Cholestasis of Pregnancy: Itching While Pregnant and Other Symptoms

Updated: May 9, 2022
Is itching during pregnancy normal? Everyone itches. It just happens. Sometimes you have a skin irritation, sometimes it’s a pesky mosquito that gets to you, and other times it’s something more serious. Intrahepatic cholestasis of pregnancy (or ICP) is a condition that affects the liver function of expectant mothers. And if you’re wondering what this has to do with severe itching, we’ve got the scoop on ICP.
Hands of a pregnant woman scratching her stomach
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Is itching during pregnancy normal? Everyone itches. It just happens. Sometimes you have a skin irritation, sometimes it’s a pesky mosquito that gets to you, and other times it’s something more serious. Intrahepatic cholestasis of pregnancy (or ICP) is a condition that affects the liver function of expectant mothers. And if you’re wondering what this has to do with severe itching, we’ve got the scoop on ICP.

What Exactly is Intrahepatic Cholestasis of Pregnancy? 

As the name implies, this is a condition that impacts pregnant women. ICP causes the normal flow of bile to slow down. This can result in a build up of bile acids in the blood.

If you’re saying, ‘Slow down, rewind. What are bile acids and what do they have to do with my pregnancy?’, we’ll start from the beginning.

While it’s no secret that you need a liver, you may not know exactly what it does. Your liver is in charge of chemical level regulation. After making a hasty exit from the stomach and intestines, blood moves to the liver. This is where your body breaks down medications you may take, converts excess glucose for storage, regulates amino acids, processes hemoglobin, and so, so, much more. According to Johns Hopkins Medicine, the liver serves over 500 vital functions!

Now on to the bile (which the liver produces). Think of bile as a liquid that, when released by the liver, helps digestion and breaks down fat from foods. The acids in bile help the body to maintain cholesterol levels and, according to a research review published in the medical journal Diabetes Care, can help to regulate some metabolic processes. When a woman has ICP, the liver cells don’t release bile correctly. When the flow of bile starts to slow, it collects in the liver. The bile acids then spill over to and build up in the bloodstream. 

What Are the Signs and Symptoms of Intrahepatic Cholestasis of Pregnancy? 

If ICP affects liver function, what exactly does it have to do with itching during pregnancy? Even though you might not associate your liver with skin sensations, the primary symptom of this pregnancy-related condition is severe itching—also known as pruritus. 

This may start with itching on the palms of the hands and spread to other areas. Along with itching, it’s also possible to develop jaundice with this type of liver disease. Jaundice causes a noticeable yellowing of the skin or whites of the eyes. Other symptoms include: 

  • Pain in the upper right area of the abdomen (where the liver is located), 
  • nausea, 
  • dark-colored urine, 
  • lighter-colored stool, 
  • loss of appetite, 
  • extreme fatigue
Itchy palms

As mamas who’ve gone through a pregnancy before already know, the nausea and fatigue aren’t always signs of a liver issue. Morning sickness can cause that rocky feeling in the pit of your stomach at any time of the day and the physical changes during pregnancy can add to exhaustion. 

What Are the Causes of Intrahepatic Cholestasis of Pregnancy? 

This is a common liver disease in pregnancy. While it can develop as early as five weeks in, it’s most often seen in the third trimester. According to the Cleveland Clinic, ICP affects between one and two women per every 1,000 pregnancies. While family history may play a role in the development of this liver disease, ICP doesn’t always have a known cause. A previous case of cholestasis during pregnancy or prior liver disease, such as hepatitis, are potential risk factors. Women who are pregnant with multiples are also at a higher risk for this liver issue during pregnancy. 

Will Cholestasis Go Away On Its Own? 

Yes, ICP will go away on your own. But there’s a catch. It will only go away after you’ve given birth. So, if you’re still pregnant, don’t expect the bile flow issue to resolve without medical help. This means you need to talk to your OB, healthcare provider, or midwife about safe ways to treat the condition during pregnancy and symptom relief. 

How Can Pregnant Women Find Relief From the Symptoms of Cholestasis?

The intense itching is irritating at best. What can you do about it? Even though antihistamines or corticosteroid lotions can help to relieve other types of itchy skin, these may not work for ICP symptoms. Never take an over the counter medication or use a med-containing cream without talking to your healthcare provider first. Anti-itch pills/antihistamines, creams, lotions, and potions may seem harmless. But they could contain harmful ingredients that pose risks to pregnant women and their unborn babies.

Instead of OTC itch lotions and creams, talk to your doc or healthcare professional about treatment options. Ursodeoxycholic acid is a prescription medication that healthcare providers use to treat this condition. It can help to reduce the levels of bile acids in the blood, restore the normal flow of bile, and improve liver function. Some women find soaking in a warm, (not hot), bath can relieve itchy skin symptoms. 

Health treatment concept. Close up portrait of young woman touching water in bath tub before water spa procedure

Depending on the number of weeks of pregnancy, you may need to deliver your baby early - especially if your liver function tests or serious symptoms do not improve after starting medication. Your medical provider will discuss the risks vs. the benefits of an induction for ICP. 

What Are the Effects on the Baby? 

ICP can cause pregnancy complications that go beyond itchy skin and jaundice. Potential problems include preterm birth, stillbirth, fetal distress, respiratory distress syndrome, meconium aspiration, and postpartum hemorrhage, according to information from the March of Dimes. A 2019 research review published in The Lancet found that risk of stillbirth increased with higher serum bile acids concentrations. This, along with other potential complications, makes it absolutely essential to make and keep regular doctor’s appointments during your pregnancy. As your provider treats you for ICP, they may order liver function tests or other bloodwork to monitor the condition. 

What Are Other Reasons for Severe Itching During Pregnancy? 

Yes, cholestasis can cause itchiness during pregnancy. But it isn’t the only possible culprit behind  itchy skin. As your belly grows, the skin stretches. This can cause an odd sensation or itching of the abdomen. Beyond scratchy, itchy skin, you may experience irritation caused by creams or other cosmetic products, your laundry detergent, a pet, bug bites, or other common contact allergens.

Whether you think you have cholestasis or you’re just not sure why you are so itchy, always talk to your healthcare provider. ICP and other pregnancy-related issues require a diagnosis of and treatment by someone with a medical license. There is no substitute for your OB’s or midwife’s professional opinion. 

Do you want to learn more about pregnancy? Take a look at our info on the third trimester!