When you’re pregnant, it is likely for you to be worried by the dozens of things that can go wrong. One of these is a little-known condition called intrahepatic cholestasis of pregnancy or ICP (1). It can be very difficult to spot as the only obvious symptom is itching. The result of this condition is devastating: a stillborn baby.
Jenny Chambers is the founder of ICP Support, a group and charity with the aim of making this condition known to a wider audience. She herself suffered from ICP in all three of her pregnancies, and she shares her tragic story with others so that ICP doesn’t claim the lives of more babies.
In 2016, Jenny shared the story of what happened that fateful day on 24th June 1991. Her little girl, Olivia, was stillborn because Jenny had ICP. Imagine her anguish as she not only lost a child but found out that there was very little awareness about ICP either. Although the condition had been documented before, it wasn’t (and still isn’t) widely known, so the hospital couldn’t do much to help her.
Jenny had been suffering from ICP in all three of her pregnancies and hence felt itchy throughout gestation. She had pleaded with the doctors to induce early labor, just like it had been done with the birth of her son Alex. Her first daughter, Victoria, had already been stillborn and had not made it so she was anxious to ensure nothing would happen to Olivia. Her doctors told her that they had done her blood work and there was no sign that early labor was necessary. At 39 weeks, she gave birth to Olivia who did not survive.
She was told that her little girl had probably died a short time before birth. It wasn’t until a few weeks later that she was diagnosed with ICP and informed that an early labor had, in fact, been warranted. Her blood tests, as it turned out, had not been normal and there was every indication that she did have ICP.
Heartbroken and in despair, she made this point a foundation of strength in her life. She decided to start the ICPSupport group, which is a charity to help raise awareness about the condition and fund research. Over the years, she has done tremendous work, helping a lot of mothers avoid the catastrophe that had befallen her (2).
In a short presentation made at an international conference on ICP in London in 2012, different women describe how they were affected by ICP.
Credit: ICPSupport [“>YouTube]
What Is ICP?
ICP, also known as obstetric cholestasis, is the most common pregnancy-specific liver condition. In the UK, it affects approximately 1% of women, with the condition predominantly affecting women of Asian origin. The exact cause of ICP are still not known, although many scientists posit the hypothesis that the interaction between pregnancy hormones and the liver is the answer.
Oestrogen and progesterone, the two pregnancy-associated hormones, affect the liver’s function of transporting certain chemicals. Some women aren’t able to deal with the levels of these hormones, causing bile levels to increase in the liver. Without an adequate flow of bile, the pressure in the liver builds up, causing it to spill into your bloodstream (3). This, in turn, is supposed to cause all the symptoms of ICP.
Symptoms Of ICP
As stated, the main symptom of ICP is itching. It may be all over but it is most common on the palms and soles of feet. It could also get worse at night. Apart from the itching, there could be other symptoms as well, such as:
- Light coloured bowel movements.
- Abdominal pain, although this isn’t that common.
- Jaundice (yellow colouration of the eyes, mucous membranes, and skin), although this isn’t very common either.
- Loss of appetite.
With such vague symptoms, ICP can be difficult to diagnose. These symptoms are often attributed to other health conditions. Although ICP most commonly occurs after 28 weeks of gestation, it has been known to occur earlier as well. Hence, you ought to consult your healthcare professional right away.
While severe itching in itself is a clear sign of ICP, it is not definitive. Hence, lab tests are done to confirm the diagnosis. Liver function tests and blood clotting time tests are most commonly used to support an ICP diagnosis.
There is no cure for ICP, unfortunately, other than giving birth. However, there are plenty of treatments that help you manage the condition and minimize the harm to your baby.
- The first go-step is a drug called UDCA (Ursodeoxycholic Acid) in doses of 600mg-2000mg per day (4). It occurs naturally in the body but not in large quantities. Itself a type of bile acid, it regulates the level of other bile acids that are present in the bloodstream.
- The next step is some medication that reduces the severity of itching such as steroids, antihistamines, or topical creams.
- Regular hospital visits are mandatory. Here, your baby’s heart rate will be monitored, and any additional ultrasound scans will be performed.
- You should keep a track of your baby’s movements. Any sudden changes or a stoppage of movement altogether is a warning sign, and you should tell your doctor right away.
- Premature birth is recommended in cases as this reduces the chances of your baby being stillborn.
While itching could just be a passing phase, Jenny’s story shows us that no unusual occurrence during pregnancy should be ignored. Further, it’s imperative to get a second opinion when you aren’t sure of what your doctor is telling you.