Intrahepatic Cholestasis of Pregnancy: Itching, Bile Acids and the Baby

Table of Contents

1. What the Condition Is
2. How Common It Is Around the World
3. Causes: Hormones, Genes and the Seasons
4. How It Is Diagnosed
5. Risks to the Baby by Bile Acid Level
6. What It Means for the Mother
7. Ursodeoxycholic Acid: What the Trials Found
8. S-Adenosylmethionine and Other Drugs
9. Timing of Birth in Published Guidelines
10. Later Pregnancies and Later Life
11. What Is Not Known
12. Key Research Papers
13. Connections
14. Featured Videos

What the Condition Is

Bile is the fluid the liver makes to help digest fat. It carries bile acids out of the liver, through the bile ducts and into the gut. In intrahepatic cholestasis of pregnancy that outflow slows inside the liver itself (that is what "intrahepatic cholestasis" means), and bile acids build up in the mother's blood. They also cross the placenta to the baby.

The Royal College of Obstetricians and Gynaecologists describes the condition in its 2022 guideline as itching without a primary skin condition, together with abnormal bile acid levels in the mother. Its main points:

• Itching. It is often all over the body and often affects the palms of the hands and the soles of the feet. It is often worse at night and can disturb sleep. The skin looks normal apart from scratch marks.
• Timing. It is most common in the third trimester but can begin earlier. The Royal College's patient leaflet says the itch usually begins after 28 weeks.
• After the birth. The guideline states that for most women the itch stops within hours or days of the birth, and that bile acids and the other liver tests return to normal.
• Other signs are uncommon. Dark urine and pale stools are seldom reported. The guideline puts jaundice (yellowing of the skin or eyes) at under 1% of women with the condition, and usually mild when it happens. Liver failure is not a typical feature.

Itching in pregnancy is common in its own right. The Royal College puts it at around 25% of pregnant women, and most of them do not have and do not develop intrahepatic cholestasis of pregnancy. An itch with a visible rash points to other conditions, such as pemphigoid gestationis. The site's general page on itching covers the wider list of causes.

How Common It Is Around the World

How often intrahepatic cholestasis of pregnancy occurs depends a great deal on where a woman lives and on her ancestry. A 2022 genetic study summed up the overall range as 0.5–2% of pregnancies.

• United Kingdom. The Royal College guideline gives 0.7% of pregnancies in mixed-ethnic populations, and 1.2–1.5% among women of Indian-Asian or Pakistani-Asian origin.
• Severe cases in the UK. A national surveillance study of 2010–2011 counted 713 confirmed cases of severe intrahepatic cholestasis of pregnancy, an estimated 9.2 per 10,000 births.
• Denmark. Among 668,461 first-time mothers who gave birth between 1995 and 2018, 6,722 (1.0%) were diagnosed.
• Sweden. A study from southern Sweden recorded 1.5% of pregnancies in 1971–74 and 1.0% in 1980–82.
• Chile. Chile has some of the highest rates ever recorded. In a 1978 survey of 869 women just after the birth, 2.4% had cholestatic jaundice of pregnancy and 13.2% had pregnancy itch of this kind. Rates were higher in women of Araucanian (Mapuche) descent, at 5.5% and 22.1%. The same Chilean group later reported that the condition had become less common there during the 1990s.
• United States community data. A population study in Olmsted County, Minnesota, found 26 cases among 35,101 pregnancies from 1996 to 2010. The authors noted that liver diseases unique to pregnancy were less common there than in reports from Europe or from US referral hospitals.

These numbers come from different eras and use different definitions. The older Chilean and Swedish figures, for example, counted itching with or without blood test changes. That makes the figures hard to compare directly.

Causes: Hormones, Genes and the Seasons

The cause is not fully known. A 2009 review by Geenes and Williamson summed up the leading explanation: the condition likely comes from the cholestatic effects of reproductive hormones and their breakdown products in women who are genetically susceptible. Estrogen and progesterone levels climb steeply in late pregnancy, which matches when the condition usually appears. The 1986 Swedish study adds a clue. Many affected women had itched in earlier pregnancies and while taking contraceptive pills, and described itching in their mothers and sisters.

Genes

• ABCB4 and ABCB11. These genes make two pumps that move bile components out of liver cells. ABCB11 makes the bile salt export pump. ABCB4 makes a pump that moves phospholipids into bile. A 2024 review by Zöllner, Williamson and Dixon reports that variants in these two genes play a significant role in about 20% of severe cases. The review names other genes as well (ATP8B1, NR1H4, ABCC2, TJP2, SERPINA1, GCKR and HNF4A). It adds that ABCB4 variants also raise the risk of drug-induced cholestasis, gallstones, gallbladder and bile duct cancer, cirrhosis and abnormal liver tests.
• Common variants. A 2022 genome-wide study of 1,138 cases and 153,642 controls found eleven regions of the genome linked to the condition, mostly in genes active in the liver.
• Families. In the Danish national study, the condition occurred in 5.3% of the twin sisters of affected women and 2.6% of their first-degree relatives. That is about 5 times and 2.5 times the expected risk. Second- and third-degree relatives showed no clear increase.

Season and climate

Several studies describe the condition rising and falling with the seasons:

• The Swedish study found a clear seasonal pattern, with cases peaking in November.
• The Chilean group reported fewer cases in summer. This matched higher blood selenium in summer, and the fall in cases over the 1990s matched a rise in selenium levels. These are associations, and they do not show that selenium prevents the condition.
• Even in healthy pregnancies, an Italian study of 612 women at term found bile acid levels were highest in winter.
• A 2026 study of 48,081 pregnancies in two Chinese cities linked higher temperature, strong sunlight and fine-particle air pollution (PM2.5) with more cases in temperate Shanghai, but found no seasonal swing in tropical Sanya.

The seasonal findings do not all point the same way, and no single environmental trigger has been confirmed.

How It Is Diagnosed

No single test proves the condition. Diagnosis rests on otherwise unexplained itching plus a raised bile acid level, after other causes have been considered. The major guidelines differ on the exact cut-off.

• Royal College of Obstetricians and Gynaecologists (2022). A bile acid level of 19 µmol/L or more in pregnancy supports the diagnosis. Blood need not be drawn fasting. The guideline says that with this cut-off, almost 20% of women who would earlier have been labelled with the condition no longer meet it. It also states that a raised liver enzyme with normal bile acids is not enough for the diagnosis. The guideline's reasoning is that only total bile acids, not the liver enzymes, track the risk of stillbirth.
• Society for Maternal-Fetal Medicine (2021). This US guideline recommends measuring serum bile acids and liver transaminases (alanine aminotransferase and aspartate aminotransferase) when the condition is suspected. A 2023 comparison by Horgan and colleagues notes that the Society counts any bile acid level above the laboratory's upper limit of normal, in a woman who itches, as diagnostic.
• Normal values in pregnancy. The Italian study of 612 healthy pregnant women at term set reference ranges of 4.4–14.1 µmol/L fasting and 4.7–20.2 µmol/L two hours after a meal. Its authors concluded that normal pregnancy carries a mild rise in bile acids, so a higher diagnostic threshold is warranted.
• Other causes. The Royal College lists pre-eclampsia, drug reactions, allergic reactions, hives and skin disease as conditions to rule out. Its 2022 guideline dropped routine viral, autoimmune and ultrasound tests, because a review of more than 500 women found they turned up no unexpected diagnoses. It reserves extra tests for unusual pictures, such as onset in the first or second trimester, very high liver enzymes, rapid worsening, signs of liver failure, or a condition that does not clear after the birth.
• Itch can come before the blood tests change. The guideline reports that the condition can develop up to 15 weeks after itching first began with normal results, which is why tests are repeated when the itch persists.

A 2025 review of six national guidelines (from the US, UK, Canada, Australia and New Zealand, China and Germany) found broad agreement on the definition but small differences in bile acid cut-offs. The site's page on the liver and pancreas tests describes the standard liver panel.

Risks to the Baby by Bile Acid Level

The central study is a 2019 meta-analysis in The Lancet by Ovadia and colleagues. It pooled 23 studies (5,557 women with the condition and 165,136 without) and gathered the individual records of 5,269 affected women from 27 studies. Stillbirth occurred in 0.83% of affected pregnancies and 0.32% of comparison pregnancies, but that overall difference was not statistically clear (odds ratio 1.46, 95% confidence interval 0.73–2.89). The clear signal appeared only when the women were sorted by their highest bile acid level. In single (not twin) pregnancies:

The peak bile acid level predicted stillbirth well, while alanine aminotransferase did not predict it at all. The authors concluded that most women with the condition have bile acids below 100 µmol/L. For them, they wrote, the stillbirth risk is probably similar to that of pregnant women in general, provided bile acids are re-tested until the birth. The Royal College guideline adopted this reading. Its patient leaflet puts the risk at around 3 in 100 women with bile acids of 100 µmol/L or more having a stillbirth after 36 weeks.

Other risks to the baby:

• Preterm birth. The 2010–2011 UK national study looked at 669 single pregnancies with severe disease (bile acids of 40 µmol/L or more). It found preterm birth in 25%, against 6.5% of controls. Some of these births began on their own; others were planned early by the care team.
• Neonatal unit admission. In the same study, 12% of babies were admitted to a neonatal unit, against 5.6% of controls.
• Meconium. The baby's first stool passed into the amniotic fluid before birth. In the UK study, the risks of preterm birth, meconium-stained fluid and stillbirth all rose as the mother's bile acids rose.
• Other complications add risk. The UK study recorded 10 stillbirths (1.5%, against 0.5% in controls), and 7 of the 10 occurred in pregnancies that also had another complication.
• Twins. The Royal College cites a Chinese study of 129 twin pregnancies with the condition, where stillbirth occurred in 3.9%, against 0.8% in twin pregnancies without it.

How bile acids harm the baby is not settled. Laboratory work by Williamson and colleagues found that taurocholate, the main bile acid that rises on the baby's side, disturbs the rhythm of heart muscle cells grown in the lab. One explanation is a sudden fetal heart rhythm problem. Another, which the Royal College guideline mentions, is sudden spasm of the placental blood vessels. This is why stillbirth in this condition is thought to be sudden, and why routine scans and monitoring do not reliably give warning, as the guideline reports.

What It Means for the Mother

The Society for Maternal-Fetal Medicine describes the condition as posing little risk to the mother herself. The burden is the itch, which the Royal College describes as ranging from mild to unbearable. Its severity does not track the bile acid level, and it can harm sleep and mental wellbeing. The same meta-analysis of more than 5,000 affected women, as summarised in the Royal College guideline, also found two other pregnancy conditions more often:

• Pre-eclampsia in 12.2% of women with the condition, against 3.4% without it (odds ratio 3.7). See pre-eclampsia.
• Gestational diabetes in 13.2%, against 5.9% (odds ratio 2.4). See gestational diabetes.

The guideline also reports that fatty stools (steatorrhoea) may occur and may come with poor absorption of vitamin K, the vitamin needed for blood clotting. It notes that most women with the condition show no sign of fat malabsorption. Three cohorts (223, 531 and 745 women) found no prolonged clotting times in uncomplicated cases.

The Royal College patient leaflet asks women with the condition to watch their baby's movements and to go to their maternity unit if they are worried about them. Maternity units treat a change in the baby's movements as urgent.

Ursodeoxycholic Acid: What the Trials Found

Ursodeoxycholic acid is a naturally occurring bile acid. It is less damaging to cells than the bile acids that build up in cholestasis, and it has long been the usual drug for this condition. The same drug is used for primary biliary cholangitis. Its record in pregnancy has been tested in two large ways, and the results point in different directions.

PITCHES, the largest trial

The PITCHES trial (Chappell and colleagues, The Lancet, 2019) enrolled 605 women at 33 maternity units in England and Wales. They were given either ursodeoxycholic acid (the trial gave 500 mg twice a day, adjustable) or a placebo. The main outcome was a combined measure for the baby: death around the time of birth, preterm birth, or neonatal unit admission for at least 4 hours.

• The combined outcome occurred in 74 of 322 babies (23%) in the ursodeoxycholic acid group and 85 of 318 (27%) in the placebo group. The adjusted risk ratio was 0.85, with a 95% confidence interval of 0.62–1.15, so the difference was not significant.
• There were two serious adverse events in the drug group and six in the placebo group. None were judged related to treatment.
• The authors concluded that ursodeoxycholic acid does not reduce harm to babies in this condition and that its routine use should be reconsidered.

The 2020 Cochrane review

The 2020 Cochrane review (Walker and colleagues) covered 26 trials with 2,007 women. It judged only two placebo-controlled ursodeoxycholic acid trials (715 women) to be at low risk of bias.

• Itch. The drug probably brings a small improvement: 7.64 points on a 100-point itch scale. The reviewers judged that for most women and clinicians this may fall below the smallest change worth having.
• The baby. The evidence on fetal distress (risk ratio 0.70, 95% CI 0.35–1.40) and stillbirth (risk ratio 0.33, 95% CI 0.08–1.37) was rated very low certainty.

The 2021 individual-records meta-analysis

Ovadia and colleagues (2021) pooled records from 6,974 women in 34 studies, 4,726 of whom took ursodeoxycholic acid. The findings point both ways:

• Stillbirth across all studies: 0.7% with the drug and 0.6% without (adjusted odds ratio 1.04, 95% CI 0.35–3.07). No effect.
• Stillbirth or preterm birth across all studies: no effect (adjusted odds ratio 1.28, 95% CI 0.86–1.91).
• Stillbirth or preterm birth in randomised trials only: lower with the drug (adjusted odds ratio 0.60, 95% CI 0.39–0.91).

The authors wrote that the low number of stillbirths probably limited the analysis. They read the randomised-trial result as evidence of benefit.

Where the guidelines landed

The guidelines split. The Society for Maternal-Fetal Medicine (2021) recommends ursodeoxycholic acid as the first-line drug for the mother's symptoms. The Royal College (2022), according to the 2023 comparison by Horgan and colleagues, recommends against its routine use because of a lack of evidence of benefit to either mother or baby. A 2025 review of six national guidelines found that every guideline except the Royal College's recommends the drug as first-line treatment for symptoms.

S-Adenosylmethionine and Other Drugs

S-adenosylmethionine (SAMe) is a compound the body makes from the amino acid methionine. It is involved in liver chemistry. In some countries it is a prescription drug for cholestasis. The site's SAM-e page covers it in general.

• A placebo-controlled trial. Ribalta and colleagues (Chile, 1991) gave 18 women with moderately severe to severe disease either intravenous S-adenosylmethionine (900 mg a day for 20 days) or a placebo. The paper's own title calls it a study "with negative results". There was no difference in itch, bile salts, alanine aminotransferase, bilirubin or alkaline phosphatase.
• Head-to-head with ursodeoxycholic acid. A 2016 meta-analysis of five randomised trials (311 patients) found that ursodeoxycholic acid lowered itch scores, bile acids and alanine aminotransferase more than S-adenosylmethionine did. Preterm birth was also less common with ursodeoxycholic acid (risk ratio 0.48). Using the two drugs together lowered some blood markers and preterm birth compared with S-adenosylmethionine alone.
• The 2020 Cochrane review. It found insufficient evidence that S-adenosylmethionine works for this condition. It reached the same verdict for guar gum, activated charcoal, dexamethasone, cholestyramine and several Chinese herbal medicines (Yinchenghao decoction, Salvia, Danxioling and Yiganling). It also found no trials of skin emollients for the itch.

The Royal College guideline states that there is no evidence that any routine drug treatment improves raised bile acids or outcomes for the baby. A trial comparing ursodeoxycholic acid with the antibiotic rifampicin in severe, early-onset disease (TURRIFIC) was under way when the 2020 Cochrane review was published.

Timing of Birth in Published Guidelines

Because stillbirth risk climbs late in pregnancy at the highest bile acid levels, the main decision in care is when the baby is born. The guidelines set timing by bile acid level, and they differ.

Royal College of Obstetricians and Gynaecologists, 2022

For a single pregnancy with no other complications, the Royal College patient leaflet sets out these bands:

• Peak bile acids 19–39 µmol/L: planned birth by the due date (40 weeks) may be considered. Waiting for labour is also an option, since the stillbirth risk is no different from that of women without the condition.
• 40–99 µmol/L: planned birth at 38–39 weeks may be recommended.
• 100 µmol/L or more: planned birth at 35–36 weeks may be recommended.

Horgan and colleagues note that the Royal College does not recommend fetal testing beyond counting the baby's movements, and that it uses repeated bile acid tests to guide timing.

Society for Maternal-Fetal Medicine, 2021 (Consult Series #53)

• Bile acids of 100 µmol/L or more: it recommends offering delivery at 36 weeks, because the stillbirth risk rises substantially around that point.
• Below 100 µmol/L: it recommends delivery between 36 and 39 weeks.
• No laboratory confirmation: it recommends against delivery before 37 weeks for women with the clinical picture but no confirmed rise in bile acids.
• Steroids for the baby's lungs: it recommends them if birth comes before 37 weeks and they were not already given.
• Monitoring: it suggests fetal surveillance from the stage of pregnancy at which an abnormal result would lead to delivery.

A search of PubMed and Europe PMC for this page did not find a newer Society for Maternal-Fetal Medicine consult on this condition after the 2021 one. The 2025 review of six guidelines found the guidelines inconsistent on how to grade the condition, how often to repeat bile acids, whether to monitor the baby, and when to deliver.

Later Pregnancies and Later Life

Recurrence

• A 2026 US cohort (Rosenberg and colleagues) found that 46 of 104 women (44%) had the condition again in their next pregnancy. The authors noted that earlier reports range from 40% to 90%. A peak bile acid level above 40 µmol/L in the first affected pregnancy predicted recurrence. Shorter gaps between pregnancies went with a lower risk.
• In the Minnesota population study, 35% of women with the condition later had a liver disease unique to pregnancy again, over a median follow-up of 7 years.
• The Royal College leaflet states that the chance of recurrence is raised, and that liver tests and bile acids are checked early in later pregnancies.

Liver and gallbladder disease later on

A Swedish national study (Marschall and colleagues, 2013) compared 11,388 women who had the condition with 113,893 who had not, for births from 1973 to 2009. The women who had the condition were more often diagnosed later with:

• any liver or bile duct disease (hazard ratio 2.62);
• gallstone disease (2.72) and cholangitis, an infection of the bile ducts (4.22);
• hepatitis C (4.16), chronic hepatitis (5.96), and liver fibrosis or cirrhosis (5.11).

Women who had hepatitis C or gallstones before pregnancy were also more likely to develop the condition. The Royal College puts these risks in context. It notes that gallstones affect 5–25% of adults in high-income countries, and that it is unclear whether the gallstones came before the pregnancy condition. See gallstones.

Cancer, immune and heart disease

A follow-up of the same Swedish cohort (Wikström Shemer and colleagues, 2015) found:

• No rise in overall cancer (hazard ratio 1.07).
• More liver cancer (3.61) and more biliary tract cancer (2.62).
• More immune-related disease (1.28), including diabetes (1.47), thyroid disease (1.30), psoriasis (1.27), inflammatory joint disease (1.32) and Crohn's disease (1.55), but not ulcerative colitis.
• A small rise in cardiovascular disease (1.12).

The Royal College notes that most of these conditions remain uncommon in absolute terms. It does not recommend routine screening for them after the condition.

Hepatitis C testing

The guidelines differ here too. The Society for Maternal-Fetal Medicine's 2021 hepatitis C consult suggests screening for viral hepatitis in women diagnosed early in pregnancy or with high bile acids. The Royal College does not recommend routine hepatitis C testing for the condition. It reserves testing for atypical cases. See hepatitis C.

What Is Not Known

• Why stillbirth happens. Fetal heart rhythm problems and placental vessel spasm are leading ideas, mostly from laboratory work. Neither has been proven in pregnant women.
• Whether any drug protects the baby. PITCHES and the Cochrane review found no clear benefit from ursodeoxycholic acid. The 2021 meta-analysis found a benefit only in the randomised-trial subset. Too few stillbirths occur for any trial so far to answer the stillbirth question directly.
• An effective treatment for the itch. The Cochrane review found no treatment with more than a small effect on itching, and no trials of emollients.
• The right cut-off and the right test. Guidelines use different bile acid thresholds and differ on fasting versus non-fasting samples. Bile acid assays also vary between laboratories, a problem large trials have had to correct for.
• The best time for birth at moderate levels. For bile acids of 40–99 µmol/L, the stillbirth difference in the 2019 meta-analysis was not statistically clear. The guidelines' timing advice at that level rests on limited data.
• The environmental trigger. Seasonal and climate patterns are reported. Selenium was proposed in Chile. No trigger has been confirmed.
• Long-term follow-up. The later-life risks come mainly from Swedish registers. The Royal College notes that few studies have followed women after the birth in detail.

Key Research Papers

1. Ovadia C, Seed PT, Sklavounos A, Geenes V, Di Ilio C, Chambers J, et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet. 2019;393(10174):899-909. PubMed PMID: 30773280
2. Chappell LC, Bell JL, Smith A, Linsell L, Juszczak E, Dixon PH, Chambers J, Hunter R, Dorling J, Williamson C, Thornton JG. Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial. Lancet. 2019;394(10201):849-860. PubMed PMID: 31378395
3. Walker KF, Chappell LC, Hague WM, Middleton P, Thornton JG. Pharmacological interventions for treating intrahepatic cholestasis of pregnancy. Cochrane Database of Systematic Reviews. 2020;7(7):CD000493. PubMed PMID: 32716060
4. Ovadia C, Sajous J, Seed PT, Patel K, Williamson NJ, Attilakos G, et al. Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a systematic review and individual participant data meta-analysis. Lancet Gastroenterology & Hepatology. 2021;6(7):547-558. PubMed PMID: 33915090
5. Zhang Y, Lu L, Victor DW, Xin Y, Xuan S. Ursodeoxycholic acid and S-adenosylmethionine for the treatment of intrahepatic cholestasis of pregnancy: a meta-analysis. Hepatitis Monthly. 2016;16(8):e38558. PubMed PMID: 27799965
6. Ribalta J, Reyes H, Gonzalez MC, Iglesias J, Arrese M, Poniachik J, Molina C, Segovia N. S-adenosyl-L-methionine in the treatment of patients with intrahepatic cholestasis of pregnancy: a randomized, double-blind, placebo-controlled study with negative results. Hepatology. 1991;13(6):1084-9. PubMed PMID: 2050326
7. Girling J, Knight CL, Chappell L; Royal College of Obstetricians and Gynaecologists. Intrahepatic cholestasis of pregnancy: Green-top Guideline No. 43 June 2022. BJOG: An International Journal of Obstetrics and Gynaecology. 2022;129(13):e95-e114. PubMed PMID: 35942656
8. Society for Maternal-Fetal Medicine; Lee RH, Mara Greenberg, Metz TD, Pettker CM. Society for Maternal-Fetal Medicine Consult Series #53: Intrahepatic cholestasis of pregnancy: Replaces Consult #13, April 2011. American Journal of Obstetrics and Gynecology. 2021;224(2):B2-B9. PubMed PMID: 33197417
9. Horgan R, Bitas C, Abuhamad A. Intrahepatic cholestasis of pregnancy: a comparison of Society for Maternal-Fetal Medicine and the Royal College of Obstetricians and Gynaecologists' guidelines. American Journal of Obstetrics & Gynecology MFM. 2023;5(3):100838. PubMed PMID: 36503152
10. Giouleka S, Zafeirati C, Siargkas A, Michos G, Stavros S, Potiris A, Mamopoulos A, Kalogiannidis I, Dagklis T, Tsakiridis I. Intrahepatic cholestasis of pregnancy: a comparative review of guidelines. Obstetrical & Gynecological Survey. 2025;80(11):717-730. PubMed PMID: 41194372
11. Dotters-Katz SK, Kuller JA, Hughes BL; Society for Maternal-Fetal Medicine. Society for Maternal-Fetal Medicine Consult Series #56: Hepatitis C in pregnancy-updated guidelines: Replaces Consult Number 43, November 2017. American Journal of Obstetrics and Gynecology. 2021;225(3):B8-B18. PubMed PMID: 34116035
12. Geenes V, Chappell LC, Seed PT, Steer PJ, Knight M, Williamson C. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Hepatology. 2014;59(4):1482-91. PubMed PMID: 23857305
13. Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World Journal of Gastroenterology. 2009;15(17):2049-66. PubMed PMID: 19418576
14. Huri M, Seravalli V, Lippi C, Tofani L, Galli A, Petraglia F, Di Tommaso M. Intrahepatic cholestasis of pregnancy - time to redefine the reference range of total serum bile acids: a cross-sectional study. BJOG: An International Journal of Obstetrics and Gynaecology. 2022;129(11):1887-1896. PubMed PMID: 35373886
15. Dixon PH, Levine AP, Cebola I, Chan MMY, Amin AS, Aich A, et al. GWAS meta-analysis of intrahepatic cholestasis of pregnancy implicates multiple hepatic genes and regulatory elements. Nature Communications. 2022;13(1):4840. PubMed PMID: 35977952
16. Zöllner J, Williamson C, Dixon PH. Genetic issues in ICP. Obstetric Medicine. 2024;17(3):157-161. PubMed PMID: 39262913
17. Li J, Chen J, Lee PMY, Zhang J, Li F, Ren T. Familial clustering of intrahepatic cholestasis of pregnancy: a nationwide population-based study in Denmark. Hepatology. 2023;78(2):389-396. PubMed PMID: 36815353
18. Reyes H, Gonzalez MC, Ribalta J, Aburto H, Matus C, Schramm G, Katz R, Medina E. Prevalence of intrahepatic cholestasis of pregnancy in Chile. Annals of Internal Medicine. 1978;88(4):487-93. PubMed PMID: 637428
19. Reyes H, Báez ME, González MC, Hernández I, Palma J, Ribalta J, Sandoval L, Zapata R. Selenium, zinc and copper plasma levels in intrahepatic cholestasis of pregnancy, in normal pregnancies and in healthy individuals, in Chile. Journal of Hepatology. 2000;32(4):542-9. PubMed PMID: 10782901
20. Berg B, Helm G, Petersohn L, Tryding N. Cholestasis of pregnancy. Clinical and laboratory studies. Acta Obstetricia et Gynecologica Scandinavica. 1986;65(2):107-13. PubMed PMID: 3727939
21. Allen AM, Kim WR, Larson JJ, Rosedahl JK, Yawn BP, McKeon K, Hay JE. The epidemiology of liver diseases unique to pregnancy in a US community: a population-based study. Clinical Gastroenterology and Hepatology. 2016;14(2):287-94.e1-2. PubMed PMID: 26305066
22. Rosenberg HM, Sarker MR, Ramos GA, Bianco A, Ferrara L, DeBolt CA. Intrahepatic cholestasis of pregnancy recurrence in a subsequent pregnancy. Obstetrics and Gynecology. 2026;147(2):239-241. PubMed PMID: 40811826
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24. Wikström Shemer EA, Stephansson O, Thuresson M, Thorsell M, Ludvigsson JF, Marschall HU. Intrahepatic cholestasis of pregnancy and cancer, immune-mediated and cardiovascular diseases: a population-based cohort study. Journal of Hepatology. 2015;63(2):456-61. PubMed PMID: 25772037
25. Williamson C, Miragoli M, Sheikh Abdul Kadir S, Abu-Hayyeh S, Papacleovoulou G, Geenes V, Gorelik J. Bile acid signaling in fetal tissues: implications for intrahepatic cholestasis of pregnancy. Digestive Diseases. 2011;29(1):58-61. PubMed PMID: 21691106
26. Chen X, Zou C, Liu Y, Zhao R, Sun H, Liu X, Shen Q, Yang Y, Du Q. Relation of climatic exposures with intrahepatic cholestasis of pregnancy in a two-center retrospective cohort. Frontiers in Endocrinology. 2026;17:1924211. PubMed PMID: 42666169

PubMed Topic Searches

1. PubMed: intrahepatic cholestasis of pregnancy, bile acids and stillbirth
2. PubMed: ursodeoxycholic acid trials in intrahepatic cholestasis of pregnancy
3. PubMed: ABCB4 and ABCB11 in intrahepatic cholestasis of pregnancy
4. PubMed: timing of delivery in intrahepatic cholestasis of pregnancy
5. PubMed: later liver and gallbladder disease after intrahepatic cholestasis of pregnancy

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Connections

• Reproductive Medicine — the parent section for pregnancy conditions
• Itching (Pruritus) — the wider list of causes of itch
• SAM-e (S-Adenosylmethionine) — the compound tested as a treatment
• Primary Biliary Cholangitis — another cholestatic liver disease treated with ursodeoxycholic acid
• Methionine for Liver Health — the methionine and liver background
• Preeclampsia — more common alongside this condition
• Gestational Diabetes — also more common alongside it
• Preterm Labor — one of the main risks to the baby
• Gallstones — more common in later life after the condition
• Pemphigoid Gestationis — a pregnancy itch that does come with a rash

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