From the Guidelines
Itching in pregnancy should be treated with ursodeoxycholic acid (UDCA) at a dose of 10-15mg/kg/day for severe cases, particularly those indicating intrahepatic cholestasis of pregnancy (ICP). This recommendation is based on the most recent and highest quality evidence from the American Journal of Obstetrics and Gynecology 1 and Gastroenterology 1, which suggest that UDCA is effective in relieving pruritus and improving laboratory abnormalities in patients with ICP.
For mild to moderate itching, non-medication options such as wearing loose cotton clothing, taking cool baths with colloidal oatmeal, and applying unscented moisturizers immediately after bathing can be considered. Over-the-counter options like calamine lotion and 1% hydrocortisone cream can also be used for localized itching. However, for more significant symptoms, especially if they might indicate ICP, medical treatment with UDCA is recommended.
The use of UDCA has been supported by multiple studies, including a large randomized, placebo-controlled trial 1, which found that UDCA improved maternal pruritus but did not significantly reduce the risk of adverse perinatal outcomes. The Journal of Hepatology also recommends UDCA for the treatment of maternal pruritus in ICP 1.
It is essential to note that while UDCA is the primary treatment for ICP, other medications like rifampicin and cholestyramine may be considered for patients who cannot take UDCA or have continued symptoms on the maximum dosage. However, the evidence for these alternative treatments is limited, and they should be used with caution.
In any case, it is crucial to consult a healthcare provider before taking any medication during pregnancy, especially for severe itching that may indicate liver issues. The provider can assess the situation and recommend the best course of treatment based on the individual's specific needs and medical history.
From the FDA Drug Label
If pregnant or breast-feeding, ask a health professional before use. The FDA drug label does not answer the question.
From the Research
Treatments for Itching in Pregnancy
Itching in pregnancy can be caused by various factors, including preexisting or acquired dermatoses, and pregnancy-specific dermatological diseases such as PEP, pemphigoid gestationis, and pruritus gravidarum 2. The treatment of itching in pregnancy requires prudent consideration due to potential effects on the fetus.
Localized Pruritus Treatments
- Emollients
- Topical anti-pruritics
- Topical corticosteroids are considered the safest options for localized forms of pruritus in pregnancy 2
Generalized Pruritus Treatments
- Systemic treatments
- UV phototherapy are adequate for generalized pruritus 2
- Systemic corticosteroids and a restricted number of antihistamines may be administered in severe cases 2
Intrahepatic Cholestasis of Pregnancy (ICP) Treatments
- Ursodeoxycholic acid (UDCA) is effective and safe in patients with ICP, attenuating pruritus and correcting some biochemical abnormalities in the mothers 3, 4, 5, 6
- Cholestyramine may be associated with improved maternal morbidity without a documented improvement in fetal outcome 4
- Phenobarbital use was not associated with improved maternal or fetal morbidity/mortality 4