What provides relief for pruritus (itching) during pregnancy?

From the Guidelines

Relief for itching in pregnancy can be achieved through the use of ursodeoxycholic acid (UDCA) at a dose of 10-15 mg/kg per day, as it has been shown to improve maternal symptoms and reduce the risk of adverse perinatal outcomes. For mild to moderate itching, non-medication options such as wearing loose cotton clothing, taking cool baths with colloidal oatmeal, and applying fragrance-free moisturizers immediately after bathing can be effective. Over-the-counter options like calamine lotion and 1% hydrocortisone cream can also be used for localized itching.

• Key considerations for itching relief in pregnancy include:
  • Staying hydrated and avoiding hot showers, harsh soaps, and scratching to prevent worsening symptoms
  • Using emollients to prevent dryness of skin and keeping nails shortened
  • Considering the use of UDCA, especially in cases of intrahepatic cholestasis of pregnancy, as it has been shown to improve maternal symptoms and reduce the risk of adverse perinatal outcomes 1, 2
  • Alternative treatments like S-adenosyl-methionine, cholestyramine, and rifampicin may be considered for patients who cannot take UDCA or have continued symptoms on the maximum dosage, but their use should be individualized and based on the severity of maternal disease 2, 3
  • Monitoring coagulation tests, such as international normalized ratio (INR), in women treated with anion exchange resins or rifampicin, and correcting vitamin K deficiency related to cholestasis and/or use of these medications 3, 4 It is essential to note that severe itching, especially on palms and soles without a rash, could indicate intrahepatic cholestasis of pregnancy, a liver condition requiring medical attention, and should be evaluated and managed accordingly 5.

From the FDA Drug Label

temporarily relieves itching associated with minor skin irritations, inflammation, and rashes The hydrocortisone (TOP) cream can be used for relief of itching in pregnancy, but only under the advice and supervision of a doctor 6.

• It is used to temporarily relieve itching associated with minor skin irritations, inflammation, and rashes.
• Itching relief is one of the uses of this product, but it should be used with caution and under medical supervision, especially during pregnancy.

From the Research

Relief for Itching in Pregnancy

• Itching in pregnancy can be caused by various conditions, including intrahepatic cholestasis of pregnancy (ICP) 7, 8, 9.
• ICP is a disease characterized by pruritus and abnormal liver-function tests, and is associated with a high risk for adverse perinatal outcome, including preterm birth, meconium passage, and fetal death 7.
• Ursodeoxycholic acid (UDCA) appears to be the most effective medication to improve maternal pruritus and liver-function tests in ICP 7, 8, 10.

Treatment Options

• UDCA has been shown to significantly reduce pruritus in women with ICP, particularly in those with severe disease 8, 10.
• S-adenosylmethionine (SAMe) has also been studied as a treatment for ICP, but the evidence is less consistent, and it may not be as effective as UDCA 10, 11.
• Other treatments, such as guar gum, activated charcoal, and dexamethasone, have been studied, but the evidence is limited, and they are not recommended as first-line treatments 10, 11.

Fetal Risks

• ICP is associated with an increased risk of fetal death, particularly after 37 weeks of gestation 7.
• UDCA may reduce the risk of fetal distress and preterm birth, but the evidence is not conclusive 10.
• The timing of delivery in women with ICP is important, and delivery at approximately 37 weeks may be recommended to reduce the risk of fetal death 7.