Pregnancy and baby

Itching and obstetric cholestasis in pregnancy

Mild itching is common in pregnancy because of the increased blood supply to the skin. Later on, as your bump grows, the skin of your tummy (abdomen) is stretched and this may also feel itchy. Mild itching is usually nothing to worry about, but if the itching becomes severe, it can be a sign of a liver condition called obstetric cholestasis, or intrahepatic cholestasis of pregnancy (ICP). This affects fewer than 1 in 100 pregnant women, but needs medical attention.

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Mild itching

Wearing loose clothes may help prevent itching, as your clothes are less likely to rub against your skin and cause irritation. You may also want to avoid synthetic materials and opt for natural ones, such as cotton, instead. These are "breathable" and allow the air to circulate close to your skin. You may find that having a cool bath or applying lotion or moisturiser can help to soothe the itching.

Some women find that products with strong perfumes can irritate their skin, so you could try using plain lotion or soap.

Mild itching is not usually harmful to you or your baby, but it can sometimes be a sign of a more serious condition. If you're worried, or if you have severe itching, it's important to see your midwife or doctor.

Serious itching: obstetric cholestasis

Obstetric cholestasis (OC), also called intrahepatic cholestasis of pregnancy (ICP), is a potentially serious liver disorder that can develop in pregnancy. Normally, bile salts flow from your liver to your gut to help you digest food. In obstetric cholestasis, the bile salts don’t flow properly and build up in your body instead. There’s no cure for OC, but it clears up once you’ve had your baby.

OC seems to run in families, although it can occur even if there is no family history. It is also more common in women of Indian and Pakistani origin. If you have had OC in a previous pregnancy, you’re more likely to develop it again in a subsequent pregnancy.

Some studies have found that babies of women with OC are more likely to be born prematurely or to be stillborn. It’s not known how much higher the risk of stillbirth is compared to women who don’t have OC. There is no reliable way to work out your baby’s individual risk of stillbirth.

Because of the link with stillbirth, you may be offered induction of labour or a caesarean section after 37 weeks of pregnancy if you have OC. You will probably be advised to give birth in hospital, under a consultant-led maternity team. 

Symptoms of OC

The main symptom is severe generalised itching (all over your body), usually without a rash, most commonly in the last four months of pregnancy. Some women get itching and a severe rash. For some women with OC, the itching is non-stop or unbearable, and can be worse at night. The itching is sometimes more pronounced on the palms of your hands and the soles of your feet.

Other symptoms include dark urine, jaundice (yellowing of the skin and whites of the eyes) and pale bowel movements (poo). 

Treatment

OC is diagnosed through taking a medical and family history, and blood tests that check your liver function. These are known as liver function tests (LFTs). Once OC is diagnosed, you will have regular LFTs until your baby is born, so that your doctor can monitor your condition. If your LFTs are normal and you continue to have severe itching, the LFTs may be repeated every week or two to keep an eye on them. 

Creams, such as calamine lotion, are safe to use in pregnancy and can provide some relief from itching. There are some medications that can reduce bile salts and ease itching, but it’s not known whether they are safe to take in pregnancy.

You may be offered a vitamin K supplement. This is because OC can affect your absorption of vitamin K, which is important for healthy blood clotting.

If you are diagnosed with OC, your midwife and doctor will discuss your health and your options with you.

Further information

The Royal College of Obstetricians and Gynaecologists (RCOG) has more information about obstetric cholestasis, including what it means for you and your baby, and the treatment that's available. You can also get information from the British Liver Trust.

Healthtalk online has video interviews with women talking about their experiences of obstetric cholestasis, including what the itching feels like.

The charity ICP Support has a video about ICP (also called OC), featuring mums and clinical experts.

 

Page last reviewed: 17/07/2014

Next review due: 17/07/2016

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