Patient education: Intrahepatic cholestasis of pregnancy (The Basics)

What is intrahepatic cholestasis of pregnancy? — 

Intrahepatic cholestasis of pregnancy, or "ICP," is a liver problem that can happen during pregnancy.

The liver stores bile, a fluid that helps the body break down fat. When you eat a meal that has fat in it, bile flows into your small intestine to help with digestion. When a person has cholestasis, bile does not flow properly. It builds up in the liver and leaks into the blood. This can cause itchy skin and other symptoms.

ICP usually happens during the second half of pregnancy and goes away after birth. In some cases, it can cause serious problems. Your doctor or midwife will monitor you and your baby during pregnancy.

What causes ICP? — 

Doctors do not know exactly what causes ICP. Genes, hormones, and things in the environment might all be involved.

Your risk of ICP is higher if you:

●Are pregnant with more than 1 baby (such as twins)

●Got pregnant using in vitro fertilization, or "IVF"

●Have liver disease

●Had ICP in a past pregnancy

What are the symptoms of ICP? — 

Symptoms can include:

●Itching – This is usually the first symptom people notice. The itching can be mild to severe. It often starts on the palms of the hands and soles of the feet, and is worse at night.

●Jaundice, which is when the skin or white part of the eye turns yellow

●Pain in the upper right side of the belly

●Nausea

●Poor appetite

●Trouble sleeping

●Bowel movements that are oily and float

Is there a test for ICP? — 

Yes. Your doctor or nurse will do an exam and ask about your symptoms. If they think you might have ICP, they will order blood tests. These include tests to:

●Measure the level of bile acids in your blood

●Check how well your liver is working

You might also get other tests to help figure out what is causing your symptoms.

How will ICP affect my pregnancy and my baby? — 

ICP increases the risk of:

●Preterm (premature) birth

●Breathing problems in the baby after birth

●Stillbirth (when the baby dies before it is born)

If you have ICP, you need to see your doctor, nurse, or midwife regularly during pregnancy. This usually means appointments twice a week. At these visits, the doctor, nurse, or midwife will check your baby's heart rate. They will also do ultrasounds to check the baby's movement.

You will also get regular blood tests to measure the level of bile acids in your blood. The higher the level, the more likely it is to cause problems with your pregnancy.

How is ICP treated? — 

The goals of treatment are to relieve symptoms and lower the risk of problems with the baby.

For symptom relief:

●Your doctor can prescribe medicine to help with itching. They might also recommend creams or lotions to put on your skin.

●Very hot baths or showers might make itching worse. It might help to avoid these.

ICP usually goes away after giving birth. Because of this, your doctor or midwife will probably have you give birth before your due date. The exact timing will depend on your and your baby's health and your blood test results.

What if I want to get pregnant again? — 

If you had ICP in 1 pregnancy, you have a higher risk of getting it again.

When should I call the doctor? — 

If you have ICP, call your doctor, nurse, or midwife if you:

●Have itching that is getting worse or is unbearable

●Have jaundice

●Think you might be in labor

●Think your baby is moving less than usual

●Have any other new symptoms that worry you

More on this topic

Patient education: Jaundice in adults (The Basics)
Patient education: Aminotransferase tests (The Basics)
Patient education: Preterm labor (The Basics)
Patient education: Prenatal ultrasound (The Basics)
Patient education: Labor induction (The Basics)

Patient education: Preterm labor (Beyond the Basics)