Intrahepatic Cholestasis of Pregnancy

Reprinted with permission
ItchyMoms.com

What is Intrahepatic Cholestasis of Pregnancy (ICP)?
ICP, otherwise known as Obstetric Cholestasis (OC), refers to a specific liver condition in which the normal flow of bile is impaired in a woman's body resulting severe itching and more rarely, jaundice. Although ICP has been reported as early as a few weeks pregnant, it is more common for it to begin in the third trimester, when hormone concentrations are at their highest levels. The figure for the percentage of women for whom ICP will recur in future pregnancies is still somewhat debated, but some sources claim it to be as high as 90%. ICP is also referred to as choleastais of pregnancy and pruritus gravidarum.

What causes ICP?
There is still much to be learned about the exact causes of ICP and it's manifestation, but researchers are currently investigating genetic, hormonal and environmental factors. There has been some research that indicate a particular gene mutation in some ICP patients, but much is yet to be defined.

Who is at risk for ICP?
Overall, 1 to 2 pregnancies in 1000 are affected by ICP. Women carrying multiples and those who have had previous liver damage may be more likely to develop ICP. The incidence of ICP also shows a striking geographical pattern, with a higher prevalence in Scandinavian and South America. The highest rates of ICP are noted in Chile, specifically in the Araucanian Indians, where as many as 28% women are affected. Mothers and sisters of patients of ICP are also at higher risk of developing the condition, proving that there is a definite genetic predisposition.

What are the symptoms of ICP?
Symptoms of ICP can vary in severity and type, but the most common ones include:

Itching all over, but often more severe on palms and soles
Dark Urine and/or Pale Stools (grayish in color)
Fatigue or Exhaustion
Sleep Deprivation from Itching
Loss of Appetite
Mild Depression

Less common symptoms include:

Jaundice
Upper-Right Quadrant Pain
Nausea
Severe Depression

What are the risks of ICP?
ICP poses several risks that are of great concern. ICP is associated with an increased risk for infant stillbirth, premature labor, fetal distress, and hemorrhaging in both mother and child.

What is the treatment for ICP?
Despite the possible outcomes of ICP, proper treatment for ICP provides a great degree of reduction in both fetal risk and maternal symptoms. The two most important factors in the treatment of ICP are reducing the bile acids in the bloodstream and delivering the mother as early as lung maturity will allow, often at 36 or 37 weeks gestation. In cases where bile acids do not respond to treatment, it may be necessary to deliver earlier than lung maturity to protect the child from the possibility of stillbirth.

Ursodeoxycholic Acid (UDCA), also known as Actigall or Urso is currently the front-line medication for the treatment of ICP. UDCA is a naturally occurring bile acid that improves liver function and helps reduce total bile acid concentration in the bloodstream. Please view the 'Treatment' page for more information about ICP treatment and management, as well as additional information about UDCA and it's use.