What is ICP?
The following is an overall summary of ICP. More detailed information about the causes, diagnosis, treatment and management of the condition can be found by following the links at About ICP.
- Intrahepatic cholestasis of pregnancy (ICP) is also known as obstetric cholestasis (OC). It affects around 5,500 women a year in the UK, but is more common in other parts of the world. It is associated with premature labour, fetal distress and, in the worst cases, stillbirth.
- ICP occurs when the flow of bile, which is produced in the liver and stored in the gallbladder, becomes sluggish. The bile acids in bile help us to digest food, but they are toxic in large amounts. As the flow of bile slows down, these bile acids build up and flow into the blood stream. They are not life-threatening for the mother-to-be, but they do cross the placenta and reach the baby. Some researchers believe that at very high levels they may cause the baby’s heart to stop working.
- ICP usually starts from 28 weeks onward in pregnancy, but it can occur as early as 7 weeks. The first sign is usually itching. The itch can be anywhere on the body, but it is usually most noticeable on the hands and feet. Most women agree that it is worse at night. Other symptoms include dark urine and pale poo. Some women also feel a dull ache or pain on their right-hand side, just underneath the rib cage.
- The causes of ICP are thought to be a combination of genetics (it runs in families), environment (it’s worse during winter) and hormones (the levels of these are much higher in pregnancy).
- ICP is diagnosed by ruling out other causes of itching and by a range of blood tests to check the liver and measure bile acid levels in the blood.
- Treatment often involves drugs such as ursodeoxycholic acid (UDCA) and rifampicin. Both drugs have some benefits, such as reducing bile acid levels and helping itch, but they do not work for everyone.
- Other treatments include using aqueous cream with menthol to soothe the skin. Sometimes an antihistamine is prescribed, but although this does not help the itch, it causes drowsiness and may help the woman to sleep.
- Because of the risk of stillbirth, most women with ICP give birth to their babies early. Induction is usually recommended at around 37–38 weeks of pregnancy. More research is needed to find out whether this is necessary in cases that are not severe.
- After the baby is born, more blood tests will be needed to make sure that everything has gone back to normal. Researchers recommend that this happens around 6–12 weeks after the birth.
Ovadia C, Williamson C. Intrahepatic cholestasis of pregnancy: recent advances. Clin Dermatol 2016; 34: 327–34.
Reyes H, Gonzalez MC, Ribalta J, Aburto H, Matus C, Schramm G, Katz R, Medina E. Prevalence of intrahepatic cholestasis of pregnancy in Chile. Ann Intern Med 1978; 88: 487–493