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Objectives <p>To compare the incidence of intrahepatic cholestasis of pregnancy (IHCP), induction of labor (IOL) rates, and maternal and neonatal outcomes before and after implementation of revised diagnostic guidelines at a tertiary perinatal center in South India. Recent guidelines updated the diagnostic threshold for total serum bile acids (TSBA) from ≥ 10 μ mol/L to ≥ 19 μ mol/L.</p> Methods <p>This analytical cohort study compared pre-guideline implementation (2017–2022; control group) and post-guideline implementation (2023; study group). Pregnant women with IHCP and delivering at the institute were included. Propensity score matching (1:4) was performed based on maternal age, body mass index, gravida, and parity. Primary outcomes were IHCP incidence and IOL rates; secondary outcomes included obstetric, and neonatal outcomes.</p> Results <p>Among 67,457 deliveries, 943 women were diagnosed with IHCP (overall incidence 1.39%). IHCP incidence was significantly lower in the study group than in the control group (0.87% vs 1.41%, <i>p</i> &lt; 0.001). Overall IOL rates were similar; however, IHCP as an indication for IOL decreased significantly after guideline implementation (52.0% vs 79.9%). Median gestational age at delivery (37.6 vs 37.0&#xa0;weeks, <i>p</i> &lt; 0.001) and median birth weight (2.82 vs 2.74&#xa0;kg, <i>p</i> = 0.010) were higher in the study group. No stillbirths or neonatal deaths occurred in the study group, compared with six perinatal deaths in the control group.</p> Conclusion <p>Revised diagnostic guidelines for IHCP were associated with reduced disease incidence and fewer IHCP-related inductions, with later delivery and improved birth weight, without increased adverse outcomes.</p>

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Intrahepatic Cholestasis of Pregnancy: Comparison of Maternal and Fetal Outcomes Before and After the Institutionalization of New Guidelines—A Analytical Cohort Study at Tertiary Perinatal Center in South India

  • 期刊论文

  • 发表日期：

    2026年7月9日

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  • Kallur Sailaja Devi,
  • Chetti Divya,
  • Ananta Ghimire,
  • Subhashini Yerramilli

摘要

Objectives

To compare the incidence of intrahepatic cholestasis of pregnancy (IHCP), induction of labor (IOL) rates, and maternal and neonatal outcomes before and after implementation of revised diagnostic guidelines at a tertiary perinatal center in South India. Recent guidelines updated the diagnostic threshold for total serum bile acids (TSBA) from ≥ 10 μ mol/L to ≥ 19 μ mol/L.

Methods

This analytical cohort study compared pre-guideline implementation (2017–2022; control group) and post-guideline implementation (2023; study group). Pregnant women with IHCP and delivering at the institute were included. Propensity score matching (1:4) was performed based on maternal age, body mass index, gravida, and parity. Primary outcomes were IHCP incidence and IOL rates; secondary outcomes included obstetric, and neonatal outcomes.

Results

Among 67,457 deliveries, 943 women were diagnosed with IHCP (overall incidence 1.39%). IHCP incidence was significantly lower in the study group than in the control group (0.87% vs 1.41%, p < 0.001). Overall IOL rates were similar; however, IHCP as an indication for IOL decreased significantly after guideline implementation (52.0% vs 79.9%). Median gestational age at delivery (37.6 vs 37.0 weeks, p < 0.001) and median birth weight (2.82 vs 2.74 kg, p = 0.010) were higher in the study group. No stillbirths or neonatal deaths occurred in the study group, compared with six perinatal deaths in the control group.

Conclusion

Revised diagnostic guidelines for IHCP were associated with reduced disease incidence and fewer IHCP-related inductions, with later delivery and improved birth weight, without increased adverse outcomes.