Intrahepatic cholestasis

It can be a serious condition and pregnant women need to recognise the signs. Here’s what you need to know.

Intrahepatic cholestasis of pregnancy (ICP) is the most common liver condition specific to pregnancy. It is a potentially serious liver disorder that typically develops in late pregnancy but it can also develop as early as the eighth week of pregnancy (Dixon and Williamson, 2006; NHS Choices, 2016).

Bile acids normally flow from your liver to your gut to help digest food. But in intrahepatic cholestasis of pregnancy, the bile acids don’t flow properly and they build up in the body. This is due to the hormonal changes that occur in pregnancy as well as genetic and environmental influences (ICP Support, 2019).

"There is no cure for intrahepatic cholestasis of pregnancy. But it usually stops after your baby is born (NHS Choices, 2016)."

Symptoms

One of the main symptoms of intrahepatic cholestasis of pregnancy is having itchy skin (Gurung et al, 2013). This can be mild or severe and is most noticeable at night (NHS, 2019).

It mostly affects the palms of your hands and soles of your feet but can come up all over your body. The itching usually comes without a rash appearing (Gurung et al, 2013).

When does it happen?

Typically, the symptoms of intrahepatic cholestasis of pregnancy start from around 30 weeks of pregnancy. Sometimes it can develop as early as eight weeks (NHS, 2019).

Diagnosis

As well as the itching, if you have intrahepatic cholestasis of pregnancy, you’ll have increased bile levels in your blood. Your doctor will test for this if you think you have the disorder. They will also test your liver function and ask about family history (NHS, 2019).

Causes

Intrahepatic cholestasis of pregnancy does seem to run in families. Yet you can suffer with it even if there is no family history.

Intrahepatic cholestasis of pregnancy is more common in women of South American, Indian and Pakistani origin (NHS, 2019). If you have had it in a previous pregnancy, you’re more likely to develop it again (NHS, 2019). Other than that, no-one knows exactly why it develops but research has shown that it’s a combination of factors.

How common is it?

If you’re suffering from the odd itch and worrying about it, don’t. Mild itching affects around 23% of pregnant women (RCOG, 2011).

Only a small proportion of women will develop intrahepatic cholestasis of pregnancy (RCOG, 2011). One in 140 pregnant women in the UK get intrahepatic cholestasis of pregnancy (NHS, 2019).

Treatment

If you have intrahepatic cholestasis of pregnancy, your doctor will ask for regular bile acid tests and liver function tests to monitor your condition. These will more than likely be weekly (RCOG, 2011; Ovadia et al, 2019).  

Some creams and medications can help. Aqueous cream with menthol can relieve some itching and it is safe to use in pregnancy (NHS, 2019).

Medications like ursodeoxycholic acid (UDCA) have not been shown to be effective although they can reduce itch a little in some people (Chappell et al, 2018).  Occasionally, women might also be offered a vitamin K supplement but only if they need it. This is because intrahepatic cholestasis of pregnancy might affect vitamin K absorption and therefore blood clotting (NHS, 2019).

Effect on labour and the baby

There is a potential risk from intrahepatic cholestasis of pregnancy for unborn babies. It is linked with higher chances of preterm labour, foetal distress and stillbirths (Ovadia et al, 2019).

You’ll need to speak to your doctor or midwife about the risks and treatments. They are likely to discuss the timing of labour with you, which may be anytime from 34 weeks up to 39 weeks of pregnancy (Ovadia et al, 2019).

This page was last reviewed in August 2019

Further information

You can find more information about and support with intrahepatic cholestasis of pregnancy through the charity ICP Support. They offer support via email and through their helpline.

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 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.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Read what else to look out for during your pregnancy with our guides.

 

 

Chappell LC, Chambers J, Dixon PH, Dorling J, Hunter R, Bell JL, et al. (2018) Ursodeoxycholic acid versus placebo in the treatment of women with intrahepatic cholestasis of pregnancy (ICP) to improve perinatal outcomes: protocol for a randomised controlled trial (PITCHES). Trials. 19(1):657. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260710/ [Accessed 27th August 2019].

Dixon PH, Williamson C. (2016)The pathophysiology of intrahepatic cholestasis of pregnancy. Clin Res Hepatol Gastroenterol. 40(2):141-53. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26823041 [Accessed 27th August 2019].

Gurung V, Middleton P, Milan SJ, Hague W, Thornton JG. (2013) Interventions for treating cholestasis in pregnancy. Cochrane Database Syst Rev.(6):CD000493. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000493.pub2/full [Accessed 1st March 2018].

ICP Support. (2019) What causes ICP? Available from: https://www.icpsupport.org/about_causes.shtml [Accessed 27th August 2019].

NHS. (2019) Itching and intrahepatic cholestasis of pregnancy. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/itching-obstetric-cholestasis-pregnant/ [Accessed 1st March 2018].

Ovadia C, Seed PT, Sklavounos A, Geenes V, Di Ilio C, Chambers J, et al. (2019) Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet. 393(10174):899-909. Available from: https://www.sciencedirect.com/science/article/pii/S0140673618318774?via… 27th August 2019].

RCOG. (2011) Obstetric cholestasis. Green-top Guideline No. 43. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_43.pdf [Accessed 1st March 2018].

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