It’s the burning question everyone with Intrahepatic Cholestasis of Pregnancy wants the answer to: can my ICP cause lasting harm to me or my baby after my pregnancy is over? It’s unsatisfying to know we don’t have great answers. The studies so far have been few and often conflicting. We do have some answers, though, and it’s mostly good news.

Long term risk to parent’s health

Overall, there are few serious long term risks as a consequence of ICP. Gallstones and other gallbladder diseases are the most common. Many people with Cholestasis of Pregnancy have their gallbladders removed either before or after pregnancy. In some cases, it is caused by an inherited gene which may lead to these gallbladder issues.

Other uncommon issues include:

• non-alcoholic fatty liver disease
• non-alcoholic pancreatitis
• Hepatitis C infection (typically pre-dates the ICP)
• Hypothyroidism

However, the best news is that the life expectancy of a person who had Intrahepatic Cholestasis of Pregnancy is not decreased compared to the general population.

You may have seen there is some concern with long term risk of cancer. The good news is that research shows your overall risk of cancer is not increased after having this condition. There was one study that showed a slight increase in risk of biliary tree cancer. This happened in patients who had other risk factors. This cancer is extremely rare, even in people who had ICP. Other studies have not been able to confirm these results.

Underlying liver disorders

Sometimes Intrahepatic Cholestasis of Pregnancy (ICP) brings to light other underlying liver disorders the patient wasn’t aware of prior to developing it. These disorders are thought to cause ICP, not the other way around. It can be considered that the Cholestasis of Pregnancy is the first sign to look for these disorders.

These include:

• Hepatitis C infection
• Primary biliary sclerosis
• Autoimmune hepatitis
• Alpha-1 antitrypsin deficiency
• PFIC/BRIC

This is why ICP Care and maternal care governing bodies recommend that everyone should have liver function retested at 6-12 weeks postpartum to make sure your ICP is resolving and not caused by an underlying disorder. It’s reassuring to know most patients do not have any underlying disorder.

Certain patients are at higher risk and should have screening for underlying disorders: patients with first trimester onset, people with multiple family members with an ICP diagnosis, patients with bile acid levels over 100, and gallstones before the age of 40.

Future symptoms

Cholestasis of Pregnancy is likely to recur in future pregnancies, but not guaranteed. The risk may be as high as 90% recurrence. If you have a twin or other multiple pregnancy, IVF, or progesterone treatment, these may increase your risk. If your first pregnancy fell under one of these categories, future risk may be reduced.

Some people who had ICP are unable to take hormonal birth control without a return of symptoms, even when they were able to tolerate it in the past. If you had the condition, you can still use hormonal birth control, but be aware that itching may return and you should have your liver enzymes monitored.

Many people who had Intrahepatic Cholestasis of Pregnancy (ICP) have itching at menstruation and/or ovulation. Unfortunately, we don’t have much research on this phenomenon, and there are not good solutions. We do know, as long as you have proper follow up testing and all findings are normal, the itching is benign and will improve.

Risks to children

What makes us all the happiest is Intrahepatic Cholestasis of Pregnancy (ICP) does not appear to confer long term risks to our babies. Studies have shown only minor differences which don’t have a significant impact on the babies or their overall health.

A single, small study showed an increase in metabolic issues such as higher weight and pre-diabetes in children born to patients with ICP. A follow up study showed these changes are prevented by using Ursodeoxycholic Acid.

Conclusion

Overall, we are thrilled to share that your health and the health of your children are unlikely to be seriously impacted by your bout with Intrahepatic Cholestasis of Pregnancy. Rest assured, long term risks are minimal. If you do have symptoms after pregnancy or your liver functions do not return to normal after pregnancy, visit your healthcare provider for further workup.

For more information

Please see our website pages on this topic for further details:

For Patient: After Pregnancy

For Provider: Considerations After an ICP Pregnancy