Will ICP harm my baby?

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.

ICP gives rise to several risks to your baby.

Preterm birth

Preterm birth is defined as delivery before 37 weeks. In ICP this may occur because labour begins spontaneously before 37 weeks (but UDCA may reduce this risk) or because doctors recommend induction of labour before 37 weeks (known as iatrogenic preterm birth). Currently, many doctors are recommending that women who have ICP are induced at around 37–38 weeks. However, the most recent research from Ovadia et al 2019 shows that many women can now wait until 38–39 weeks of pregnancy before they need to be induced. This does, however, rely on regular bile acid testing with results available within 24 hours.

The causes of spontaneous pre-term labour are still not fully understood and need further research. See our suggested guideline for diagnosis, treatment and management of ICP.

Meconium staining

Meconium is the first poo that a baby passes. In some cases the baby may poo before it is born. This is very common if the baby is overdue, but less common if not. In ICP there is an increased risk of the baby passing meconium before delivery, even if the baby is born prematurely. However, the PITCH trial (2009) showed that there was a reduction in meconium staining of the amniotic fluid for women taking UDCA, although this involved a relatively small number of women. A larger trial called PITCHES has confirmed this.

Neonatal admission

There is an increased risk of your baby being admitted to the neonatal unit, although many babies only stay a short while. In ICP common reasons for the baby being admitted to the neonatal unit are that they are born prematurely and need some extra help with breathing or feeding. Your doctor will be able to explain more about the reasons for admission to the neonatal unit and what it may mean for the baby.

There is also a suggestion that very high bile acids may impact on the production of lung surfactant in the fetus, which could result in something called ‘bile acid pneumonia’. This in turn increases the risk of admission to the neonatal unit for oxygen therapy (see Zecca 2004).

Stillbirth

The most feared complication associated with ICP is stillbirth. Several studies have reported that stillbirth is more common in ICP than in uncomplicated pregnancies, and the most recent research from Ovadia et al 2019 links it to high bile acid levels.

How the stillbirth happens is not fully understood, but may be due to high bile acid concentrations affecting the fetal heart (Miragoli et al., 2011; Schultz et al., 2016; Vasavan et al., 2020).

It has also been reported that the risk of stillbirth in ICP is increased if there are also other complications of pregnancy, including pre-eclampsia and gestational diabetes.

The information given here is further supported by the revised RCOG Guideline on ICP (published August 2022).

Note: The Ovadia research is based on singleton pregnancies only, as there were insufficient twin (or more) pregnancies in her research to draw firm conclusions. However, experts in ICP currently use Ovadia's findings to guide their management of the condition in twin (or more) pregnancies.