Intrahepatic cholestasis of pregnancy

What is intrahepatic cholestasis of pregnancy?

Intrahepatic cholestasis of pregnancy (also called ICP or cholestasis of pregnancy) is the most common liver condition that happens during pregnancy. The liver is the largest organ in your body. It helps your body digest (break down and use) food, store energy and remove poisons. The liver makes a fluid called bile that helps your body break down fats and helps the liver get rid of toxins (poisonous substances) and waste. ICP slows the normal flow of bile, causing bile to build up in your liver. This buildup can cause chemicals called bile acids to spill into your blood and tissues, leading to severe itching.

ICP is most common during the third trimester, but some women with ICP have severe itching earlier in pregnancy. ICP affects about 1 to 2 in 1,000 pregnant women (less than 1 percent) in the United States, and it’s more common in Latina women. About 5 in 100 Latina women (5 percent) in this country have ICP.

What problems can ICP cause during pregnancy and after birth?

If you have ICP, you and your baby are at increased risk of having of complications, including:

• Preterm birth. This is birth that happens too soon, before 37 weeks of pregnancy. Babies born this early may have more health problems or need to stay in the hospital longer than babies born later.
• Fetal distress. This is when a baby isn’t getting enough oxygen in the womb. Signs of fetal distress include reduced fetal movement (when your baby moves less often than usual), changes in your baby’s heart rate and your baby passing meconium. Meconium is your baby’s first bowel movement. A baby usually passes meconium after birth, but a baby in fetal distress may pass meconium into the amniotic fluid that surrounds him in the womb before or during labor and birth.
• Stillbirth. This is when a baby dies in the womb after 20 weeks of pregnancy.
• Meconium aspiration. This is when a baby has breathing problems after he breathes in amniotic fluid with meconium. If your baby breathes in meconium during birth, it can block his airways.
• Respiratory distress syndrome (also called RDS). RDS is a breathing problem that happens in newborns whose lungs have not yet fully developed. Babies with RDS have don’t have enough surfactant, a slippery substance that helps the lungs fill with air and keeps the small air sacs in the lungs from collapsing. RDS is common in premature babies.
• Postpartum hemorrhage (also called PPH). This is heavy bleeding after giving birth. It's a serious but rare condition. 

What causes ICP? 

We’re not sure what causes ICP, but genes and pregnancy hormones may play a role. Genes are part of your body’s cells that stores instructions for the way your body grows, looks and works. Genes are passed from parents to children. During the third trimester of pregnancy, your body makes more of the pregnancy hormones estrogen and progesterone. The increase in these hormones may slow the flow of bile out of your liver. 

More women are diagnosed with ICP during the winter than other times of the year, but experts aren’t sure why. We need more research on ICP to find out more about it and why women get it.  

You may be at an increased risk for ICP if you:

• Had ICP before. More than half of women who have ICP have it again in another pregnancy.
• Have a family history of ICP. ICP is more common in some families, so tell your health care provider if your mother or sister had ICP. Fill out the March of Dimes family health history form to record health information about your family and share the form with your provider.
• Have a history of liver disease, like hepatitis C. Hepatitis C is a disease caused by the hepatitis C virus (also called HVC) that makes your liver swollen. Hepatitis C usually spreads though infected blood. It also can spread through unprotected sex with an infected person or from mom to baby during childbirth.
• Have ABCB11 or ABCB4 gene changes (also called mutations). These genes help the body make and use bile. A gene change is a change to instructions that are stored in a gene. A person’s gene can change on its own, or a changed gene can be passed from parents to children.
• Are pregnant with multiples (twins, triplets or more). If you’re pregnant with multiples, your estrogen levels may be higher than if you were pregnant with just one baby. 

What are signs and symptoms of ICP? 

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy.

Signs and symptoms of ICP can range from mild to severe and may begin in your second or third trimester. Call your provider if you have signs and symptoms of ICP, including:

• Severe itching. Itchy skin is the most common symptom of ICP. You may itch all over your body, but it may be most severe on the palms of your hands and the bottom of your feet. Itching may be the worst at night, and it may wake you up or make it hard to sleep.
• Dark urine or light-colored bowel movements
• Jaundice. This is a condition that makes your eyes and skin look yellow. It happens when your liver isn’t working well and there's too much of a substance called bilirubin in the blood.
• Loss of appetite (not hungry)
• Nausea (feeling sick to your stomach) or pain in the upper right belly

To check you for ICP, your health care provider may give you a physical exam and a blood test. The blood test checks the amount of bile acids and other chemicals in your blood that show how well your liver is working. 

How is ICP treated? 

Talk to your provider about treatment for ICP. Your provider may give you prescription medicine called ursodiol (brand names Actigall® and Urso®). A prescription is an order for medicine given by a health care provider. Ursodiol helps lower the amount of bile acids in your blood, relieves itchy skin and may help reduce your baby’s risk of having complications caused by ICP. Don't take any prescription medicine during pregnancy without talking to your provider first.

Don’t use medicines like antihistamines or corticosteroid creams or lotions to help relieve itching. You can buy these medicines over the counter without a prescription. Antihistamines are medicines that treat allergy symptoms, like skin rashes or itchy eyes. They often don’t work, and they may harm your baby during pregnancy. Corticosteroid creams and lotions don’t relieve itching caused by ICP, and they may harm your baby during pregnancy. Soaking in a bath with lukewarm water may help you feel better. Don't take any over-the-counter medicine during pregnancy without talking to your provider first. 

If you have ICP, your provider may monitor your baby with tests, like:

• Amniocentesis. This is a test that takes some amniotic fluid from around your baby in the uterus (also called womb). The test checks for birth defects and genetic conditions in your baby. Your provider may use ultrasound to check your baby’s amniotic fluid for meconium or find out if your baby’s lungs are developed for birth. Ultrasound uses sound waves and a computer screen to show a picture of your baby inside the womb.
• Fetal heart rate monitoring (also called a nonstress test or NST). This test checks your baby’s heart rate in the womb and sees how the heart rate changes when your baby moves. Your provider uses this test to make sure your baby’s getting enough oxygen.
• Biophysical profile (also called BPP). This test combines a nonstress test with an ultrasound. Your provider can use BPP to find out how much amniotic fluid is in your womb and check your baby’s muscle tone and movements.

If you have ICP, your provider may recommend inducing labor to help prevent complications like stillbirth. Inducing labor is when your provider gives you medicine or breaks your water (amniotic sac) to make your labor begin. The American College of Obstetricians and Gynecologists (ACOG) suggests women may need to have their baby before 37 weeks and 7 days of pregnancy. If your baby needs to be delivered before 39 weeks, ask your provider about the type of care your baby may need.

Does ICP cause problems after you give birth?

Itching should stop within a few days of giving birth. Your provider may recommend blood tests after giving birth to check your bile acid levels and make sure your liver is working well. 

Last reviewed: July 2020