Medical Articles & Reference of Intrahepatic Cholestasis of Pregnancy (ICP)

ICP Care Publications

• Patient Brochure – An easy-to-read summary of all you need to know regarding Intrahepatic Cholestasis of Pregnancy.
• Healthcare Professional Brochure: Diagnosis & Treatment – A helpful reference regarding diagnosis and management of Intrahepatic Cholestasis of Pregnancy which you can share with your health care providers.
• Healthcare Professional Brochure: Considerations After Pregnancy – A helpful reference regarding considerations after Intrahepatic Cholestasis of Pregnancy which you can share with your healthcare providers.
• ICP Care Infographic – A one-page visual graphic containing clickable links to facts and information regarding Intrahepatic Cholestasis of Pregnancy.
• ICP Diagnosis & Treatment Flowchart – This diagnosis flowchart provides an overview on diagnosis and recommended treatment protocols when Intrahepatic Cholestasis of Pregnancy is suspected.

Symptoms and Diagnosis of Intrahepatic Cholestasis of Pregnancy

• Medscape – contains information regarding consensus on diagnostic levels for bile acids
• Consult Series #53: Intrahepatic Cholestasis of Pregnancy – publication from the Society for Maternal-fetal Medicine, giving information on diagnosis and treatment
• Visual Summary (Downloadable PDF on SMFM – Click “Visual Summary” link on right side of the page) – SMFM Consult Series #53: Intrahepatic cholestasis of pregnancy
• Understanding Intrahepatic Cholestasis of Pregnancy – publication from the Society for Maternal-fetal Medicine, giving information on diagnosis and treatment
• Bile acid concentration reference ranges in a pregnant Latina population – A study of a non-ICP pregnant population to establish non-fasting reference ranges for bile acids finding the upper range of normal to be 8.5 μmol/L.
• Pruritis may precede abnormal liver function tests in pregnant women with obstetric cholestasis: a longitudinal analysis – A series of case studies are presented which show that itching can begin long before bile acids or liver functions are elevated. Also shows that when liver functions are elevated they may become elevated before or after bile acids become elevated.
• Intrahepatic Cholestasis of Pregnancy – An excellent review of the literature providing a good summary of symptoms and diagnosis. Includes: ICP may appear as early as 8 weeks pregnant. Jaundice is rare. Itching is common on hands and feet but may affect other parts of the body. Summary of risks and much more important information
• Lysophosphatidic acid is a potential mediator of cholestatic pruritis – Presents the relationship between lysophosphatidic acid and itching.
• Never Too Soon: An Unusual Case of Intrahepatic Cholestasis of Pregnancy at Five Weeks Gestation.
• Re-evaluating diagnostic thresholds for intrahepatic cholestasis of pregnancy: case-control and cohort study – Demonstrates that bile acid testing should take place in a non-fasting state.

Treatment of Intrahepatic Cholestasis of Pregnancy

• Understanding Intrahepatic Cholestasis of Pregnancy – publication from the Society for Maternal-fetal Medicine, giving information on diagnosis and treatment.
• Efficacy of ursodeoxycholic acid in treating intrahepatic cholestasis of pregnancy – a meta-analysis – Demonstrates that UDCA is safe and superior to other medications at treating ICP, and data shows that it may help to improve outcomes for the baby as well.
• The effects of ursodeoxycholic acid treatment for intrahepatic cholestasis of pregnancy on maternal and fetal outcomes – a meta-analysis including non-randomized studies – Demonstrates the effectiveness of UDCA in improving both maternal and fetal outcomes, concluding that UDCA treatment should be recommended for ICP.
• The reversed feto-maternal bile acid gradient in intrahepatic cholestasis of pregnancy is corrected by ursodeoxycholic acid – Shows that the use of UDCA may reduce the levels of bile acids the baby is exposed to prior to birth.
• Sterological assessment of placental morphology in intrahepatic cholestasis of pregnancy – Shows how bile acids can cause premature aging of the placenta and that UDCA helps to prevent this aging.
• A placental phenotype for intrahepatic cholestasis of pregnancy – Shows how bile acids can cause premature aging of the placenta and that UDCA helps to prevent this aging.
• Ursodeoxycholic Acid administration from the first trimester in case of severe early-onset intrahepatic cholestasis of pregnancy – a case report of ICP beginning at 6 weeks gestation and treated with UDCA beginning at 9 weeks gestation. The authors concluded that UDCA can be used to manage early-onset ICP.
• Consult Series #53: Intrahepatic Cholestasis of Pregnancy – publication from the Society for Maternal-fetal Medicine, giving information on diagnosis and treatment.
• Visual Summary (Downloadable PDF on SMFM – Click “Visual Summary” link on right side of the page) – SMFM Consult Series #53: Intrahepatic cholestasis of pregnancy
• Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses – Analyzed risk correlated with bile acids. Bile acids over 100 confer additional risk to baby.
• Ursodiol-Ovadia-2021URSO / UDCA for intrahepatic cholestasis of pregnancy decreased certain adverse outcomes in pregnant women with ICP.
• ACOG monitoring guidelines ACOG new recommendations for fetal monitoring during ICP pregnancies

Studies which support early delivery in managing ICP

• The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy by gestational age – Analyzed a comparison of risk of early delivery vs. risks of ICP, concluding that 36 weeks is ideal delivery age.
• Intrahepatic cholestasis of pregnancy and timing of delivery – Analyzed a comparison of risk of early delivery vs. risks of ICP, concluding that 36 weeks is ideal delivery age. Also concluded that delivery need not be accompanied by fetal lung maturity testing or steroid injections.
• Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes – a prospective population-based case-control study. A study of exclusively severe ICP pregnancies (over 40 μmol/L total bile acids), which found a high risk of adverse outcomes. The authors suggest that the benefits of delivery from 37 weeks would likely outweigh the risks.
• Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acids – A study finding increased risk for ICP pregnancies in which bile acids reach 100 μmol/L. The authors conclude that earlier delivery (34-37 weeks) should be considered in these cases.
• Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy – A second study finding increased risk for ICP pregnancies in which bile acids reach 100 μmol/L.
• Induction of labor at less than 38 weeks gestation in cholestasis of pregnancy: a six year cohort. Read the ICP Metropolitan flowchart of this study. A large prospective study examining the use of early induction in cases of ICP, concluding that delivery at 36-38 weeks is a viable option for managing ICP pregnancies.
• Towards Data Science ICP Dad professor at Duke University who studies health and technology shares how researching the optimal week for delivery based on ICP research.

Other website resources

• Society for Maternal-fetal Medicine – This directory for SMFM specialists contains a search feature which allows you to find members by state.
• ACOG (American College of Obstetrics and Gynecology) – Medically Indicated Late-Preterm and Early-term Deliveries – ACOG. 2021. Web Feb 2021.
• Liver Foundation – Contains information regarding many liver-related conditions, including ICP.
• What to Expect: Cholestasis during pregnancy – The popular pregnancy publication’s page regarding ICP.
• American Pregnancy Association – Promoting Pregnancy Wellness. ICP Pregnancy Complication details.