In plain words
Intrahepatic cholestasis of pregnancy, or ICP, is a liver condition that usually appears in the third trimester. build up in the blood because the liver does not move them through as it normally does. The most common sign is , often on the palms and soles, that may be worse at night. The itch can be intense, and the skin often looks normal. Some people also have dark urine or pale stool. ICP is linked to a higher chance of preterm birth and, less often, , so it is watched closely. A blood test of bile acids confirms the diagnosis. Clinicians often discuss the timing of birth with the goal of lowering those risks. The itching usually resolves after birth. Call your provider the same day for new itching, especially with or eyes, dark urine, or pale stool.
The deeper version
ICP is defined by pruritus, typically in the third trimester, with elevated serum total bile acids and no other cause of liver disease. Guidelines use a serum bile acid threshold of about 10 micromoles per liter for diagnosis, with thresholds for management varying by guideline. It is associated with variants in ABCB4 and ABCB11 and with estrogen-related cholestasis. Ovadia and colleagues (Lancet, 2019) reported in an individual-patient meta-analysis that the risk of stillbirth and preterm birth rose with higher bile acid levels. The Society for Consult Series #53 (Lee and colleagues, 2021) describes monitoring and delivery timing. The optimal threshold for delivery, and the role of in improving outcomes, remain contested.
Where it comes up
- Itching that won't stop: cholestasisPregnancy: Your Body
- Skin in pregnancy: stretch marks, linea nigra, melasma, itchingPregnancy: Your Body
What mothers here say about intrahepatic cholestasis of pregnancy
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Sources
- Ovadia C et al. — Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet, 2019
- American College of Obstetricians and Gynecologists — Practice Bulletin 245: Intrahepatic Cholestasis of Pregnancy, 2022