Cholestasis of Pregnancy: Itching While Pregnant and Other Symptoms

Is itching during pregnancy normal? Everyone itches. It just happens. Sometimes you have 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, commonly called cholestasis) is a condition that affects the liver function of pregnant people.

What Is Intrahepatic Cholestasis of Pregnancy?

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

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 much more. According to Johns Hopkins Medicine, the liver serves over 500 vital functions.

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 person has ICP, the estrogen and progesterone produced by your body during pregnancy affect the way that your body can transport bile. When the flow of bile starts to slow, it backs up in the biliary system and collects in the liver. The bile acids then spill over to and build up in the bloodstream. 

While the symptoms of ICP will go away after you have your baby, it is important to know that people who have ICP during pregnancy need careful monitoring. People who have ICP have an increased risk of several pregnancy complications, such as preeclampsia and gestational diabetes, and may have a higher chance of liver damage or liver disease later in life.

Signs and Symptoms of Intrahepatic Cholestasis of Pregnancy

The primary symptom of ICP is severe itching – also known as pruritus. 

This may start with itchiness on the palms of the hands and the soles of the feet, 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 may 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. 

As people who’ve gone through a pregnancy before will already know, 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?

It is common for ICP to occur during pregnancy. While it can start from as early as five weeks gestation, it’s most often seen in the third trimester. According to the Cleveland Clinic, the incidence of ICP is between one or two people per 1,000 pregnancies. 

While family history may increase your risk of developing 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. People who are pregnant with multiples are also at a higher risk for this liver condition during pregnancy. 

Will Cholestasis Go Away on Its Own? 

Yes, ICP will resolve on its 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 go away without medical help. This means you need to talk to your healthcare provider about safe ways to treat the condition during pregnancy. 

How Can Pregnant People Find Relief From ICP?

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 medication-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 people and their unborn babies.

Talk to your doctor or healthcare professional about treatment options. Ursodeoxycholic acid (also known as UDCA) 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 people find soaking in a warm (not hot) bath can relieve itchy skin symptoms. 

After a diagnosis of ICP, 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 versus the benefits of scheduling an early induction of labor or cesarean section for ICP. 

What Are the Effects of ICP on the Baby?

ICP can cause pregnancy complications that go beyond itchy skin and jaundice. Potential fetal complications include preterm birth, stillbirth, fetal distress, respiratory distress syndrome, meconium aspiration, and postpartum hemorrhage.

A 2019 research review published in The Lancet found that risk of stillbirth increased with higher serum bile acid concentrations. This, along with other potential complications, means it’s absolutely essential to schedule and attend regular prenatal 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?

Many people notice that pregnancy hormones make their skin more sensitive during pregnancy. 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 and treatment by someone with a medical license. There is no substitute for the professional opinion of your doctor or midwife. 

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