Will ICP harm me?
While ICP is a distressing condition, it’s still classed as being a benign (harmless) condition of pregnancy and the symptoms will resolve soon after your baby is born. However, there are some other consequences that you should know about.
- Severe excoriations – scratch marks – from constant scratching.
- An increased risk of post-partum haemorrhage (PPH) – very heavy bleeding after the delivery of your baby – but this is thought to affect less than 10% of women. Treatment with oral vitamin K may prevent this.
- Several studies have shown that gallstones occur more commonly in women with ICP. Because ICP is associated with gallstones you may have had gallstones or been diagnosed as having them at the time of pregnancy. You could also develop them later on in life. Your doctor may recommend that you have your gallbladder removed (cholecystectomy), but research does not show that this reduces your chances of developing the condition in a subsequent pregnancy. If you haven’t had a liver ultrasound scan you may want to ask your doctor for one, as it is another way of excluding any other liver problems that may be causing your cholestasis (cholestasis simply means sluggish or interrupted bile flow).
- Some women develop itching that is termed ‘cyclical itching’. This can usually be linked to ovulation or the start of menstruation. It generally only lasts for a few days and is not as intense as the itching experienced during an ICP pregnancy. There has been no research to explain why this happens, but current thinking suggests that it happens because your liver has been left ‘sensitive’ to hormone fluctuations – hence the link to ovulation and menstruation.
- Some women have reported that they experience itching again in times of extreme tiredness and stress, but the reasons for this are not yet known.
We know (because you tell us) that many women suffer increased anxiety due to the potential (albeit small) risk of stillbirth. Add to this the effects of sleep deprivation because of nocturnal scratching and it doesn’t need a full clinical trial to suggest that women who have ICP may have an increased risk of depression during, or after, the pregnancy. Although this has not been fully investigated we would recommend that you let someone know if you are finding it difficult to cope.
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. There is also some suggestion that women who have had ICP may have an increased risk of 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 hepatologists that it makes sense to have annual liver function and bile acid tests. This is very new thinking and your doctor is unlikely to be aware of this advice. It’s all very early research, so much more is needed.
If you have had ICP, the chance of it occurring in a future pregnancy is between 60% and 90%. The risk is slightly less if this is a singleton pregnancy following a twin or triplet pregnancy.
Ovadia C, Williamson C. Intrahepatic cholestasis of pregnancy: recent advances. Clin Dermatol 2016; 34: 327–34.
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.