Itchy skin in pregnancy and intrahepatic cholestasis of pregnancy (ICP)

Itching in pregnancy is common, with around one in four women and pregnant people experiencing it (RCOG, 2022). Pregnancy hormones may be the cause, or the skin stretching over the bump (NHS, 2023a). You might hear different terms for itching in pregnancy, such as pruritis. 

Coping with itchy skin

Experiencing itchy skin can be very uncomfortable and distressing. Wearing loose clothes in natural fibres like cotton can help. Using simple, non-scented moisturiser or having a cool bath may also be beneficial (NHS, 2023a).  

Aqueous cream and calamine lotion are safe to use during pregnancy to relieve the itching. Antihistamines suitable for pregnancy can also be used (RCOG, 2022).

Usually itching isn’t a cause for concern. However, always tell a healthcare professional in case it’s a symptom of something more serious. 

Supporting a pregnant woman or person with itchy skin

Itchy skin can be distressing and make it hard to relax or sleep. It can be especially frustrating if it’s not taken seriously by healthcare professionals, friends or family. Support the pregnant woman or person by understanding that it is very unpleasant. You can also help with different strategies to soothe the itch.

While most itching in pregnancy is of unknown cause, below are some conditions during pregnancy which cause itchy skin. They are not contagious. 

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy, or ICP, causes itching most noticeably on the palms of the hands and soles of the feet. However, it can be all over the body. It is often worse at night (NHS, 2023a; RCOG, 2022).

Sometimes called obstetric cholestasis (OC), ICP is a serious liver condition that needs medical care. It is not known what causes ICP (NHS, 2023a; RCOG, 2022).

It affects the normal process of bile acids flowing from the liver to the gut to digest food. Instead, the bile acids build up in the body. In severe cases or when there are other complications this might cause the baby to be born early, or sadly even stillborn (NHS, 2023a; RCOG, 2022).

It affects around 7 in 1,000 pregnancies, rising to 15 in 1,000 of those of South Asian origin. It’s more likely if there is a family history, or if ICP has been experienced in a previous pregnancy.  It can also be more likely to occur in twin or triplet pregnancies or where there are other health issues (ICP Support, no date; NHS, 2023a; RCOG, 2022).

Symptoms of ICP

Symptoms of ICP usually appear at around 28 weeks of pregnancy, but it can be earlier (NHS, 2023a; RCOG, 2022):

• Very itchy skin is the most common symptom. 
• There is usually no rash.  
• Dark wee or pale poo may also be symptoms. 
• Jaundice is possible but less common. It appears as yellowing of the whites of the eyes. 

Diagnosis

If any of the symptoms above are experienced, contact a GP or midwife. They will want to exclude any other reasons for itching and ask about family history. They will take blood tests to check for liver function and bile acid levels. Tests can be repeated if they were negative but the itching persists (NHS, 2023a; RCOG, 2022).

Extra care during pregnancy

Doctors will continue to use blood tests to monitor liver function and bile acid levels throughout pregnancy. Extra scans of the baby aren’t needed with ICP, but if there is any worry about the baby’s movements, go to the maternity unit straight away (NHS, 2023a; RCOG, 2022).

Long term effects

Depending on the severity of ICP, doctors may suggest that the baby is born earlier. This could be by induction of labour or planned caesarean. If this happens, the baby may need to spend time in a neonatal unit (RCOG, 2022).

ICP may also mean your baby is more likely to pass meconium before they are born. If meconium gets into their lungs during labour, it can make them unwell (RCOG, 2022).

However, ICP will only last during pregnancy and the parent will probably be better by the 6-week postnatal check. There are no known long-term health risks to the baby (RCOG, 2022).

You can find support for ICP here.

Other causes of itching

There are other possible causes of itching during pregnancy, which is why it’s important to tell the midwife about it.  

Polymorphic Eruption of Pregnancy (PEP)

PEP, also known as Pruiritc Uticarial Papules and Plaques of Pregnancy (PUPPP) is an itchy rash. It appears on and around the tummy, usually in the third trimester of a first pregnancy. However, it can also happen after birth (British Association of Dermatologists, 2021).

It is relatively common, at between 1 in 120 and 1 in 200 pregnancies (Taylor et al, 2016). It is more common in multiple pregnancies (Chouk & Litaiem, 2023). Although uncomfortable, it doesn’t affect the health of the parent or baby. A health professional can monitor it and rule out other more serious conditions (British Association of Dermatologists, 2021).

Even if the pregnant woman or person has PEP after the baby is born, it should get better without treatment and within a few weeks of birth. It doesn’t affect breastfeeding. Having PEP doesn’t make it more likely to occur in future pregnancies, unless it is a multiple pregnancy (Chouk & Litaiem, 2023; British Association of Dermatologists, 2021).

Gestational pemphigoid (GP)/ Pemphigoid gestationis (PG)

GP or PG is a rare but serious condition which can affect the growth of the baby or causes early labour.  It starts as an itchy rash on the abdomen which spreads to other parts of the body, often with blisters on the skin. It’s important to get medical help to treat the skin and protect the health of the baby (Mohsen et al, 2022).

GP can recur and become more severe in future pregnancies (Mohsen et al, 2022).

Impetigo herpetiformis

This is a very rare form of psoriasis which usually happens during the third trimester of pregnancy. Although only mildly itchy, it causes inflamed skin with green-yellow pustules (Jones & Black, 2008; Cohen & Kroumpouzos, 2009).

Fever, diarrhoea, chills and vomiting are experienced as well as a rash on the body. It’s important to get medical help as it can cause maternal death, stillbirth or fetal abnormalities. It can occur in subsequent pregnancies, but goes away between pregnancies (Jones & Black, 2008; Cohen & Kroumpouzos, 2009).

Eczema

When a person already has eczema, it can get worse during pregnancy (NHS, 2023b). Speak to a GP or midwife or midwife about treating eczema during pregnancy.

Further information

Our antenatal courses can help you find out more about labour, birth and life with a new baby.

Our NCT Infant Feeding Line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

Make friends with other parents-to-be and new parents in your local area and see what NCT activities are happening nearby.