Intrahepatic Cholestasis of Pregnancy

Itching is a normal complaint during pregnancy, with a great number of women experiencing the urge to scratch at some point before they give birth. Often the itching is caused by the stretching of skin as it tightens over the growing uterus, or by the effects of certain hormones during pregnancy. Rarely, however, itching during pregnancy can be a symptom of a very serious liver disorder, known as Intrahepatic Cholestasis of Pregnancy.

Intrahepatic Cholestasis of Pregnancy, or ICP, is a condition that results when the flow of bile from the liver becomes abnormal, resulting in a build-up of bile acids in the mother's blood. It begins most often in the third trimester of pregnancy, but some women begin developing symptoms as early as the first trimester. According to the March of Dimes, approximately seven out of every 1,000 pregnant women will develop ICP in the United States. This liver disorder does not harm the mother's health, but can be very dangerous to the unborn child and sometimes results in premature birth, hemorrhaging, or even stillbirth. For this reason, all itching during pregnancy should be promptly reported to your obstetrician.

Symptoms of ICP:

Often, the only symptom of ICP is severe itching that progressively worsens and is most severe at night. Itching is generally more severe on the palms of the hands and the soles of the feet, but many women experience itching over most or all of their body. Other symptoms of this disorder include dark urine, pale stools, fatigue, loss of appetite, depression, jaundice, pain in the upper-right abdominal area, and nausea.

Diagnosis of ICP:

A diagnosis of ICP can be made based on symptoms and blood work that measures the levels of bile acids in the blood. The most important test used in the diagnosis of this disorder is known as a serum bile acid test. Unfortunately, not all labs perform this test making it likely that the results will take a week or more to get back to your doctor. For this reason, when ICP is strongly suspected, treatment is generally started before the test results are in. Other tests used in the diagnosis of ICP include liver function tests, and tests to measure clotting time.

Treatment of ICP:

Medication can be very helpful in the treatment of ICP if it is started early enough during the pregnancy. Ursodeoxycholic Acid is one of the most important and commonly prescribed medications for ICP, and helps by replacing toxic bile acids in the blood and improving bile acid transport across the placenta. Frequent blood tests and fetal monitoring are also very important in the treatment of ICP, and may help reduce the risk of a stillbirth. Most doctors also recommend that women diagnosed with ICP be delivered at no later than 37 weeks, with many opting to induce their patients as early as 36 weeks.