The month of June is recognized as Intrahepatic Cholestasis of Pregnancy (ICP) Awareness Month, a time to spread awareness about the rare condition among the general public and the medical field. In playing our part to help spread awareness this month, we share the story of Dr. Laura Bonebrake, who experienced intrahepatic cholestasis of pregnancy in all four of her pregnancies.
About Intrahepatic Cholestasis of Pregnancy
Intrahepatic cholestasis of pregnancy (ICP), sometimes called jaundice of pregnancy or obstetric cholestasis, is a condition in which cholestasis occurs during pregnancy. This means that bile is unable to travel from the liver to the duodenum. The condition can lead to complications, potentially impacting both the mother and the developing baby. The cause of intrahepatic cholestasis of pregnancy is not well understood. However, a number of genetic, environmental, and hormonal factors are believed to play a role. The primary symptom of the condition is itching, typically on the soles of the feet and palms of the hands. Urine may be darker, and itching tends to worsen later in the day. Less common symptoms include jaundice, light colored stools, upper right quadrant pain, nausea, appetite loss, increased clotting time, and fatigue. Treatments may include vitamin K or ursodeoxycholic acid. In addition, delivery from 34 weeks can be critical to prevent stillbirth. Induction is usually recommended from 34-39 weeks. To learn more about intrahepatic cholestasis of pregnancy, click here.
Laura’s Story
Dr. Laura Bonebrake is an OBGYN physician, so when she first started to experience
symptoms, she already had a hunch about what was going on:
“At 23 weeks I had pneumonia and was in the hospital with elevated liver functions, and no one really knew what was going on with that. I went home and about a week later was when I started having the itching.”
Laura’s itching always started between her fingers, which then spread and got severe enough that it wasn’t possible to sleep through. She promptly contacted her physician, underwent testing, and had a confirmed diagnosis of cholestasis. Laura’s knowledge played a critical role in getting a rapid diagnosis, and unfortunately, most patients don’t have this experience.
Overall, the biggest risks from this condition are for the baby, with stillbirth being the most concerning outcome. Her first child was delivered at 36 weeks and required some time in the neonatal intensive care unit (NICU), but is a healthy 11 year old today.
“Even though I’ve done this four times, I’m kind of one of the lucky moms that didn’t have to have the worst experience.”
Laura also is involved with ICP Care, which is an advocacy organization dedicated to supporting ICP patients. She found the group when she was pregnant with her second child. She also is involved in a Facebook support group through ICP Care for patients as well.
“We want to be a place that’s up to date on the latest research…our website is more than just a mom’s group, it’s a comprehensive resource where you can go and get information.”
A clinical trial is also ongoing in the hopes that a more effective medication for the condition can be developed that can prevent harm to the developing baby. Laura also notes that research suggests that some of the people that develop intrahepatic cholestasis of pregnancy may have a preexisting condition that plays a role, such as autoimmune hepatitis or alpha-1 antitrypsin deficiency.
“Advocate for yourself. Even as a physician it was tough for me to do. If you can find an OB that listens and works with you, then it’s absolutely worth it.”
