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Intrahepatic cholestasis of pregnancy (ICP) generally occurs in the third trimester and rarely before 25 weeks gestation. This medical condition is characterized by severe itchy skin, usually including the palms and soles, and sometimes yellow discoloration of the skin (jaundice), with mild-to-moderate elevations in transaminases, alkaline phosphatase, bilirubin, and bile acids.

Since the metabolism of progesterone and bile acids is changed in ICP, it results in an increased bile acids in maternal serum, which results in both higher bile acid levels in the fetus and an impaired transport of bile acids from the fetal to the maternal compartment. Although the mother’s condition is generally benign, the fetus faces an increased risk of preterm delivery, perinatal mortality, abnormal intrapartum fetal heart rate rhythm, and meconium passage.

ICP shows a perinatal mortality as high as 1 to 3%, and may be higher without treatment. ICP recurs in approximately 40 to 60% of pregnancies in affected women.

Treatment of ICP

Ursodeoxycholic acid (Actigall), is a relatively hydrophilic bile acid and is thought to alter the progress of ICP by changing the overall hydrophilicity of the bile acid pool in maternal circulation. This ultimately decreases the bile acids “seen” by the fetus. With medical treatment of ICP, women usually see an improvement in pruritus (itchy skin) and liver enzymes.  It is currently unknown if medication reduces the risk of stillbirth and perinatal morbidity.

Antepartum Testing

Antepartum fetal surveillance is not proven to prevent fetal deaths from ICP. Additionally, there is no convincing information about specific antepartum fetal tests that are useful for identifying fetuses at an increased risk of fetal death in this condition. However, data are showing that an increased fetal surveillance for women with ICP results in lower perinatal mortality rates compared to patients who are not monitored. Despite unclear evidence, we generally recommend antepartum surveillance in patients with ICP.

Delivery

Centers with extensive experience in treating women with ICP, including Maternal Fetal Medicine, recommend delivering patients early to avoid late fetal deaths. Delivery is typically recommended at approximately 37 weeks gestation and sometimes earlier.

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Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!