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When you’re pregnant, you expect certain changes to happen to your body: your feet may swell, you may experience morning sickness — and you may even have itchy skin.

Itching during pregnancy can be caused by a variety of factors, but it is important to consult your physician if you experience itching.

What is Intrahepatic Cholestasis of Pregnancy?

Intrahepatic Cholestasis of Pregnancy (ICP) — or cholestasis, for short — is a rare liver disorder that occurs when the liver produces too much bile acid. To put it simply, bile acids are created to assist with digestion.

During pregnancy, when your liver produces too much of these bile acids, the main symptom is itching — and the biggest, though statistically unlikely risk, is stillbirth.

Who is at risk?

Patients with preexisting hepatobiliary (liver, bile ducts, pancreas or gallbladder) diseases, such as viral hepatitis or cirrhosis, are more susceptible to ICP.

It is well-documented that if you have ICP with one pregnancy, you will very likely have it with future pregnancies. Patients carrying twins or who have pregnancies at an advanced maternal age are also at an increased risk.

What are the symptoms?

“When we have a patient who is complaining of itching, but we don’t see a rash, the first thing we are going to think about is cholestasis,” says Dr. Michael Armstrong, a high-risk OB-GYN who practices at the WakeMed Obstetrics and Gynecology Clayton, Raleigh Campus and Oberlin locations.

Due to the persistence of itching, some individuals become uncomfortable and irritated. For many patients, the itching can be worse at night, which can lead to a lack of quality sleep.

Are there treatment and monitoring options?

Once you are diagnosed with ICP via a blood test of your bile acids, there are options to keep the baby safe and help with that pesky itching.

Your physician will likely suggest adopting a strict moisturizing routine and prescribe medication that can lessen the intensity of the itch.

To ensure the baby is happy and healthy, you will have your bile acid levels checked with increasing frequency throughout your pregnancy.

“We’ll start doing early antenatal surveillance type testing on these patients, usually when they reach the third trimester. This will include ultrasounds to follow up on growth and weekly testing to make sure we are not seeing any signs of hypoxia (lack of oxygen),” says Dr. Armstrong.

What should a patient expect during delivery?

As the pregnancy progresses, the bile acids may continue to rise which can impact the baby’s APGAR score. (APGAR is a set of standard scores that the delivery team uses after birth to determine how well the baby is doing.)

For this reason, most patients will receive a labor induction between 36-37 weeks — depending on the bile acid levels.

“Decreased APGARs after delivery are a risk with preterm births,” says Dr. Armstrong.

Is there any good news?

Once the condition is identified, the outcomes are overwhelmingly positive.

“It is unlikely that we are going to have a poor outcome. When we are aware of it, we look for signs and symptoms that the baby is not doing well, so we can intervene,” says Dr. Armstrong.

The bottom line is if you are pregnant and are experiencing itching, consult with your doctor to determine if you have ICP.

About Michael Armstrong, MD, FACOG

After graduating from medical school in 1998, Dr. Armstrong completed his residency in Obstetrics and Gynecology at the University of Virginia. Upon completion he was an assistant professor of Obstetrics and Gynecology at the Medical University of South Carolina. He returned to North Carolina in 2008, where he served as a Clinical Associate Professor of OB-GYN at the University of North Carolina School of Medicine. In 2013 he joined the WakeMed Faculty, where he serves as a clinical physician in obstetrics and gynecology.

In addition to teaching, Dr. Armstrong has spoken at countless seminars and workshops and published articles on various topics related to obstetrics and gynecology. Dr. Armstrong is a graduate of the North Carolina School of Science and Mathematics. He has a passion for performing procedures and surgeries, including laparoscopic surgery. He treats women with fibroids, endometriosis and menstrual abnormalities, and enjoys caring for adolescents and women during pregnancy.

His journey was motivated by his love for math and science, but his passion for medicine comes from his life experience as a young child seeing his grandfather battle cancer. He knew then he wanted to pursue medicine to make an impact on others’ lives. Dr. Armstrong quickly realized his passion for women’s health doing his Obstetric Clerkship at WakeMed in 1996, and his journey has come full circle.

Dr. Armstrong loves his team at WakeMed and they work together to provide quality patient care. Dr. Armstrong has three daughters and a son, and he spends much of his time outside of work exploring nature or traveling with them.

About WakeMed OB-GYN

Welcoming more babies than any other system in Wake County, we’re experts when it comes to pregnancy and childbirth.

Our OB-GYNs are committed to the health and well-being of our patients, and our high-risk doctors are here for patients who need extra support.

Learn more about WakeMed OB-GYN.



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