My first pregnancy was smooth and easy. I didn’t even have the infamous nausea. I carried my baby to full term and delivered our little girl at 41 weeks. Two years later, I was pregnant with our second baby and everything seemed to be on par with my first pregnancy, until I reached 31 weeks. I woke up one morning itching my arms and neck, as if I had mosquito bites. I didn’t think too much of it but that same day I remember dragging my feet on the carpet because it was relieving an itch I also had on the soles of my feet. Later that night, I did a bit of research and stumbled upon stories about Intrahepatic Cholestasis of Pregnancy. I worried about whether this was what I had but decided to wait a few days and see if the itch developed.
Sure enough, the itch intensified and was unmistakably affecting the arches of my feet, in addition to my hands, legs, arms and neck. The sudden occurrence and intensity of the itch, the lack of any rash, and the fact that I was well into my third trimester made me sure of my diagnosis.
I had an appointment with my OB a few days later and brought up my symptoms. I came prepared with print outs of ICP from the ICP Care website in case she wasn’t aware of the condition, but luckily, she immediately recommended that I get my blood tested for ICP. She called me a day later to confirm that I indeed had elevated bile acid levels at 22.1 and that I had ICP (week 32). A plan was set into motion to get weekly ultrasounds, bi-weekly non-stress tests, take 750mg daily dose of Ursodeoxycholic Acid, and to deliver the baby between 36 and 37 weeks.
I had appointments at a center with neonatal fetal specialists for the ultrasounds and non-stress tests who would then send reports and recommendations to my OB. It was common to book appointments with whichever physician was available and therefore I received several varying recommendations. The first physician I met didn’t think it was necessary for me to do weekly blood tests to test my bile acid levels. I asked her if I could still do it anyway for my own peace of mind and she agreed to send in a standing order to the lab. The second physician I met said that it wasn’t an option to not have weekly tests done and I felt good about having insisted on the lab work. There were also various opinions about whether to do the blood tests fasting or non-fasting. The consensus was that fasting was better as it gave you a baseline measurement of your bile acid levels.
At week 33, my bile acids decreased to 10.5 and my itching subsided as well. I felt tremendous relief. At week 34, my bile acids decreased further to 7.6 and my itching was again minimal to nearly gone. Even so, the physician recommended that I increase my Urso medication to 1500mg a day. I continued to feel good about our course and we set the delivery date for 36 weeks and 6 days. At week 35, things shifted. I began to feel increasingly itchy and on Tuesday of week 35, my bile acid levels rose to 32.1. The physician increased my Urso medication again to 2250mg a day and I became very nervous, especially when my itching became intolerable. I decided to test myself again that same week on Thursday and received results on Friday that my bile acids had risen to 105.5. That very same day, I received a first shot of steroids to help develop the baby’s lungs and we scheduled the delivery date for that Sunday, 35 weeks and 5 days. We had 2 days to suddenly get organized to meet our baby earlier than expected and I couldn’t wait. I had the second shot of steroids administered on Saturday and did another non-stress test. On Sunday morning at 8:02am, I gave birth to a healthy baby boy. He was late preterm and still had to spend a week in the NICU before we could bring him home, but the nightmare of ICP was finally over and more importantly, our baby was healthy.
Do not ignore your instincts and push for what you feel is right for you and your baby. None of the physicians advised me to get biweekly blood tests but I did anyway. I fear what my levels would have been if I had waited a few days later rather than get that second weekly test. They had risen over 70 points in 3 days.
ICP care was a tremendous resource for me in this difficult time. It encouraged me not to ignore the itch and the stories I read also compelled me to want to get tested. I hope in turn that my story will help you too.