Do Intrahepatic Cholestasis of Pregnancy Management Strategies Reduce Risk for Stillbirth?
BACKGROUND AND PURPOSE:
Current strategies to mitigate the increased risk of stillbirth associated with intrahepatic cholestasis of pregnancy (ICP) include antenatal assessment, ursodiol use and preterm/early term delivery
Estin et al. (AJOG, 2023) assessed whether management strategies for intrahepatic cholestasis of pregnancy (ICP) can successfully mitigate elevated risk for stillbirth
Retrospective cohort study
US National Readmissions Database Population (AHRQ)
Delivery hospitalizations 2015 to 2020
ICP diagnosis at time of delivery hospitalization
ICD diagnosis and procedure codes used for
Delivery hospitalizations | Gestational age at delivery | Occurrence of ICP and stillbirth | Comorbid conditions
Timing of delivery
9,987,705 delivery hospitalizations
ICP diagnosis: 0.8% (152,040 pregnancies)
Rates of stillbirth were lower among individuals with ICP
ICP: 252 per 100,000 deliveries
No ICP: 386 per 100,000 deliveries
Risk difference (RD): 133 fewer stillbirths per 100,000 deliveries (95% CI, 98 to 170)
Finding still present after adjustment for insurance status, socioeconomic factors, and comorbid conditions
RD 160 fewer per 100,000 deliveries (95% CI, 127 to 194)
ICP patients were more likely to deliver preterm than those without ICP
No ICP: 9.3%
There was no increase in stillbirth rate after stratifying by gestational age
Patients with ICP are more likely to delivery preterm than patients without ICP
However, rates of stillbirth are actually lower among the ICP cohort, even when patients were stratified by gestational age at delivery
A limitation of this study is the absence of data regarding bile acid levels or treatment with UDCA | A few severe cases may have been diluted by large number of mild cases
The authors state
Our study suggests that contemporary ICP management as provided in the United States effectively mitigates the ICP-associated stillbirth risk although at a cost of notably higher rates of preterm birth
Given the dreaded nature of a stillbirth diagnosis, this information may provide reassurance to patients who are receiving an ICP diagnosis
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan