By CAFMI From Nature Reviews Disease Primers
Recognizing Intrahepatic Cholestasis of Pregnancy
Intrahepatic cholestasis of pregnancy (ICP) is a liver condition that occurs exclusively during pregnancy, usually in the third trimester. It presents primarily with intense itching on the palms and soles without any visible rash. This symptom, combined with elevated bile acids in the blood, helps in diagnosing the condition. ICP stems from impaired bile flow within liver cells, influenced by pregnancy hormones and genetic factors. For primary care physicians, early identification of ICP is crucial because the itching can be severe and distressing for the patient, and the condition signals potential risks to the fetus.
Clinical Implications and Management Strategies
ICP carries significant risks for the developing fetus, including preterm birth, fetal distress, and stillbirth, making careful monitoring essential in clinical practice. The mainstay of treatment is ursodeoxycholic acid, which helps lower bile acid levels and relieve itching, although its effectiveness in improving fetal outcomes requires further validation. Monitoring liver enzymes and bile acid levels guides management decisions. Primary care physicians should also be aware that delivery is frequently recommended between 37 and 38 weeks to minimize risks, highlighting the importance of timely referral and coordinated care with obstetrics specialists.
Advances in Understanding and Future Directions
Research has identified multiple genetic and environmental factors that contribute to ICP by affecting bile acid transport and liver function. This evolving understanding has refined diagnostic criteria and broadened treatment possibilities. For clinicians, staying informed about these advances helps optimize patient care, balancing interventions with potential side effects to improve both maternal and fetal outcomes. Continuing studies aim to better define management protocols and therapeutic efficacy, ensuring that ICP patients receive evidence-based, personalized care throughout pregnancy.
Read The Original Publication Here
