Cholestasis of Pregnancy (ICP)
A liver problem in pregnancy that causes itching without a rash
What is ICP?
ICP is a liver problem that can happen during pregnancy. It is also called intrahepatic cholestasis of pregnancy.
Bile is a fluid made by the liver. It helps the body digest food. Bile contains bile acids. In ICP, bile acids build up in the blood and may cause itching. ICP usually starts late in pregnancy and gets better after birth.
What are the signs?
- Itching without a rash
- Itching on the palms or soles
- Itching that is worse at night
Scratching may leave marks. Rarely, the eyes or skin may look yellow. Tell your care team about new or strong itching.
How is it found?
Your care team will check your skin and order blood tests:
- Bile acids - to see if they are too high
- Liver tests - to see how the liver is working
Blood tests may be normal when itching first starts. If itching continues, the tests may need to be repeated. Other liver or skin problems may also need to be checked.
How is it treated?
Ursodiol (ursodeoxycholic acid) is often used to reduce itching. Cool baths, loose cotton clothes, and skin creams may also help.
Medicine may help the itching, but it does not remove all risk to the baby. Do not start medicine or supplements without asking your care team.
What can ICP mean for the baby?
Most babies do well. ICP can raise the chance of:
- Birth before 37 weeks
- Meconium, the baby's first stool, in the fluid
- Breathing problems after an early birth
- Stillbirth, mainly when bile acids are very high
The risk rises as the bile-acid level rises. The risk is greatest when the level is very high (levels > 100 micromol/L).
Monitoring and baby testing
- Repeat bile-acid and liver blood tests
- A nonstress test checks the baby's heartbeat over time
- A biophysical profile uses ultrasound to check movement, breathing motions, and fluid
- A plan for when to give birth
Baby testing usually starts when a poor result could lead to delivery. When testing starts and how often it is done depend on the weeks of pregnancy, bile-acid level, and other health concerns.
A normal test does not remove all risk. Keep watching your baby's usual movements and follow the planned delivery date.
Call your maternity unit now if:
- Your baby moves less than usual
- You cannot feel your baby move
- You think labor has started or your water breaks
Do not wait until the next day.
When will the baby be born?
Your care team will use your highest bile-acid level, weeks of pregnancy, symptoms, and other health problems to choose the safest time.
A higher level may mean an earlier planned birth. When the level is very high, birth is often planned near 36 weeks. With lower levels, birth may be planned later.
If birth is planned before 37 weeks, steroid shots may help the baby's lungs. Early birth should not be planned for suspected ICP alone unless blood tests show high bile acids. Twins or other health problems may change the plan. ICP alone does not mean a cesarean birth is needed.
After the baby is born
Itching usually goes away soon after birth. Bile-acid and liver blood tests should be checked again at about 6 weeks. If itching continues or the tests stay abnormal, more testing and a liver specialist may be needed.
A liver specialist may help if ICP starts early, levels are very high, tests are unusual, or the problem does not clear. ICP may raise the chance of liver or gallbladder problems later. It also often returns in a later pregnancy.
Important: This handout gives general information. Your own care and delivery plan may be different. Follow the advice of your obstetrician or maternal-fetal medicine specialist.