Elevated serum bile acid levels may play a role in the symptoms associated with cholestasis of pregnancy. Nineteen women (20 pregnancies) with cholestasis of pregnancy were randomized to receive either activated peroral charcoal (9 women, 10 pregnancies) with a dose of 50 g 3 times a day for 8 days or only normal follow-up (n = 10). Serum total bile acids, aminotransferases, alkaline phosphatase, albumin, total cholesterol, and bilirubin (total and conjugated) were evaluated after overnight fasting at the start of the study and on days 4 and 8 of follow-up. By day 8 of treatment serum total bile acid concentrations were lower in patients of the charcoal group than in the control group (P < 0.05). A decrease of total bile acids was observed in seven patients but in only one of the controls (P < 0.05). No other observations (including pruritus) were changed significantly by charcoal. The outcome of pregnancy was good in both groups. This preliminary study suggests that peroral activated charcoal may be considered an alternative in the treatment of intrahepatic cholestasis of pregnancy.