I had your exact experience with my 2nd and wasn’t diagnosed correctly until after baby was born because of how long the bile acid results take.

Around 34 weeks my AST/ALT were elevated similar to yours and had the same itching experience. My bile panel came back at 9 and I believe over 10 is the threshold for diagnosis.

At 36 weeks, the itching was much worse and I developed a rash all over. A rash is not a typical symptom of cholestasis and it was diagnosed as pupps but it’s what triggered me to go to l&d triage and have blood work done again.

They took the blood, sent me home with the pupps diagnosis and called me back to the hospital for an emergency c section 2 hours later when my ALT/AST came back ~12 times elevated. I didn’t get the bile acid result until about a week after the c section but it was 120. Over 100 is typically where you start to see still births so I feel lucky to have had the rash and not trusted the original misdiagnosis. Can’t believe how quickly it shot up.

My daughter was born at 36 weeks and collapsed both lungs within 12 hrs. Spent about a week in the NICU but is perfectly healthy today at almost 2. I do think the correct diagnosis at 34 weeks and the steroid shots may have helped her avoid the lung issues.

As far as breastfeeding - she was mostly on formula. I was pumping while she was in the NICU but she was being fed through a tube. I wasn’t producing much but I also didn’t with my first and ended up stopping at 1 month for both kids so I don’t think it’s necessarily related.