Effect of Guideline Change on Gestational Age at Delivery for Intrahepatic Cholestasis of Pregnancy [A254]. (May 2022) - Berra, Alexandra L.
Abstract : INTRODUCTION: The optimal gestational age to deliver women with intrahepatic cholestasis of pregnancy (ICP) is unknown. Traditionally, delivery has been recommended at 37 0/7 weeks of gestation or greater when diagnosed. In 2019, the American College of Obstetricians and Gynecologists (ACOG) updated guidelines for induction to occur at 36 0/7 weeks, or at diagnosis if later. Our objective was to estimate the effect this guideline change had on the gestational age at delivery. METHODS: Retrospective chart review of women undergoing induction of labor for ICP one year before compared with one year after ACOG guideline change in 2019. To detect a one-week-earlier delivery (from 37 to 36 weeks of gestation), with a standard deviation of two weeks at P <.05 with a 90% power, would require 85 women in each group. RESULTS: During the one year prior to the guideline change, 159 women underwent an induction of labor for ICP, versus 134 in the one year post guideline change. No difference was noted in the gestational age at delivery, median 37.1 (range, 28.7–40.3) weeks versus 37.1 (range, 33.4–40.3) weeks ( P =.65). No difference was noted in the gestational age at diagnosis of ICP, median 34.4 (range, 13.0–40.1) weeks versus 34.1 (range, 17.0–40.3) weeks ( P =.62). Similar levels of bile acid were used at diagnosis, median 14 (range, 10–225) micromoles/L versus 15 (range, 10–264) micromoles/L ( P =.36). CONCLUSION: Current change to ACOG guidance for delivering women with ICP has not resulted in earlier delivery.