Intrahepatic cholestasis of pregnancy (ICP)
(Date: June 2020. Version: 3)
This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by the UK Health Security Agency (UKHSA) on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.
What is it?
Intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis, is a liver condition that causes the build-up of bile acids in the blood and only occurs in pregnancy. ICP affects about one in every 100 pregnant women in the UK, usually in the third trimester. The main symptom of ICP is itching, which might be severe, 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 that you have ICP they will arrange for blood tests that check your bile acid levels and also your liver function. 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 and goes away on its own after delivery. However, ICP can severely affect quality of life as the itching can be very unpleasant and may interrupt sleep. ICP can occasionally cause serious problems in pregnancy (see below) and women with ICP are often anxious about their baby’s wellbeing.
Historically, ICP has been thought to increase the risk of stillbirth, but research published in 2019 suggests that this is only true for a small proportion of women with ICP. In the background population in the UK, around one in every 200 pregnancies ends in stillbirth. The latest research suggests that most women with ICP have a similar chance of having a stillbirth as women in the background population, while only the small number of women with blood bile acid levels over 100 µmol/L have a much higher chance of stillbirth.
Women with ICP will be offered at least weekly monitoring of their bile acid levels and may be offered early delivery of their baby depending on the results. Induction of labour in women with ICP may be offered at around 37 weeks of pregnancy after discussion of the risks and benefits of earlier delivery.
ICP is linked to preterm birth, both because some women with ICP have their deliveries induced, and because ICP increases the chance of spontaneous 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 deliver 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 considered safe to use in pregnancy.
Antihistamines
Antihistamines that cause drowsiness are sometimes prescribed for women who are experiencing severe itching, to help them sleep at night. The antihistamines for which there is the most information on use in human pregnancy are chlorphenamine and promethazine. Use in later pregnancy does not appear to cause problems in the baby before or after birth. If you are prescribed an antihistamine, please check to see if we have a bump leaflet summarising the known effects in pregnancy.
Ursodeoxycholic acid
Ursodeoxycholic acid (UDCA), or ‘urso’ is sometimes used in women with ICP. UDCA can reduce bile acid concentrations and relieve itching, although it does not work for everyone. There is no evidence to suggest that UCDA is harmful in pregnancy, and while some women benefit from reduced itching, there is no proof that its use 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.
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General information
Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks. They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.
Medicines use in pregnancy
Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby. There are, however, some medicines that can harm a baby’s normal development. How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.
If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.
When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.
Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.
www.medicinesinpregnancy.org