Intrahepatic Cholestasis of Pregnancy: Symptoms, Risks & Support | Complete Medical Guide

Disclaimer: This article is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your qualified healthcare provider regarding any questions about pregnancy, liver conditions, or treatment options.

Intrahepatic Cholestasis of Pregnancy (ICP): Symptoms, Risks & Support

Author: Dr Humaira Latif, MBBS, Gynae & Obs Specialist with 14 years of clinical experience.
Last Updated: February 1, 2026

Introduction

Intrahepatic Cholestasis of Pregnancy (ICP) is a liver disorder that occurs during pregnancy, characterized primarily by intense itching (pruritus) and abnormal liver function tests. While it usually resolves after delivery, ICP can increase the risk of complications for both the mother and baby. Early recognition and management are essential to ensure safe pregnancy outcomes.

Understanding ICP: Pathophysiology & Causes

ICP occurs when bile acids accumulate in the liver and spill into the bloodstream due to impaired bile flow. Key factors include:

• Hormonal influences: Elevated estrogen and progesterone during pregnancy.
• Genetic predisposition: Mutations in bile transporter genes (e.g., ABCB4, ABCB11).
• Liver dysfunction: Pre-existing liver conditions may increase susceptibility.
• Environmental factors: Seasonal patterns and dietary influences have been observed in some populations.

Symptoms of ICP

The most common symptom is intense itching, usually affecting the hands and feet and worsening at night. Other symptoms may include:

1. Dark urine and pale stools.
2. Fatigue and mild jaundice (yellowing of skin or eyes).
3. Upper right abdominal discomfort.

Diagnosis of ICP

Diagnosis relies on clinical evaluation and laboratory testing. Key steps include:

• Serum bile acids: Values ≥10 μmol/L are considered indicative of ICP; severe cases often exceed 40 μmol/L. [Source: ACOG Practice Bulletin]
• Liver function tests (LFTs): Elevated ALT and AST are common.
• Rule out other causes: Hepatitis, gallstones, or drug-induced liver injury.
• Fetal monitoring: Regular ultrasounds and non-stress tests may be indicated.

Complications and Risks

Although maternal health is usually not severely affected, ICP can impact fetal outcomes. These include:

Complication	Estimated Risk / Data
Preterm birth	Up to 60% of cases
Fetal distress / meconium-stained amniotic fluid	Increased relative risk 2–3x
Stillbirth	0.4–1.5% (higher in severe ICP with bile acids >100 μmol/L)
Neonatal respiratory issues	Observed in 10–15% of infants

Management and Treatment

ICP management focuses on symptom relief, monitoring maternal liver function, and reducing fetal risks. Recommended strategies include:

1. Medications

• Ursodeoxycholic acid (UDCA): First-line therapy to lower bile acids and improve liver function. Dose: 10–15 mg/kg/day in divided doses. [Source: RCOG Guidelines]
• Antihistamines: Can relieve itching but do not treat underlying cause.
• Topical emollients: Mildly soothing for pruritus.

2. Monitoring

• Weekly serum bile acids and liver function tests.
• Fetal growth assessment via ultrasound every 2–4 weeks.
• Non-stress tests or biophysical profiles after 32 weeks.

3. Timing of Delivery

Guidelines recommend individualized delivery planning based on bile acid levels and gestational age:

• Bile acids <40 μmol/L: Consider delivery at 37–38 weeks.
• Bile acids 40–99 μmol/L: Close monitoring, delivery around 36–37 weeks.
• Bile acids ≥100 μmol/L: Early delivery recommended due to increased stillbirth risk.

Supportive Lifestyle Measures

• Maintain a balanced diet rich in omega-3 fatty acids.
• Avoid triggers such as high-fat meals or alcohol.
• Wear loose clothing and use gentle skincare products to reduce itching discomfort.
• Stay hydrated and rest frequently.

ICP During Previous Pregnancies

Women with a history of ICP have a higher recurrence risk in future pregnancies (up to 60–70%). Preconception counseling and early prenatal monitoring are advised.

Internal Links for Further Reading

• Hormonal Imbalance in Pregnancy
• Gestational Diabetes Diet Plan
• Common Pregnancy Complications
• Liver Health During Pregnancy

References & Related Resources

1. ACOG Practice Bulletin No. 222: Intrahepatic Cholestasis of Pregnancy, Obstetrics & Gynecology, 2020.
2. RCOG Green-top Guideline No. 43: Obstetric Cholestasis, 2011 (updated 2021).
3. Mayo Clinic: Intrahepatic Cholestasis of Pregnancy Overview. Updated 2025.
4. PubMed: Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol. 2009;15(17):2049-66.

Author Note

Dr Humaira Latif, MBBS, Gynae & Obs Specialist with 14 years of clinical experience, aims to provide accurate, evidence-based guidance for expectant mothers and healthcare professionals. This article is written to educate and support informed pregnancy management.