Elara guides
The itch that matters: cholestasis
Most itching is harmless — but this kind needs a call.
Updated · Sources
Itchy skin is common in pregnancy as your bump stretches and hormones shift. Almost always it's harmless. But one particular pattern of itching can signal a liver condition called intrahepatic cholestasis of pregnancy (ICP), which needs medical attention — so it's worth knowing the tell-tale signs.
The kind to flag
ICP itching is typically intense, often on the palms of the hands and soles of the feet, and frequently worse at night — sometimes bad enough to stop you sleeping. There's usually no rash. It tends to appear in the third trimester. If your itching matches this picture, contact your provider; a simple blood test checks your bile acids and liver function.
Ordinary, harmless itching
- Mild itching over a stretching bump, breasts or hips.
- Dry-skin itch that eases with moisturiser.
- A localised itchy rash (often its own, separate skin condition).
- Itching that isn't focused on palms and soles and doesn't keep you awake.
Why it matters
ICP raises the risk of complications for the baby, so when it's diagnosed you'll be monitored more closely, sometimes given medication to ease the itch, and your team may recommend planning the birth a little earlier. With monitoring, outcomes are usually good — which is exactly why catching it matters.
What happens in ICP
ICP is a liver condition that appears during pregnancy. The normal flow of bile from the liver is affected, so bile acids build up in the blood. That build-up is what causes the itching, and it is why the diagnosis is made with a blood test rather than by looking at the skin.
It most often starts in the third trimester, although it can begin earlier. It usually goes away after the baby is born, and liver blood tests are normally checked again after birth to make sure they have returned to normal.
How it is diagnosed
If your itching matches the ICP pattern, your midwife or doctor will usually arrange blood tests for bile acids and liver function. A first normal result does not always rule it out: if the itching continues, the tests may be repeated, because results can change over the following weeks.
Tell your team about any other symptoms you have noticed, such as dark urine, pale stools or yellowing of the skin or eyes, and whether you had ICP in a previous pregnancy — it is more likely to happen again.
What treatment and monitoring can look like
- Regular blood tests to follow your bile acid levels, which help your team decide how closely to monitor you.
- Medicines or creams that may ease the itching; ask your team what is suitable for you rather than buying remedies yourself.
- Extra check-ups to follow your baby’s wellbeing and your own symptoms.
- A conversation about the timing of birth. Depending on your bile acid levels and other factors, your team may recommend planning birth earlier than your due date.
Looking after yourself in the meantime
Itching at night can be exhausting. Cool showers, loose cotton clothing, keeping the bedroom cool and a fan by the bed help some people. Keep nails short to limit skin damage from scratching. None of these treat ICP itself, so they are for comfort alongside medical care, not instead of it.
Keep paying attention to your baby’s movements. If they slow down, stop or change from their usual pattern, contact your maternity unit straight away rather than waiting for your next ICP appointment.
Common questions
Is all itching in pregnancy a sign of cholestasis?
No. Mild itching over a stretching bump or dry skin is very common and usually harmless. The pattern to report is intense itching, often on the palms and soles, often worse at night and usually without a rash.
Does ICP go away after birth?
In most people the itching settles soon after the baby is born. Your team will usually repeat liver blood tests after birth to make sure they have returned to normal.
Can ICP come back in another pregnancy?
Yes, it is more likely to happen again in a future pregnancy. Tell your midwife or doctor early in any later pregnancy so they can watch for it.
Why might my team suggest an earlier birth?
ICP can raise the risk of complications for the baby, particularly when bile acid levels are high. Your team weighs your blood test results and other factors when recommending the timing of birth.
Sources & editorial process
- NHS — Itching and intrahepatic cholestasis of pregnancy
- RCOG — Intrahepatic cholestasis of pregnancy (patient information)
- ICP Support (UK charity)
Written by the Elara editorial team from the sources above. This page has not been reviewed by an independent clinician. Read how we write and update health pages. Last updated .
Medical disclaimer: this page is general education, not medical advice, diagnosis or treatment. If you are worried about yourself or your baby, contact your midwife, doctor or maternity unit straight away. In an emergency call your local emergency number.