All you need to know about ICP
Intrahepatic Cholestasis of Pregnancy (ICP) and itching when pregnant.
It can be normal to itch during pregnancy due to changes in hormones and skin stretching. But itching can also be a symptom of intrahepatic cholestasis of pregnancy (ICP) so needs further investigation.

What is ICP?

Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder of pregnancy that affects around 5000 women each year in the UK alone; at present this figure is unknown in South Africa.

What are the symptoms?

  • Itching (also called pruritus):
  • Although itching typically starts from around 28 weeks it can present as early as the first trimester, and may be mild or so severe that you scratch your skin until it bleeds..
  • The itch usually affects the hands and feet, but may occur anywhere on your body.
  • Many women find that it is worse at night and it disturbs their sleep.
  • There is no rash associated with the itch, but there may be marks on your skin from scratching.
Other symptoms:
  • Some (but not all) women with ICP develop other symptoms. These may include dark urine, pale stools and, less commonly, jaundice (yellowing of the skin and whites of the eyes).
  • Some women with ICP may feel generally unwell, tired and lose their appetite.
What are the risks?

There is a risk of spontaneous preterm labour, fetal distress and in severe cases, stillbirth. However, with careful management the risk of stillbirth in an ICP pregnancy is believed to be the same as that of a normal pregnancy (1%).

What are the causes?

The cause of ICP is not fully understood but is likely multifactorial: researchers have found hormonal, genetic and environmental links.

How is ICP diagnosed?

To make a diagnosis of ICP, other liver conditions need to be ruled out first with either blood tests or liver ultrasound scanning.
Bile acid test: A bile acid test is believed to be the most specific test for ICP. Bile acids are thought to be harmful because they may be responsible for some of the complications that could affect your baby. In South Africa, bile acid may be ordered by special request.
Liver function test: This blood test looks at how well the liver is working. With ICP, special attention is paid to your ALT levels, although these are not always raised.

How is ICP treated?

The most effective treatment is still to be established but typically includes prescribing the medication UDCA (ursodeoxycholic acid), monitoring bile acid levels closely with weekly blood tests, and delivering the baby around 36–38 weeks.

What happens once my baby is born?

Around 6-12 weeks after you have your baby your liver function should be checked to confirm that is normal, as sometimes there may be an underlying liver condition that is not ICP and has caused the itching and abnormal liver readings during your pregnancy.

Will I get ICP again?

In a subsequent pregnancy there is a 90% chance of you developing ICP again.

More information and support

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Always consult a medical professional with your medical concerns during pregnancy.

Have you had any problems during your pregnancy?
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