Optimal Delivery Timing for Intrahepatic Cholestasis of Pregnancy (ICP) [36D

Abstract

INTRODUCTION: While consensus exists regarding delivery timing for pregnancies affected by ICP, the differential impact of varying gestational age (GA) remains incompletely understood. This study evaluated the impact of GA at delivery in affecting maternal and neonatal outcomes in ICP. METHODS: We performed a retrospective cohort study of patients with ICP who were delivered at a tertiary teaching hospital from Jan 2008 to Dec 2015. The study cohort was divided into 3 groups: less than 37, at 37, greater than 37 weeks. We compared the maternal and neonatal outcomes using one way ANOVA and chi-squared / Fisher exact test for continuous and categorical data, respectively. Multivariable logistic regression analyses were performed to predict the likelihood of adverse perinatal outcomes while adjusting for sociodemographic, clinical and laboratory characteristics. RESULTS: Out of a total of 110 patients with ICP - 53 (48.19%) delivered at 37 weeks, with 28 (25.46%) and 29 (26.37%) patients delivered at less than 37 and greater than 37 weeks, respectively. Preterm delivery was significantly associated with higher bile acid levels, Hepatitis C, earlier diagnosis, lower Apgar scores, higher rates of hyperbilirubinemia, NICU admission, and length of NICU stay. Induction prior to 37 weeks resulted in higher cesarean rates, with vaginal delivery being higher for inductions ≥ 37 weeks. CONCLUSION: In our study, advanced ICP disease, often resulted in spontaneous preterm labor before a scheduled induction. Further prospective studies are warranted to characterize the influence of gestational age at delivery in modulating perinatal outcomes in ICP.