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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Assessment online. A doctor can recognise the pattern and explain results; the blood tests, monitoring and birth plan are with your maternity team.
- What it is: a liver condition of pregnancy in which bile acids build up in the blood, causing itching, usually after 28 weeks.
- How common: about 7 in 1,000 pregnancies in the UK, and up to 15 in 1,000 in women of Indian-Asian or Pakistani-Asian origin.
- Typical sign: itching without a rash, often of the palms and soles, and often worse at night.
- Emergency: contact your maternity unit straight away if your baby moves less than usual; call 112 for heavy bleeding or collapse.
If you have itching of the palms of your hands or the soles of your feet, or itching that keeps you awake at night, contact your maternity unit promptly for blood tests: a video appointment does not replace them. If your baby is moving less than usual, call your maternity unit straight away, even at night.
Can an online doctor help with cholestasis of pregnancy?
With understanding it, yes. Intrahepatic cholestasis of pregnancy is diagnosed with blood tests of bile acids and liver function, and it is monitored by your maternity team, who plan the timing of the birth. A doctor by video can tell whether your itching fits the pattern and how urgently you need the tests, explain your bile acid results and what they mean for you and your baby, and suggest what eases the itch. Itchy palms or soles mean blood tests through your maternity unit, and fewer movements mean a call straight away.
How an online consultation helps with cholestasis of pregnancy
- Itch pattern recognised: Which itching points to cholestasis, and which to a skin condition.
- Results explained: What your bile acid level means for the risks and the timing of the birth.
- Itch relief: Creams, cool baths, loose cotton clothes and antihistamines at night.
- After the birth: The 6-week blood test, contraception and the next pregnancy.
What the doctor checks in an online assessment for cholestasis of pregnancy
The doctor looks at the pattern of the itching and at anything that changes the urgency. The doctor asks about:
- Warning signs: your baby moving less, bleeding, or yellowing of your skin or eyes.
- The itch: where it is, whether there is a rash, when it started, and whether it keeps you awake.
- Your stage: how many weeks pregnant you are, and whether you are expecting twins or more.
- Tests: any bile acid and liver function results, and their dates.
- Other conditions: gestational diabetes or pre-eclampsia, which can change the plan.
- Your history: cholestasis in an earlier pregnancy, or itching on the combined pill.
Before the call, have any blood test results to hand.
What is cholestasis of pregnancy?
Intrahepatic cholestasis of pregnancy (ICP), also called obstetric cholestasis, is a liver condition of pregnancy in which bile acids build up in the blood, causing itching. It usually starts after 28 weeks and goes away after the birth.
Changes in how the liver works in pregnancy let bile acids build up, though it is often unclear why it happens in one pregnancy and not another. Itching is common in pregnancy, affecting about 1 in 4 women, but most women who itch do not have ICP.
How common is cholestasis of pregnancy?
About 7 in 1,000 pregnancies in the UK, under 1 in 100. It is more common in women of Indian-Asian or Pakistani-Asian origin, affecting up to 15 in 1,000.
What are the symptoms of cholestasis of pregnancy?
Itching without a rash, usually from 28 weeks, though it can start earlier. It often affects the palms of the hands and the soles of the feet, is often worse at night and can disturb sleep. Jaundice, a yellowing of the skin or the whites of the eyes, is rare.
The itching can come days or weeks before the blood tests become abnormal, so tests are sometimes repeated while the itching continues. Itching with a rash is usually something else: see rashes in pregnancy and itchy skin in pregnancy.
Is cholestasis in pregnancy an emergency?
The itching itself is not an emergency, but itchy palms or soles, or itching that keeps you awake, need blood tests promptly through your maternity unit. Fewer movements from your baby always need a call straight away.
How is cholestasis of pregnancy diagnosed?
With two blood tests:
- Liver function tests, which check how the liver is working.
- A bile acid test, which measures the level of bile acids in the blood, in micromol/L.
Bile acid levels are grouped as mild (19 to 39), moderate (40 to 99) and severe (100 or more). Raised bile acids can have other causes, which the team checks. Blood tests are usually repeated after a week, and some women's levels return to normal without treatment.
What are the risks for your baby, and when will your baby be born?
The risk depends on the highest bile acid level. With mild ICP the risk of stillbirth is no higher than in other pregnancies, and with moderate ICP it is similar until 38 to 39 weeks; with severe ICP it is higher, about 3 in 100 after 36 weeks. The birth is planned around that level.
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| Highest bile acid level | Risk of stillbirth | Planned birth |
|---|---|---|
| 19 to 39 micromol/L (mild) | No higher than without ICP | By 40 weeks may be considered, or waiting for labour |
| 40 to 99 micromol/L (moderate) | Similar to without ICP until 38 to 39 weeks | At 38 to 39 weeks |
| 100 micromol/L or more (severe) | Higher: about 3 in 100 after 36 weeks | At 35 to 36 weeks |
Gestational diabetes, pre-eclampsia or a multiple pregnancy can raise the risk and change the plan. ICP brings a small risk of birth before 37 weeks, and a small increase in admission to the neonatal unit, with no known long-term risk to the baby. A planned caesarean section is not needed just because of ICP.
Can a baby survive cholestasis?
Yes. Most people with ICP make a full recovery and have a healthy birth. The monitoring and the planned timing of the birth are there to keep the risk low.
How is cholestasis of pregnancy treated?
No treatment brings bile acid levels down reliably, so care focuses on easing the itch, monitoring you and your baby, and planning the birth at the right time.
- Ursodeoxycholic acid: may slightly reduce itching in some women and may lower the chance of a premature birth, but it does not prevent stillbirth.
- For the itch: aqueous cream, with or without menthol, cool baths, loose cotton clothes, and an antihistamine at night to help you sleep.
- Vitamin K: daily vitamin K is recommended for a small number of women.
- Monitoring: repeat blood tests, and noticing your baby's movements; extra scans are not needed for ICP alone.
- In labour: continuous monitoring of the baby's heartbeat if bile acids are 100 or more, or there are other risk factors.
After the birth, and the next pregnancy
The itching usually stops soon after the birth, although blood tests can take several weeks to return to normal. At the 6-week check, the itching should have gone, and your liver tests and bile acids are checked again; if they are still abnormal, you are referred to a specialist.
- Next pregnancy: ICP is more likely to come back, so ask for liver tests and bile acids early in your next pregnancy.
- Contraception: once your tests are normal, ICP does not limit your choice. If you develop itching on an oestrogen pill, such as the combined pill, get it checked straight away.
- Later life: hormone replacement therapy can still be taken in future.
What might the doctor recommend for itching in pregnancy?
What happens next depends on the itch, your stage of pregnancy and any results. This is the framework the doctors use:
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| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Your baby moving less than usual | Checking the baby | No | Maternity unit straight away |
| Itchy palms or soles without a rash | Bile acid and liver tests | Yes, to assess urgency | Maternity unit promptly for the tests |
| Itching with a rash | Looking for a skin cause | Yes | If the rash blisters, or you feel unwell |
| ICP diagnosed, questions about results | Explaining the risk and the birth plan | Yes | Monitoring and the birth with your maternity team |
| After the birth | The 6-week tests, contraception, next pregnancy | Yes | Blood tests at your practice |
Itching in pregnancy, or questions about your results? A doctor can go through them with you in one consultation.
See available times →Special situations
Cholestasis in an earlier pregnancy
Tell your midwife at booking, and ask for liver tests and bile acids at the start of the pregnancy.
Twins, gestational diabetes or pre-eclampsia
Each can raise the risk and change the timing of the birth; see gestational diabetes and pre-eclampsia.
Itching before 28 weeks
ICP usually starts after 28 weeks, but it can start earlier, so the same pattern needs the same tests.
When cholestasis of pregnancy is assessed online, and when you need in-person care
Assessed online: recognising the itch pattern, how urgently to have the tests, explaining results, risks and the birth plan, itch relief, and the 6-week check, contraception and the next pregnancy.
In-person care: the blood tests, monitoring, ursodeoxycholic acid and vitamin K, the birth, and any time your baby moves less.
When to get in-person care
Call 112 now for:
- heavy vaginal bleeding
- collapse, or a fit
Contact your maternity unit straight away, at any hour, for:
- your baby moving less than usual, or a change in the pattern
- itching of the palms or soles, or itching that keeps you awake at night
- yellowing of your skin or the whites of your eyes
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about the itching or your results: say where you itch, how many weeks pregnant you are, and any bile acid results.
- Leave with a plan: which tests you need and how urgently, what your results mean, what eases the itch, and which signs mean your maternity unit. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Itching in pregnancy can have more than one cause. Tick every symptom you have to see each page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
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Similar symptoms, different condition? Itchy Skin in Pregnancy can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about cholestasis of pregnancy
What is cholestasis of pregnancy?
A liver condition of pregnancy in which bile acids build up in the blood and cause itching. It is also called intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis.
What are the symptoms of cholestasis of pregnancy?
The main symptom of cholestasis of pregnancy is itching without a rash, usually from 28 weeks but sometimes earlier, often worst on the palms of the hands and the soles of the feet and worse at night, so it disturbs sleep. Some women have dark urine, pale poo, tiredness or loss of appetite, and jaundice, a yellowing of the skin or eyes, is rare. Scratch marks are common, but a rash with spots or weals points to another cause.
Is it cholestasis of pregnancy or ordinary pregnancy itching?
Mild itching is common in pregnancy as the skin stretches, and it usually affects the bump, comes with dry skin or a rash, and eases with moisturiser. Cholestasis of pregnancy itches without a rash, often on the palms and soles, is worse at night and does not ease with cream; a rash with weals points to hives, and itchy spots on the bump to the pregnancy rash PEP. Any itching without a rash after 28 weeks needs a bile acid test rather than guesswork.
How common is cholestasis of pregnancy?
Cholestasis of pregnancy affects about 7 in 1,000 pregnancies in the UK, and up to 15 in 1,000 in women of Indian-Asian or Pakistani-Asian origin, which makes it the most common liver condition specific to pregnancy. It is more likely with twins, a family history, hepatitis C, gallstones and in a pregnancy after a previous ICP, and it affects women of every age.
What causes cholestasis of pregnancy?
Cholestasis of pregnancy happens when pregnancy hormones, especially oestrogen and progesterone at their highest in the third trimester, slow the flow of bile out of the liver, so bile acids build up in the blood; genes play a large part, which is why it runs in families and is more common in some ethnic groups, and it is more likely with twins, a previous ICP, gallstones or hepatitis C. It is not caused by anything you ate or did.
How is cholestasis of pregnancy diagnosed?
Cholestasis of pregnancy is diagnosed from itching without a rash together with a raised bile acid level on a blood test, usually with liver function tests as well; other causes of liver trouble are ruled out if the picture is unusual. Tests are often repeated every week or two while the itching continues, because the itching can start days or weeks before the blood results change.
Is cholestasis in pregnancy an emergency?
Cholestasis of pregnancy is not an emergency in itself, but the itch needs blood tests promptly through your maternity unit, because the bile acid level decides how closely you and your baby are monitored and when the birth is planned. Fewer movements from your baby always need a call to the maternity unit straight away, whatever the stage of pregnancy and whatever the last test showed.
Can a baby survive cholestasis?
Yes. Most people with cholestasis of pregnancy have a healthy birth. The risk depends on the bile acid level, and the timing of the birth is planned around it.
Is delivery by 37 weeks necessary for cholestasis?
Not usually. With cholestasis of pregnancy, a birth at 35 to 36 weeks is recommended only for levels of 100 or more; at 40 to 99 it is 38 to 39 weeks, and with mild ICP up to 40 weeks.
Does ursodeoxycholic acid help?
Ursodeoxycholic acid may slightly reduce the itching of cholestasis of pregnancy and may lower the chance of a premature birth, but the largest trial found it does not improve outcomes for the baby and it does not prevent stillbirth, so it is no longer routinely recommended for everyone; your maternity team may still offer it for severe itching. Nothing replaces the monitoring of bile acids and the planned timing of the birth.
What helps the itching?
For the itching of cholestasis of pregnancy, aqueous cream with or without menthol, kept in the fridge, cool baths or showers, loose cotton clothes, keeping the bedroom cool and a sedating antihistamine at night to help you sleep all help a little, and keeping nails short limits damage from scratching. The itch goes only when the pregnancy ends, which is why it is treated by planning the birth rather than with creams.
Will cholestasis come back in my next pregnancy?
Cholestasis of pregnancy is likely to come back: most women who have had it get it again in a later pregnancy, often earlier and sometimes more severely. Tell your midwife at the booking appointment, ask for liver function tests and bile acids early and whenever you itch, and know that it can also be triggered by the combined pill or HRT, which are usually avoided afterwards.
Does cholestasis of pregnancy go away after the birth?
Yes. The itching of cholestasis of pregnancy usually stops soon after the birth, although the blood tests can take several weeks to return to normal, which is why a blood test is arranged about 6 weeks after the birth to check that the liver and bile acids have settled. Cholestasis of pregnancy is more likely to come back in a next pregnancy, so ask for liver tests and bile acids early next time, and tell the team if the itching returns.
Can an online doctor help with cholestasis of pregnancy?
Yes, with the assessment of your itching, explaining your bile acid and liver results, what they mean for the timing of the birth, and relief for the itch; a doctor can also tell you how urgently you need tests. The blood tests, monitoring of your baby and planning the birth are with your maternity team, and fewer movements need the maternity unit straight away.
- Intrahepatic cholestasis of pregnancy: patient information, RCOG, Royal College of Obstetricians and Gynaecologists, 2022, updated April 2026.
- Itching and intrahepatic cholestasis of pregnancy, NHS, National Health Service (UK), reviewed 24 February 2026.
- Your baby's movements, NHS, National Health Service (UK), reviewed 8 July 2024.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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