Intrahepatic cholestasis of pregnancy (ICP) is a disease where patients develop pruritus and elevated liver function values. The true etiology of this condition is unknown but thought to be multifactorial, including genetic, hormonal, and environmental factors. ICP is more common in patients of Northern European descent and those with ancestry from Chile / South America. Family history is a predisposing factor. Other risk factors include multifetal pregnancy, personal history of the disease, patients receiving assistive reproductive treatments, and patients with advanced maternal age. Rarely, use of thiopurines has been associated with ICP.

This condition occurs in about 1:1000 pregnancies in the United States. Although it may occur in any trimester, patients will usually present in the third trimester with complaints of new-onset itching throughout their body but notably on their hands (palms) and feet (soles). Usually there will be no rash / visible findings at time of examination. Symptoms are often worse at night and can vary in severity from mild to severe. Patients may also complain of right upper quadrant pain, fatigue, a change in the color of their bowel movements, or jaundice.

Bile acids cross the placenta and can build up in the fetus. Risks to the fetus include fetal demise in utero (FDIU), meconium-stained amniotic fluid, preterm delivery, and respiratory distress.