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
Graphical Abstract
Abbreviations:
ICP (intrahepatic cholestasis of pregnancy), HR (hazard ratio), CI (confidence interval), ICD (International Classification of Disease)Keywords
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Article info
Publication history
Published online: March 14, 2015
Accepted:
March 4,
2015
Received in revised form:
February 8,
2015
Received:
October 1,
2014
Identification
Copyright
© 2015 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.
