PUPPPs vs. ICP

Sorry for yet another PUPPPs note, but I learned something new that I wanted to have down for any future women I run into with severe itchy skin in their 3rd trimester!

I have been taking prenatal yoga since I was 12 weeks pregnant. The woman who teaches my class is just about the best person you can put yourself in contact with if you are pregnant in Colorado Springs. She is widely respected amongst the birthing community here and she knows EVERYBODY! I mentioned to her that I have PUPPPs, and she immediately thought of one of her former students that she knew that had the same issue really bad, to the point of electing to be induced rather than live with it any longer. She then formed a support group (no longer in existence. This was years ago) for women with the same issue. My yoga teacher put me in contact with her. The two of us have been emailing back and forth a bunch this week.

This lady didn’t have PUPPPs, she had something much more serious called ICP (Intrahepatic Cholestasis of Pregnancy). It is very dangerous to the baby, and needs to be watched very closely. Women are commonly mis-diagnosed with PUPPPs when they really have ICP. That happened in her first pregnancy. They told her she had PUPPPs. Her second pregnancy when it happened again she did more research, read about ICP and insisted that she be tested for it, and discovered that she had it. Fortunately, both of her children came out fine. In her support group that she used to run, she strongly encouraged all the women to go get tested for ICP even if you really think that isn’t want you have. Better to be safe than sorry, and it’s a very simple blood test. Nothing invasive or difficult to do.

From my understanding (and please google it to get a more official explanation), ICP is an allergic reaction to pregnancy just as PUPPPs is. Both make you extremely itchy in your 3rd trimester. There are some subtle differences between the two, mainly in the onset of symptoms. ICP starts in your hands and spreads to the rest of your body. There may not necessarily be a rash associated with it. It is also genetic (although not always). If other women in your family get itchy 3rd trimester, it could be ICP. PUPPPs starts on your belly and spreads from there, and you definitely have a rash. ICP effects your liver primarily. Your body makes this acidic bile that your liver processes. If you have ICP, your liver stops processing the bile, and the responsibility of processing this stuff passes to the baby’s immature liver, for both mom and baby. As you can imagine, this can do considerable damage to baby’s liver and related organs, and can lead to intrauterine death. Women who have ICP are usually induced as soon as it is viable to do so. Very serious stuff.

My itchiness started on my belly and spread, and I definitely had the rash, so I don’t think I have ICP. I did have rashes on my arms and hands, so my doctor agreed that it would be a good idea to test for ICP just on the slim chance that that’s what I have. I went today to have it done. As I mentioned, it is a simple blood test. You have to fast for 12 hours before doing it, so I made an appointment first thing in the morning at the lab, so I could just roll out of bed and go. They took 2 vials of blood. It is kind of cool, they have to freeze the blood before testing it for some reason. I will find out the results in the next day or so. I am not anticipating that I have ICP by any stretch, but just want to be sure.

Anyways, I thought that was good advice to just go have it checked, and will remember to tell any women who are dealing with this to do the same since the two things (PUPPPs and ICP) are close enough in symptoms that you should really be thorough and check for both to make sure you are treating the right thing.

Thanks for reading!