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Women with ICP found to have increased risk for CVD, liver cancer

Women with intrahepatic cholestasis of pregnancy had an increased risk for developing hepatobiliary cancer and immune-mediated and cardiovascular diseases over time compared with women who did not, according to study data.

“Intrahepatic cholestasis of pregnancy is the most common liver disease in pregnancy,” the researchers wrote. “It is associated with hepatobiliary diseases that might predispose to cancer and also with gestational diabetes and pre-eclampsia. … We perform[ed] a population-based study to investigate the association between [intrahepatic cholestasis of pregnancy] and later cancer, diabetes mellitus and other autoimmune-mediated diseases, and cardiovascular diseases.”

The researchers analyzed data of 11,388 women with intrahepatic cholestasis of pregnancy (ICP) in the Swedish Medical Birth Register and linked it with data of women (n = 113,893) without ICP from the Swedish Patient Register. Each woman with ICP was matched to 10 women without ICP according to maternal age and calendar year of delivery and each woman had given birth between 1973 and 2009.

Analyses showed that ICP was not associated with developing overall cancer over time (HR = 1.07 95%; CI, 0.94-1.21), but was associated with liver cancer (HR = 3.61; 95% CI, 1.68-7.77) and biliary tree cancer (HR = 2.62; 95% CI, 1.26-5.46) over time.

ICP was also associated with immune-mediated diseases over time (HR = 1.28; 95% CI. 1.19-1.38), as well as 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, 1.14-2.1) over time. However, ICP was not associated with developing 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). For women with ICP, the risk of subsequent cardiovascular disease was only increased in those also diagnosed with pre-eclampsia (P < .001), not in those diagnosed with gestational diabetes (P = .104). However, for women without ICP, a diagnosis of gestational diabetes or pre-eclampsia was associated with subsequent cardiovascular disease

(P < .001).

“This study in women with ICP found increased risks of later hepatobiliary cancer and immune-mediated diseases and a small increased risk of later cardiovascular disease,” the researchers concluded. “Cardiovascular disease was particularly prevalent in women with ICP and concomitant pre-eclampsia.”

Disclosures: The researchers report no relevant financial disclosures.