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Hepatobiliary disease linked to intrahepatic cholestasis of pregnancy

Women with intrahepatic cholestasis of pregnancy are at increased risk for hepatobiliary disease, and testing for hepatitis C may be warranted in this population, according to recent results.

In a population-based cohort study in Sweden, researchers evaluated data collected from the Swedish Medical Birth and Swedish Patient registers on 11,388 women with intrahepatic cholestasis of pregnancy (ICP) who gave birth between 1973 and 2009, along with 113,893 matched controls without ICP. Incidence of pre-existing hepatobiliary diseases and any that emerged after giving birth was recorded and compared between groups.

Patients with ICP were at significantly increased risk for any hepatobiliary disease in the future (HR=2.62; 95% CI, 2.47-2.77), with an approximate 1% increase in risk annually. Specifically, chronic hepatitis (HR=5.96; 95% CI, 3.43-10.33), fibrosis and/or cirrhosis (HR=5.11; 95% CI, 3.29-7.96), cholangitis (HR=4.22; 95% CI, 3.13-5.69), hepatitis C (HR=4.16; 95% CI, 3.14-5.51) and gallstone disease (HR=2.72; 95% CI, 2.55-2.91) were significantly associated with ICP.

Sensitivity analysis excluding births before 1997 did not significantly alter results; nor did adjustment for maternal country of birth. No association was observed between hepatobiliary disease risk and tobacco use during early pregnancy, age of ICP diagnosis or prior pregnancy.

Investigators said women were more likely to develop ICP if they had any hepatobiliary disease before pregnancy (OR=1.98; 95% CI, 1.45-2.7). Specific illnesses linked to ICP risk included chronic hepatitis (OR=8.66; 95% CI, 1.05-71.48), HCV (OR=5.76; 95% CI, 1.3-25.44) and gallstone disease (OR=3.29; 95% CI, 2.02-5.36).

“Women with ICP have a substantially increased risk of later hepatobiliary disease,” the researchers concluded. “The prevalence and later diagnosis of chronic hepatitis C and its complications are of particular importance, since this potentially life-threatening infection can now be treated successfully in the majority of patients. Thus, we strongly advocate testing for hepatitis C in women with signs of ICP.”

Disclosure: The researchers report no relevant financial disclosures.