Itching is common in pregnancy. Usually it's thought to be caused by raised levels of certain chemicals in the blood, such as hormones.
Later on, as your bump grows, the skin of your tummy (abdomen) is stretched and this may also feel itchy.
However, itching can be a symptom of a liver condition called intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis (OC).
ICP needs medical attention. It affects 1 in 140 pregnant women in the UK, around 5,500 a year.
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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 unperfumed 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 mild or more severe itching occurs after 28 weeks (in the third trimester) you should see your midwife or doctor.
Serious itching: intrahepatic cholestasis of pregnancy
Intrahepatic cholestasis of pregnancy (ICP) is a potentially serious liver disorder that can develop in pregnancy.
Normally, bile acids flow from your liver to your gut to help you digest food. In ICP, the bile acids don't flow properly and build up in your body instead. There's no cure for ICP, but it should go once you've had your baby.
ICP seems to run in families, but it can occur even if there is no family history. It is more common in women of South American, Indian and Pakistani origin.
If you have had ICP in a previous pregnancy, you have a high chance of developing it again in a subsequent pregnancy.
Some studies have found that babies of women with ICP have a higher chance of being born prematurely or being stillborn.
The most recent research suggests that the risk of stillbirth is between 1 and 2 in 100 for those women whose bile acid levels are greater than 40µmol/L. The risk of stillbirth rises to between 4 and 5 in 100 when the bile acids are 80µmol/L.
Because of the link with stillbirth, you may be offered induction of labour around 37-38 weeks of pregnancy if you have ICP. Some specialists might advise earlier induction than this if the condition is severe (defined as bile acids over 40µmol/L).
If you have ICP, you will probably be advised to give birth in hospital under a consultant-led maternity team.
Symptoms of ICP
Symptoms of ICP typically start from around 30 weeks of pregnancy but it is possible to develop the condition as early as eight weeks.
The main symptom is itching, usually without a rash. The itching is often more noticeable on the hands and feet, but can be all over the body.
For many women with ICP the itching is unbearable and can be worse at night, preventing sleep.
Other symptoms can include dark urine, pale bowel movements (poo) and less commonly jaundice (yellowing of the skin and whites of the eyes).
Diagnosis and treatment of ICP
ICP is diagnosed by excluding other causes of the itch. Your doctor will probably talk to you about your medical and family history, and order a variety of blood tests. These will include tests to check your liver function (LFT) and to measure your bile acid levels (BA).
Monitoring your condition
If you are diagnosed with ICP, you will have regular liver function tests so that your doctor can monitor your condition.
There is no agreed guideline on how often these tests should happen, but the Royal College of Obstetricians and Gynaecologists and the British Liver Trust advise weekly tests.
The UK's largest research group investigating ICP recommends weekly bile acid measurements as well. It is the level of bile acids that helps doctors recommend when your baby should be born.
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 and medications for ICP
Creams, such as aqueous cream with menthol, are safe to use in pregnancy and can provide some relief from itching. There are some medications, such as ursodeoxycholic acid (UDCA) that help to reduce bile acids and ease itching.
UDCA is considered safe to take in pregnancy, although it is prescribed on what is known as an 'informed consent' basis because it hasn't been properly tested in pregnancy.
You may be offered a vitamin K supplement. This is because ICP can affect your absorption of vitamin K, which is important for healthy blood clotting.
Most experts on ICP only prescribe vitamin K if the mother-to-be reports pale stools, has a known blood clotting problem or has very severe ICP from early in pregnancy.
If you are diagnosed with ICP, your midwife and doctor will discuss your health and your options with you.
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.
The charity ICP Support has a video about ICP (OC), featuring mums and clinical experts.