Intrahepatic Cholestasis of Pregnancy (ICP): What You Need to Know

Intrahepatic Cholestasis of Pregnancy (ICP) is a rare but serious liver condition that can occur during pregnancy. It affects the flow of bile from the liver, leading to a buildup of bile acids in the mother’s blood. While it’s treatable, it does carry risks for the baby, most significantly, an increased risk of stillbirth if not properly managed.

Understanding the early signs and getting prompt medical care is crucial. This post breaks down everything you need to know about ICP: symptoms, testing, treatment, and how to advocate for yourself during pregnancy.

What Is Intrahepatic Cholestasis of Pregnancy (ICP)?

ICP is a liver disorder that only occurs during pregnancy. Normally, bile acids help digest fats and are processed by the liver. But in ICP, these bile acids don’t flow normally, and instead build up in the bloodstream. This can lead to uncomfortable symptoms for the pregnant person and serious risks for the baby.

ICP usually develops in the third trimester, but it can happen earlier. The condition typically resolves after delivery.

How Common Is ICP?

  • ICP affects 0.5% to 2% of pregnancies in the general population.

  • It is more common in people of South Asian, Scandinavian, and South American descent.

  • People with a family history of ICP or a personal history of liver or gallbladder issues are at higher risk.

  • In twin or multiple pregnancies, the incidence can be higher (up to 5%).

 

Symptoms of ICP

The most common and often the first symptom of ICP is itching.

Common Signs and Symptoms:

  • Severe itching, especially on the hands and feet (often worse at night)

  • Dark urine

  • Pale stools

  • Right upper quadrant pain (under your ribs)

  • Fatigue or exhaustion

  • Loss of appetite or nausea

  • Mild jaundice (yellowing of the skin or eyes)

 

⚠️ Important: There is no visible rash associated with ICP. The skin may appear normal even though the itching is intense.

Why ICP Is Dangerous for Babies

The buildup of bile acids in the mother’s blood can cross the placenta and affect the baby. ICP increases the risk of:

  • Stillbirth, particularly after 37 weeks

  • Preterm labour

  • Fetal distress

  • Meconium-stained amniotic fluid

  • Neonatal respiratory distress

 

Risk of Stillbirth:

Recent studies show that the risk of stillbirth becomes significantly higher when bile acid levels rise above 100 µmol/L. However, even mild cases (under 40 µmol/L) still require careful monitoring.

When to Seek Medical Advice

If you experience persistent itching especially on your hands and feet, speak to your doctor or midwife immediately. Don’t let it be dismissed as a “normal” pregnancy symptom. Ask for bile acid testing and liver function tests (LFTs).

How Is ICP Diagnosed?

ICP is diagnosed through blood tests, specifically:

  1. Serum bile acid levels – the most important indicator

  2. Liver function tests (LFTs) – to check for elevated liver enzymes

 

If your tests come back normal but you’re still experiencing symptoms, retesting is essential. Bile acid levels can take time to rise and fluctuate over time.

Treatment and Management of ICP

1. Medication

  • The most common medication used is Ursodeoxycholic acid (UDCA).

  • It can reduce bile acid levels and relieve itching in some patients.

  • While studies are mixed on whether UDCA reduces the risk of stillbirth, it’s still widely prescribed for symptom relief.

2. Regular Monitoring

  • Weekly or twice-weekly blood tests to track bile acids and liver enzymes.

  • Regular fetal monitoring (non-stress tests, ultrasounds, etc.).

  • Kick counting to track your baby’s movement daily.

3. Early Delivery

  • In most ICP pregnancies, delivery is recommended between 36 and 38 weeks, depending on bile acid levels and how stable the condition is.

  • Early delivery is currently the only intervention known to reduce the risk of stillbirth.

 

What Causes ICP?

The exact cause is unknown, but research suggests a combination of:

  • Genetics (including mutations in genes involved in bile salt transport)

  • Hormonal changes during pregnancy

  • Environmental factors (such as seasonal variation, higher incidence in winter months)

 

Will ICP Happen Again?

Unfortunately, ICP almost always recurs in future pregnancies, with recurrence rates estimated at 60–90%. It’s essential to inform your care team about your history before or early in your next pregnancy.

Emotional Impact

Beyond the physical symptoms, ICP can cause anxiety, fear, and trauma, especially if it results in stillbirth or other complications. Many people feel their symptoms were dismissed or not taken seriously.

Support is available:

  • Peer support groups

  • Mental health counselling

  • Pregnancy loss communities (if applicable)

 

Tips for Advocating for Yourself

  • If you’re itching and concerned, ask directly for bile acid and LFT testing.

  • Keep a log of symptoms, especially patterns in itching.

  • Trust your instincts, if something feels wrong, speak up.

  • If needed, seek a second opinion or escalate to a consultant.

 

Helpful Resources

 

Final Thoughts

ICP can be an isolating and frightening diagnosis, but with proper monitoring and timely intervention, most babies are born healthy. The key is awareness, advocacy, and trusting your body. If you’re experiencing persistent itching, especially in the third trimester, push for testing. It could save your baby’s life.

 

Learn more about Carrie's story with ICP here: https://healingafterinfantloss.com/carrie-hauskens/

Follow Carrie on Instagram: https://www.instagram.com/bloomingwithcare

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