Cholestasis of pregnancy symptoms most often begin with intense itching, which may happen without a rash. [1] The itch commonly affects your palms or the soles of your feet, though it can also occur elsewhere. [2][1] To go further, see Cholestasis of Pregnancy: What It Is and What to Know.
Itching can be easy to dismiss as an ordinary pregnancy discomfort, especially when your skin looks unchanged. But noticing where it occurs and letting your care team know gives them a chance to advise you on what to do next. You do not need to figure out the cause on your own.
For example, you might feel itchy on your hands while getting dressed, on your feet while settling into bed, or in another area without seeing a rash. Make a note of what you feel and where, then share those details with your care team. Keep the focus on the symptom rather than waiting for a particular pattern to appear.
What does the itching feel and look like?
The itching linked with cholestasis of pregnancy can be intense, widespread, and noticeable even when your skin looks normal. It often starts on the palms of your hands or the soles of your feet, or feels strongest in those areas. [2][1] Related reading: Cholestasis of Pregnancy Diagnosis: Tests and Follow-Up.
You might first notice an uncomfortable itch on your hands or feet, then find that it affects other parts of your body. The severity can vary, but severe itchiness is a typical early symptom. [2]
What your skin may look like
A rash is typically absent, so your skin may look unchanged even while the itching feels strong. [1] Try not to wait for a visible skin change before mentioning persistent or intense itching to your pregnancy care team. [1]
As you describe the itching, note where it began and whether it has spread—for example, from your palms to your arms or legs. You can also mention how intense it feels and whether you can see a rash; these details help you explain what you are experiencing. [1]
What other signs can happen?
Other signs can include changes in urine, stool, skin color, appetite, or how your stomach feels, but you do not need to have them all for cholestasis to be a concern. [3][4][5][6]
You might notice urine that looks darker than usual or bowel movements that look pale or light-colored. [5][6] Yellowing of your skin or the whites of your eyes, called jaundice, is another possible sign. [4][5][6] For example, you may see that your stool looks unusually light or that your eyes appear yellow.
Some people also have nausea, less interest in food, or discomfort in the upper abdomen. [4][6] Pain in the belly is reported as an uncommon symptom. [3] These signs can appear in different combinations, so the absence of dark urine, pale stools, or jaundice does not mean you should dismiss a concern. [3][4][5][6]
If you notice a change in urine, stool, or skin color, make a note of what changed and when, and share it with your pregnancy care team. If you have nausea or abdominal discomfort, describe where you feel it and whether it is affecting your appetite. You do not need to wait until several signs appear before bringing a concern to your clinician.
When should you contact your pregnancy care team?
Contact your pregnancy care team promptly if itching is intense or persistent, particularly when it affects your palms or soles. [2] You do not need to wait for another symptom before reaching out; explain what you are feeling and ask what they recommend next.
When you call, give a clear description of the itch: when it started, where you feel it, whether it is continuing, and how it is affecting you. For example, you could say, “The itching has continued, and I’ve noticed my urine looks darker.”
Be ready to answer questions about what has changed and when; if you are unsure how to describe a symptom, say so. You can also ask what to do if the itching changes or does not ease while you wait for guidance.
Share the details you have, even if you have not noticed every change.
Take persistent itching seriously
When itching is intense or persistent, the absence of a rash does not rule out a concern worth discussing with your pregnancy care team. [1] You do not need to wait for a rash or another symptom before sharing what you are experiencing.
Tell your team how long the itching has lasted, whether it comes and goes, and where you notice it. For example, you might say that it has been keeping you awake or that it feels stronger at certain times. These details can help your team understand the pattern; follow their advice about what to do next. If you are unsure whether your symptoms are significant, reach out rather than trying to decide on your own.