Itching during pregnancy: when should you be checked for cholestasis?

English version

Mild itching is common during pregnancy. Hormonal changes, stretching skin, dryness, eczema, heat or sensitivity to a product may be responsible.

However, persistent itching without an obvious rash—particularly when it affects the palms or soles or becomes worse at night—may be a symptom of intrahepatic cholestasis of pregnancy, also called ICP or obstetric cholestasis.

ICP affects how the liver handles bile acids during pregnancy. It usually develops later in pregnancy but can begin earlier. It requires medical assessment and an individual maternity-care plan.

What type of itching may suggest ICP?

• Itching without a primary skin rash.
• Itching on the palms of the hands or soles of the feet.
• Symptoms that become worse during the evening or at night.
• Itching severe enough to disturb sleep.
• Itching that becomes persistent or spreads over the body.
• Scratches or skin damage caused by repeated scratching.
• Less commonly, yellowing of the skin or eyes, dark urine or unusually pale stools.

ICP itself does not usually produce a rash. Scratching may nevertheless cause marks or broken skin. Most women with itching during pregnancy do not have ICP. Eczema, allergy, pregnancy-related skin eruptions and other conditions can cause similar symptoms.

When should you contact your maternity-care team?

• Your palms or soles are itchy.
• The itching is worse at night.
• There is troublesome itching without a rash.
• Itching repeatedly interrupts sleep.
• Symptoms persist despite using a moisturiser.
• Itching is widespread or becoming worse.
• You previously had ICP.
• You have a multiple pregnancy or another pregnancy complication.
• Your skin or eyes appear yellow.
• Your urine becomes unusually dark or stools become pale.

Very severe itching, itching involving the palms or soles, or symptoms that worsen at night warrant prompt contact with your maternity team.

Which tests may be required?

Assessment may include examination for a rash or skin condition, blood tests measuring bile acids, liver-function tests, review of medicines and other possible causes of liver changes, and routine pregnancy assessment.

Bile acids may be raised even when some liver-function results are normal. Itching can also begin before blood tests become abnormal. If symptoms continue and the first results are normal, the doctor may advise repeating the tests. A normal initial result should not be used to ignore persistent or worsening symptoms.

What happens if ICP is diagnosed?

Care depends on the bile-acid level, pregnancy duration, symptoms and other risk factors. It may include:

• Repeat bile-acid and liver-function tests.
• Review by an obstetrician.
• Discussion of medicines to reduce itching.
• Monitoring for other pregnancy complications.
• Advice about watching the baby’s usual movement pattern.
• An individual plan for the timing and method of birth.

An ICP diagnosis does not automatically mean that a caesarean birth is required. Delivery timing should be discussed according to the blood-test results and complete clinical situation. Do not take liver medicines, antihistamines, herbal preparations or supplements without pregnancy-specific medical advice.

What may provide temporary relief?

• Cool or lukewarm showers rather than hot water.
• An unperfumed moisturiser or emollient.
• Loose cotton clothing.
• Keeping the bedroom cool and fingernails short.
• Patting or tapping the skin instead of scratching.
• Avoiding perfumed soaps, intimate washes and newly introduced products.

These measures may reduce discomfort but cannot diagnose or treat ICP.