. Honeydew melon
  15. Cantaloupe

>> Find a pregnancy nutritionist that can help with your cholestasis of pregnancy diet

Foods to eat with cholestasis of pregnancy

The foods you should eat with cholestasis of pregnancy may or may not change the outcome, and they won’t prevent the condition. On the other hand, these are foods known to carry the least risk when your liver isn’t functioning well.

  • Whole fruits and vegetables. While all fruits and veggies are good for you, those on the Clean Fifteen list have the lowest pesticide content (even if not organic). These include carrots, mangoes, watermelon, sweet potatoes, mushrooms, cabbage, honeydew melon, kiwi, asparagus, sweet peas, papaya, pineapple, onions, sweet corn, and avocados.
  • Healthy fats. Remember that most fats will be poorly absorbed when you have cholestasis. To get some of the healthiest fats into your system, eat mostly those foods high in good fat and avoid other types of fat. The best choices are fish, nuts, seeds, coconut oils, palm kernel oils, and low-fat dairy products. Don’t go overboard with fats, though. Eating a keto diet during pregnancy is generally considered unsafe.
  • Lean protein sources. The best lean proteins have all the amino acids you need and little of the fat you don’t. Good choices include fish, poultry, lean beef, lean pork, beans, and lentils. Beans and lentils are excellent sources of fiber and protein and have very little fat, making them excellent choices.
  • Whole grains. Whole grains have the grain protein and carbs you need plus bran that serves to add fiber to your food. Whole grains include brown rice, whole grain bread, oats, or other baked products.
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Foods to avoid with cholestasis of pregnancy

This list of foods to avoid when you have cholestasis of pregnancy includes foods that can worsen your health or increase the risk of negative pregnancy outcomes. These foods are generally more challenging for your liver to process.

  • High-fat foods. Foods high in fat may not harm you; however, they are poorly absorbed, leading to gastrointestinal upset and diarrhea. Diarrhea alone can mean that other nutrients you need don’t get absorbed well.
  • High-sugar foods. There are many reasons to avoid these foods. They are often highly processed and offer no valuable nutrients.
  • Refined complex carbs. Things like pastries, crackers, and cookies that are high in fat, trans fats, and preservatives will be hard on your liver and GI tract.
  • Soy products. Soy is good for you in most situations; however, it is currently difficult to find products made of soy that don’t contain a lot of pesticides or aren’t genetically modified (GMO) foods.
  • Alcohol. Alcohol is dangerous in pregnancy for many reasons. If your liver is compromised from cholestasis, alcohol will be even riskier to consume.
  • Foods from Dirty Dozen (unless organic). These are foods you can eat during pregnancy (and should eat) but they need to be carefully chosen. To reduce the pesticide content of your diet, select only organic foods from this list: strawberries, mixed greens, spinach, peaches, pears, nectarines, apples, grapes, and peppers (hot or green).

>> Related Resource: 7-Day Fatty Liver Meal Plan (Best & Worst Foods to Eat)

How a prenatal nutritionist can help if you have cholestasis of pregnancy

Cholestasis of pregnancy is uncomfortable and scary. A prenatal nutritionist can provide both information and support. They are trained in advanced nutritional practices and have special training in nutrition for high-risk pregnancies.

Your prenatal nutritionist can evaluate your current diet. They will learn your likes and dislikes before working with you to develop a dietary plan that will carry you through your pregnancy. They can help you with meal planning and teach you the best foods to eat while pregnant and ways to eat with cholestasis to reduce your chances of suffering from this illness.

The nutritionist may meet with you once for a longer period to fully evaluate your diet and make recommendations. After that, you may reach out again to address concerns that may come up in implementing the dietary plan.

If you’re interested in finding help with your cholestasis of pregnancy diet, we can help you find a prenatal nutritionist that accepts your insurance here at Zaya Care. Simply browse through our network of licensed providers, find one that fits your needs, and book completely online!

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Christine Traxler MD is a family physician, lifelong writer, and author with a special interest in mental health, women’s healthcare, and the physical after-effects of psychological trauma. As a contributing writer and editor for numerous organizations, she brings a holistic focus to her work that emphasizes healing and wellness through daily self-care, connecting with others, and setting stepwise goals toward achieving more balanced and authentic lives.