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ICP increases risk for liver and biliary cancer, CVD

Researchers in Sweden found that women with intrahepatic cholestasis of pregnancy had an increased risk for developing late liver and biliary tree cancer, immune-mediated diseases and cardiovascular disease, according to published findings in the Journal of Hepatology.

“Intrahepatic cholestasis of pregnancy is the most common liver disease during pregnancy, with reported prevalence rates between 0.4% and 1.5%,” the researchers wrote. “Women with [intrahepatic cholestasis of pregnancy] have a substantially increased risk of hepatobiliary diseases, such as hepatitis C, cirrhosis and gallstones, both before and after [intrahepatic cholestasis of pregnancy] diagnosis. … However, it [has not been] known whether women with [intrahepatic cholestasis of pregnancy] are at increased risk of hepatobiliary cancer and immune-mediated and cardiovascular diseases after delivery.”

Hanns-Ulrich Marschall

To investigate this, Hanns-Ulrich Marschall, MD, of Sahlgrenska Academy, University of Gothenburg, Sweden, and colleagues linked the Swedish Medical Birth Register and Swedish Patient Register to identify women with intrahepatic cholestasis of pregnancy (ICP) and compare them with other women without ICP who gave birth between 1973 and 2009. The researchers were able to identify 11,388 women with ICP and 113,893 matched controls. Any diagnosis of cancer, immune-mediated diseases and cardiovascular diseases (CVD) among these women were obtained via the Patient Register.

Overall, the researchers found an association between ICP and an increased risk for liver cancer (HR = 3.61; 95% CI, 1.68-7.77) and biliary tree cancer (HR = 2.62; 95% CI, 1.26-5.46). The research showed that women with ICP had a 2.5-times increased risk for cancer in the biliary tree and a 3.5-times increased risk for liver cancer later in life compared with matched controls.

In addition, ICP was found to be associated with immune-mediated diseases later in life, such as diabetes mellitus (HR = 1.47; 95% CI, 1.26-1.72), thyroid disease (HR = 1.3; 95% CI, 1.14-1.47), Crohn’s disease (HR = 1.55; 95% CI, 1.14-2.1), inflammatory polyarthropathies (HR = 1.32; 95% CI, 1.11-1.58) and psoriasis (HR = 1.27; 95% CI, 1.07-1.51). However, ICP was not associated with an increased risk of developing ulcerative colitis (HR = 1.21; 95% CI, 0.93-1.58).

Women with ICP also had a small increased risk for developing CVD later in life (HR = 1.12; 95% CI, 1.06-1.19).

“We strongly recommend a follow-up of serum liver tests 6 [to] 12 weeks after delivery in all women with ICP, with and without persisting pruritus, and if serum liver test results are elevated, further evaluation by a hepatologist,” Marschall said in a press release.

The researchers concluded: “This population-based 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. Cardiovascular disease was particularly prevalent in women with ICP and concomitant pre-eclampsia.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.