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Cholestasis of Pregnancy Tests and Diagnosis

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Intrahepatic Cholestasis of Pregnancy (ICP), also known as Cholestasis of pregnancy, is a pregnancy-specific condition of the liver that disrupts the flow of bile (a digestive fluid). It can develop in the second or third trimester of your pregnancy.

ICP leads to a buildup of bile in your bloodstream, causing intense itching.

Testing for Cholestasis of pregnancy is important for ensuring the safety and health of the expecting mother and baby. 

Read ahead to learn about Cholestasis of pregnancy tests and diagnosis.

Blood Tests for Cholestasis of Pregnancy

The primary and easiest method for diagnosis is blood tests for Cholestasis of pregnancy. Your doctor will probably suggest a combination of tests to get a complete picture. Here’s a breakdown of the main blood tests involved:

Liver Function Tests (LFTs)

These tests are used to measure the levels of proteins and enzymes produced by your liver. Elevated levels of certain enzymes can indicate liver problems. While not specific to ICP, abnormal LFT results during your second or third trimester can raise suspicion of ICP, especially when accompanied by other pregnancy symptoms.

Serum Bile Acid Test

This is the most important test for diagnosing ICP. It directly measures the amount of bile acids in your bloodstream. High bile acid levels are a strong indicator of ICP. Most studies used an upper limit of bile acids between 10 and 14 micromoles/L to diagnose ICP, but it may vary.

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  • Depending on your situation, your doctor might recommend further blood tests to rule out other potential causes of your second-trimester or third-trimester pregnancy symptoms that might be similar to ICP. These tests might include:

    Viral Hepatitis Tests: To check for infections affecting your liver function.

    Gallbladder Function Tests: To assess any issues with your gallbladder that could imitate ICP symptoms.

    Supplementary Tests for ICP Diagnosis

    Doctor checking the health of pregnant womanSource: pixelshot
    Check up of pregnant woman

    While lab tests for Cholestasis of pregnancy are the usual methods of diagnosis, your doctor might also recommend additional examinations for a more comprehensive picture:

    Physical Examination: Your doctor will visually check for yellowing of the skin, and whites of the eyes, to rule out Jaundice which can be a symptom of ICP. They may also feel your abdomen to check for an enlarged gallbladder, although this isn’t always present with ICP.

    Fetal Surveillance: If you’re diagnosed with ICP, your doctor might suggest more frequent monitoring of your baby’s health. This might involve tests like non-stress tests (NST) and biophysical profiles (BPP) to assess your baby’s heart rate, movement, and well-being, especially during the later stages of your pregnancy.

    If your urine becomes dark, especially during the second or third trimester of pregnancy, and is accompanied by severe itching, it could be a sign of Cholestasis of Pregnancy (ICP). Seek immediate medical attention.

    Diagnosis and Implications

    A diagnosis of ICP shouldn’t cause undue worry. With proper management, most women with ICP have healthy pregnancies. Here’s what typically happens after diagnosis:

    • Treatment: Your medical expert will discuss treatment options to manage your itching symptoms and reduce potential risks to your baby. Treatment might involve medications to improve bile flow and relieve itching.
    • Delivery Considerations: Early delivery might be recommended in certain cases, especially if your symptoms are severe or your baby shows signs of distress during fetal monitoring. Your doctor will make this decision based on your individual situation and the severity of your ICP.

    Cholestasis of pregnancy can lead to premature or stillbirths. In severe cases, it can interfere with nutrient absorption, resulting in lower birth weight.

    Bile acids can also irritate your baby’s digestive system, potentially leading to complications like meconium aspiration during birth and breathing difficulties.

    Meconium aspiration occurs when a baby inhales a mixture of meconium (their first stool) and amniotic fluid before or during birth, which can cause breathing problems.


    Cholestasis of pregnancy (ICP) is a liver condition affecting bile flow during the second or third trimester of pregnancy. 

    Diagnosis includes blood tests like LFTs and a Serum Bile Acid Test. On the basis of your condition, these tests might be accompanied by additional tests, like a Gall bladder function test or a Viral Hepatitis test. 

    A physical exam and fetal monitoring may also be recommended to ensure your baby’s well-being. 

    The treatment usually includes medications to manage the itching and early delivery, depending on your case.

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    Frequently Asked Questions

    Is delivery by 37 weeks necessary for Cholestasis of pregnancy?

    Delivery by 37 weeks isn’t always mandatory for Cholestasis of pregnancy, but a doctor may recommend it on a case-by-case basis. Early delivery is suggested to reduce the risk of complications for your baby, as bile acids can increase during later pregnancy.

    Is Cholestasis worse at night?

    Yes, itching caused by Cholestasis of pregnancy often worsens at night. This is because, during sleep, body temperature slightly decreases, leading to increased bile acid levels in the bloodstream and intensified itching.

    What foods trigger Cholestasis?

    There’s no direct link between specific foods and triggering Cholestasis of pregnancy. However, a high-fat diet may worsen symptoms. Focus on a healthy diet with lean protein, fruits, and vegetables while consulting your doctor for personalized guidance.

    How early can Cholestasis be detected?

    Cholestasis of pregnancy typically doesn’t become apparent until the second or third trimester, making early detection challenging. However, some women with a history of ICP or high-risk factors might get tested earlier, during the second trimester, as a precaution.

    How quickly can bile acids rise in pregnancy?

    While the exact rate of bile acid rise in pregnancy is unknown, it is likely that bile acid levels rise slowly throughout pregnancy, but the rate of increase becomes more rapid as you approach the end of the second trimester and into the third trimester.

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    Photo of author Janet Fudge
    Janet Fudge is a highly skilled and experienced pharmacologist who serves as a contributing writer for With a strong academic background from a premier US University and a passion for helping others, Janet has become a trusted voice in the pharmaceutical world. After completing her Doctor of Pharmacy degree, Janet embarked on a successful career in the pharmaceutical industry, working with various clients, including hospitals, retail pharmacies, and drug manufacturers. Her in-depth knowledge of pharmacology and dedication to patient-centered care has led her to excel in her field. As a writer for, Janet uses her wealth of expertise to provide readers with accurate, reliable, and up-to-date information on various topics related to medicine and healthcare. Her engaging writing style and ability to break down complex topics into easily digestible content make her a valuable resource for healthcare professionals and the general public.
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