Understanding Cholestasis of Pregnancy

Cholestasis of pregnancy (also called ICP) is a liver condition that can happen in the third trimester.

It causes bile acids—substances your liver makes to help digest food—to build up in your blood.

This buildup causes itching and can affect your baby.

We don't know the exact cause, but three things work together:

• Pregnancy hormones: High levels in late pregnancy can slow bile flow
• Genetics: Some people have genes that make this more likely
• Timing: It usually starts after 28 weeks of pregnancy

This is not caused by anything you did or didn't do.

The main symptom is intense itching, especially on your:

• Palms of your hands
• Soles of your feet
• Arms and legs

The itching is often worse at night.

You won't see a rash, but the itching can be very uncomfortable.

Blood test: We measure bile acid levels in your blood.

Cholestasis is confirmed when bile acids are 10 μmol/L or higher.

We'll also check your liver function with the same blood draw.

Results usually come back within a few days.

Medication: We'll prescribe ursodeoxycholic acid (UDCA).

This medicine helps:

• Reduce itching (you should feel better within a week or two)
• Lower bile acid levels
• Improve liver function

UDCA is safe for you and your baby.

Regular blood tests: We'll check your bile acid levels every 1-2 weeks.

Fetal monitoring: We'll track your baby's heart rate with NSTs (non-stress tests).

These tests help us know when it's safest to deliver your baby.

Our team will stay in close contact with you.

With mild to moderate levels (under 100), the risk to your baby is similar to any other pregnancy.

With severe levels (100 or higher), risks increase after 36 weeks.

This is why we plan delivery carefully based on your levels.

Important: If your itching gets much worse or you develop yellowing of your skin, call us right away.

Good news: Itching usually stops within 1-2 days after birth.

We'll check your bile acids and liver function 6-12 weeks after delivery to make sure everything returns to normal.

This follow-up helps us rule out any underlying liver problems.

Cholestasis has a 60-90% chance of returning in your next pregnancy.

If you get pregnant again:

• Tell your doctor about your history
• We'll monitor you starting around 28 weeks
• We can start treatment early if symptoms return

With close monitoring, most women go on to have healthy babies.

What we'll do together:

• Monitor your bile acid levels regularly
• Manage your symptoms with medication
• Watch your baby closely
• Plan the safest delivery timing for you both

You're not alone in this. Our team is with you every step of the way.