• Bile contains bile acids, bilirubin, water, and cholesterol. Bile passes through tubes called bile ducts from the liver and is stored in a small organ called the gallbladder. During digestion, bile is released from the gallbladder into the intestines, where it helps break down fats. It then returns to the liver, where it is reused to make more bile.

• In ICP, bile flow from the liver is slowed or stopped (cholestasis). Pregnancy hormones are thought to cause these changes in bile flow. As a result, bile builds up in the liver (intrahepatic means “in the liver”), causing bile acid levels in the blood to increase.

ICP doesn’t usually cause problems for a pregnant person, and it typically goes away after delivery. However, there is a small risk of problems for the fetus. The risk of stillbirth is slightly increased in ICP. The risk is highest when bile acid levels are very high. The chance of preterm birth, which can happen either on its own or because of a decision to deliver the baby early, is increased in ICP. The risk of the baby having breathing problems is also higher.

• ICP causes itching, which can be intense. The hands and soles of the feet are the most common areas affected, but itching can occur anywhere on the body. No one is sure what causes the itching in ICP, but it’s thought that bile acids can irritate the skin. Itching can come and go or be severe all the time. It may be so bad that it prevents sleep. Some people with severe itching from ICP can scratch so hard that the skin bleeds. ICP does not cause a rash, but scratching may cause rash-like marks on the skin.

• Jaundice occurs in a few people with ICP. Jaundice is caused by an increase in bilirubin in the bloodstream.

• Other symptoms include pain in the upper right abdomen (where your liver is located), nausea, fatigue, and loss of appetite.

• ICP is diagnosed with a blood test that confirms increased levels of bile acids.

• There are some cases of ICP where itching is present, but bile acid levels are normal. In this case, other conditions that cause itching in pregnancy need to be ruled out before ICP is diagnosed.

• If your itching doesn’t go away and the initial bile acid levels are normal, the test may be repeated to see if the levels are increasing.

• Ursodeoxycholic acid (UDCA) is the most commonly used drug to treat ICP. It treats the symptoms of ICP and reduces the risk of fetal complications. UCDA starts to relieve itching within 1 or 2 weeks. In the meantime

• Antenatal testing is done to monitor fetal well-being. When this testing starts depends on when ICP is diagnosed. How often it’s done depends on bile acid levels and whether other problems are present. Testing may be done more frequently if bile acid levels are very high.

• Early delivery is a way to prevent possible stillbirth. If bile acid levels are very high (100 umol/L or greater), delivery is recommended at 36 weeks and sometimes earlier in some situations. With lower bile acid levels, delivery is recommended between 36 and 39 weeks.

• The decision about when to have your baby to prevent possible stillbirth should be balanced against the risks that preterm babies face. These include trouble staying warm, feeding difficulties, and breathing problems. The risks increase the earlier a baby is born. Preterm birth can also happen on its own in ICP. These delivery decisions can be complex. You and your healthcare professional will discuss the risks and benefits of all your options before deciding what’s best for you and your baby.

• A corticosteroid medication can help the fetal organs mature if delivery is planned for earlier than 37 weeks.

ICP tends to happen again in future pregnancies. Experts think that ICP may run in families.

Having ICP can be scary, and it can cause a lot of stress and anxiety. But remember: most people with ICP have healthy babies. Learning about the disease and how others have coped can help calm your fears. Here are some resources that offer information about ICP:

• ICP Care: A website dedicated to education and support of people with ICP. Offers a support group and stories from people who’ve had ICP.

• March of Dimes: This organization has a web page about ICP, including symptoms, diagnosis, and treatment.

• BabyCenter: This popular website has lots of information about ICP.