Medically reviewed content. Last updated: April 2026.
Medically reviewed content. Last updated: April 2026.
Itchy skin is common in pregnancy, and most of the time it is nothing to worry about. But intense itching, especially on your hands and feet, could be a sign of a liver condition called obstetric cholestasis (also known as intrahepatic cholestasis of pregnancy, or ICP). This guide explains the difference between normal itching and something that needs medical attention.
Mild itching is very common, particularly as your bump grows and your skin stretches. The areas most likely to feel itchy include your abdomen, breasts, and thighs. Hormonal changes and increased blood supply to the skin also contribute.
Common causes of normal pregnancy itching include skin stretching (especially in the third trimester), dry skin (hormonal changes can reduce your skin's moisture), eczema or existing skin conditions flaring up, heat and sweating, and PUPPP (polymorphic eruption of pregnancy), an itchy rash that usually appears in stretch marks.
These types of itching, while annoying, are not harmful to you or your baby and usually respond to simple measures like moisturising, wearing loose cotton clothing, and avoiding hot baths.
You should contact your midwife promptly if:
These are the hallmark features of obstetric cholestasis, and it needs investigation with a blood test.
Obstetric cholestasis is a liver condition specific to pregnancy. It occurs when the normal flow of bile (a digestive fluid produced by the liver) is impaired, causing bile acids to build up in the blood. This buildup causes intense itching.
ICP affects around 1 in 140 pregnancies in the UK, though rates are higher in certain ethnic groups (South Asian and South American populations have a higher incidence).
The main symptom is intense itching without a rash, characteristically worse on the palms and soles and more severe at night. Other possible symptoms include dark urine, pale stools, mild jaundice (yellowing of the skin or eyes, though this is uncommon), fatigue, and loss of appetite.
ICP is important because raised bile acid levels can affect the baby. The condition is associated with an increased risk of premature birth (spontaneous or planned), meconium staining of the amniotic fluid, and in rare cases, stillbirth. The risk to the baby is related to the level of bile acids in your blood, with higher levels carrying greater risk.
This is why prompt diagnosis and monitoring are important. With appropriate care and monitoring, the vast majority of ICP pregnancies result in healthy outcomes.
Your midwife or GP will arrange a blood test to check your liver function and bile acid levels. The key tests are:
Important: bile acid results can take several days to come back, and levels may be normal initially even if ICP is developing. If your itching continues or worsens, ask for repeat testing even if the first result was normal. RCOG guidelines recommend weekly bile acid monitoring once ICP is diagnosed.
Ursodeoxycholic acid (UDCA) is the most commonly prescribed treatment. It helps reduce bile acid levels and may relieve itching. Not all studies agree on whether UDCA reduces the risk of complications, but it is widely used in UK practice and is considered safe.
Aqueous cream with menthol can provide topical relief for itching.
Antihistamines (such as chlorphenamine) may help with sleep if itching is severe at night, though they do not treat the underlying cause.
Once diagnosed with ICP, you will have regular blood tests (usually weekly) to monitor bile acid levels and liver function. Your baby's growth and wellbeing may also be monitored with additional scans.
RCOG guidelines recommend discussing delivery timing based on your bile acid levels. For bile acids between 10 and 39 micromol/L, delivery is generally recommended by 40 weeks. For bile acids of 40 micromol/L or above, earlier delivery (from 37 weeks) may be recommended. For very high levels (above 100 micromol/L), even earlier delivery may be considered. These decisions are made on an individual basis with your consultant.
While medication addresses the underlying condition, these measures can help with comfort:
ICP almost always resolves completely after birth. Your bile acid levels and liver function will return to normal, usually within a few weeks. The itching typically stops within the first few days after delivery.
If you have had ICP in one pregnancy, there is approximately a 45 to 90% chance of it recurring in subsequent pregnancies. Let your midwife know about your history so monitoring can begin early.
ICP does not cause long-term liver damage.
Mild itching is very common, particularly as your bump grows and your skin stretches. The areas most likely to feel itchy include your abdomen, breasts, and thighs. Hormonal changes and increased blood supply to the skin also contribute.
You should contact your midwife promptly if:
Obstetric cholestasis is a liver condition specific to pregnancy. It occurs when the normal flow of bile (a digestive fluid produced by the liver) is impaired, causing bile acids to build up in the blood. This buildup causes intense itching.
Your midwife or GP will arrange a blood test to check your liver function and bile acid levels. The key tests are:
While medication addresses the underlying condition, these measures can help with comfort:
ICP almost always resolves completely after birth. Your bile acid levels and liver function will return to normal, usually within a few weeks. The itching typically stops within the first few days after delivery.
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