Elisabeth A Wikström Shemer1, Olof Stephansson2, Marcus Thuresson3, Malin Thorsell1, Jonas F Ludvigsson4, Hanns-Ulrich Marschall5. 1. Department of Obstetrics and Gynaecology and Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. 2. Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska University Hospital and Institutet, Stockholm, Sweden. 3. Statisticon AB, Uppsala, Sweden. 4. Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet and University Hospital, Stockholm, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden. 5. Sahlgrenska Academy, Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden. Electronic address: hanns-ulrich.marschall@gu.se.
Abstract
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.
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.
Authors: Peter H Dixon; Melissa Sambrotta; Jennifer Chambers; Pamela Taylor-Harris; Argyro Syngelaki; Kypros Nicolaides; A S Knisely; Richard J Thompson; Catherine Williamson Journal: Sci Rep Date: 2017-09-18 Impact factor: 4.379
Authors: Maria C Estiú; Maria A Frailuna; Carla Otero; Marcela Dericco; Catherine Williamson; Jose J G Marin; Rocio I R Macias Journal: PLoS One Date: 2017-04-24 Impact factor: 3.240