Mums-to-be experience a range of symptoms and bodily changes during pregnancy, and it’s hard to know whether a symptom is related to pregnancy or something more serious altogether.
Recently, a young mum, Christina DePino appealed to other pregnant women to be alert if they experience unbearable itching on their body. This could be a sign of intrahepatic cholestasis of pregnancy (ICP). This condition affects approximately one in every 1000 pregnancies, but not all pregnant women are aware of the condition.
ICP can be potentially deadly to the baby and has been linked to premature birth and stillbirth after 37 weeks.
What is ICP and why does it occur?
ICP is a condition which interrupts the normal flow of bile from the liver. Typically caused by high hormone levels during pregnancy, this causes bile to build up in the bloodstream, resulting in chronic itching for the mum-to-be.
What are the symptoms?
ICP is mainly characterised by severe itching without a rash, mainly on the palms and soles of the feet but can be widespread.
Although many women experience itchiness during pregnancy, this itching is unbearable and won’t respond to anti-histamines or any topical itch relief treatment, such as calamine lotion.
Less common symptoms include: darker urine, lighter stools, increased clotting time, fatigue, increased nausea, decreased appetite, upper right quadrant pain, (upper chest and abdomen) and jaundice in a small number of cases.
How common is it?
ICP occurs in approximately one-in-1000 pregnancies, according to the Cincinnati Children’s Hospital Medical Centre. This is higher in some countries and ethnic groups. For instance, in Chile and Bolivia, one in 20 women can develop ICP.
When does it occur?
ICP typically occurs in the third trimester, when hormone levels are at their highest. It’s also more commonly reported in winter than in summer.
Who is at risk?
ICP can affect anyone, but twin and triplet pregnancies show a higher incidence of ICP, due to the high hormone levels. It is also more common in Swedish and Chilean ethnic groups and can occur in subsequent pregnancies. It has a recurrence rate of 40 to 75 percent.
Women whose mothers and sisters have had this condition, and women who have liver damage are also at risk.
What are the risks to the baby?
Risks to the baby include foetal distress, premature birth, or stillbirth.
A developing baby needs the mother’s liver to remove bile acids from the blood; so, the elevated levels of maternal bile cause stress on the baby’s liver.
Women with cholestasis need close medical supervision to ensure the best outcome possible for both Mum and Baby.
What are the risks to mums?
ICP generally doesn’t affect the mother, apart from the unbearable itching; but there is a possible risk of haemorrhage after birth.
How can it be treated?
ICP is a tricky condition, as only delivery can stop the production of placental hormones.
Your midwife and doctor will advise you on whether induction is required, depending on your stage of pregnancy. Induction is sometimes recommended when the baby’s lungs are mature enough.
ICP can also be treated with ursodeoxycholic acid, which decreases the concentration of bile acids. People with liver problems often have decreased levels of vitamin K, which is essential for blood clotting functions. If blood clotting is a problem, vitamin K can reduce the risk of haemorrhage after birth.
Natural remedies such as milk thistle can also be beneficial to the liver, but ask your doctor’s advice before trying natural remedies. Regular blood tests can help monitor bile levels and liver function, and monitoring the foetal heartbeat is also important.
There is no cure, but bathing in iced water, taking cool showers and sleeping without covers can relieve the itch.
Anti-histamines will not help in cases of ICP.
If you are concerned about ICP, always be sure to contact your doctor for advice.