Note: The Pregistry website includes expert reports on more than 2000 medications, 300 diseases, and 150 common exposures during pregnancy and lactation. For the topic Intrahepatic Cholestasis, go here. These expert reports are free of charge and can be saved and shared.
When I was 34 weeks pregnant with my second child, I started to feel uncontrollably itchy. It originated with the skin over my belly and then spread out over my legs and arms to my hands and feet. A quick google search suggested that a certain amount of itching during pregnancy can be normal, but my intuition told me something more was going on. I kept reading and learned that sometimes one of the only signs of intrahepatic cholestasis of pregnancy (more commonly known as ICP or obstetric cholestasis) is feeling very itchy.
After I talked to a friend who’d had cholestasis during her pregnancy the year before, I was feeling panicky. I made an appointment to see a midwife at the birth center where I planned to birth my baby for that Friday and kept reading on the internet about ICP. This is a great blog post from The Pulse about ICP, but there is also a lot of information out there that can be pretty scary in the absence of guidance from your healthcare provider.
By the time of my appointment, I was feeling really overwhelmed and worried. I started crying almost the moment the midwife came in. She was wonderful—calm and reassuring—and ordered the blood test that would check the level of bile acids and liver enzymes in my blood, while encouraging me to take an oatmeal bath and moisturize to help with the itchiness.
The following Sunday evening, I got a call from another birth center midwife. She let me know that I did appear to have cholestasis of pregnancy and explained that I was itchy because my cholestasis is a slowing down or stopping bile flow. Rather than leaving the liver, as it’s supposed to, bile builds up in the livers of people with ICP and bile salts (also known as bile acids) eventually spill over into the bloodstream where they can be deposited throughout the body and cause itching.
The test that my midwife did showed that bile acids were elevated in my bloodstream and that the enzymes that my liver was producing were slightly low, suggesting that my liver wasn’t functioning as it should be. She prescribed a medication for me to start taking called ursodeoxycholic acid (UDCA or ursodiol) to help control the level of bile acids in my blood.
Because my cholestasis was mild, the medicine helped resolve my itchiness, but due to the risk of stillbirth that comes with ICP, my pregnancy and baby now needed to be monitored more and my midwives recommended induction by week 40 of pregnancy. If I’d had a more severe case, the midwives might have recommended that I be induced sooner to keep me and my baby safe. As it was, I had a weekly nonstress test to check that baby was doing okay.
I scaled back most of my work in order to focus on getting ready for baby and staying healthy. In addition to taking ursodiol, I also drank multiple cups of dandelion leaf and root tea, which is supposed to support liver function, and also received acupuncture every other week. By week 39, I was shocked to still be pregnant as my first baby had been born after my water broke at week 38. Luckily, my midwives had some tricks to get my labor started. On the morning of my 39th week of pregnancy, I drank castor oil mixed with a green smoothie and my baby was born safely by 7 pm.
After pregnancy, they checked my bile acids and liver function again and it was all back to normal, which is typical for ICP. Because pregnancy is the source of the stress to the liver, once the pregnancy is over, then liver function usually returns to normal.
I was lucky to have care providers that I trusted to listen to me about my concerns and who knew how to manage my ICP. There are lots of stories of providers who didn’t catch ICP, so if you experience itching that’s not related to a rash and that doesn’t go away, it’s okay to insist on testing of your bile acids and liver enzymes. When ICP is detected and managed, there’s a good chance that your baby will be born healthy.