Why do I Have Itchy Hands and Feet During Pregnancy?

Are itchy hands and feet driving you crazy? Itchiness that increases during the third trimester of pregnancy could be the sign of a serious liver condition in pregnant women that can cause pregnancy complications.

Let’s learn about what intrahepatic cholestasis of pregnancy is, its symptoms, causes, and what increases your risks of developing it. 

There are a few reasons why a pregnant woman's hands and feet might itch, ranging from harmless to more serious. Harmless itchiness could be related to hormonal changes, certain skin conditions, or increased sweating. These can be managed with at-home comfort measures or prescribed medications. 

A more serious cause of itchiness in your hands and feet could be a condition called intrahepatic cholestasis of pregnancy.

Intrahepatic cholestasis of pregnancy (ICP), or obstetric cholestasis, is a liver disorder that typically occurs in the third trimester.

Cholestasis affects liver function, slowing the normal movement of bile in your body and causing a buildup of bile acids in the liver. This buildup of bile acids increases the level of bile in your liver at a given time, and this stalled bile can end up in your bloodstream as a result. The buildup under your skin causes the sensation of pruritus, or itchy skin. 

Its main symptom is an intense itching sensation on the palms of your hands and the soles of your feet, without the presence of a rash. It is most likely to be the only symptom, although you may have others. Below we list other possible symptoms: 

• Itchy skin concentrated to your palms and soles, which can also be widespread across your body, is the main, and sometimes only, symptom. The itchiness will be severe, and may become worse at night, affecting your ability to sleep and relax. 

• Yellowing of the skin and eyes, called jaundice, is caused by excess bilirubin deposits in the body. Jaundice is a symptom of liver dysfunction, caused by a variety of blood or liver disorders. 

• Dark urine is most commonly caused by dehydration, but it can also be a sign of a liver condition. Dark urine from cholestasis is also caused by excess bilirubin, this time as it is being excreted. 

• Nausea is a very common symptom in healthy pregnant women. But having both itchy skin and nausea in the third trimester can be a symptom of obstetric cholestasis. 

You may experience pain on the right side of your abdomen, as your liver enlarges.

Symptoms such as dizziness are generally not expected with cholestasis, but can be signs of other conditions. Check out our article to learn more about dizziness during pregnancy. 

• The majority of pregnant women with ICP have a genetic predisposition. If you developed obstetric cholestasis in a previous pregnancy or have a family history, you are at risk of developing it during any of your pregnancies. However, it is not definite. There are other factors that may influence your risk level. 

• Hormonal changes slow the flow of bile, leading to ICP. An increase in estrogen and progesterone can slow down bile acids and cause a buildup that leads to cholestasis. 

• Gallstones cause inflammation, which can slow the flow of bile and lead to ICP. 

• Environmental factors are known to play a role in ICP development since not everyone with a genetic predisposition will get intrahepatic cholestasis of pregnancy. “Isolated studies have linked ICP with pregnancy during winter months and selenium deficiency, although there is no evidence to suggest an improved diet reduces the risk of ICP”, for more information about environmental factors and other causes, you can visit ICP Care’s website. 

If you experience severe itching with or without other symptoms, it could be a sign of cholestasis. If you have itchy skin, or any other concerns, remember to mention them to your healthcare provider. Your ob/gyn can order blood tests to check for ICP or prescribe creams or lotions for other skin conditions that could be causing your itchiness. 

There are certain things that may put you at a higher risk of developing this liver condition. Whether you are at risk or not, it is important to get regular prenatal care for you and your baby. 

Cholestasis can create increased risks for both maternal and fetal health. Pregnant women with ICP have a higher chance of developing gestational diabetes or preeclampsia—a dangerous condition characterized by high blood pressure and sudden swelling. 

ICP increases the baby’s risk of low birth weight and preterm delivery. Respiratory distress can occur from the increased risk of meconium staining the amniotic fluid. Meconium staining means the baby has had their first bowel movement inside the amniotic fluid. This can put the baby at risk if they inhale this stained fluid into their lungs, leading to severe illness or worse. 

Mild cholestasis can be managed by your ob/gyn, likely with the help of a maternal-fetal medicine specialist and other healthcare professionals. More extreme cases of intrahepatic cholestasis of pregnancy increase the risk of stillbirth, which could make an early delivery necessary. 

Some factors that may increase your risk of developing ICP are:

• A family history of cholestasis of pregnancy. Most cases are caused by a genetic predisposition.
• Being pregnant with multiple babies. This may be due to the higher levels of pregnancy hormones. 
• Pregnancy at an older age, such as age 35 or older
• History of liver damage or diseases like hepatitis C or gallbladder stones
• Previous pregnancy with cholestasis of pregnancy. According to the Mayo Clinic, the risk of recurrence can range from 60-90%.

Itchy hands and feet can be bothersome, but there are things that can be done to alleviate the itchiness. The first step should always be checking in with your healthcare provider and having any tests done to determine if your symptoms are due to ICP. If they are, your doctor may prescribe an oral medication called ursodiol to help improve liver function and lower bile acid levels. 

Vitamin K supplements may also be given, since this is negatively affected by ICP. Poor fat absorption leads to lowered levels of vitamin K. This vitamin is important for healthy blood clotting. 

Medicated lotions or creams may also be prescribed. Check in with your doctor before taking any antihistamines or other over-the-counter medications. Since cholestasis can be a serious condition, be safe and avoid self-treatments, even for mild itching, before checking with your ob/gyn. 

If you are nearing the last few months of your pregnancy and are feeling itchy, or if you have any of the risk factors listed, don't be afraid to talk to your doctor about your worries.

Your healthcare provider can order blood tests, prescribe medications or treatments to relieve your symptoms, and continue to monitor your health throughout your pregnancy. 

Try your best to maintain a healthy pregnancy through regular prenatal care, eating a healthy diet, and exercising. Check out our articles on safe pregnancy workouts and exercises for back pain for tips and ideas. 

At Nurture& we want to share many other tips and advice for everything you need to know about pregnancy and beyond.  And for all your nursery needs, we invite you to visit our store!