Itching can be a normal part of pregnancy BUT there is a condition where itching is a horrible symptom that just about drives you crazy!!
This condition is called Intrahepatic Cholestasis of pregnancy (ICP) and I have suffered from it with all four of my pregnancies!
What is Intrahepatic Cholestasis of Pregnancy (ICP)?
ICP is caused by an excessive build up of bile acids in the blood that are deposited in the skin and this causes severe itching. It affects approximately 1% of pregnancies but the exact cause is not known, it is thought that it is due to a genetic predisposition, high hormone levels and maybe some environmental factors. Women carrying multiples and women who have had IVF treatment also appear to have a higher risk.
There are also parts of the world where is it more prevalent. Chile and Scandinavia are among those cultures with an increased occurrence of the disorder. My mother was Swedish and maybe that’s where I get my predisposition for it.
What are the symptoms of ICP?
The most common symptom is itching – usually more intense on the hands and feet but I had it all over my body, which can occur too. Usually it starts in the 3rd trimester but I found that it started earlier in each subsequent pregnancy starting as early as 16 weeks in my 4th pregnancy. Although there is intense itching, usually worse at night there is NO rash.
There is treatment that can be taken to help bind the bile acids and help excrete them from the body but I did not find anything helpful. My obstetrician said that the best treatment was Brown Bear Bile, but this is not a practical solution!
How is ICP diagnosed?
I was not diagnosed with the condition until my second pregnancy, as it was just considered normal "pregnancy itch" in my first. However liver function tests conducted during my second pregnancy showed highly elevated liver enzymes with a normal bilirubin. I was not jaundiced but some people can be. My enzyme levels were so high they had to recalibrate the machine to measure them!! I remember the lab people ringing the Practice I was working at thinking I must have Fulminating Hepatitis the levels were that abnormal.
Some people may have dark urine and pale stools too. Vitamin K deficiency has been noted also, which may cause postpartum haemorrhage.
What are the risks of ICP?
There is some evidence that this condition can increase foetal problems such as stillbirth and ingestion of meconium, and often women are either induced early or have caesareans at 36-38 weeks to ensure a good outcome for the baby. I know I was just relieved to have the itching stop! All my babies were delivered by caesarean at 38, 37, 36 and 37 weeks. All were fine and had no significant problems at birth.
The itching subsides after birth and liver function returns to normal, but there is an increased risk of it happening in subsequent pregnancies – as it did with me.
The reason I had a caesarean for my first child, was not due to ICP but because I had an undiagnosed extended breech, but I’m saving that story for another day!
What is the treatment for ICP?
As to things to help relieve the itch I never found anything that worked long term. I spent a lot of time in the bath, putting ice on my skin and getting my hubby to scratch me with a spaghetti utensil! I was very sleep deprived and an emotional wreck with it.
My heart goes out to anyone who suffers this, but I can promise the itching gets forgotten as soon as you can hold your baby, that’s what makes all the suffering worthwhile. Oh and I did have more kids even after the diagnosis and long-term implications were known to me! I think mothers are very resilient.
My advice is if you are pregnant, and have excessive itching with no rash, it’s important to let your doctor know so you can have your liver function checked and be referred to a specialist, if required, for expert advice and care.
Another great resource is the ICP Care website which hosts a wealth of research-based information on Intrahepatic Cholestasis of Pregnancy (ICP), including a guide to diagnosis and treatment options. You can also find them on Facebook.
About the Author:
Corinne, together with her partner Mary McClure are Precious Kids Great Parents - two mums with over 59 years combined child rearing experience. Between them they have 9 kids, 3 grand children, have had 4 caesareans, 1 miscarriage, 4 natural no drug births and a foster child! They also have over 60 years of work experience in the fields of medicine, education and counselling.