Intrahepatic cholestasis of pregnancy

Itching is a very common symptom in pregnancy. It is generally thought to be due to raised levels of certain chemicals in the blood, such as hormones. Furthermore, as the belly grows, the skin of the abdominal area is increasingly stretched, with the consequent possibility that it also produces a source of itching. But, in some cases, itching can be a symptom of  intrahepatic cholestasis of pregnancy  (IGC), a disease also known by the names of jaundice of pregnancy, intrahepatic cholestasis of  pregnancy, cholestasis of pregnancy and obstetric cholestasis. In English it  is called  Intrahepatic Cholestasis of  P regnancy  – ICP.

Intrahepatic cholestasis of pregnancy (IGC)

Intrahepatic cholestasis of pregnancy is a potentially serious liver disease that can develop during pregnancy. This is a liver disease that needs medical attention.

Bile acids flow from the liver to the intestines to assist in the digestion of foods. In intrahepatic cholestasis of pregnancy however, bile acids are not channeled correctly, and they accumulate in the body.

There is currently no cure for intrahepatic cholestasis of pregnancy. However, this condition should disappear once you give birth.

It appears to have a hereditary basis, but can also occur in the absence of relatives with the disease.

It is a disease that is more common among women of South American, Indian or Pakistani descent. It affects one in 140 pregnant women in England.

If you have had intrahepatic cholestasis of pregnancy in a previous pregnancy, it is likely that you will also develop it in a subsequent pregnancy.

Some studies have shown that babies whose mothers had intrahepatic cholestasis during pregnancy are more likely to be born prematurely or stillborn.

Recent research has shown that the risks of stillbirth,

  • in women whose bile acids are higher than 40µmol/L. they are in the proportion of 1-2 out of 100.
  • while when levels rise to 80µmol/L, they increase to 4-5 out of 100.

Because of the link just highlighted, induction of labor could be recommended to the pregnant woman at about 37-38 weeks.

When the disorder is particularly severe – with bile acids higher than 40µmol/L – some specialists recommend early induction.

If you have intrahepatic cholestasis of pregnancy, you will probably be advised to give birth in a hospital under the supervision of the most suitable professionals.

Symptoms of intrahepatic cholestasis of pregnancy

The main symptom of intrahepatic cholestasis of pregnancy is itching, without necessarily having a rash. In many women affected by this disorder, itching,

  • manifests itself, stronger on the hands and feet,
  • but it can also affect any other area of ​​the body,
  • worse at night.

Other less common symptoms of this pathology are,

  • a dark urine,
  • pale feces,
  • yellow skin and corneas.

These symptoms usually appear around the 30th week of pregnancy, but they may also appear as early as the 8th week .

Tell your doctor or midwife if you experience uncomfortable itching anywhere on your body (especially in your hands and feet), and if it gets worse at night. This is because itching in these cases could be a sign of a intrahepatic cholestasis of pregnancy, and therefore a visit is necessary.

What to do in case of a light itch

Wearing comfortable clothes can help prevent itching, because by doing so, the clothes are less likely to rub against the skin and cause irritation.

It is also good to avoid wearing clothes made with synthetic materials, and it is preferable to choose cotton clothes. These are more breathable and allow more air to circulate next to the skin.

In some cases, a cool bath or applying a moisturizer can help soothe the itch.

For some women, heavily scented products can irritate the skin, so for these it is preferable to choose soaps without fragrances.

If mild, itching usually does no harm to your child, but it could be a sign of a more serious condition, particularly if it gets worse in the evening or at night.

Tell your doctor or midwife about your symptoms, so they can decide if further examinations are needed.

The diagnosis and treatment of ICG

Intrahepatic cholestasis of pregnancy is diagnosed by ruling out all possible other causes of pruritus.

Your doctor will likely ask about your medical and family history and order a series of tests.

These will include tests to check the health of your liver and measure bile acid levels.

Its monitoring over time

If you are diagnosed with intrahepatic cholestasis of pregnancy, you will have regular tests to check your liver function, so your doctor can monitor the condition over time.

There are no agreed guidelines on how often these tests should be performed, but the  Royal College of Obstetricians and Gynecologists (RCOG)  and the  British Liver Trust  advise weekly tests.

The largest research group in the UK researching intrahepatic cholestasis of pregnancy also recommends weekly bile acid measurements.

This information helps doctors decide when is the best time to induce the baby.

If your liver and bile acid values ​​are normal and you still experience severe itching, it is a good idea to get blood tests done every week or two to keep your values ​​under control.

Cig creams and drugs

Ointments, such as water-based creams with menthol, are safe substances, which can also be used during pregnancy, and can relieve itching.

There are also some drugs, such as ursodeoxycholic acid, which help reduce bile acids, and therefore also relieve itching.

Ursodeoxycholic acid is also considered safe in pregnancy, even if it is prescribed on the basis of the so-called “informed consent” as it has not yet been adequately tested on pregnant women.

You may also be prescribed a vitamin K supplement to decrease the symptoms of this condition. This is because intrahepatic cholestasis of pregnancy can affect the body’s absorption of vitamin K, which is important for proper blood clotting.

Most specialists in intrahepatic cholestasis of pregnancy only prescribe vitamin K if the future mother

  • report pale stools,
  • have a known blood clotting problem,
  • have very severe intrahepatic cholestasis of pregnancy from an early stage of pregnancy.

However, if you are diagnosed with intrahepatic cholestasis of pregnancy, your midwife and doctor will discuss with you both your health and the various treatment options available.

Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.

She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform,

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