Will ICP harm my baby?

Will ICP harm my baby?

ICP gives rise to several risks to your baby.

Preterm birth

Preterm birth is defined as delivery before 37 weeks. In ICP this may occur because labour begins spontaneously before 37 weeks (but UDCA may reduce this risk) or because doctors recommend induction of labour before 37 weeks (known as iatrogenic preterm birth). Currently, many doctors are recommending that women who have ICP are induced at around 37–38 weeks. However, the most recent research from Ovadia et al 2019 shows that many women can now wait until 38–39 weeks of pregnancy before they need to be induced. This does, however, rely on regular bile acid testing with results available within 24 hours.

The causes of spontaneous pre-term labour are still not fully understood and need further research. See our suggested guideline for diagnosis, treatment and management of ICP.

Meconium staining

Meconium is the first poo that a baby passes. In some cases the baby may poo before it is born. This is very common if the baby is overdue, but less common if not. In ICP there is an increased risk of the baby passing meconium before delivery, even if the baby is born prematurely. However, the PITCH trial (2009) showed that there was a reduction in meconium staining of the amniotic fluid for women taking UDCA, although this involved a relatively small number of women. A larger trial called PITCHES has confirmed this.

Neonatal admission

There is an increased risk of your baby being admitted to the neonatal unit, although many babies only stay a short while. In ICP common reasons for the baby being admitted to the neonatal unit are that they are born prematurely and need some extra help with breathing or feeding. Your doctor will be able to explain more about the reasons for admission to the neonatal unit and what it may mean for the baby.

There is also a suggestion that very high bile acids may impact on the production of lung surfactant in the fetus, which could result in something called ‘bile acid pneumonia’. This in turn increases the risk of admission to the neonatal unit for oxygen therapy (see Zecca 2004).


The most feared complication associated with ICP is stillbirth. Several studies have reported that stillbirth is more common in ICP than in uncomplicated pregnancies, and the most recent research from Ovadia et al 2019 links it to high bile acid levels.

How the stillbirth happens is not fully understood, but may be due to high bile acid concentrations affecting the fetal heart (Miragoli et al., 2011; Schultz et al., 2016; Vasavan et al., 2020).

It has also been reported that the risk of stillbirth in ICP is increased if there are also other complications of pregnancy, including pre-eclampsia and gestational diabetes.

The information given here is further supported by the revised RCOG Guideline on ICP (published August 2022).

Note: The Ovadia research is based on singleton pregnancies only, as there were insufficient twin (or more) pregnancies in her research to draw firm conclusions. However, experts in ICP currently use Ovadia's findings to guide their management of the condition in twin (or more) pregnancies.

Next >  Bile acids – what’s all the fuss?

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Girling J, Knight CL, Chappell L; on behalf of the Royal College of Obstetricians and Gynaecologists. Intrahepatic cholestasis of pregnancy. BJOG 2022; 1–20.

Ovadia C, Seed PT, Sklavounos A, Geenes V, Di Illio C, Chambers J et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. The Lancet 2019;

Ovadia C, Sajous J, Seed PT, Patel K, Williamson NJ, Attilakos G, Azzaroli F, Bacq Y, Batsry L, Broom K, Brun-Furrer R, Bull L, Chambers J, Cui Y, Ding M, Dixon PH, Estiù MC, Gardiner FW, Geenes V, Grymowicz M, Günaydin B, Hague WM, Haslinger C, Hu Y, Indraccolo U, Juusela A, Kane SC, Kebapcilar A, Kebapcilar L, Kohari K, Kondrackienė J, Koster MPH, Lee RH, Liu X, Locatelli A, Macias RIR, Madazli R, Majewska A, Maksym K, Marathe JA, Morton A, Oudijk MA, Öztekin D, Peek MJ, Shennan AH, Tribe RM, Tripodi V, Özterlemez NT, Vasavan T, Audris Wong LF, Yinon Y, Zhang Q, Zloto K, Marschall H-U, Thornton J, Chappell LC, Williamson C. Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a systematic review and individual participant data meta-analysis. Lancet Gastroenterology & Hepatology 2021; Online 26 April.

Zecca E, Costa S, Lauriola V, Vento G, Papacci P, Romagnoli C. Bile acid pneumonia: a "new" form of neonatal respiratory distress syndrome? Pediatrics 2004; 114: 269–72.

Schultz F, Hasan A, Alvarez-Laviada A, Miragoli, M, Bhogal N, Wells S, Poulet C, Chambers, J, Williamson C, Gorelik J. The protective effect of ursodeoxycholic acid in an in vitro model of the human fetal heart occurs via targeting cardiac fibroblasts. Progress in Biophysics and Molecular Biology 2016; 120(1–3): 149–163.

Vasavan T, Deepak S, Jayawardane IA, Lucchini M, Martin C, Geenes V, Yang J, Lövgren-Sandblom A, Seed PT, Chambers J, Stone S, Kurlak L, Dixon PH, Marschall H-U, Gorelik J, Chappell L, Loughna P, Thornton J, Pipkin FB, Hayes-Gill B, Fifer WP, Williamson C. Fetal cardiac dysfunction in intrahepatic cholestasis of pregnancy is associated with elevated serum bile acid concentrations. J Hepatol 2020; 74(5): 1087–96.

Miragoli M, Siti H, Sheikh Abdul Kadir, Sheppard MN, Salvarani N, Virta V, Wells S, Max J Lab, Nikolaev VO, Moshkov A, Hague WM, Rohr S, Williamson C, Gorelik J. A protective antiarrhythmic role of ursodeoxycholic acid in an in vitro rat model of the cholestatic fetal heart. Hepatology 2011; 54(4): 1282–92.