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After your baby is born

Note: the information on this page has been updated following the publication of the third edition of the RCOG Green-Top Guideline on 9 August 2022.

The longer term effects of ICP

After your baby is born

  • You will need to have follow-up checks on your liver. This is because sometimes there may be an underlying liver condition which is not ICP that has caused the itching and abnormal liver readings during your pregnancy. The check-up should include a liver blood test and bile acid test. Although the current RCOG Guideline on ICP recommends that these tests should be done four weeks after birth, our experience, together with the experience of experts in ICP shows that 6–12 weeks is fine. This is because although bile acid concentrations will drop rapidly once your baby is born, the liver enzyme alanine aminotransferase can take a little longer to return to normal. Alkaline phosphatase (another enzyme in the liver blood test) can also take longer to return to normal if you are breastfeeding.
  • If the results still show elevated ALT/AST or bile acid levels you will need to have the tests repeated. If, after six months, your levels are still not improving it may be advisable to be referred to a hepatologist (liver specialist) or, if there not one in your area, a gastroenterologist with a special interest in the liver. You may have another liver condition (although this is quite rare) or your liver is just taking a little while to settle down. This has been known to happen with women who have had ICP. Whatever the underlying reason you will need to see a specialist who will advise you on what to do next.
  • We already know that women who have ICP have a greater risk of developing gallstones, but there is some suggestion that women who have had ICP may also have an increased risk of developing other forms of liver disease, such as biliary tree cancer, in later life. We must stress that this risk is very, very small (your risk of developing something like breast cancer is much higher), but we have received advice from a hepatologist that it makes sense for women who have had ICP to have annual liver blood tests and bile acid tests. This is very new thinking and your doctor is unlikely to be aware of this advice.
  • Recent research suggests that women with ICP have an increased risk of developing Type 2 diabetes and/or cardiovascular disease in later life. This is because ICP is a metabolic disease and it’s thought that the metabolic changes that take place during an ICP pregnancy have an effect not only on the woman but also on her children. For example, there may also be an increased risk of Type 2 diabetes for children in later life. It’s all very early research, so much more work is needed to fully understand the implications.
  • Antibiotics taken after an ICP pregnancy may cause a return of the itching (and sometimes cholestasis), but it is important to take the antibiotics if you need them. Any itch should resolve once you stop taking the antibiotics, although it may take a few days to settle. Always let your doctor know if you do experience itch on antibiotics.

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References

Girling J, Knight CL, Chappell L; on behalf of the Royal College of Obstetricians and Gynaecologists. Intrahepatic cholestasis of pregnancy. BJOG 2022; 1–20. https://doi.org/10.1111/1471-0528.17206.

Martineau M, Raker C, Powrie R, Williamson C. Intrahepatic cholestasis of pregnancy is associated with an increased risk of gestational diabetes. Eur J Obstet Gynecol Reprod Biol 2014; 176: 80–5. https://doi.org/10.1016/j.ejogrb.2013.12.037.

Martineau MG, Raker C, Dixon PH, Chambers J, Machirori M, King NM, Hooks ML, Manoharan R, Chen K, Powrie R, Williamson C. The metabolic profile of intrahepatic cholestasis of pregnancy is associated with impaired glucose tolerance, dyslipidemia, and increased fetal growth. Diabetes Care 2015; 38: 243–8. https://doi.org/10.2337/dc14-2143.

Papacleovoulou G, Abu-Hayyeh S, Nikolopoulou E, Briz O, Owen BM, Nikolova V, Ovadia C, Huang X, Vaarasmaki M, Baumann M, Jansen E, Albrecht C, Jarvelin MR, Marin JJ, Knisely AS, Williamson C. Maternal cholestasis during pregnancy programs metabolic disease in offspring. J Clin Invest 2013; 123: 3172–81. https://doi.org/10.1172/JCI68927.

Wikström Shemer EA, Stephansson O, Thuresson M, Thorsell M, Ludvigsson JF, Marschall HU. Intrahepatic cholestasis of pregnancy and cancer, immune-mediated and cardiovascular diseases: a population-based cohort study. J Hepatol 2015; 63(2): 456–61. https://doi.org/10.1016/j.jhep.2015.03.010.