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Intrahepatic cholestasis (obstetric cholestasis) of pregnancy

Obstetric cholestasis symptoms include severe itching in pregnancy. Read to learn about the signs of intrahepatic cholestasis in pregnancy, which can be a serious condition.

Intrahepatic cholestasis of pregnancy (ICP), formerly known as obstetric cholestasis, affects an estimated one in every 140 pregnant women in the UK. Its effects can be distressing and, as a result, you will be offered extra care during your pregnancy.

The main symptom of ICP is feeling itchy when you are pregnant. Mild itching during pregnancy is very common, at any stage, because of the increased blood supply to the skin and also because, in the later stages, the skin stretches to accommodate your growing abdomen and you may find your tummy itches as a result.

Women with ICP generally have much more severe itching, usually on their hands and feet but anywhere on the body can be affected, too. They may feel unwell, and very tired a lot of the time. 

What causes it?

ICP is a liver condition during pregnancy where there is a build-up of bile acids in the blood. A blood test to measure liver function and levels of bile acid in the blood can confirm if you have the condition. 

You may also have a test to check how your blood is clotting, as the condition can cause a lack of vitamin K, which is needed for the clotting process.

When would I notice symptoms of ICP in pregnancy?

Typically, symptoms of OC are felt in the last trimester of pregnancy. However, it sometimes develops earlier than this. You would notice a severe itch, which would affect your sleep, concentration and mood. Some women develop a yellowing of the whites of the eyes and skin. Tell your midwife or doctor about these symptoms at any time – don’t just wait for your routine antenatal appointment to find out whether you are experiencing liver problems when you are pregnant.

Can ICP harm the baby? 

Usually, your baby is unaffected by ICP. However, there seems to be a slightly higher risk of premature labour, foetal distress and, in severe cases, stillbirth. Generally, these cases have happened only when a severe condition is left untreated. Extra antenatal checks may be offered, so your baby’s progress can be monitored more closely.

How is ICP treated?

There is no cure and the symptoms will go once the baby is born. However, if the itching is at a distressing level, you can take steps to relieve the feeling. This may include using a mild moisturising cream to relieve dryness of the skin. It is also helpful to make sure you keep cool, especially at night. Wearing loose clothing may help.

You may be offered medication to help reduce the build-up of bile salts in the blood and antihistamine to relieve the itching.

Vitamin K supplements may also be suggested by your doctor as levels of vitamin K are often lower in people with liver and bile problems.

How might labour and birth be affected by ICP in pregnancy?

The midwives and doctors may want to discuss with you the possibility of inducing labour slightly early, as the risk of problems can increase slightly after about 36-37 weeks. For this reason too, you may be offered continuous foetal monitoring in labour. 

Will there be any problems after the birth?

The itching symptoms disappear after birth. ICP is not thought to cause permanent liver damage. However, if you have had the condition when you have been pregnant before there is a greater possibility you will suffer from it again in other pregnancies.

Page last updated: 9 May 2014

Further information

NCT's helpline offers practical and emotional support in all areas of the antenatal stage, birth and early parenthood: 0300 330 0700.  We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

ICP Support provides support and information to women who have, or who may have, the condition, and their families, and also keeps up-to-date on the most recent research into the condition.