A spectrum of liver diseases can affect women both during pregnancy and after delivery. Four pregnancy-specific liver diseases include:

1. Intrahepatic cholestasis of pregnancy (ICP)
2. Acute fatty liver disease of pregnancy (AFLDP)
3. Haemolysis elevated liver enzymes low platelets (HELLP) syndrome
4. Hyperemesis gravidarum (HG)

Intrahepatic cholestasis of pregnancy (ICP) affects the movement of bile from the liver, reducing its flow and resulting in its accumulation. Accumulation of bile can cause damage to liver cells, inflammation and consequent irritation of tissue and interference with liver function. ICP is likely due to increased hormones in the blood due to pregnancy, which slow down bile movement.

Typical symptoms

Symptoms of ICP include a general feeling of being unwell, severe pruritis or skin itching and, in some cases, jaundice.

Diagnosis

ICP is only definitively diagnosed after the mother has given birth. This is due to the fact that raised liver enzymes and bile salts in blood analyses will return to normal at that point, having been elevated during pregnancy. If the symptoms are caused by another disease, the woman’s liver blood tests will likely remain elevated post-delivery. A medical history might reveal other cases of ICP within the family, which could assist diagnosis.

Incidence

Approximately 3% to 10% of all pregnancies are affected by pregnancy-related liver disease, with ICP identified as affecting one in 140 or 0.7% of pregnancies.

Treatment

Treatment and management aim to keep mother and baby safe and well. Management of symptoms with medication and skin soothing treatment, in addition to close monitoring by a multi-disciplinary team will occur throughout the pregnancy.

Prognosis

If not managed and monitored closely, ICP can result in pregnancy complications. Additionally, in a survey conducted in 2021, 78% of respondents admitted a diagnosis of ICP during pregnancy resulted in significant stress.