What Is Cholestasis of Pregnancy?

Feeling more itchy than usual? It could be a symptom of this rare liver condition that occurs during pregnancy.

Cholestasis in Pregnancy Pattraporn Panyachotirat/Shutterstock
It's normal to experience mild itching during pregnancy as your bump grows and your skin expands and stretches—in fact, almost a quarter of all pregnant women complain of itchy skin. However, more intense, persistent itchiness could be a symptom of intrahepatic cholestasis of pregnancy (ICP), a group of liver disorders specific to pregnancy that interfere with the flow of bile. Though there's no long-term risk to your health, this condition can be dangerous to your baby if it goes untreated. That's why you should always tell your doctor if you have significant itching.

What is intrahepatic cholestasis of pregnancy (ICP)?

ICP impairs the functioning of the liver, resulting in a buildup of bile—a fluid produced in the liver to digest fats—in the blood. Itching is triggered when the blood deposits these bile acids into the tissues, which can be uncomfortable but not life-threatening. For your baby, however, elevated bile levels are toxic and can cause complications if left untreated, including preterm birth, fetal distress, meconium  in the amniotic fluid, and stillbirth.

What are the symptoms?

Here's how to tell the difference between the harmless itching many women experience during pregnancy and ICP: "Itching associated with cholestasis occurs in the second and third trimesters of pregnancy, and it's typically severe, particularly at night," explains Christine Miller, M.D., a professor of reproductive medicine at the University of California School of Medicine. "It can be all over the body but is often worse on the palms and soles."

Tell your doctor promptly if you experience severe itching to rule out the possibility of ICP. He or she will likely order blood tests and bile acid tests, and evaluate your liver function to determine a diagnosis. "If you are experiencing severe itching and your doctor is unfamiliar with ICP and resistant to learning more about the condition, get a second opinion," says Dr. Miller.

In the majority of cases, itching is the only symptom reported. However, less common symptoms associated with ICP may include:

  • Dark urine and/or pale stool
  • Fatigue
  • Respiratory distress syndrome (RDS) and failure to establish breathing
  • Yellowing of the skin and whites of the eyes (aka jaundice)
  • Nausea
  • Loss of appetite

Symptoms of ICP usually resolve after delivery, but there is a high chance of recurrence with subsequent pregnancies.

Treatment for cholestasis of pregnancy

The good news for you and your baby is that ICP is treatable. In fact, with active management the risk of stillbirth is less than 1 percent, which is the same as an uncomplicated pregnancy. According to Dr. Miller, active management typically includes:

  • Taking the prescription medication Ursodiol. This medication helps decrease bile acid levels in the mother's bloodstream and relieves itchiness. Moreover, it may help protect the baby in several ways including preventing premature aging of the placenta, reducing the risk of meconium staining, protecting the baby's heart and cells against damage due to bile acids and restoring the placenta's ability to transport bile acids away from the baby.
  • Early delivery at 36 or 37 weeks, or at the time of diagnosis if later.
  • Additional screenings to monitor your well being and your baby's. These tests may include blood work to monitor your bile acid levels; nonstress tests, which can detect signs of fetal distress; and biophysical profile scores to measure the volume of amniotic fluid and fetal activity.

For more information about ICP including managing symptoms and finding a doctor who is knowledgeable about the condition, visit ICPcare.org.

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