Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy is a liver condition that happens during pregnancy, usually in the third trimester. It occurs when bile acids build up in your bloodstream instead of flowing normally from your liver to your digestive system. This buildup can cause intense itching and may create risks for your baby.

The condition affects about 1 in 100 pregnancies in the United States. It typically goes away within days to weeks after delivery. While the itching can be very uncomfortable, the bigger concern is the increased risk of premature birth and stillbirth if left unmanaged. Early detection through blood testing helps your healthcare team monitor your condition and decide the safest timing for delivery.

This is not the same as normal pregnancy itching from stretching skin. The itching from cholestasis is usually severe, worse at night, and often starts on the palms of your hands and soles of your feet. Understanding your bile acid and bilirubin levels gives you and your doctor important information to protect both you and your baby.

Common symptoms of intrahepatic cholestasis of pregnancy include:

• Intense itching, especially on palms and soles, that worsens at night
• Itching that spreads to other parts of the body
• Dark urine that looks like tea
• Light-colored or pale stools
• Yellowing of skin or eyes, though this is less common
• Nausea or loss of appetite
• Fatigue beyond normal pregnancy tiredness

The itching usually appears in the third trimester but can start earlier. Some people have severe itching without any visible rash. The intensity of itching does not always match the severity of the condition, which is why blood testing is essential for proper diagnosis and monitoring.

Intrahepatic cholestasis of pregnancy happens when pregnancy hormones affect how your liver processes bile acids. Your liver makes bile to help digest fats, and normally this bile flows into your intestines. During pregnancy, rising hormone levels can slow or block this flow, causing bile acids to build up in your blood. The exact reason this happens to some people and not others is not fully understood, but genetics play a significant role.

Risk factors include having a personal or family history of cholestasis in pregnancy, carrying twins or multiples, having a history of liver damage, and being pregnant with in vitro fertilization. The condition is more common in certain ethnic groups, including women of Scandinavian and Chilean descent. If you had cholestasis in one pregnancy, you have a 60 to 70 percent chance of developing it in future pregnancies. Previous liver conditions or hepatitis C infection also increase your risk.

Diagnosis starts with your symptoms, especially severe itching without a rash. Your doctor will order blood tests to measure bile acid levels, which is the primary test for confirming cholestasis of pregnancy. Total bilirubin testing helps assess how your liver is functioning and can indicate the severity of the condition. Elevated bilirubin levels, along with high bile acids, help your healthcare team make decisions about monitoring frequency and delivery timing.

Rite Aid offers total bilirubin testing through our preventive health panel at Quest Diagnostics locations nationwide. Regular monitoring of your liver function during pregnancy helps track the condition and guides your treatment plan. Your doctor may recommend testing every week or two once cholestasis is diagnosed to watch for any changes that might require earlier delivery.

Treatment focuses on reducing itching, protecting your baby, and planning for safe delivery:

• Ursodeoxycholic acid medication to lower bile acid levels and reduce itching
• Regular fetal monitoring with non-stress tests and ultrasounds
• Weekly or twice-weekly blood tests to track bile acid and bilirubin levels
• Early delivery, typically between 36 and 38 weeks, to reduce stillbirth risk
• Vitamin K supplements if bilirubin is elevated, to prevent bleeding problems
• Cool baths and moisturizers for temporary itch relief
• Avoiding hot showers that can worsen itching

Your doctor will create a monitoring plan based on your bile acid levels. Higher levels often mean more frequent testing and earlier delivery. Most healthcare providers recommend delivery by 37 weeks to minimize risks to the baby. The condition resolves quickly after delivery, though you should have follow-up liver function tests about 6 to 12 weeks postpartum to confirm everything has returned to normal.