Intrahepatic cholestasis of pregnancy (ICP)

Date: September 2024, Version 4.0

Quick read

Intrahepatic cholestasis of pregnancy (ICP) is a liver problem that occurs in about one in every 100 pregnancies. It can be unpleasant but is usually harmless. Women with ICP will be more closely monitored and may be offered early delivery of the baby. Severe ICP is unusual but can increase the risk of stillbirth.

What is it?

ICP, also known as obstetric cholestasis, is a liver condition that affects about one in every 100 pregnant women. ICP causes the build-up of bile acids in the blood and usually starts in the third trimester.

The main symptom is itching, which can particularly affect the palms of the hands and soles of the feet and is often worse at night.

If your doctor or midwife suspects you have ICP, they will arrange for blood tests. Women with ICP have raised blood bile acid levels and often (but not always) have other abnormalities in their liver function tests.

Are there any risks to me or my baby from ICP?

ICP is not life-threatening for pregnant women but can greatly affect quality of life as the itching can be very unpleasant and may disrupt sleep. ICP can occasionally cause serious pregnancy complications (see below) and women with ICP are often concerned about their baby’s wellbeing.

Severe ICP (with blood bile acid levels over 100 µmol/L) is uncommon but can increase the risk of stillbirth. In the background population in the UK, around one in every 250 pregnancies ends in stillbirth. Most women with ICP have blood bile acid levels lower than 100 µmol/L and have a similar risk of stillbirth compared to women in the background population.

Because high blood bile acid levels can be dangerous for the baby, women with ICP will be offered at least weekly blood tests and may be offered early delivery of their baby depending on their bile acid levels.

ICP is linked to preterm birth, both because some women with ICP have their deliveries induced, and because ICP increases the chance of a woman going into preterm labour. ICP is also linked to the baby passing meconium (the first poo) while still in the womb, and as this can cause breathing problems in the newborn baby, increases the chance that they will need to be looked after in a neonatal intensive care unit.

It is recommended that pregnant women with ICP receive consultant-led care and have their baby in a hospital unit.

What are the treatments for ICP?

Moisturising skin creams

Moisturising skin creams, particularly those containing menthol, may reduce the feeling of itching in some women and are safe to use in pregnancy.

Antihistamines

Antihistamines that cause drowsiness are sometimes prescribed to help women with ICP sleep if they are experiencing itching. The antihistamines chlorphenamine and promethazine are widely used in pregnancy and are not known to harm the baby.

Ursodeoxycholic acid

Ursodeoxycholic acid (UDCA), or ‘urso’ is sometimes used in women with ICP. UDCA can reduce bile acid levels. UCDA is not known to be harmful in pregnancy, and while it helps some women with itching, there is no strong proof that it reduces the chance of other ICP-related problems.

Rifampicin

Rifampicin is occasionally prescribed alongside UCDA if a woman’s bile acid levels are high. Taking rifampicin is not known to be harmful in pregnancy; however, only a small number of studies have investigated its use in pregnant women. Ongoing research is therefore required. Rifampicin can reduce vitamin K levels, so when it is used, it is recommended that vitamin K is given to the baby after delivery.

For more detailed information on the medicines used to treat ICP please read the bump leaflets on: chlorphenamine, promethazine, ursodeoxycholic acid, and rifampicin.

Will I or my baby need extra monitoring during pregnancy?

As part of their routine antenatal care, most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects and to check the baby’s growth.

Women with ICP will be offered extra blood tests to check their bile acid levels and liver function. They may also be offered extra monitoring of the baby, particularly if they are anxious about the baby’s wellbeing. It is recommended that pregnant women with ICP receive consultant-led care and that they give birth in a hospital unit.

If you received treatment with rifampicin, it is important that your baby receives vitamin K after birth.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet, please discuss them with your midwife, obstetrician or GP. They can access more detailed medical and scientific information from www.uktis.org.

How can I help to improve drug safety information for pregnant women in the future?

Our online reporting system (MyBump Portal) allows women who are currently pregnant to create a secure record of their pregnancy, collected through a series of questionnaires. You will be asked to enter information about your health, whether or not you take any medicines, your pregnancy outcome and your child's development. You can update your details at any time during pregnancy or afterwards. This information will help us better understand how medicines affect the health of pregnant women and their babies. Please visit the MyBump Portal to register.

General information
Sadly, miscarriage and birth defects can occur in any pregnancy.

Miscarriage occurs in about 1 in every 5 pregnancies, and 1 in every 40 babies are born with a birth defect. This is called the ‘background risk’ and happens whether medication is taken or not.

Most medicines cross the placenta and reach the baby. For many medications this is not a problem. However, some medicines can affect a baby’s growth and development.

If you take regular medication and are planning to conceive, you should discuss whether your medicine is safe to continue with your doctor/health care team before becoming pregnant. If you have an unplanned pregnancy while taking a medicine, you should tell your doctor as soon as possible.

If a new medicine is suggested for you during pregnancy, please make sure that the person prescribing it knows that you are pregnant. If you have any concerns about a medicine, you can check with your doctor, midwife or pharmacist.

Our Bumps information leaflets provide information about the effects of medicines in pregnancy so that you can decide, together with your healthcare provider, what is best for you and your baby.