Intense itching on the palms of your hands and the soles of your feet that keeps you awake at night. Itching that no moisturizer can soothe. If this sounds familiar, it could be intrahepatic cholestasis of pregnancy (ICP) — a condition that's important to have evaluated.

Intrahepatic cholestasis of pregnancy (ICP) occurs when bile acids build up in the liver. The itching is clearly different from the common itching many pregnant women experience as the skin stretches over the belly. Here's what to look out for, and what you should do.

What Is Intrahepatic Cholestasis of Pregnancy?

Intrahepatic cholestasis of pregnancy is a liver condition that occurs during pregnancy. Bile flow from the liver is impaired, and bile acids leak into the bloodstream. Elevated bile acid levels in the blood cause the characteristic intense itching.

ICP affects approximately 0.5–2 percent of pregnancies in Western countries, though rates vary significantly by ethnicity and geographic region. In 80 percent of cases, ICP occurs after week 24 of pregnancy, but in rare cases it can begin earlier. Most women notice symptoms in the third trimester.

Hormonal changes in pregnancy, particularly high estrogen levels, play a central role in the development of cholestasis. Women carrying twins have up to five times increased risk.

Symptoms You Should Know

The most important symptom is intense itching without a visible rash. The itching differs from normal pregnancy itching in several ways:

Characteristics of ICP

Itching on palms and soles of feet — the most typical symptom
Worst at night — many cannot sleep because of the itching
No rash — the skin looks normal but the itching is intense
Generalized itching — can eventually spread to other parts of the body

Other Symptoms That May Occur

Fatigue and weakness
Dark urine
Pale stools
Pain in the abdominal area
In rare cases, mild jaundice (yellowing of skin and eyes)

It's worth knowing that there is no correlation between how much you itch and the bile acid level in your blood. You can have severe itching with moderate levels, and vice versa.

Contact your doctor or midwife if you experience intense itching without a rash, especially on the palms of your hands and soles of your feet. Symptoms can appear before blood tests show abnormalities, so persistent itching should be followed up even if the first test is normal.

Diagnosis — How It's Established

ICP is diagnosed with a simple blood test. Your doctor will order tests for:

Bile acids (serum bile acids) — levels above 10 micromol/L (fasting) or above 19 micromol/L (non-fasting) are diagnostic for ICP
Liver function tests — ALT, AST, GGT, and bilirubin
Clotting studies — if liver enzymes are significantly elevated or jaundice is present

ICP is generally classified into three severity levels based on bile acid levels:

Mild ICP — bile acids 10–40 micromol/L
Moderate ICP — bile acids 40–99 micromol/L
Severe ICP — bile acids 100 micromol/L or higher

All pregnant women with ICP should have their biochemical markers checked weekly. Follow up all your prenatal appointments — this is where the condition is most often identified.

Risk to Mother and Baby

ICP requires monitoring because elevated bile acids can affect the fetus. A large 2019 meta-analysis with over 5,000 patients showed that the risk of stillbirth increases significantly when bile acids exceed 100 micromol/L.

Possible Complications

Premature birth — increased risk, especially with high bile acid levels
Fetal distress — bile acids can have a direct effect on the fetal heart
Vitamin K deficiency in the mother — can increase bleeding risk after birth
Gallstones — some develop these in addition

It's important to emphasize that with good monitoring and proper treatment, the vast majority of women have a good outcome. Healthcare providers will follow you closely and continually assess whether labor needs to be induced.

Use a pregnancy tracking app or week-by-week guide to keep track of your pregnancy weeks and upcoming appointments. After an ICP diagnosis, appointments become more frequent, and it helps to have a clear overview.

Treatment of ICP

Treatment focuses on relieving the itching, reducing bile acid levels, and protecting the baby.

Medication

Ursodeoxycholic acid (UDCA/Ursofalk) is the first-line treatment. The medication helps to:

Reduce bile acid levels in the blood
Relieve itching in many patients
Improve liver function

The starting dose is typically 1 gram daily. If this is not sufficient, the dose can be increased to 1.5–2 grams daily.

In severe cases, rifampicin may be added to the treatment. Antihistamines can be used to reduce itching and help with sleep difficulties.

Delivery Timing Based on Bile Acid Levels

Guidelines vary by country, but general recommendations based on severity are:

Mild ICP (bile acids <40 micromol/L) — induction at term, unless other factors indicate earlier delivery
Moderate ICP (bile acids 40–99 micromol/L) — delivery around 37–38 weeks
Severe ICP (bile acids ≥100 micromol/L) — delivery at 34–35 weeks

If you've been told labor will be induced, pack your hospital bag early and prepare for the birth.

Tips for Living with ICP

While medication is the main treatment, there are measures that can help day-to-day:

Wear light, loose clothing — cotton against the skin is most comfortable
Stay cool — heat worsens itching for many
Moisturize your skin — fragrance-free moisturizer can provide some relief
Cool compresses — cool, damp cloths on the hands can help at night
Avoid hot baths — lukewarm water is better than hot
Try to stay active — distractions help reduce the perception of itching

After Birth

The good news is that ICP resolves after birth. Most women find the itching subsides quickly after the baby is born, and bile acid levels normalize.

You should have your liver function checked by your doctor approximately 2 weeks after birth to confirm that levels have returned to normal.

Important for the Future

Recurrence risk — 40–70 percent risk of ICP in future pregnancies
Hormonal contraception — some oral contraceptives can trigger similar symptoms in women who have had ICP, so discuss contraceptive choices with your doctor
Menstrual cycle — some women experience itching during the luteal phase of their menstrual cycle after having had ICP

Frequently Asked Questions

What's the difference between normal pregnancy itching and ICP?

Normal pregnancy itching is caused by skin stretching, especially over the belly, and is harmless. ICP causes intense itching without a rash, typically on the palms and soles of feet, and is confirmed by blood test. Common itching occurs frequently in pregnancy, while cholestasis affects around 0.5–2 percent of women.

Can ICP harm the baby?

With proper monitoring and treatment, the vast majority of women with ICP have a good outcome. The risk increases significantly only at very high bile acid levels (over 100 micromol/L). This is why weekly blood test monitoring is important.

Does changing my diet help?

There is no evidence that dietary changes can treat ICP. But a balanced diet is always beneficial during pregnancy. Medication with ursodeoxycholic acid is what has documented effectiveness.

When should I contact my doctor?

Contact your doctor or midwife with intense itching without a rash, especially on hands and feet. If you've already received a diagnosis, contact your doctor if the itching worsens, if you develop jaundice, or if you notice reduced fetal movement.

Summary

ICP is a condition that requires monitoring, but with proper treatment and surveillance, the vast majority of women do well. The most important thing you can do is take the itching seriously, ask for blood tests, and attend all your appointments.

Sources: ICP Support charity (icpsupport.org) — patient information; ACOG — Practice Bulletin on ICP; SMFM — Diagnosis and management of intrahepatic cholestasis of pregnancy

Last updated: March 2026

Intrahepatic Cholestasis of Pregnancy — When Itching Is More Than Uncomfortable