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Intrahepatic cholestasis of pregnancy and cancer, immune-mediated and cardiovascular diseases: A population-based cohort study

Published:March 14, 2015DOI:https://doi.org/10.1016/j.jhep.2015.03.010

      Background & Aims

      Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease in pregnancy. It is associated with hepatobiliary diseases that might predispose to cancer and also with gestational diabetes and preeclampsia. In this study, we examined associations between ICP and cancer, and immune-mediated and cardiovascular diseases.

      Methods

      By linking the Swedish Medical Birth Register and the Swedish Patient Register, we identified 11,388 women with ICP and 113,893 matched women without ICP who gave birth between 1973 and 2009. Diagnoses of cancer and immune-mediated and cardiovascular diseases both before and after delivery were obtained from the Patient Register. The main outcome measures were hazard ratios (HRs), calculated through Cox regression, for the indicated diseases after delivery.

      Results

      ICP was not associated with later overall cancer (HR 1.07, 95% confidence interval [CI] 0.94–1.21), but it was associated with later liver and biliary tree cancer (HR 3.61, 95% CI 1.68–7.77, and 2.62, 95% CI 1.26–5.46, respectively). ICP was also associated with later immune-mediated diseases (HR 1.28, 95% CI 1.19–1.38), and specifically diabetes mellitus (HR 1.47, 95% CI 1.26–1.72), thyroid disease (HR 1.30, 95% CI 1.14–1.47), psoriasis (HR 1.27, 95% CI 1.07–1.51), inflammatory polyarthropathies (HR 1.32, 95% CI 1.11–1.58) and Crohn’s disease (HR 1.55, 95% CI 1.14–2.10), but not ulcerative colitis (HR 1.21, 95% CI 0.93–1.58). Women with ICP also had a small increased risk of later cardiovascular disease (HR 1.12, 95% CI 1.06–1.19).

      Conclusions

      Women with ICP have increased risk of later hepatobiliary cancer and immune-mediated and cardiovascular diseases.

      Graphical abstract

      Abbreviations:

      ICP (intrahepatic cholestasis of pregnancy), HR (hazard ratio), CI (confidence interval), ICD (International Classification of Disease)

      Keywords

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