An itchy tummy is a common complaint among pregnant women. It’s usually attributed to the skin being stretched tight across an expanding belly or increased blood flow to the abdomen. Sometimes, though, it can signify a liver disease associated with pregnancy that commands medical intervention, as one mother in England recently discovered.

Magdalen Rees was 35 weeks into her first pregnancy when intense itching across her abdomen prompted her to mention it to her midwife. The midwife suggested moisturizer to soften the skin and relieve the itch. Rees felt it was something more than merely stretching skin but said no more.

Rees’s story was published in the December 9, 2013, edition of the British tabloid newspaper, Daily Mail. In it, she describes the itch as seeming to come from deep inside, underneath the skin, but the midwife assured her it was only the natural stretching of the skin.

Three weeks later, her water broke early. She was rushed to the hospital but no heartbeat could be heard from her baby. Her son was stillborn.

A second pregnancy produced a daughter and no alarming itch, but the third pregnancy came with intense itching in week 32 that spread to her arms, back, and legs. Rees’s sister experienced the same intense itch and was diagnosed with intrahepatic cholestasis of pregnancy (ICP), a disease caused by elevated levels of bile acids. Rees had ICP, too.

The condition, also known as pruritus gravidarum (severe itching), occurs only about once in every 1,000 pregnancies. Unlike Rees, most women experience the itching on the palms of the hands and soles of the feet. Each year, about 5,000 women in the UK are diagnosed with ICP. Women of Swedish and Chilean descent are more likely to develop ICP, as are women carrying multiple babies. When ICP affects one pregnancy, it is highly likely it will be experienced in future pregnancies, too.

The condition can be treated with medications and planned early delivery minimizes risk to the baby. Most cases of ICP develop during the late stages of pregnancy but it has been seen as early as week 6. When ICP is severe, the risk of stillbirth increases by nine times the normal risk. In addition to fetal distress, premature delivery, and stillbirth, mothers are at increased risk for postpartum hemorrhage.

During pregnancy, hormones are thought to interfere with gallbladder function. The gallbladder, attached to the liver, works as a holding tank for the bile produced in the liver. Bile acids are needed for proper digestion of fats in the diet. When the flow of bile to the digestive tract is slowed or stopped, as happens in ICP, bile acids can build up dangerously in the liver and spill over into the bloodstream. Itching and jaundice (yellowing of the skin and eyes) are common symptoms when this happens.

Source: “Cholestasis of Pregnancy.” Health Encyclopedia. University of Rochester Medical Center, New York. Dec 16, 2013. Web. Dec 16, 2013.