Symptoms
The most common symptom of ICP is itching. This can range from quite mild to very severe.
It usually starts after 20 weeks of pregnancy.
The itching can be anywhere, it is often on many parts of your body. It is often on the palms of your hands or the soles of your feet. It does not cause a rash. But it might look red if you have scratched a lot.
If you are more than 20 weeks pregnant and have itching that is not linked to a rash, then you should contact your maternity care team.
Most people will not have any other symptoms of ICP. In rare cases you can develop jaundice. This is a yellow colour to your eyes or skin. Or notice that your poo is a very pale, putty colour.
Tests and diagnosis
Itching in pregnancy is very common and is not always caused by ICP. To diagnose ICP, health professionals such as doctors or midwives will ask you a number of questions and examine you. If they think you might have ICP you will need some blood tests.
Tests
Examination
You should be checked to see if you have a rash that is causing the itch. ICP does not cause a rash. But it is possible to have more than one condition at the same time, for example eczema and ICP.
Liver blood tests
If, after talking to you and examining you, the health professional thinks you might have ICP, you should have a liver blood test. You might hear this called an LFT or liver function test. The normal results for liver blood tests are a bit different in pregnancy. Your doctor should compare your results to the pregnancy reference range. Not the standard reference range.
Many liver conditions can cause itching and changes in the liver blood tests results. Your doctor may ask for more blood tests, but this is not needed in most people with ICP.
Urine test and blood pressure test
If you have ICP you should have a blood pressure measurement and a urine dip stick test at each of your check-ups. This is to look for other pregnancy conditions. Such as pre-eclampsia, which can also cause changes in liver tests, and which is more common in women with ICP.
Diagnosis
It is likely that you have ICP if you have all these things:
- your bile acid level is 19µmol/L or more
- and you have itching in your skin
- and you are otherwise well
Doctors can only be sure that you have ICP if your itching and bile acids go back to normal after your baby is born. So it is important that you are checked again at around 6 weeks after the birth.
Doctors look for the “peak bile acid concentration”. This is the highest result in any of your tests. So it is possible to move up a group e.g. from mild ICP to moderate ICP. It is not possible to move down to a less severe group, e.g. from severe to moderate.
Bile acid concentration is measured in micromoles per litre. This is usually written as micromol/L or µmol/L.
ICP is divided into 3 groups, depending on the highest amount of bile acid found in your tests:
Mild ICP– Itching and peak bile acid concentration of 19-39 µmol/L
Moderate ICP – Itching and a peak bile acid concentration of 40-99 µmol/L
Severe ICP – Itching and a peak bile acid concentration of 100 or more µmol/L
Research has shown that the amount of itching you feel is not related to the level of bile acids. So even if your itching is very severe you may not be in the severe ICP group.
How will ICP affect me?
ICP is not dangerous for you, and it should get better soon after your baby is born. But it might affect your decision about when and where your baby is born. You can find out more about this in the next section.
People with ICP have an increased risk of a condition called pre-eclampsia. You should have regular blood pressure and urine dip stick tests to check for this.
Your care
If you have ICP, your maternity care should come from a consultant led team. Depending on where you are, this might mean changing where you have your appointments. Or who you see for them.
Some people will need to have weekly blood tests to check on their bile acid level.
Most people with ICP are looked after by maternity teams. You should not have to see a specialist liver doctor (hepatologist) as well. If your case is more unusual or complicated, your obstetrician might talk to a hepatologist about your care. Your maternity care team should let you know if this is happening.
Coping with itching
Even though it is not harmful, itching can be very difficult to cope with. Especially if it is stopping you from sleeping. Unfortunately there are no treatments that have been shown to work well for most people. But there are some things you can try:
Medicines
Ursodeoxycholic acid
You might also hear this called urso or UDCA.
The evidence for using Ursodeoxycholic acid is unclear. The Royal College of Obstetrics and Gynaecology do not recommend giving it everyone with ICP. This is because of research that found it makes no difference or very little difference to itching.
However, some people have reported that it reduced their itching. There is no evidence that taking ursodeoxycholic acid is dangerous in pregnancy.
Different hospitals also have different policies on using ursodeoxycholic acid for ICP. Other things to do with your health or your pregnancy might affect if it is suitable for you. Talk to you doctor or midwife if you would like to find out more or get personal advice.
You can find out more about taking medicines when you are pregnant from the bumps website here.
Other ways to help itching
- Creams
Aqueous cream with menthol can sometimes provide some relief.
Emollient creams and ointments can sometimes help with itching. You can ask your local pharmacist to suggest which to try.
- Cool water
Having a cool bath or placing a cool, wet cloth on the itching area can help to reduce itching.
- Loose fitting cotton clothing
Try to avoid tight clothes or clothes made from wool or synthetic fabrics.
- Keep your nails short
Keep your nails clean, short and smooth to reduce the damage to your skin if you scratch
Diet
There is no evidence that any foods will help with ICP or make it worse. It is best to try and eat a healthy balanced diet. Follow the usual pregnancy advice about food safety and supplements.
Getting support
The charity ICP support offers a telephone and email support service run. This is run by people who have had the condition. They also have Facebook groups and more information about the latest ICP research. Find out more here.
Will ICP affect my baby?
It is unlikely that ICP will cause any serious problems for your baby.
It can increase the risk of your baby being born early.
It can increase the chance of meconium in your amniotic fluid. Meconium is your baby’s first poo. Amniotic fluid is the water around your baby. It can be a problem if meconium comes out of the baby before birth and gets into their lungs. If meconium is present during your labour, the maternity team may discuss using electronic monitoring of your baby’s heart beat
ICP can sometimes increase the risk of stillbirth late in pregnancy. This is rare, and the risk can be reduced by planning to have your baby a few weeks early.
As with any pregnancy, if you notice any change in your baby’s movements you should contact your maternity care team straight away.
Scans and monitoring
Studies have shown that ICP does not affect how babies grow. So there is no benefit to having more scans unless you need them for other medical reasons. Having extra scans does not reduce the risk of stillbirth caused by ICP.
The birth
When to have your baby
This information is just a guide. If you are having more than one baby or have other medical or maternity conditions as well as ICP then the advice may be different.
Talk to your maternity care team about your options and the risks and benefits of each of them. It is fine to ask for a bit of time to think things through before you decide.
Mild ICP (Peak bile acid 19-39 µmol/L)
The risk of a stillbirth is the same as it would be for someone without ICP. But this risk could increase if you are still pregnant after your baby’s due date. You might be advised to consider a planned birth at 40 weeks.
Moderate ICP (peak bile acid 40-99 µmol/L)
The risk of stillbirth is similar to people without ICP. But the risk goes up at the end of pregnancy. You should consider a planned birth between 38 and 39 weeks of pregnancy. Or at the time of the diagnosis if you are already beyond 39weeks.
Severe ICP (peak bile acid 100 µmol/L or more)
In the last weeks of the pregnancy, the risk of still birth is a bit higher than it is for someone without ICP. You will be advised to plan to have your baby early, between 35 and 36 weeks of pregnancy. Or at the time of diagnosis if you are already beyond 36weeks.
Type of birth
If you have moderate or severe ICP you might be advised to have your baby early. Before labour starts naturally. This is sometimes referred to as a planned birth. A planned birth should not affect your choices about how you give birth. If there are no other complications you will usually be offered induction of labour. This is where your labour is started early
ICP alone does not mean that you must have a Caesarean birth.
Things can change throughout your pregnancy. If you are making a birth plan it might help to think about alternative options. For example,
- What would you prefer if you go overdue?
- What would you prefer if you are moved to a higher ICP risk level?
Where to have your baby
You will be advised to have your baby in a hospital maternity ward if:
- your labour is being started early because of ICP
- you are having a planned Caesarean birth because of ICP
- you are planning to wait for labour to start and you have an increased risk of still birth
- there are any other concerns in the pregnancy (such as pre eclampsia, diabetes, twins etc)
If you have mild ICP and go into labour before 40 weeks, your risk of still birth is not increased. So unless there are other issues in your pregnancy, you can choose the place of birth that works best for you.
The Royal College of Obstetricians and Gynaecologists (RCOG) also has information on ICP. You can find it on their website here.
After your pregnancy
Itching usually stops within a few days of birth, often in the first few hours.
ICP should have no long-term effects on your liver or your general health. But it is important to get another blood test to check that everything has gone back to normal.
Pregnancy and birth will alter test results. You should wait at least 4 weeks after the birth before having these tests.
They can be done as part of the 6 week check. You should have a 6 week check with your GP for yourself as well as for your baby. This can often be done in the same appointment.
Your GP should have information about your ICP. But if they do not ask about it, then it is important to bring it up. Your GP should arrange for you to have a liver blood test and a bile acid blood test.
If your test results are normal, this will confirm that your itching was caused by ICP. You will not need any further treatment.
If your test results are not normal, there could be something else going on with your liver. You might need to have more tests. Or be referred to a hepatology or gastroenterology department so that they can find out more.
Find out more about tests for liver conditions
Contraception and Hormone Replacement Therapy (HRT)
ICP does not change which contraceptives you can use. Or which types of HRT you might try when you reach perimenopause.
Some other types of liver disease can have an impact on these choices.
Future pregnancies
It is possible that you could get ICP again in future pregnancies. If you get pregnant again you should tell your midwife about your ICP at the booking appointment. They should arrange for you to have blood tests to check your bile acid levels. This is called a baseline test as your results should be normal in early pregnancy. If you have more tests later in pregnancy these can then be compared to the baseline to look for any changes.
You should contact your maternity care team if you start to have itching again.
In very rare cases there might be a genetic cause for the ICP. This is more likely where ICP starts very early in the pregnancy. It means ICP is more likely to happen again.
Special thanks
We would like to thanks the patients and medical experts who helped us to create this information.
Published October 2024
Support for you
Find out more
Living with a liver condition
Find out more