Itching during pregnancy: when to worry and what to do
In brief
Itching during pregnancy (pruritus) is common and usually harmless, caused by dry skin or the stretching of your bump. You should see a doctor promptly if it is intense and mainly affects the palms of your hands and soles of your feet, especially at night and in the third trimester: it may then be a sign of obstetric cholestasis, which is detected with a simple blood test (bile acids and liver function tests). Under French guidelines (CNGOF 2023), the first-line treatment is ursodeoxycholic acid, and the timing of the birth depends on the bile acid level.
Why do I get itchy during pregnancy?
Itching (doctors call it pruritus) is one of the most common reasons for seeing a doctor during pregnancy. In most cases, it is linked to normal skin changes:
- dry skin, made worse by hot showers, hard water and some soaps;
- stretching of the skin on the abdomen, breasts and thighs, often when stretch marks appear;
- more sweating and a higher body temperature.
This itching stays in one area, is moderate, has no particular rash and improves with simple skin care. Your pregnancy care and birth preparation are described on the Giving birth in Paris page.
However, itching in pregnancy should never be dismissed straight away: some causes need specific monitoring, for both mother and baby.
What conditions cause itching in pregnancy?
There are three main groups of causes.
| Cause | Usual timing | What the skin looks like | Effect on the baby |
|---|---|---|---|
| Dry skin, stretch marks | Throughout pregnancy | Normal or dry skin | None |
| Obstetric cholestasis | Mainly third trimester | No rash; scratch marks; palms and soles | Possible (preterm birth, foetal distress, rarely stillbirth if bile acids are very high) |
| Polymorphic eruption of pregnancy (PUPPP) | Late pregnancy, often a first pregnancy | Red patches starting in the stretch marks on the abdomen, sparing the belly button | None |
| Atopic eruption of pregnancy | Often before the third trimester | Eczema patches, small spots on the trunk and limbs | None |
| Pemphigoid gestationis | Second or third trimester, or just after the birth | Patches around the belly button, then blisters | Possible: low birth weight, preterm birth; monitoring needed |
| Causes unrelated to pregnancy | Any time | Variable: eczema, hives, scabies, fungal infection, drug allergy | Depends on the cause |
Skin conditions specific to pregnancy are covered in detail in the article on skin problems and dermatoses in pregnancy. Itching around the vulva is more likely to be thrush: see vulvar itching.
More rarely, widespread itching reveals a general condition (liver, thyroid, kidneys, blood) or a side effect of a medicine you have recently started.
What is obstetric cholestasis and why does it need monitoring?
Intrahepatic cholestasis of pregnancy (obstetric cholestasis) is a liver condition specific to pregnancy: under the influence of hormones, bile acids drain less well and build up in the blood. It usually occurs in the third trimester and goes away after the birth.
Typical signs
- intense itching, without a rash, mainly on the palms of the hands and soles of the feet;
- worse at night, disturbing sleep;
- more rarely, dark urine, pale stools or jaundice.
Diagnosis
It is based on a blood test: total bile acids and liver function tests (transaminases). According to the CNGOF (2023), the diagnosis is made when typical itching (palms and soles, at night) is combined with total bile acids above 10 µmol/L or ALT (a liver enzyme) above twice the normal level, after other causes have been ruled out. If the first test is normal and the itching continues, it is often repeated.
Risks
The risk to the baby is linked to the bile acid level. A large meta-analysis showed that the risk of stillbirth is only clearly increased when bile acids reach or exceed 100 µmol/L. Milder forms mainly carry a risk of preterm birth and meconium-stained fluid.
Treatment
- Regular monitoring of bile acids and liver function tests, and monitoring of the baby.
- Ursodeoxycholic acid (UDCA) is the recommended first-line treatment in France (CNGOF 2023, strong recommendation): it reduces itching as well as bile acid and liver enzyme levels.
- The timing of the birth is discussed according to the peak bile acid level: under the French guidelines (CNGOF 2023), if bile acids are 100 µmol/L or more, birth is recommended from 36 weeks; if they are below 100 µmol/L, induction of labour may be considered between 37 and 39 weeks.
- After the birth, liver function tests are repeated to check they have returned to normal.
Cholestasis often comes back in later pregnancies: mention it at your first appointment. It can also reappear with combined (oestrogen-progestogen) hormonal contraception.
How can I relieve harmless itching in pregnancy?
- Take short, lukewarm showers, using a soap-free cleansing bar or shower oil.
- Apply a plain, unperfumed emollient (moisturising) cream every day, straight after your shower.
- Pat your skin dry rather than rubbing.
- Wear loose cotton clothing; avoid wool and synthetic fabrics directly against the skin.
- Keep your nails short to limit damage from scratching.
- Avoid perfumed products, essential oils and self-treatment with steroid or antihistamine creams without advice.
If the itching lasts more than a few days despite these measures, see a doctor.
Which tests and treatments are used for itching in pregnancy?
Examining the skin points to the diagnosis: whether there are spots, patches or blisters, and where they are. Depending on the case, the doctor may request:
- bile acid and liver function tests for any itching without a rash, especially in the third trimester;
- sometimes thyroid or kidney tests, or a blood count;
- a dermatology opinion, sometimes with a skin biopsy if pemphigoid gestationis is suspected.
Treatment is tailored to the cause and to pregnancy: emollient creams, steroid creams for PUPPP or atopic eruption, specific treatment and closer monitoring for pemphigoid gestationis, obstetric monitoring for cholestasis. Any medicine must be approved by your doctor (see medicines and pregnancy).
When should I seek urgent care for itching in pregnancy?
See your doctor or midwife promptly (within 24 to 48 hours) if:
- the itching is intense, widespread or keeps you awake;
- it mainly affects your palms and soles, in the third trimester;
- red patches, bullae or blisters appear;
- you have had obstetric cholestasis or pemphigoid gestationis before;
- the itching started after a new medicine.
Go straight to the maternity unit's emergency department (the one where you are registered: Maternité Sainte-Félicité or Clinique Sainte-Thérèse) if the itching comes with:
- reduced baby movements;
- jaundice (yellow skin or eyes), very dark urine;
- contractions, bleeding or leaking fluid;
- sudden swelling of the face or lips, or difficulty breathing: call 15 or 112 in France, or your local emergency number (severe allergic reaction).
Frequently asked questions
Is an itchy bump normal in pregnancy?
Yes, mild itching of the abdomen caused by the skin stretching is common and harmless. See a doctor if it spreads, becomes intense or comes with patches or blisters.
Why are itchy hands and feet at night a concern in pregnancy?
This pattern is typical of obstetric cholestasis, a liver condition of late pregnancy. A blood test measuring bile acids can confirm or rule it out.
Does obstetric cholestasis mean I need a caesarean?
No, cholestasis does not require a caesarean. Depending on the bile acid level, early induction of labour may be offered, and a vaginal birth is usually still possible.
Can I take an antihistamine for itching while pregnant?
Some antihistamines can be used in pregnancy, but your doctor should decide which one and for how long. They ease the symptom without treating the cause, which must be identified first.
References
- Sentilhes L, et al. Cholestase intrahépatique gravidique : recommandations pour la pratique clinique du Collège national des gynécologues et obstétriciens français (CNGOF). [Intrahepatic cholestasis of pregnancy: CNGOF clinical practice guidelines] Gynécologie Obstétrique Fertilité & Sénologie, 2023. doi:10.1016/j.gofs.2023.09.004 — PMID 37806861
- Ambros-Rudolph CM, et al. The specific dermatoses of pregnancy revisited and reclassified: results of a retrospective two-center study on 505 pregnant patients. Journal of the American Academy of Dermatology, 2006. doi:10.1016/j.jaad.2005.12.012 — PMID 16488288
- Ovadia C, et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. The Lancet, 2019. doi:10.1016/S0140-6736(18)31877-4 — PMID 30773280
Dr Olivier KadochObstetrician-gynaecologist and gynaecological surgeon in Paris (16th and 5th arrondissements). Former chef de clinique-assistant (senior registrar) at the Paris public hospitals (AP-HP); individually accredited by the French National Authority for Health (HAS). RPPS 10003957809. Background and practice locations
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