Itching during pregnancy

Itching during pregnancy is very common and can have several different causes. Often it is due to harmless skin reactions - but sometimes the itching can be a sign of hepatosis, a liver condition that requires monitoring.

Here we go through the two most common causes of itching during pregnancy: PUPP and hepatosis (intrahepatic cholestasis).

PUPP - rash and itching during pregnancy

PUPP (Pruritic Urticarial Papules and Plaques of Pregnancy) is an allergy-like condition that causes itching and red rash on the skin.

The rash is similar to hives and often occurs on stomach, thighs or arms. The cause is not fully known, but the condition is completely harmless both for you and for the child.

The important thing is that exclude hepatosis, as the symptoms may partly overlap.

PUPP causes a red, itchy rash during pregnancy but is completely harmless to both mother and baby.

Hepatosis - itching without rash

Hepatosis (intrahepatic cholestasis during pregnancy, Wikidata: Q1563407) is a liver involvement which causes severe itching without rash.

The itching usually occurs on hands and soles of feet, especially at night. You may get scratches after scratching, but no rash is visible on the skin.

The condition is most common in third trimester and may recur in future pregnancies. The itching usually goes away shortly after childbirth.

Risks and follow-up in hepatosis

• In severe hepatosis there is a increased risk of harm to the fetus.
• There is also a increased risk of gestational diabetes and pre-eclampsia (pre-eclampsia).
• A small proportion who had hepatosis during pregnancy may later develop liver disease.

After giving birth, you may need monitor liver values at the maternity hospital.

When should I seek medical help?

Contact your midwife or health center if you get:

• Persistent itching, especially at night
• Itching of hands or feet without rash
• Feeling of itchy skin ”from within”
• Dark urine or light stools

The midwife can help you assess whether you need tests for the liver (hepatosis) or if it is a question of PUPP or other skin condition.

Always discuss itching with your midwife - especially if you itch a lot at night or on your hands and feet.

FAQ - Frequently asked questions about itching during pregnancy

1. Is itching normal during pregnancy?
Yes, mild itching is common and is usually due to skin changes, heat or PUPP.

2. What is the difference between PUPP and hepatosis?
PUPP causes a rash, hepatosis causes itching without a rash. Hepatosis affects the liver and requires follow-up.

3. When is hepatosis most common?
Most common in the third trimester (last part of pregnancy).

4. Is PUPP dangerous for the child?
No, PUPP is harmless to both the baby and the pregnant woman.

5. Does the itching go away after childbirth?
Yes, in both PUPP and hepatosis, the itching usually disappears within a few days after delivery.

6. How is itching during pregnancy treated?
PUPP is treated with soothing creams. Hepatosis is treated with medicines and follow-up care.

7. Can I get hepatosis again in the next pregnancy?
Yes, the risk is increased if you have had hepatosis before.

Itching during pregnancy is common and can have different causes. These include allergic reactions, eczema, heat rash, puritic urticarial papules and plaques of pregnancy (PUPP) or hepatosis (intrahepatic cholestasis). Here we go through the two most common causes!