Intrahepatic Cholestasis of Pregnancy (ICP): The Itch You Can’t Ignore

Many expectant mothers experience itchy skin as their bellies grow, but sometimes the itch isn’t normal; it’s a warning sign.

If you’re pregnant and experiencing intense itching, especially on your hands, feet, or limbs and particularly at night, it could be a sign of a rare but serious liver condition called Intrahepatic Cholestasis of Pregnancy (ICP).

While it might seem harmless at first, ICP needs medical attention. Left untreated, it can increase the risk of complications for both mother and baby.

ICP is a pregnancy-specific liver disorder that typically develops in the third trimester. It occurs when the normal flow of bile (a digestive fluid made by the liver) slows down or becomes blocked. This causes a build-up of bile acids in the blood, leading to itching and liver irritation.

The exact cause isn’t fully understood, but it’s believed to be influenced by:

The hallmark symptom of ICP is itching without a rash and it can be intense.

Look for:

If you’re pregnant and experiencing these symptoms, don’t ignore them or dismiss them as “normal.” Always inform your obstetrician, who can recommend specific tests to confirm or rule out ICP.

Diagnosis is confirmed through:

Because bile acid levels can fluctuate, your doctor may repeat the test after a few days if the first results are inconclusive but symptoms persist.

Yes, if left unmanaged, ICP can pose serious risks to the baby, such as:

This is why early diagnosis and close monitoring are so important.

For the mother, the symptoms usually resolve within days after delivery, and long-term liver damage is uncommon. However, recurrence in future pregnancies is likely (up to 60%).

Treatment focuses on lowering bile acid levels, easing the itching, and preventing complications.

1. Medication:

The most commonly prescribed medicine is ursodeoxycholic acid (UDCA). It helps improve bile flow and reduces bile acids in the blood. It’s safe for pregnancy and often brings symptom relief within a few days.

2. Regular Monitoring:

You’ll likely have:

3. Early Delivery:

Depending on your bile acid levels and how far along you are, your doctor may recommend delivering the baby early often between 36 and 37 weeks to reduce the risk of stillbirth.

4. Lifestyle Tips (supportive care):

The good news: ICP symptoms usually go away within a few days postpartum as hormone levels normalize and bile flow returns to normal.

However:

Yes, there is a high chance of recurrence up to 60–90% depending on your history. If you’ve had ICP once, inform your doctor early in future pregnancies so they can monitor your bile acids proactively.

Your sisters or daughters may also have a slightly increased risk, as genetic factors are involved.

Pregnancy brings many changes, and it’s easy to brush off discomforts. But when the itch becomes severe, especially at night or on your hands and feet, it’s your body’s way of signaling something more. Intrahepatic Cholestasis of Pregnancy isn’t common, but it is serious.

With early diagnosis, close monitoring, and proper treatment, most women with ICP go on to deliver healthy babies safely. If something feels off, trust your instincts and talk to your doctor.

Because in pregnancy, every signal matters.