The Scoop On ICP- Intrahepatic Cholestasis of Pregnancy

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Intense Itching? Don’t Brush It Off- Tell Your Provider! Here’s Why.

Itching during pregnancy can happen for many reasons- dry skin, skin stretching, new stretch marks. Pregnancy definitely has its less fun aspects. However, Itching during pregnancy can be a sign of a bigger issue going on called Intrahepatic Cholestasis of Pregnancy or ICP.

Typically occurring during the 3rd Trimester, ICP is caused by pregnancy hormones effecting liver function. This can result in slowing or stopping the flow of bile. When this happens to the bile flow in the liver- it causes a build up of bile acids that can spill into the bloodstream. This means that itch might be much more than a simple skin rash! Other symptoms include: abdominal pain, loss of appetite, dark urine, and fatigue/exhaustion.

From ICPCare.org (which is a phenomenal resource hub for those diagnosed with Cholestasis by the way!):

ICP is not a single disease, rather, it is a group of related disorders which all affect the liver’s ability to transport bile effectively. Research has identified several genes which contribute to Intrahepatic Cholestasis of Pregnancy, however there are many others which have not yet been discovered. Many of these genes cause problems in a protein called the Bile Salt Export Protein (BSEP). This protein is responsible for moving the bile which is created in liver cells out of the cells and into the bile duct. Because there are many variants of Intrahepatic Cholestasis of Pregnancy, the disorder can present very differently in affected women.

To rule out ICP- your provider will need to order blood tests after examining you. It is not something that can be easily diagnosed remotely or via “Dr. Google.” ICP is a diagnosis of exclusion, meaning that other causes of impaired liver function and cholestasis, such as viral hepatitis, biliary obstructions or strictures, or autoimmune hepatitis, among others, must be ruled out before the diagnosis can be made.

It is important to note that this condition is FAIRLY rare at about 1-2 in every 1,000 pregnancies, but it is extremely important for mother and baby for it to be ruled out due to serious risks including pre-term labor and fetal distress. Cholestasis is more common in women carrying multiples, women with prior liver damage, and women who have a mother or sister with a history of ICP.

ICP can be treated with medication, however extra monitoring is usually warranted. Early delivery between 36-37 weeks or once fetal lung development is close to complete is often recommended.. If caught early, outcomes are often very positive. It’s important to note that the evidence is not conclusive, however women who have Cholestasis in one pregnancy have about a 90% chance of reoccurrence in future pregnancies per the current available research.

For more resources and information regarding Cholestasis- visit these sites!

https://icpcare.org/resources/medical-articles-reference/

https://www.marchofdimes.org/complications/intrahepatic-cholestasis-of-pregnancy.aspx

https://americanpregnancy.org/pregnancy-complications/cholestasis-of-pregnancy/

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