It was probably about a month ago when asked how I was feeling I would respond with, “Good! Just really itchy!” It started off just on my growing belly, and naturally, I assumed the itchiness was a product of stretching skin. But then it started to happen on my arms, my legs, my butt even. Enter Dr. Google. Itchiness during pregnancy could be nothing. Estrogen alone can make you want to scratch. But when the itch worsens at night, isn’t relieved by the scratching and feels “deeper” than your average dry skin itch, then you could have what is known as Intrahepatic Choleostasis of Pregnancy or ICP. ICP is uncomfortable at worst from mom but can be deadly for baby, so it’s nothing to take lightly. Although the risk for a stillborn is not high overall, the increased risk is enough to require labor induction between 36-38 weeks gestation.
I brought this to the attention to my midwife when the symptoms were sufficiently disturbing enough for this crunchy momma to be worried. She didn’t want to worry or want me to be worried, so promptly suggested milk thistle and lemon water and that we would discuss at our next appointment.
So here’s the long and short of it in as simplest terms I can put this extremely complicated condition:
- ICP is most likely to be diagnosed in the 3rd Trimester
- Itching is the most notable and often ONLY symptom and will worsen at night
- Itching is common on the palms and soles of feet but can be anywhere and everywhere and maybe not on your palms at all
- The test used to diagnose is a Bile Acids (BA) test, that usually takes anywhere from 5 days to 2 weeks if you’re remote to even get back, adding to the stress of the disease.
- Normal bile acid levels can be as high as 14, but with symptoms, a diagnosis is made if the levels are above 10.
- The risk for a stillbirth increase when levels are above 40, (considered severe ICP) but stillbirth is still possible below that.
- Those levels can rise astronomically towards the end of pregnancy, 200+, and are believed to be what puts the baby at risk, although they are not sure of the mechanism of intrauterine death.
- Most women will experience itching long before BA levels rise, which is why it’s important to monitor levels even if they come back normal at first.
- Natural remedies can help lower BA levels, like milk thistle, SAMe, Apple Cider Vinegar and Lemon water, HOWEVER the most effective treatment to lower BA is Ursodeoxycholic acid (INN, BAN and AAN), also known as ursodiol (USAN).
- After delivering the baby, most women return to normal and stop itching.
- There are no long-term effects of this condition on mom or baby, once baby is born healthy!
- Most importantly to note, this condition manifests differently in every pregnant woman, so catching it as early as possible and managing it are imperative to preserving the health and life of your baby!!
I am in a unique position, now that I am 37 weeks pregnant and have only had a confirmed elevated level of 14.2 this last week. Most women would opt to be induced at this point or would have been already. This is where instinct, trust in your body, and truly taking control of your health becomes an individual endeavor for each and every person. I want to have a home birth and not a hospital birth, but I also want to have a LIVE baby. Balancing this is particular equation is quite challenging at my stage. We have decided to give this one more week of monitoring to give my levels a chance to either hover or decline. If they go above 20, I will agree to the induction. I am so close to the end and my levels only rose this last week and are still technically in normal range (if I were asymptomatic—my itching HAS decreased with Urso), not having much time to impact baby negatively.
Most women who plan a hospital birth anyway look at this situation as a no-brainer: you just get your baby earlier. The important thing is that you are informed and can make a decision without being trivialized by your health care provider. ICP is very rare, and many nurses and doctors don’t even know what it is, don’t recognize the signs or acknowledge the severity of it. Many women have been dismissed and have lost children because of it.
My midwife felt like I googled my way into anxiety, but I disagree: I’m not at all anxious. I am in control of my health and choose to be informed of all risks and options so I can proceed as I desire and not as I am told. Yes, some people unnecessarily worry themselves into a frenzy, as may be their nature. But if that might save your baby’s life, I’d say that’s a small price to pay.
If you are pregnant and itchy PLEASE read more about ICP here: