Intrahepatic Cholestasis and How to Manage It

Pregnancy is such an exciting time, but let’s be real—it can also bring its share of discomfort. One thing I didn’t expect was the itching. While mild itching is pretty common and usually nothing to worry about, I found out that persistent, intense itching—especially on the palms of my hands and soles of my feet—could be a sign of something more serious, like intrahepatic cholestasis of pregnancy (ICP).

I want to share what I learnt about itchy skin during pregnancy and what ICP really means, so you can feel more confident navigating this part of your pregnancy journey.
 

ICP is a liver condition that can show up during the second or third trimester. It happens when the flow of bile—a fluid that helps with digestion—slows down, causing bile acids to build up in your bloodstream. This buildup not only leads to intense itching (especially on your palms and soles) but can also pose potential risks for both you and your baby. Recognising the signs and understanding this condition is key to managing it effectively.

Common Signs and Symptoms of ICP

The most notable signs and symptoms of ICP pregnancy include:

• Intense Itching: Often starts on the palms of your hands and soles of your feet, spreading to other areas and worsening at night.
• No Rash: Unlike other causes of itching during pregnancy, ICP doesn’t involve a rash.
• Dark-Coloured Urine: Caused by the build-up of bile acids in your bloodstream.
• Pale Stools: A sign of disrupted bile flow.
• Jaundice: Yellowing of the skin and the whites of the eyes, though this is less common.

There are several factors that can increase a woman's likelihood of developing ICP. These include:

• Genetic predisposition: Women with a family history of ICP, especially if their mothers or sisters had the condition, have a higher risk.
• Hormonal factors: Elevated levels of oestrogen and progesterone during pregnancy can impact the liver's bile transport function.
• Multiple pregnancies: Carrying twins or triplets increases the risk of developing ICP.
• Previous liver issues: A history of liver disease or ICP in a prior pregnancy raises the chances of recurrence.
• Seasonal variation: More cases are diagnosed during winter, suggesting a potential environmental trigger.

To diagnose intrahepatic cholestasis of pregnancy (ICP), the key test is a bile acid test, which measures bile acid levels in your blood. A reading of 10 micromoles per litre or higher typically confirms ICP.

Additional tests to diagnose ICP may include:

• Liver Function Tests (LFTs): To check how well your liver is working.
• Prothrombin Time Test: To assess blood clotting ability.
• Ultrasound: To examine the liver and bile ducts for any abnormalities.

ICP can lead to significant complications for both the mother and the baby if left unmanaged.

• Intense Itching: Often worse at night, especially on the palms and soles, and may be accompanied by dark urine, pale stools, or jaundice in rare cases.
• Mental Health Impact: Persistent itching can cause distress or anxiety, negatively affecting mental well-being.
• Additional Conditions: Increased risk of pre-eclampsia (high blood pressure and protein in urine) or gestational diabetes, requiring closer monitoring.

Potential Risks for the Baby

Babies born to mothers with ICP face an increased risk of several complications, including:

1. Premature labour: ICP is linked to a higher rate of spontaneous preterm labour, affecting up to 60% of deliveries in some studies.
2. Foetal distress: Elevated bile acids can cause the baby's heart rate to become abnormal, indicating foetal distress.
3. Meconium staining: There is a higher likelihood of the baby passing meconium (first stool) in the amniotic fluid, which can lead to respiratory issues if inhaled.
4. Stillbirth: In severe cases, ICP can tragically result in stillbirth, particularly if left untreated or if bile acid levels are extremely high.

Staying on top of your health during pregnancy is so important, especially if you're dealing with ICP. Regular check-ups, monitoring, and following your doctor’s advice can really help reduce the risks for both you and your baby. If you spot symptoms early and get treatment quickly, you can significantly lower the chances of complications.

Dealing with ICP can be challenging, but with the right approach, you can manage the condition and reduce the risks for both you and your baby. Here are a few key steps to keep in mind:

1. Stay in Close Contact with Your Doctor: Regular monitoring of bile acid levels, liver function tests, and your baby’s well-being is crucial. Keep your doctor informed about any changes in symptoms, especially itching or discomfort.
2. Medications: Your doctor may recommend medications to help reduce bile acid levels and ease symptoms. Never take any medication without consulting your doctor.
3. Timing of Delivery: Depending on your bile acid levels and overall health, your healthcare team may recommend early delivery to minimise the risks. This could involve inducing labour or scheduling a caesarean section.
4. Manage Stress: The discomfort of itching can be emotionally taxing, so it’s important to find ways to relax. Light exercises, mindfulness, or simply taking breaks can help reduce anxiety.
5. Diet and Hydration: Eating a balanced diet and staying hydrated can help support liver function and overall health. If you're unsure what to eat, ask your doctor for dietary recommendations.

ICP is a serious condition characterised by intense itching, often on the palms, soles, and sometimes itchy breasts, along with elevated bile acids. In some cases, it can lead to cholestatic jaundice. Managing ICP involves medications to lower bile acid levels, symptom relief, and regular monitoring of ICP symptoms. In many cases, early delivery may be recommended to reduce risks for both the mother and baby. Proper care and early intervention can help ensure the best possible outcome for both.