In brief — the direct answer
Intrahepatic Cholestasis of Pregnancy (ICP), also known as obstetric cholestasis, is a liver disorder that occurs in late pregnancy. It causes an accumulation of bile acids in the mother's blood, most notably characterized by intense itching. While ICP is primarily uncomfortable for the mother, the elevated bile acids can be dangerous for the baby, increasing the risk of preterm birth and, in severe cases, sudden stillbirth. At the MFM Unit, we prioritize rapid diagnosis and intensive monitoring for mothers with ICP.
What is Cholestasis of Pregnancy (ICP)?
Bile is a fluid made by the liver that helps with digestion. During pregnancy, hormones can slow down the normal flow of bile out of the liver. This causes bile acids to build up in the liver and eventually spill over into the mother's bloodstream. These extra bile acids are what cause the intense, relentless itching and can cross the placenta, potentially affecting the baby's heart rhythm.
Who is at risk?
ICP is more common in:
- Individual/Family History: If you or your mother/sister had it.
- Multiple Pregnancies: Women carrying twins or triplets.
- Liver Conditions: History of hepatitis or gallstones.
- Season/Ethnicity: ICP is more frequent in certain ethnic groups and has been noted to increase in winter months in some regions.
How we diagnose it
The diagnosis is based on symbols and blood work:
- Severe Itching: Specifically itching on the palms of the hands and soles of the feet that is worse at night. Critically, there is typically no rash associated with this itch.
- Bile Acid Test: The primary diagnostic test. A level over 10-19 µmol/L is considered abnormal.
- Liver Function Tests (LFTs): Checking for elevated liver enzymes (ALT/AST).
What does management involve?
Confirm the diagnosis with bile acids, liver tests and assessment of other causes; repeat testing may be needed if itching persists despite an initially normal result. Treatment such as ursodeoxycholic acid may help maternal symptoms, but should not be described as proven prevention of stillbirth. Fetal surveillance has limitations and does not reliably predict every sudden event. Plan birth using peak bile acids, gestation, other risks and the guideline followed by your team.
What are the outcomes?
Risk is related to bile-acid level and other pregnancy factors. Very high levels (100 micromol/L or more) require a different birth-timing discussion from lower levels; a single universal week is inappropriate. Guidance varies, so document the applicable plan rather than applying one threshold to every patient. Repeat liver and bile-acid tests after birth and investigate persistent abnormalities. The condition can recur in a future pregnancy.
When to see a subspecialist
If you experience itching that is worse at night and affects your hands and feet, do not dismiss it as 'normal pregnancy skin stretching.'
Our maternal medicine specialist, Dr. Maria Haji Liga, provides expert care for ICP. We ensure that your bile acid levels are tracked with the highest accuracy and that your delivery plan is optimized for your baby's safety.