Mild itching is usually nothing to worry about, but if the itching becomes severe it can be a sign of a serious liver condition called obstetric cholestasis. This affects fewer than 1 in 100 pregnant women, but needs medical attention.

Mild itching

Wearing loose clothes may help prevent itching, as your clothes are less likely to rub against your skin and cause irritation. You may also want to avoid synthetic materials and choose natural fabrics such as cotton that allow the air to circulate close to your skin. You may find that having a cool bath or applying lotion or moisturiser can help to soothe the itching.

Some women find that products with strong perfumes can irritate their skin, so you could try using plain lotion or soap.

Serious itching: obstetric cholestasis

If you’re worried about your itching, or if you have severe itching, it’s important to see your midwife or doctor.

Obstetric cholestasis (OC), also called intrahepatic cholestasis of pregnancy, is a serious liver disorder that affects a small number of pregnant women, usually in the last 3 months of pregnancy.

Causes of obstetric cholestasis

The cause of OC is unclear, but it’s thought the rise of pregnancy hormones later in pregnancy may slow the normal flow of bile — the digestive fluid made in the liver that helps your digestive system break down fats. In OC, bile salts build up rather than leaving the liver, eventually entering the bloodstream, which can make you feel itchy.

OC seems to run in families, although it can occur with no family history. It is also more common in women of Indian and Pakistani origin. If you have had OC in a previous pregnancy, you're more likely to develop it again in a subsequent pregnancy.

Babies of women with OC are more likely to be born prematurely or to be stillborn, or to have lung problems from breathing in meconium. Because of these complications, your doctor may consider inducing labour before you are due.

Symptoms of obstetric cholestasis

The classic symptom of OC is itching without rash, usually on the palms and soles of the feet, but it may be more widespread. The itching can be non-stop or unbearable, and worse at night.

Other symptoms include dark urine, jaundice (yellowing of the skin and whites of the eyes), and pale bowel movements (poo).

The itchiness usually goes away within a few days after giving birth.

Treatment of obstetric cholestasis

OC is diagnosed through taking a medical and family history, and blood tests that check your liver function (liver functions tests — LFTs). Once OC is diagnosed, you will have regular LFTs until your baby is born, so that your doctor can monitor your condition.

Creams, such as calamine lotion, are safe to use in pregnancy and can provide some relief from itching. Your doctor may prescribe a medication to reduce bile salts and ease itching.

OC can affect your absorption of vitamin K, which is important for healthy blood clotting so you may be offered a vitamin K supplement.

If you are diagnosed with OC, your midwife and doctor will discuss your health and your options with you.