Liver disorders

What is intrahepatic cholestasis of pregnancy?

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-related liver disorder in which there are abnormalities in the flow of bile (a substance produced by the liver that aids in the digestion and absorption of fats). These abnormalities lead to a build-up of bile acids (components of bile) in the mother's blood, resulting in symptoms such as severe skin itching.

What are the symptoms of ICP?

The symptoms of ICP can range from mild to severe. Symptoms usually start in the second or third trimester of pregnancy. The most common symptoms include:

  • Skin itching: Itching often is most severe on the palms of the hands and soles of the feet, but many affected women itch all over their bodies. It often gets progressively worse and may interfere with sleep and daily activities.
  • Jaundice: This yellowing of the skin and whites of the eyes occurs in 10 to 20 percent of women with ICP. Jaundice is caused by a build-up of a chemical called bilirubin in the blood, resulting from the liver disorder and decreased bile flow.

A pregnant woman should call her health care provider if she has these symptoms.

How common is ICP?

In the United States, ICP affects less than 1 percent of women.

What are the risks of ICP in pregnancy?

ICP can be very uncomfortable for the pregnant woman. It also can hurt the baby. Up to 60 percent of women with ICP deliver prematurely (before 37 weeks of pregnancy). Premature babies are at increased risk for health problems during the newborn period and for lasting disabilities and death. ICP also increases the risk for stillbirth, though the risk is small (1 to 2 percent). It is important to diagnose and treat ICP to help prevent these potential problems.

How is ICP diagnosed?

There are a number of skin disorders of pregnancy that can cause itching; most do not harm the mother or baby. Blood tests can tell if a woman's itching is due to ICP. These often include a blood test that measures various chemicals that show how well a woman's liver is functioning and the amount of bile acids in her blood.

How is ICP treated?

ICP often is treated with a medication called ursodeoxycholic acid (Actigall). This medication relieves skin itching, helps correct liver function abnormalities and may help prevent stillbirth.

The health care provider monitors the baby closely (with ultrasound and tests that measure heart rate) to see if the baby appears to be developing any difficulties, such as heart rate abnormalities, due to ICP. If the baby is having difficulties, the provider may recommend early delivery to help reduce the risk of stillbirth. The provider also may do a test called amniocentesis when the baby is at about 36 weeks gestation to see if the lungs are mature. If the baby's lungs are mature enough for the baby to breathe on his own, the provider may induce labor at 36 to 38 weeks to help prevent stillbirth.

What causes ICP?

The cause of ICP is not well understood. Pregnancy hormones and heredity appear to play a role. ICP appears to be more common in twin (or other multiple) pregnancies, possibly due to increased hormone levels. About half of women with ICP have a family history of related liver disorders.

Does ICP go away after giving birth?

Symptoms of ICP generally clear up on their own by about 2 days after a woman gives birth. However, about 60 to 70 percent of affected women develop ICP again in another pregnancy.

What is acute fatty liver of pregnancy?

Acute fatty liver of pregnancy is a rare, life-threatening complication of pregnancy. About 1 in 10,000 to 1 in 15,000 pregnant women are affected by this disorder, which is characterized by a build-up of fat in liver cells.

What are the symptoms of acute fatty liver of pregnancy?

Symptoms of this disorder generally begin in the third trimester of pregnancy and may resemble those seen in HELLP syndrome. A pregnant woman should call her health care provider if she has any of these symptoms:

  • Persistent nausea and vomiting
  • Pain in the stomach or upper-right abdomen
  • General malaise
  • Jaundice
  • Headache

What are the risks of acute fatty liver of pregnancy?

Without prompt treatment, acute fatty liver of pregnancy can lead to coma, organ failure and death of mother and baby.

How is acute fatty liver of pregnancy diagnosed?

Acute fatty liver of pregnancy can be diagnosed with blood tests that measure a number of factors related to liver and kidney functions.

How is acute fatty liver of pregnancy treated?

The mother may require blood transfusions to stabilize her condition. The baby is delivered as soon as possible to prevent serious complications.

What causes acute fatty liver of pregnancy?

The cause of this condition is not well understood. Genetics may play a role. A recent study found that 16 percent of women had this condition when their babies had certain inherited errors in body chemistry (fatty acid oxidation defects). These disorders prevent an affected individual from properly processing certain fats. Babies with these disorders can develop life-threatening liver, heart and neuromuscular problems unless they are fed special low-fat foods. These findings suggest that all babies of women with acute fatty liver of pregnancy be tested for fatty acid oxidation defects so they can receive prompt treatment. (Many babies are routinely screened for these disorders as part of a panel of newborn screening tests. However, states vary in the newborn screening tests they require.)

Does acute fatty liver go away after pregnancy?

Most women start to improve within a few days of delivery and suffer no lasting harm from the condition. Women who carry a gene for a fatty acid oxidation defect (including women who have had an affected baby) have an increased risk of fatty liver occurring again in another pregnancy; the recurrence risk is unknown in other women.