Intrahepatic Cholestatis of Pregnancy (ICP) also known as obstetric cholestasis is a liver disorder that can develop during pregnancy.  

Normally bile acids flow from your liver to your gut to help you digest food. In ICP, the bile acids build up in your body and “leak” into the bloodstream. ICP usually goes away after you have had your baby.  

Is ICP common?

No. It affects less than 1% of women in the UK. It is slightly more common in women of South Asian origin, affecting about 1.24%.    

What causes ICP?

Research shows that ICP is likely to be due to a combination of hormones during pregnancy and genetic factors. ICP also seems to run in families (although it can happen even if there’s no family history).   

What are the symptoms?

The main symptom is itching, usually without a rash. This is often worse at night and more noticeable on the palms of the hands and soles of the feet although it can be anywhere on the body. Itching is very common in pregnancy and only a small number of people will have ICP. But it is important to trust your instincts if you feel something isn’t right and call your midwife or the 24 Hour Maternity Helpline 01708503742 

Other symptoms of ICP may include: 

• Dark wee  
• Pale poo 
• Tenderness or pain on the right-hand side, just underneath your rib cage.  
• Less common symptoms include jaundice (yellowing of the skin and eyes).  

Symptoms of ICP typically start from around 30 weeks of pregnancy. But it is possible to develop it as early as 8 weeks. 

How is ICP diagnosed?

ICP is typically diagnosed by excluding other causes of the itching. If you have unexplained itching, you may be offered liver function tests (LFTs) and bile acid tests. You do not need to fast for this test. 

How does ICP affect you?

ICP can be a very uncomfortable condition as the itching ranges from mild to intense. For some women, it can disturb their sleep and even make them want to scratch their skin until it bleeds. The itching does get better after birth, but some women will be at risk of long-term health issues such as gallstones and other liver diseases. 

There has also been some research to suggest that women who have had ICP may be at increased risk of developing type 2 diabetes or cardiovascular (heart) problems, but this needs further research and is likely to be avoided by adopting a healthy lifestyle.  

There are some things that may help relieve the itching, including: 

• Creams, such as aqueous cream with menthol, which are safe to use in pregnancy 
• Sitting directly in front of a fan, soaking in a cool bath, and applying ice packs for short periods to affected areas 
• Applying naturally-cooling substances, such as aloe to affected areas before rinsing off in a shower 
• Wearing cool, loose, cotton clothing  
• Using unperfumed lotion or soap. 

Pregnancy can be an emotional experience. But if you are diagnosed with a complication such as ICP, this may cause some stress and anxiety. Tell your midwife or GP if you are finding it hard to cope with these feelings. You may need some extra support.  

How does ICP affect your baby?  

ICP increases the risk of: 

• Your baby passing meconium (poo) during pregnancy or labour – this may cause breathing problems after birth 
• Premature birth – research shows that about 1 in 10 women diagnosed with ICP will have their baby early (most preterm deliveries are induced, rather than spontaneous/happen naturally)  
• Stillbirth. This can be difficult to read. But recent research suggests that the risk of stillbirth is increased in women with intrahepatic cholestasis of pregnancy carrying 1 baby when bile acids are 100 μmol/L or more. It may be reassuring to hear that most women with ICP have bile acids below this number, so their risk of a stillbirth is similar to that of pregnant women in the general population. Bile acids can rise and fall, so you will be tested regularly during your pregnancy to make sure your bile acid level is low. You may also be offered an induction to reduce the risk of stillbirth. This could be any time from 35 weeks, depending on the level of bile acids. It is important to monitor your baby’s fetall movemnts because feeling your baby move is a sign that the baby is well.You should continue to feel your baby move right up to the time you go into labour and also during labour. Any concerns with your baby’s movements please call the 24 hour maternity helpline 01708503742  

Will you still have ICP after you give birth? ICP usually goes away after you have your baby. You should have a bile acid test and liver function test around 6-12 weeks after you give birth to confirm this. If the results are still abnormal, the test will be repeated. If the results are still abnormal after this check, you may need to see a specialist. It’s rare for ICP to last longer than this, so your healthcare professional may look for other things that could cause liver problems.   

Will you develop ICP if you get pregnant again? If you have had ICP in a previous pregnancy, you have a high chance (up to 90%) of developing it again. It’s a good idea to tell your midwife about your medical history as soon as you can in your next pregnancy, so they can make sure you get the care you need.   

ICP Support is the leading charity for anyone affected by ICP. For more information and support please click on the link below: 

ICP Support (icpsupport.org)