(850) Risk of Stillbirth in US Patients with Diagnosed Intrahepatic Cholestasis of Pregnancy

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: Intrahepatic cholestasis of pregnancy (ICP) is associated with a 4 to 10 fold increase in stillbirth risk without intervention, prompting recommendations for antenatal assessment, ursodiol, and often preterm or early term delivery. Whether there remains an increased rate of stillbirth due to ICP using this management strategy is unknown.

Study Design: This retrospective cohort study used the National Readmissions Database to identify delivery hospitalizations, gestational age at delivery, occurrence of ICP and stillbirth, and comorbid conditions using diagnosis and procedure codes. The cohort was limited to patients delivering on or after 28 weeks gestation, as ICP is typically diagnosed in the third trimester. We compared timing of delivery and stillbirth rates for pregnant patients with ICP versus those without that diagnosis at time of delivery hospitalization.

Results: We identified a cohort of 8,113,915 delivery hospitalizations between 10/2015 and 12/2019, corresponding to a national estimate of 15,231,883; of these, 120,771 (0.8%) had an ICP diagnosis. Patients with ICP were older, with small differences in comorbidities such as a higher rate of gestational diabetes (Table 1). Rates of stillbirth were lower among those with ICP than those without ICP (0.25% vs. 0.38%; risk difference -0.13% (95% CI: -0.01% to -0.18%); a finding that remained after adjustment for age, socioeconomic factors, and comorbid conditions (risk difference: -0.24% (95% CI: -0.22% to -0.27%). ICP patients were more likely to deliver preterm than those without ICP (29.7% vs. 9.3%, p< 0.001; Panel A), but stillbirth rates were the same or lower among ICP patients even when stratified by gestational age at delivery (Panel B).

Conclusion: Patients with ICP delivered earlier than those without ICP, but stillbirth rates were also lower, even when stratifying for gestational age at birth. These results may provide reassurance to patients receiving an ICP diagnosis that contemporary United States clinical practice mitigates stillbirth risk from ICP.

Primary & Presenting Author(s)

Miriam Estin, MD,PhD
Maternal-Fetal Medicine Fellow
Duke University Medical Center
Durham, North Carolina, United States

Coauthor(s)

Virginia Y. Watkins, MD
Virginia Watkins
Washington University School of Medicine
St. Louis, Missouri, United States
Sarah K. Dotters-Katz, MD
Assistant Professor
Duke University Medical Center
Durham, North Carolina, United States
AC
Alexa Campbell, MPH
Medical Student
Duke University Hospital
Chapel Hill, North Carolina, United States
CB
Carla Brady, MD
Duke University Hospital
Durham, North Carolina, United States
Jerome J. Federspiel, MD, PhD
Duke University Hospital
Durham, North Carolina, United States