Intrahepatic Cholestasis

INFORMATION FOR WOMEN WHO HAVE INTRAHEPATIC CHOLESTASIS OF PREGNANCY

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is intrahepatic cholestasis of pregnancy?

Intrahepatic cholestasis of pregnancy (ICP) is a liver condition that can occur during the late second trimester or any time during the third trimester of pregnancy.

Known by several other names cholestasis of pregnancy, jaundice of pregnancy, obstetric cholestasis, and prurigo gravidarum ICP is characterized by an abnormally high flow of a liver substance called bile, resulting from the presence of high levels of the pregnancy hormone, estrogen.

How common is intrahepatic cholestasis during pregnancy?

Intrahepatic cholestasis of pregnancy is fairly common, though its incidence varies greatly based on geography. Several decades ago, native peoples in Chile and Bolivia experienced ICP in almost 28 percent and almost 14 percent of pregnancies, respectively.  Today, the highest rates occur in Scandinavian and Baltic countries, where ICP develops in about 2 percent of pregnancies, whereas in other parts of Europe, and in North America, Australia, and Asia, just below 1 percent of pregnancies are affected, but this still makes ICP very common.  If you have had ICP in a previous pregnancy, you have at least a 50 percent chance of developing it in a subsequent pregnancy.

How is intrahepatic cholestasis of pregnancy diagnosed?

The suspicion that a woman has ICP is high based on her symptoms and, importantly, the timing of the symptoms. As with many conditions of pregnancy, symptoms include nausea and vomiting, plus your skin may look yellow (jaundice). If this is happening in late pregnancy (any time from the late 2nd trimester on) and you also feel itchy, especially on the hands and feet, ICP is at the top of the list of possible diagnoses. Doctors will then run basic blood tests, including tests for liver function. If your liver function is normal or only mildly abnormal, and, importantly, if you show high levels of bile acids, this establishes a diagnosis of ICP.

Does intrahepatic cholestasis cause problems during pregnancy?

A woman with ICP may experience flu-like symptoms, such as nausea and vomiting as well as abdominal pain and anorexia (lack of appetite). Urine may darken, and its possible that a deficiency of vitamin K will develop, due to problems absorbing it. If this happens, it can lead to bleeding problems.  If the duct that carries bile from the liver becomes obstructed, the woman can develop severe pain and require surgery, but this is very rare.

Does intrahepatic cholestasis of pregnancy cause problems for the baby?

Effects of ICP on the developing baby are a subject of controversy and ongoing investigation, but there is some evidence that the condition slightly increases the risk of spontaneous abortion, early onset of labor, and premature birth. There also is a risk of stillbirth, but the risk can be eliminated by delivering the baby early.

What to consider about taking medications when you are pregnant or breastfeeding:

  • The risks to yourself and your baby if you do not treat the ICP
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat intrahepatic cholestasis during pregnancy?

ICP is treated effectively with ursodeoxycholic acid (UDCA), which is safe both for the mother and her developing baby.

Who should NOT stop taking medication for intrahepatic cholestasis during pregnancy?

Nobody with ICP should stop taking UDCA until the treatment is complete, as it is both effective and safe.

What should I know about choosing a medication for my intrahepatic cholestasis during pregnancy?

You may find Pregistrys expert reports about the individual medications used to treat ICP here. Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for my intrahepatic cholestasis when I am breastfeeding?

Usually, ICP resolves following delivery, so if you are taking UDCA youll be able to stop the treatment. UDCA is not approved for use during breastfeeding but is thought to be safe in the event that you are still using it while nursing.

What alternative therapies besides medications can I use to treat intrahepatic cholestasis during pregnancy?

Typically, labor is induced or cesarean section is performed to cure the condition by delivering the baby early, generally around 37 weeks gestation.

What can I do for myself and my baby when I have intrahepatic cholestasis during pregnancy?

Cooperate with your physicians by agreeing to early delivery, or treatment with UDCA, if your doctors think this is the best course.

Resources for intrahepatic cholestasis of pregnancy:

For more information about ICP during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or check the following links:

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Last Updated: 04-03-2020
General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.