Pregnancy Guide

Obstetric cholestasis

Itching is common in pregnancy.  Usually it's thought to be caused by raised levels of certain chemicals in the blood, such as hormones.

Later on, as your bump grows, the skin of your tummy (abdomen) is stretched and this may also feel itchy.

However, itching can be a symptom of a liver condition called intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis (OC).

ICP needs medical attention.  It affects 1 in 140 pregnant women in the UK, around 5,500 a year.

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Mild itching

Wearing loose clothing may help prevent itching, as your clothes are less likely to rub against your skin and cause irritation.

You may also want to avoid synthetic materials and opt for natural ones, such as cotton, instead. These are "breathable" and allow the air to circulate close to your skin.

You may find that having a cool bath or applying lotion or moisturiser can help to soothe the itching.

Some women find that products with strong perfumes can irritate their skin, so you could try using plain lotion or soap.

Mild itching is not usually harmful to you or your baby, but it can sometimes be a sign of a more serious condition, particularly if you notice it more in the evenings or at night.

Let your midwife or doctor know if you are experiencing itching so they can decide whether you need to have any further investigations.

Serious itching: obstetric cholestasis

Obstetric cholestasis (OC), also called intrahepatic cholestasis of pregnancy (ICP), is a potentially serious liver disorder that can develop in pregnancy.

Normally, bile salts flow from your liver to your gut to help you digest food.

In obstetric cholestasis, the bile salts don't flow properly and build up in your body instead. There's no cure for OC, but it clears up once you've had your baby.

OC seems to run in families, although it can occur even if there is no family history. It is also more common in women of Indian and Pakistani origin.

If you have had OC in a previous pregnancy, you're more likely to develop it again in a subsequent pregnancy.

Some studies have found that babies of women with OC are more likely to be born prematurely or to be stillborn.

The most recent research suggests the risk of stillbirth is between 1 and 2 in 100 for those women whose bile acid levels are greater than 40µmol/L.

The risk of stillbirth rises to between 4 and 5 in 100 when the bile acids are 80µmol/L.

Because of the link with stillbirth, you may be offered induction of labour at around 37-38 weeks of pregnancy if you have OC.

You will probably be advised to give birth in hospital, under a consultant-led maternity team.

Symptoms of OC

Symptoms of ICP typically start from around 30 weeks of pregnancy, but it is possible to develop the condition as early as eight weeks.

The main symptom is itching, usually without a rash. The itching is often more noticeable on the hands and feet, but can be all over the body.

For many women with ICP, the itching is unbearable and can be worse at night, preventing sleep. For others, the itching is mild.

Other symptoms can include dark urine, pale bowel movements (poo) and, less commonly, yellowing of the skin and whites of the eyes jaundice.

Diagnosis and treatment of ICP

ICP is diagnosed by excluding other causes of the itch. Your doctor will probably talk to you about your medical and family history, and order a variety of blood tests.

These will include tests to check your liver function (LFT) and measure your bile acid levels (BA).

Monitoring your condition

If you are diagnosed with ICP, you will have regular liver function tests so your doctor can monitor your condition.

There is no agreed guideline on how often these tests should happen, but the Royal College of Obstetricians and Gynaecologists (RCOG) and the British Liver Trust advise weekly tests.

The UK's largest research group investigating ICP also recommends weekly bile acid measurements. These readings help doctors recommend when your baby should be born. 

If your LFTs and bile acids are normal and you continue to have severe itching, the blood tests should be repeated every week or two to keep an eye on them. 

Creams and medications for ICP

Creams, such as aqueous cream with menthol, are safe to use in pregnancy and can provide some relief from itching.

There are some medications, such as ursodeoxycholic acid (UDCA), that help reduce bile acids and ease itching.

UDCA is considered safe to take in pregnancy, although it is prescribed on what is known as an "informed consent" basis as it hasn't been properly tested in pregnancy.  

You may also be offered a vitamin K supplement. This is because ICP can affect your absorption of vitamin K, which is important for healthy blood clotting.

Most experts on ICP only prescribe vitamin K if the mother-to-be reports pale stools, has a known blood clotting problem, or has very severe ICP from early in pregnancy.

If you are diagnosed with ICP, your midwife and doctor will discuss your health and your options with you.

Further information

The Royal College of Obstetricians and Gynaecologists (RCOG) has more information about obstetric cholestasis, including what it means for you and your baby, and the treatment that's available. You can also get information from the British Liver Trust.

The charity ICP Support provides information about ICP. You can also watch their video about ICP (OC) featuring mums and clinical experts.

Last Updated: 08/11/2017 13:24:46
The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website