Cholestasis of pregnancy diagnosis usually combines pregnancy-related itching with blood test results. Your clinician may assess bile acids and liver enzymes, then interpret the findings in context and decide whether follow-up testing is needed. [1][2] For more detail, see Cholestasis of Pregnancy: What It Is and What to Know.
The process is not just a lab result in isolation: your care team considers the test findings alongside what you are experiencing. [1] If testing is part of your appointment, ask how your symptoms and results will guide the next step, and how you will hear about any follow-up.
A practical way to prepare is to note when the itching began and whether it has changed, then share that information with your pregnancy care team. This gives you a clear starting point for the conversation; your clinician can explain what the results mean for your situation and whether another check is appropriate. The sections below cover the tests, how results are considered, and what to do if symptoms continue after an initial assessment.
Which blood tests may be ordered?
A bile acid test and liver function tests may both be ordered when your clinician evaluates suspected cholestasis of pregnancy. [2] Each test checks a different part of the picture, so you can ask which tests are being drawn and what each one measures. For the next step, see Cholestasis of Pregnancy Delivery Timing: What to Expect.
Total bile acids
A total bile acid blood test measures the amount of bile acids in your blood. [3] Your care team may order it specifically to assess bile acids as part of the evaluation. [2]
For example, if your lab order lists “total bile acids,” that is the test measuring bile acids directly. The result is one piece of the test panel your clinician has requested; ask how it will be shared with you if that is not clear.
Liver function tests
Liver function tests are blood tests that assess liver-related markers, including aminotransferases. [4] They may be ordered alongside a bile acid test when cholestasis is suspected. [2]
Your order may list liver function tests separately from total bile acids, even when the blood is collected during the same visit. If you are unsure whether both are included, check the order with your pregnancy care team before the draw.
What to check on your lab order
Look for the names of the tests rather than assuming that one test includes every measurement. You can ask, “Does this order include total bile acids and liver function tests, including aminotransferases?”
You can also ask when to expect the results and whom to contact with questions. Keeping a copy of the order or writing down the test names can make it easier to follow what was checked.
How are test results considered?
Clinicians consider test results together with your itching and the rest of your clinical picture; a single number should not be read in isolation. [1] In suspected cholestasis of pregnancy, the diagnosis is usually based on itching during pregnancy associated with elevated serum bile acids and/or serum aminotransferases. [1]
That means your care team looks at whether the bloodwork fits your symptoms, rather than treating a lab value as the whole story. For example, if a result is elevated, your clinician can consider it alongside when the itching began and your overall assessment. [1]
There is not one cutoff you should apply on your own to decide what a result means. Ask your pregnancy care team to explain how they interpret your specific results and how those results fit your symptoms. The interpretation belongs to the clinicians caring for you, who can consider the full clinical picture. [1]
When you review results, you might ask, “What does this finding mean in my situation?” or “How does it fit with the itching I’ve described?” If the meaning is unclear, ask the clinician to explain the result in plain language and what it contributes to their assessment. This can help you understand the reasoning without trying to diagnose yourself from a single lab value.
A result is one part of an assessment, not a standalone answer for you to interpret without context. [1]
What if the first blood tests are normal?
If your first blood tests are normal but the itching continues, ask your pregnancy care clinician how they will review your results alongside your symptoms and whether they recommend checking again. A normal result at one point is a reason to clarify the next step, not to guess on your own what the symptoms mean.
You might ask, “How will you interpret these results given that I’m still itchy?” and “Would repeat bloodwork be appropriate if this continues?” These questions keep the conversation focused on your situation without assuming that another test is always needed. Diagnosis is based on itching during pregnancy associated with elevated aminotransferases and/or bile acids. [1]
Before you leave or end a call, make sure you know when to contact the care team again. For example, ask whether to call if the itching is still present tomorrow, becomes more bothersome, or changes; your clinician can tell you what follow-up makes sense for you. Avoid waiting in uncertainty if you are unsure whether a change warrants a call—contact the team and ask.
You can also ask how you will receive any repeat results and whom to reach if symptoms persist before you hear back. A simple note on your phone with the date of the test, your symptoms, and the agreed follow-up can help you explain what has changed at your next check-in. Keep the discussion centered on interpreting tests and deciding whether reassessment is appropriate, rather than trying to make sense of a result without your care team.
What should you ask about testing?
Ask your clinician three practical questions: which blood tests are planned, how you’ll receive the results, and what to do if itching continues. Getting the follow-up plan clear can make it easier to know whom to contact and when.
Clarify the tests
Ask, “Are you ordering bile acid tests, liver function tests, or both?” Blood tests can measure bile acids and check how well your liver is working. [2] The total bile acid test is used in testing for intrahepatic cholestasis of pregnancy, and liver function tests may also be part of the evaluation. [3]
If you see test names in your patient portal, ask your clinician to explain what was ordered and whether any results are still pending. For example, you might ask, “Will I see the bile acid result and liver test results together, or at different times?”
Agree on how results will reach you
Ask, “When should I expect to hear from you, and will you call, send a portal message, or ask me to schedule a visit?” You can also confirm whom to contact if you have not received an update by the time you expected one. These questions help you leave the conversation with a clear communication plan.
Ask what happens if itching continues
Before you finish the visit, ask, “If my itching continues, when should I contact you, and what would reassessment involve?” You can ask whether the care team wants you to call or message if symptoms persist, and how they will decide whether another check is needed. [4]
Write down the plan, including the best way to reach the office and what to do if you cannot get through. If you are unsure what your clinician meant, ask them to explain the next step in plain language before you leave.
Common questions about diagnosis
Can diagnosis involve more than one blood test?
Yes. Your pregnancy care team may check bile acids and liver-related blood markers as part of assessing suspected cholestasis. [2] For example, they may review both kinds of results rather than relying on a single measurement. [3]
If you are unsure which tests were ordered, ask your clinician to name each one and explain what it checks. You can also ask when you should expect to hear about the results and whom to contact if you have questions.
Does a blood test alone explain every symptom?
No single result should be treated as the whole picture: diagnosis is considered alongside symptoms and clinical assessment. [1] Your clinician can help connect what you are feeling with the test findings and decide whether further review is needed.
It may help to describe your concern in specific terms—for instance, when it started, whether it is continuing, and whether anything has changed. This gives your care team clearer context for discussing the results.
Should you wait for symptoms to pass before calling?
Contact your pregnancy care team about new or persistent concerns rather than waiting for them to pass. If you are not sure whether a change matters, call and explain what you have noticed.
For example, you might say, “This is new for me and has continued since yesterday.” Ask what the next step should be and when to check back if the concern remains. You do not need to decide on your own whether a symptom is significant before getting in touch.
Keep the testing conversation open
Keep the testing conversation open: ask your pregnancy care team what your blood test results mean for you and what should happen next. Blood tests that measure bile acids and check liver function are central to assessing suspected cholestasis. [2] [3]
When you discuss your results, ask how they fit with what you are experiencing and whether the team recommends follow-up. For example, you might ask, “How do these results relate to my symptoms?” and “Should I check in again, and when?” The aim is to leave the conversation knowing whom to contact and what to do if your concerns continue.
If you are waiting to hear back, ask when and how the team plans to share the results. You can also clarify what they would like you to do if symptoms change or you have a new concern. These practical details can make it easier to follow the plan without trying to interpret a test report on your own.
If you remain concerned, contact your pregnancy care team rather than sitting with unanswered questions. Bring a short note with your main concern and the questions you want answered, such as whether further follow-up is needed. Keep the conversation open until you understand the next step.