ICP – Intrahepatic Cholestasis of Pregnancy and My Story with Itchy Hands & Feet!

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Everything in the post I have learned from my Dr, google, and an amazing ICP support group I am in. I am not a Dr and if you have concerns with your pregnancy you should seek medical advice asap. ICP or Intrahepatic cholestasis of pregnancy is a very serious pregnancy condition that needs to be treated and monitored by a medical professional. Itching while pregnant (mainly hands & feet at night) is scary, but I hope this post can help to ease your mind a little. 

Per Wikipedia – Intrahepatic cholestasis of pregnancy (ICP), is a medical condition in which cholestasis occurs during pregnancy. It typically presents with troublesome itching and can lead to complications for both mother and fetus.

Sit down, grab a drink, and hold on. This post is going to be a little long, but I really want to explain my story and what I’ve learned. I see so many moms talk about being itchy while pregnant and their Doctor has no idea what it is. It breaks my heart because I worry for their unborn babies and I know what that stress feels like because I have been there. Add on the “unexplained” itching that makes your life hell, it makes for a tired and stressed out mama to be.

When I was pregnant with our oldest I came home from work on a Friday night. I remember taking off my uggs and itching my feet on the carpet. I mentioned to my husband how they were very itchy and he shrugged and said I probably needed to apply some lotion. I don’t remember the weekend, but I remember getting ready for work on Monday and my arms and hands being very itchy while taking a shower. I mentioned it again and once again he said I just needed lotion. I was 35 weeks pregnant at the time and when I got to work I googled “itching during pregnancy”. Of course, the worst thing possible, cholestasis of pregnancy, came up and I freaked out. I called my midwife and she told me I needed to fast (not eat for a certain amount of time) and come in ASAP the next morning for blood work. The next day I got the call that the liver panel (ast’s and alt’s) they ran were severely elevated and they weren’t going to wait for the second test (bile acids) to come back to confirm it, but that I did have ICP.

I called my husband freaking out. It just happened to be my last week of work before maternity leave and I remember packing my stuff up and going home that day not knowing if I would be back. I had a Dr’s appointment the next morning and that would decide what was going to happen. They told me a little about ICP and said they wanted to induce me right when I hit 36 weeks, which would be that Sunday. We went out and bought all the things we still needed to get for the baby, that I had been putting off on getting until I was on maternity leave, like a car seat and everything thing else that was important. I had never been so scared in my life. They gave me steroid shots on two different days and then on Sunday we got to the hospital so they could induce me. Our daughter was born in the wee hours of the morning, screaming and healthy. At 36 weeks she was small (5.6 lbs), but she was doing great and she needed no NICU time and got to go home a few days later.

This thing with ICP is no one knows what causes it. They do know that 70-90% of people will develop it with subsequent pregnancies. So if you have it once, chances are you’ll have it again. For me, it made my feet, legs, arms, and hands very itchy. To the point I wanted to rip my skin off and there is nothing to help relieve the itching since it’s due to your liver not working properly because of the pregnancy hormones. There are natural herbs you can take like dandelion root and milk thistle (please consult your doctor prior to use) to help relieve symptoms, from what I’ve been told, and there is a medication that can help stop your bile acids from rising called Ursodiol. With my first ICP pregnancy, everything happened so quick that I didn’t have time to take meds. I would take Benadryl at night so I could get a few hours of sleep. It didn’t help the itching, but it made me sleepy to where I was able to fall asleep.

When my husband and I decided to have another child I knew developing ICP would be a concern. I hoped it wouldn’t return, but I was fully prepared for it too. When the itching returned around 24 weeks I called my new Dr and she ran the tests, they came back normal and my itching just happened to go away for a few more weeks. I actually started to think I had imagined the few days of itching I did have because it went away, but around 28 weeks it came back again and stayed around. This is where things for us got stressful. When I had our daughter my Dr’s were very on top of it and handled everything perfectly. Since we moved to Colorado I had to find a new Dr and this Dr wasn’t very understanding of it. When I asked to be tested again she objected and thought I was making it all up because my first set of tests came back normal. The thing with ICP is you can have normal lab work for weeks before your tests come back elevated and your levels can rise drastically over a matter of hours or days. She said I was too early to have it because a lot of cases don’t come on until the end of pregnancy. After multiple phone calls and lots of arguing I finally convinced them to do one of the tests. We got to the hospital and we bumped into my Dr and my husband told her she needed to order the second test. The results came back within a few days and they were elevated again. I was put on Ursodiol and told I needed to do twice weekly stress tests until I delivered at 36 weeks. We ended up having nothing but issues with the Dr and since all of our family is back in San Francisco I called my old midwife and told her what was going on. She told me if I wanted to come back she would see me again and we made the choice to finish my pregnancy in California and have our son there. Our son’s birth was a breeze and he was also born in the wee hours of the morning. Screaming and healthy. He also required no NICU time.

When we had our third baby we were living back in California and I saw my previous midwife and high-risk dr at UCSF. They were amazing and when my itching returned at 21 weeks they regularly tested me, put me on Ursodiol, and after 28 weeks I was given twice weekly stress tests. Since I had been through it 2 times before it was a lot less stressful and I knew what to expect the whole time. I was induced in my 36th week and she was born healthy and screaming. She also required no NICU time.

No one knows a whole lot about ICP and the information available is pretty basic and all the same. It occurs at different times for different women and it can range from mild itching to severe itching and can show up anywhere on the body. There is an amazing Facebook group for ICP support that I love. They were a great resource for information when I was pregnant and if you’re looking for other moms to connect with who have been through ICP or you need some info I would encourage you to check it out. I learned a lot about ICP while I was pregnant with my son and most of it was because of that group.

• ICP can show up anytime during your pregnancy. It’s most common at the end (after 34 weeks), but it does show up in people early on. If you’re itching please get checked out.
• ICP causes the placenta to age. A 36 week ICP placenta is comparable to a 40/41 week healthy placenta and that’s why it can cause issues for baby. When a placenta ages too much it can cut off oxygen and nutrient supply to a baby and in turn cause stillbirth.
• ICP is a risk to baby, but not mom. Once you have your baby ICP goes away and there are no lasting effects.
• When monitored properly ICP shouldn’t harm your baby. Kick counts are important to do.
• Ursodiol doesn’t stop itching. It helps to protect the baby by working to dissolve the “bad” bile in your liver.
• You will itch until you deliver your baby and can notice itching around your menstruation cycle and while on certain birth control pills. You can also continue to itch while breastfeeding. It’s because of the hormones.
• ICP has been diagnosed as early as 8 weeks.
• Learn more about ICP via ICPcare.org

I think I covered everything that I’ve learned and with my story. Any questions? Leave them in the comments below. Please remember that I am not a doctor. I am just sharing my experience and you should consult your doctor if you have itching during your pregnancy. If your doctor won’t take you seriously, please get a second opinion. ICPCare.org is a great website filled with lots of information!