From the Guidelines
Itching of the hands and feet during pregnancy is most commonly caused by intrahepatic cholestasis of pregnancy (ICP), a liver condition that causes bile salts to build up in the bloodstream, leading to intense itching particularly on the palms and soles, as supported by the most recent evidence from 2021 1.
Causes of Pruritus
The causes of pruritus (itching) of the hands and feet during pregnancy can be attributed to various factors, including:
- Hormonal changes
- Increased blood flow
- Dry skin
- Specific pregnancy-related conditions, such as ICP, pruritic urticarial papules and plaques of pregnancy (PUPPP), and eczema
Diagnosis and Treatment
The clinical diagnosis of ICP is based on pruritus symptoms and supported by the presence of elevated total serum bile acid levels and the absence of diseases associated with similar laboratory findings and symptoms 1. Ursodeoxycholic acid (UDCA) is the most commonly used treatment for ICP, with a typical starting dose of 10-15 mg/kg per day, which can be divided into 2 or 3 daily doses, as recommended by the most recent guidelines 1. For relief, the following measures can be taken:
- Use fragrance-free moisturizers regularly
- Take cool oatmeal baths
- Wear loose cotton clothing
- Avoid hot showers
- Over-the-counter antihistamines like diphenhydramine (Benadryl) may help with mild itching If the itching is severe, occurs mainly on hands and feet, or is accompanied by jaundice, dark urine, or light-colored stools, contact your healthcare provider immediately as this could indicate cholestasis, which requires medical treatment and monitoring.
Management of ICP
The management of ICP involves reducing the maternal symptoms of pruritus and reducing the risk for adverse perinatal outcomes. UDCA is the first-line agent for the treatment of maternal symptoms of ICP, with a recommended dose of 10-15 mg/kg per day, as supported by the most recent evidence from 2021 1. Alternative drugs, such as S-adenosyl-methionine and cholestyramine, can be considered for patients who cannot take UDCA or who have continued symptoms on the maximum dosage.
From the Research
Causes of Pruritus in Pregnancy
The causes of pruritus (itching) of the hands and feet during pregnancy can be attributed to several factors, including:
- Hormonal changes during pregnancy 2
- Pregnancy-specific skin conditions, such as:
- Preexisting skin conditions, such as atopic dermatitis, psoriasis, and fungal infections 2
Intrahepatic Cholestasis of Pregnancy (ICP)
ICP is a pregnancy-specific condition characterized by intense pruritus, particularly on the palms and soles, and elevated bile acid levels 3, 4. It is associated with significant maternal and perinatal adverse effects, including increased risk of preterm birth, meconium-stained amniotic fluid, respiratory distress syndrome, and stillbirth 3.
Diagnosis and Management
Diagnosis of the underlying cause of pruritus in pregnancy is crucial to provide appropriate management and prevent potential complications 5, 6. Clinical history and physical examination are essential diagnostic tools, and laboratory tests may be necessary to confirm the diagnosis 3, 5. Treatment options vary depending on the underlying cause, but may include symptomatic relief, such as antipruritic medications, and specific treatments for conditions like ICP, such as ursodeoxycholic acid 3, 6.