Thanks to hormonal changes and a rapidly growing belly, it is not uncommon for skin changes to occur during pregnancy. You’ve probably heard of the pregnancy glow, but some mums-to-be complain about itchy skin and dry patches – and it’s all normal.

But if you have cholestasis in pregnancy, you will experience intense itching without a rash, usually in late pregnancy and most often on the palms and soles.

Cholestasis of pregnancy (also known as intrahepatic cholestasis of pregnancy) affects about 1 in 1,000 pregnant women in the United States. While untreated cholestasis can lead to serious complications for your baby, monitoring and treatment help reduce the risk.

What is cholestasis?

Cholestasis in pregnancy is a potentially serious liver condition that causes sudden, severe itching. This happens when bile begins to build up in the liver.

The liver is an important station for processing and cleansing. In addition to creating nutrients that your body can use, your liver helps clean up waste materials that you don’t need, in part by producing bile. This greenish-yellow liquid consists of cholesterol, bile salts (or bile acids), bilirubin (pigment), water and electrolytes.

Bile comes out of the liver and is stored in the gallbladder. Every time you eat, your gallbladder releases bile into the small intestine, where it helps break down fat. But when you have cholestasis, bile salts begin to accumulate in your liver. Bile acids can then spill into the bloodstream and tissues, causing severe itching.

The exact cause of cholestasis in pregnancy is unknown, but hormonal and genetic factors likely play a role. High levels of progesterone and estrogen can slow the flow of bile from the liver, usually in the third trimester, when pregnancy hormones peak. Women with a family history of cholestasis are more likely to have this condition.

About two-thirds of women who had cholestasis during pregnancy develop it again in later pregnancies. It is also more common in women who carry multiples and in women with a history of liver damage or disease.

“This is my third pregnancy and I was told I would get it again as I had it with my second pregnancy,” she says BabyCenter Community member of Selena44. “A few weeks ago I started itching and I knew it! I’m currently 29 weeks with the twins, so the situation has become more serious. I’m taking medication and doing weekly ultrasounds at the hospital, along with fetal stress tests.”

Intrahepatic cholestasis in pregnancy

Cholestasis of pregnancy is also known as intrahepatic cholestasis of pregnancy or ICP. A slightly different name, but the same causes, symptoms and treatments.

What are the symptoms of cholestasis in pregnancy?

Call your doctor if you have any of the following symptoms of cholestasis of pregnancy:

• Intense itching. Severe itching without a rash is the first and most obvious symptom of cholestasis. Itching usually starts in the third trimester and usually affects the palms of the hands and soles of the feet, but can occur anywhere on the body and is often worse at night. Cholestasis itching in pregnancy is much more distressing than the mild itching that many pregnant women experience from stretched, dry skin.
• Weakness or lack of appetite. You may experience mild nausea or a general feeling of sickness or discomfort, and you may not feel like eating. You may also feel pain in the upper right part of your abdomen.

I had cholestasis in my first pregnancy, and it was difficult! The medicine did not make the itching go away completely. But it disappeared almost immediately after my daughter was born.

– BabyCenter DesiGie community member

Although cholestasis in pregnancy doesn’t cause a rash, you could end up with red, irritated skin and small cuts in areas you scratch a lot.

Call your doctor right away if you think you have cholestasis. Without treatment and monitoring, cholestasis could become dangerous for your baby.

How is cholestasis diagnosed in pregnancy?

To diagnose cholestasis in pregnancy, your health care provider will order blood tests to make sure your liver is working well and to check the level of bile acids in your blood.

How is cholestasis treated in pregnancy?

Treatment for cholestasis in pregnancy usually involves taking ursodeoxycholic acid (UDCA, also known as Actigall or Ursodiol). This medicine can reduce the amount of bile acid in your blood and help your liver work better.

If you are still itching, your doctor may prescribe anti-itch medication. You can also try rubbing an ice cube over the itchy skin or soak in a cold bath or oatmeal for relief. Try to wear soft and loose clothing.

“I had cholestasis in my first pregnancy, and it was severe!” he says BabyCenter Community a member of DesiGia. “The meds didn’t make the itching go away completely. But it went away almost immediately after my daughter was born. I also tried showering on the cooler side and applying a lot of lotion… really, it’s internal, so I think those things were more than mental aid than anything else.”

You will also likely have periodic ultrasounds and fetal heart monitoring to check your baby’s condition as part of your treatment. You may continue to have blood tests to monitor liver function and bile levels.

If your baby is doing well and the test results are encouraging, your doctor will wait as long as possible to deliver your baby, to give it more time to grow. But you will likely be induced before your due date to reduce the risk of stillbirth.

Cholestasis and itching disappear after delivery, usually within a few days, and usually do not cause liver problems in the future. However, cholestasis often recurs in the next pregnancy, so be sure to inform your doctor that you have already had it.

“It can also happen with the combined birth control pill, so let your doctor know when you’ve chosen the right form of birth control for you,” says Layan Alrahmani, MD, OB/GYN, maternal-fetal medicine specialist and member of BabyCenter’s Medical Advisory Board.

Can you have a healthy baby with cholestasis?

Cholestasis in pregnancy increases the risk of several complications, including:

• Preterm birth or birth before 37 weeks of pregnancy
• Respiratory distress syndrome (RDS), a condition where the baby does not have enough surfactant for the lungs to inflate properly; it is more common in premature babies
• Meconium aspiration, as cholestasis in pregnancy increases the risk of meconium (your baby’s first stool) passing from your baby’s gut into the amniotic fluid, putting your baby at risk of inhaling meconium into the lungs
• Stillbirth or death of an unborn baby after the 20th week of pregnancy
• Preeclampsia

The risks to your baby increase with higher levels of bile acids in your blood and the closer you are to your due date. That’s why your healthcare provider will monitor you closely, and your baby will likely be born before your due date.

In most pregnant women, the symptoms of cholestasis disappear within a few days after giving birth. If you still have itching and other symptoms, your doctor will check for an underlying liver condition or other health problem.