Burden of Future Liver Abnormalities in Patients With Intrahepatic Cholestasis of Pregnancy

Abstract

INTRODUCTION:There are limited data on the incidence, predictors, and time to future liver abnormalities in patients with intrahepatic cholestasis of pregnancy (ICP). METHODS:Single-center retrospective study of pregnant women with and without ICP who delivered from 2005 to 2009 evaluating incidence and time to future liver abnormalities. Women returning for care with liver function tests at a minimum of 6 months postpartum were included. Liver disease diagnoses and liver functions test abnormalities were compared. Time to development of alanine aminotransferase (ALT) >25 U/L, alkaline phosphatase (ALP) >140 U/L, and diagnosis of liver disease (through imaging or clinical evaluation) were compared between women with and without ICP using Kaplan-Meier methods and Cox regression models. RESULTS:A total of 255 women with ICP and 131 age-matched control subjects with delivery during the same period were identified. Subjects in both groups were similar in follow-up time, age at pregnancy, prepregnancy body mass index, and ethnicity (≥75% were Hispanic in both groups). On univariate analyses, ICP was associated with increased incidence of ALT >25 U/L P < 0.01 ALP >140 U/L (P < 0.01) and liver disease (P = 0.03). Adjusting for metabolic factors, ICP diagnosis was associated with risk of future liver abnormalities: postpartum ALT >25 U/L (hazard ratio [HR] 1.9, P < 0.01), ALP >140 U/L (HR 3.4, P < 0.01), and liver disease (HR 1.5, P = 0.05).

Liver pathology in pregnancy

“…Additionally, a recent study has shown that patients with ICP have an increased risk of elevated liver enzymes detected greater than 6 months postpartum and subsequent diagnosis of liver disease, most commonly non-alcoholic fatty liver disease (NAFLD). 16 Other studies have demonstrated an increased risk of gallstones, hepatitis C infection, cirrhosis, and hepatobiliary malignancies in patients with ICP, although the causality is unclear. 17,18 Patients with ICP may therefore benefit from postpartum surveillance for liver disease and screening for hepatitis C.…”

“…While ICP symptoms typically resolve postpartum, the condition can recur in future pregnancies. Additionally, a recent study has shown that patients with ICP have an increased risk of elevated liver enzymes detected greater than 6 months postpartum and subsequent diagnosis of liver disease, most commonly non‐alcoholic fatty liver disease (NAFLD) 16 . Other studies have demonstrated an increased risk of gallstones, hepatitis C infection, cirrhosis, and hepatobiliary malignancies in patients with ICP, although the causality is unclear 17,18 .…”

Manejo da colestase intra-hepática gestacional / Gestational intrahepatic cholestase management

“…No que concerne os fatores genéticos, as mutações dos genes ABCB11, ABCB4, ABCC2, ATP8B1 e receptor farnesoide X (FXR) são os principais causadores deste agravo, encontrados em até 15% das pacientes portadoras de CIHG. Estas mutações culminam em susceptibilidade ao estrogênio e a progesterona que inibem a bomba exportadora de sais biliares dos hepatócitos (5)(6)(7) .…”

Effect of intrahepatic cholestasis of pregnancy on infantile food allergy: A retrospective longitudinal study cohort in Southwest China

“…The incidence of intrahepatic cholestasis of pregnancy is reported to be between 0.2% and 2% but varies widely with ethnicity and geographic location. It is most common in South America and northern Europe [8][9][10]. There is a higher incidence of intrahepatic cholestasis of pregnancy in women with a multiple pregnancy (up to 22% in one study) [11,12].…”

“…Previous studies have shown that children's food allergy may be closely related to family genetic history and abnormal maternal metabolism during pregnancy [24][25][26]. Increasingly intrahepatic cholestasis of pregnancy is recognized to be associated with an abnormal metabolic profile [9,27]. Thus, it is essential to clarify whether the incidence rate and degree neonatal food allergy worsens among pregnant women with intrahepatic cholestasis of pregnancy.…”