What is Intrahepatic Cholestasis of Pregnancy (ICP)
If you’re expecting twins, you may have heard about Intrahepatic Cholestasis of Pregnancy (ICP). ICP is a liver condition that can cause itching during pregnancy and, in some cases, affect the health of your babies. While ICP can happen in any pregnancy, it’s more common in twin pregnancies. Here’s what you need to know, with some helpful numbers to put the risks in perspective.
Why Twin Pregnancies Have a Higher Risk
ICP is thought to be related to hormones, which are naturally higher in twin pregnancies. Because of this:
- About 20–25% of twin pregnancies are affected by ICP.
- In comparison, ICP occurs in only about 0.3–0.5% of singleton pregnancies.
If your twins were conceived through IVF, the risk may be even higher. IVF pregnancies may also develop ICP earlier and with more severe symptoms, likely due to the hormones used during fertility treatments.
When ICP Appears and What It Means
In twin pregnancies, ICP is often diagnosed around 33 weeks, but symptoms may appear earlier. Bile acid levels, measured with a blood test, tend to be higher in twin pregnancies with ICP, which can increase certain risks.
Studies show that twin pregnancies with ICP may have higher chances of:
- Preterm birth
- Cesarean delivery
- Fetal distress
- NICU admission
Doctors also watch liver function tests like ALT, bilirubin, and albumin, since severe changes may indicate higher risks.
Understanding Stillbirth Risk
Even without ICP, twin pregnancies have about twice the risk of stillbirth compared to singleton pregnancies. ICP may raise this risk further. Unlike single pregnancies, where stillbirth risk usually rises only if bile acids exceed 100 µmol/L, twin pregnancies may have an increased risk even at lower bile acid levels. This is why monitoring and close care are so important for twin pregnancies affected by ICP.
How You Can Stay Safe
If you have twins and ICP, your healthcare team may recommend:
- Frequent monitoring of bile acids and liver function
- Regular ultrasounds to check on your babies
- Planning the timing of delivery to reduce risks
Key Takeaways
- ICP affects 1 in 4 twin pregnancies and is much more common than in single pregnancies.
- IVF twins may be at higher risk and may experience earlier or more severe symptoms.
- Even low bile acid levels in twin pregnancies may increase the risk of stillbirth.
- Close monitoring and early intervention can help keep both you and your babies safe.
While ICP can be concerning, with the right care, twin pregnancies can have healthy outcomes.
Don’t hesitate to talk with your doctor about any symptoms or concerns. You are not alone.
For more info and related research article visit: Twin Pregnancies and Intrahepatic Cholestasis of Pregnancy