Short on time? Then the key things to know are:

• Itching affects about 1 in 4 pregnant women and so is completely normal
• It is most often harmless, but if severe, can indicate intrahepatic cholestasis (ICP)
• ICP affects the liver during pregnancy and gets better once your baby is born
• The cause of ICP is not yet fully understood but the main symptom is itching without a skin rash - if you have this you should call your GP or midwife
• Medication can be given to relieve itching including Aqueous cream with menthol

 

There are a wide range of things that happen when you fall pregnant. Hair growth, food cravings, swollen feet… we go through it all! But one side effect that catches many women by surprise is itching.

Why do we feel itchy in pregnancy? And how can we treat it? Here our pregnancy experts answer your common questions about the common itch!

Itching during pregnancy - what can be done to help?

Is it normal to feel itchy all over when pregnant?

Itching is a common symptom throughout pregnancy, affecting 23% of pregnant women. Normally it is related to the change in hormones in your body and the stretching of your skin over a growing bump.

Whilst the skin stretches, the oil glands cannot meet their normal moisture requirement which could be why you have dry and itchy skin in pregnancy, often worse on your tummy and legs. If you suffered from eczema before getting pregnant, this may worsen in pregnancy causing itchiness.

There is often no rash associated with pregnancy itching. If a new rash is present, notify your GP or midwife as this may be attributable to other pregnancy-related conditions such as polymorphic eruption of pregnancy.

Mild body itching is not usually harmful to you or your baby, but it may signify a more serious condition. If you find your itching is distressing, worse at night, particularly on your hands and feet (but can be all over your body) this may need further investigation. Feeling an itch like this may be attributable to intrahepatic cholestasis and needs to be investigated.

Is it normal to get itchy breasts/nipples during pregnancy?

As well as experiencing itchiness over your abdomen, it is also possible to experience itchy breasts and for a similar reason. The breasts tend to grow and expand as the pregnancy progresses so the skin becomes stretched and may become dry and itchy as a result.

It is perfectly normal to go up one or two bra sizes in the first few months of pregnancy, so don’t be too alarmed. Keep the skin moisturised and keep yourself well hydrated to help combat this dryness and itchiness. It is also worth getting yourself measured and fitted for a comfortable bra during your pregnancy and again after you’ve had the baby as your breasts are likely to fluctuate massively over the next few months.

The nipples can at times become a little dry and cracked, this is again due to pregnancy hormone fluctuations and the stretching and growing of the breasts and nipples. A simple nipple cream, or moisturiser can help in this situation. Discover more about how to treat dry and cracked nipples during pregnancy.

Some women experience leaking from their breasts from quite early on in pregnancy. At times if you leak just a tiny bit of colostrum milk, these droplets can dry on the nipples and become quite flaky. Again, this is not a reason to be alarmed and can be very common - this is what your body is supposed to do during pregnancy.

How to stop itching in pregnancy

Normally, itching while pregnant is harmless, although it can be very irritating. Here are a few things you can do to try and stop the itch/scratch cycle:

• Take cool baths for temporary relief
• Wear loose fitting clothing, and try to avoid synthetic materials and choose natural ones like cotton
• Use a simple moisturiser and try to avoid heavily perfumed products as these may make the itching worse

If the itch is getting you down or you are concerned, do raise it with a clinician, midwife or doctor.

Help! I’m itching ‘down there’ in my early pregnancy

Vaginal itching, or an itchy vulva in pregnancy is a common experience and is often due to the hormonal changes to the vagina during this time. Sometimes it can signify an infection - especially If accompanied by new vaginal discharge - most commonly yeast infections (thrush) which are more common in pregnancy. Other infections causing itching include bacterial vaginosis and trichomoniasis.

If you have a new vaginal discharge, or are concerned about vaginal itching during pregnancy speak with your healthcare professional, as some over the counter treatments are not safe to use while pregnant.

Severe itching: intrahepatic cholestasis

Itching in the ninth month, or later in pregnancy (which can start on the palms of the hands and soles of the feet) could signify intrahepatic cholestasis (ICP), also referred to as obstetric cholestasis.

Typically, this starts in the third trimester (28 weeks), but it has been reported as early as eight weeks. The itching can spread to other parts of the body, and a yellow tinge to the skin and whites of the eyes can occur.

It is important to speak with your midwife or healthcare professional if you have any of these symptoms, as the condition will need medical attention and monitoring throughout the rest of your pregnancy and labour.

When should I be worried about itching during pregnancy?

Call your midwife or GP if:

You have itch or cholestasis itching, usually without a rash that is

• more prominent on the hands and feet
• worse at night

You may also notice

• dark urine
• pale poo
• yellowing of the skin and whites of the eyes signifying jaundice (this is less common however)

ICP affects approximately 1 in 140 pregnant women in the UK and is a potentially serious liver disease that can develop during pregnancy. Our bile acids normally flow from the liver to the gut to help digest food after we eat. In ICP, this flow is interrupted and the bile acids build up inside the body. It is thought that the rise in oestrogen and progesterone when pregnant may trigger the condition.

Although there is no cure for ICP, it should resolve once your baby is born.

Causes of intrahepatic cholestasis

There appears to be a genetic component to ICP and it can run in families (although it can happen if there has been no family history). It seems to be more prevalent in women from South Asia affecting 1 in 70 to 1 in 80 pregnancies. Indeed, if you have had ICP in one pregnancy, it is more likely that you will develop it again in future pregnancies (45-90% risk).

Studies have also identified that there is a link between the risk of premature birth and stillbirth in babies born to mothers with ICP. As a result of this, your medical team may offer you an induction of labour any time from 35 weeks, and will be balanced against the level of bile acids in your blood. It is likely that if you have ICP you will be advised to deliver your baby in hospital under a consultant team.

Diagnosis and treatment

The primary diagnosis of ICP takes place by excluding other causes of itching. Your doctor or midwife will take a detailed medical and family history, as well as organise some blood tests including those to check your liver and bile acid levels.

Creams and medicines for ICP

Aqueous cream with menthol is safe to use during pregnancy and may provide some relief from the itching symptoms. There are also other medicines that can help to reduce bile acids and ease itching including ursodeoxycholic acid or ‘UCDA’. This is considered safe in pregnancy, but there is a lack of robust data and so it is usually prescribed on an ‘informed consent’ basis as it has not properly been tested in pregnancy.

Some women are also offered a vitamin K supplement as ICP can affect the absorption of vitamin K from the diet, which helps in clotting the blood. Experts typically only offer this if pale stools are reported, the pregnant woman has a known clotting issue, or has severe ICP from early in pregnancy.

Changing what you eat can help cholestasis

As ICP is linked to the liver, some women may notice a difference in itching whilst eating a healthier diet. This includes consuming more fruit and vegetables, organic produce, dried beans and whole foods. Women with severe itching can also try to avoid sugars and refined foods, soy products, processed meats and full-fat dairy goods.

Find out more about what you can and can't eat during pregnancy.

Monitoring intrahepatic cholestasis

If you are diagnosed with ICP, you will have ongoing liver function tests to allow for monitoring. There is no national agreed guideline on how often these are performed, but the Royal College of Obstetricians and Gynaecologists (RCOG) and the British Liver Trust suggest weekly tests.

Weekly bile acid readings can also help the medical team recommend when your baby should be born. If your tests all remain normal but you continue to have severe itching, these tests should be repeated every other week to keep a close eye on the trend of the results.

Postpartum itching

After the delivery of your baby, the signs and symptoms of ICP should disappear. This should be confirmed by a blood test at your GP to ensure that the liver function levels have returned to normal. There are no known long term effects of having ICP. However, it can be more common to develop ICP in future pregnancies.

Get more advice and guidance from our friendly experts at Naytal. Discover how to soothe a swollen vulva during pregnancy, the best at-home remedies for greasy hair and how to manage skin tags whilst pregnant.

Looking for one-to-one support for your pregnancy concerns? Speak to a midwife online who can provide specialist advice at a time that suits you.

Further information and references:

Royal College of Obstetricians and Gynaecologists. Obstetric cholestasis (itching liver disorder): information for you. London: RCOG; 2007

British Liver Trust

ICP Support

NHS

Kenyon AP, Tribe RM, Nelson-Piercy C, Girling JC, Williamson C, Seed PT, et al. Pruritus in pregnancy: a study of anatomical distribution and prevalence in relation to the development of obstetric cholestasis. Obstet Med 2010;3:25–9

Abedin P,Weaver JB,Egginton E.Intrahepatic cholestasis of pregnancy: prevalence and ethnic distribution. Ethn Health 1999;4:35–7

Fisk NM, Storey GN. Fetal outcome in obstetric cholestasis. Br J Obstet Gynaecol 1988;95:1137–43

Saleh MM,Abdo KR. Consensus on the management of obstetric cholestasis: national UK survey. BJOG 2007; 114:99–103

Diaferia A, Nicastri PL,Tartagni M, Loizzi P, Iacovizzi C, Di Leo A. Ursodeoxycholic acid therapy in pregnant women with cholestasis. Int J Gynecol Obstet 1996;52:133–40