In plain words
Pruritus is the medical word for itching. Itching is common in pregnancy, and most of the time it comes from stretched skin or a harmless rash. The clinical question is whether the itch comes with a rash. An itch without a rash, especially on the palms and soles or worse at night, can be a sign of a liver condition called . Another rare skin condition, , can start around the belly button and cause blisters. Both need a provider to check. Tell your provider about itching that is new, widespread, or keeps you up at night, even if you do not see a rash. Your provider can order blood tests to find the cause.
The deeper version
Pruritus in pregnancy is classified by the presence or absence of a primary rash. Pruritus without rash is the central clinical flag for intrahepatic cholestasis of pregnancy (ICP), which is diagnosed by elevated serum , and pemphigoid gestationis, a blistering autoimmune disease, is the key discriminator when onset is periumbilical or blistering occurs. Ovadia and colleagues (The Lancet, 2019) reviewed the diagnosis, screening, and management of ICP, including bile acid thresholds and associated fetal risk. Pruritic papules and plaques of pregnancy and are more common and usually benign. The main controversy concerns how and when to treat ICP, and whether bile acid monitoring should drive delivery timing.
Where it comes up
- Itching that won't stop: cholestasisPregnancy: Your Body
- Skin in pregnancy: stretch marks, linea nigra, melasma, itchingPregnancy: Your Body
- Baby moving less: what to doPregnancy: Your Body
- Going past your due datePregnancy: Your Body
What mothers here say about pruritus
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Sources
- Ovadia C et al. — Diagnosis, screening, and management of intrahepatic cholestasis of pregnancy. The Lancet (2019)
- Royal College of Obstetricians and Gynaecologists — Green-top Guideline No. 43: Obstetric Cholestasis (2011)