My name is Guadalupe Manrique-Maldonado, and I am the Pennsylvania Ambassador for ICP Care. In 2017, I was 36 weeks pregnant with my first baby. One day I woke up feeling different, uncomfortable. The palms of my hands and the soles of my feet were itchy. I knew something was not right and called my health care provider. “It must be dryness,” the nurse said, “but I’m going to book an appointment for you to have some peace of mind.” Intrahepatic cholestasis of pregnancy’s (ICP) most common symptom is itchiness, precisely in the palms of the hands and soles of feet. It should have been a trip to the emergency room to check for my bile acids. Instead, I stayed home feeling that I was overreacting, and I had to wait for another three days until I could be seen by my doctor. Now, sometimes I think I was lucky. My medical appointment ended with a pass to the delivery room, and I gave birth to a beautiful boy at 37 weeks. Although everything went fine, I still feel upset when I think about my symptoms not being acknowledged by my healthcare provider. Two years after, I felt prepared to have another baby. I knew there was a high probability of having ICP again. I spent a lot of time doing research, preparing physically and mentally, and in April (2019) I got pregnant again. I had a different health care provider this time. She supported me, listened to my concerns carefully and respectfully. However, I found myself advocating for bloodwork and tests all the time. Luckily, she listened to me, and we caught ICP at 35 weeks. I have to say that I was so focused on my symptoms that I wasn’t paying attention to the mental exhaustion I was going through. Then, at 36 weeks I was at the hospital for a non-stress test when my baby started going through fetal distress. I was fortunate enough to be at the hospital at that moment because I felt nothing, there was no warning, and nothing felt wrong. If the doctors weren’t monitoring my baby’s heartbeat at that time, we wouldn’t have realized what she was going through. ICP is unpredictable, and there is a lot to learn about it. I also realized that being able to advocate for yourself is critical to go through an ICP pregnancy. At the same time, it can be mentally exhausting and traumatic, and pregnant mothers and their families need to be aware of that to have the appropriate physical and mental care.

My goals as an ICP Care Ambassador are to spread the message, I would like ICP to be a disease doctors mention to every pregnant woman at their routine checkups. ICP is a very unpredictable condition, and is still treated as an uncommon disease. Pregnant mothers should be focused on their health instead of going through the mental exhaustion of advocating for themselves. For that we need to spread the message, to raise awareness, and to make this condition visible to everyone. ICP Care was a huge support for me. The pregnancy stories from the ICP website and the articles available for downloading were very helpful, and I wish every ICP mom could feel supported as I did.