Appearance
The most common symptom of intrahepatic cholestasis of pregnancy is itching which typically develops in the third trimester of pregnancy. The itching begins on the palms and soles, and then spreads to the rest of the body. The rash of ICP is caused by scratching the intensely itchy skin. Jaundice occurs in 10% to 15% of cases and typically develops 2 to 4 weeks after the itching starts. After delivery, both itching and jaundice resolve spontaneously. ICP does recur with subsequent pregnancies in 40% to 50% of women.

Cause
Intrahepatic cholestasis of pregnancy is caused by an impairment of bile secretion in the liver. As the bile backs up in the liver, the level of bile acids increases in the bloodstream. These bile acids are deposited in the skin causing the intense itching. Cholesterol, triglyceride, and bilirubin levels are also increased.

Several complicated mechanisms have been proposed to explain this impairment of bile secretion, but it appears that genetic and hormonal factors are involved. Women who have a mother or sister who has had ICP are at a higher risk of developing this condition. Also, estrogen interferes with the clearance of bile from the liver, and progesterone interferes with the clearance of estrogen from the liver.