Intrahepatic cholestasis of pregnancy and associated hepatobiliary disease: A population-based cohort study

Abstract

Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease in pregnancy. We aimed to estimate the risk of developing hepatobiliary disease in women with ICP and the odds of developing ICP in women with prevalent hepatobiliary disease. We analyzed data of women with births between 1973 and 2009 and registered in the Swedish Medical Birth Register. By linkage with the Swedish Patient Register, we identified 11,388 women with ICP who were matched to 113,893 women without this diagnosis. Diagnoses of preexisting or later hepatobiliary disease were obtained from the Patient Register. Main outcome measures were hazard ratios (HRs) for later hepatobiliary disease in women with ICP and odds ratios (ORs) for developing ICP in preexisting hepatobiliary disease. Risk estimates were calculated through Cox and logistic regression analyses. Women with ICP were more often diagnosed with later hepatobiliary disease (HR 2.62; 95% confidence interval [CI] 2.47-2.77; increment at 1% per year), hepatitis C or chronic hepatitis (HR 4.16; 3.14-5.51 and 5.96; 3.43-10.33, respectively), fibrosis/ cirrhosis (HR 5.11; 3.29-7.96), gallstone disease or cholangitis (HR 2.72; 2.55-2.91, and 4.22; 3.13-5.69, respectively) as compared to women without ICP (P < 0.001 for all HRs). Later ICP was more common in women with prepregnancy hepatitis C (OR 5.76; 1.30-25.44; P 5 0.021), chronic hepatitis (OR 8.66; 1.05-71.48; P 5 0.045), and gallstone disease (OR 3.29; 2.02-5.36; P < 0.0001). Conclusion: Women with ICP have substantially increased risk for later hepatobiliary disease. Beyond gallstone-related morbidity we found a strong positive association between ICP and hepatitis C both before and after ICP diagnosis. Thus, we advocate testing for hepatitis C in women with ICP, in particular, since this potentially life-threatening infection can be treated successfully in the majority of patients. (HEPATOLOGY 2013;58:1385-1391 I ntrahepatic cholestasis of pregnancy (ICP) is the most common liver disease during pregnancy, 1 with reported prevalence rates of between 0.4% and 1.5%.2,3 ICP is characterized by otherwise unexplained pruritus with elevated bile acids and/or transaminases in the late second and third trimester of pregnancy.2,3 Genetic predisposition (variants of hepatobiliary transport proteins), impaired turnover of reproductive hormones, and environmental factors play key roles in the etiology and pathogenesis of ICP. 2,3 By definition, ICP is a diagnosis of exclusion. Pruritus in ICP spontaneously resolves and deranged liver function tests typically normalize within 4 weeks after delivery. Thus, ICP is usually a self-limiting, benign condition for the mother, although the fetus is at increased risk of adverse outcome, in particular preterm delivery. 4,5 In a small number of women with ICP, liver function does not return to normal, suggesting an underlying hepatobiliary disease that needs further diagnostic testing.6 These women might have been misclassified as suffering from ICP only.Abbreviations: CI, confidence interva...

ACG Clinical Guideline: Liver Disease and Pregnancy

“…IHCP is the most common liver disease in pregnancy with prevalence ranging between 0.3 and 5.6% (36)(37)(38). IHCP presents in the second and third trimesters as persistent pruritus, typically involving the palms and soles as well as the rest of the body, with elevated bile acid levels, and resolves with delivery.…”

“…Some studies suggest a higher prevalence in patients with hepatitis C, cholelithiasis, and nonalcoholic fatty liver disease ( 37,39,40 ). Evaluation for alternative etiologies should be pursued if cholestasis fails to resolve aft er delivery.…”

Intrahepatic Cholestasis of Pregnancy and Cancer: A Cohort Study

“…There is higher risk of hepatobiliary disease and particularly chronic hepatitis among women with a history of ICP [26,27]. The latter disease causes liver cirrhosis and is often complicated by hepatocellular cancer [17].…”

“…The latter disease causes liver cirrhosis and is often complicated by hepatocellular cancer [17]. Also cholelithiasis and chronic cholangitis are associated with ICP [26,27] and are associated with gallbladder and cholangiocellular cancer [17].…”

Hepatobiliary Quiz Answers—17 (2016)

“…Such patients also have higher HCV viral load compared with those without ICP. [23][24][25] It is also more common in women with prior history of ICP, multi-fetal gestation, and advanced age. 22, Though classically a disease of the third trimester, it has been seen to occur as early as seventh weeks of gestation.…”