title: A population-based cohort study of pregnancy outcomes among women with primary sclerosing cholangitis.
abstract: OBJECTIVE
  Studies of primary sclerosing cholangitis (PSC) and pregnancy outcomes have been limited in size and have been inadequate to rule out excess risks. We examined pregnancy outcomes among women with PSC.
  
  
  METHODS
  Women with PSC were identified from inpatient and hospital-based outpatient data in the Swedish National Patient Register. Through linkage with the Medical Birth Register, we identified 229 singleton births, from 1987 through 2009, to women with PSC before delivery. These were compared with 2,304,863 births to women without a diagnosis of PSC. We used logistic regression, adjusted for maternal age, smoking, education, parity, and year of birth, to calculate adjusted prevalence odds ratios (aPORs) for adverse pregnancy outcomes.
  
  
  RESULTS
  Maternal PSC was associated with a 3.63-fold increase in preterm birth (95% confidence interval [CI] for aPOR, 2.35-5.61) as well as an increased risk of cesarean section (aPOR, 2.18; 95% CI, 1.50-3.17). We found no increased risk based on analyses of the 5-minute Apgar score, small for gestational age, stillbirths, or neonatal deaths. Maternal PSC was not a risk factor for congenital abnormalities (aPOR, 1.12; 95% CI, 0.56-2.22). Stratification by inflammatory bowel disease status did not affect the risk estimates more than marginally.
  
  
  CONCLUSIONS
  Maternal PSC is associated with both preterm birth and cesarean section but not with congenital malformation or other adverse outcomes of pregnancy. Pregnancy should not be discouraged in women with PSC.
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, New York. Electronic address: jonasludvigsson@yahoo.com.
authors.forename: Jonas F
authors.initials: JF
authors.lastname: Ludvigsson
authors.affiliation: Department of Gastroenterology and Hepatology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Bergquist
authors.affiliation: Department of Women's and Children's Health, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Ajne
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, New York.
authors.forename: Sunanda
authors.initials: S
authors.lastname: Kane
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Ekbom
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology and Hepatology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Olof
authors.initials: O
authors.lastname: Stephansson
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D015209:Cholangitis, Sclerosing / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D013548:Sweden; D055815:Young Adult
keywords: Bile Duct Diseases; CD; CI; Child; Crohn's disease; IBD; ICD; International Classification of Diseases; LGA; Liver; MBR; PH; POR; PSC; Pregnancy; Primary Sclerosing Cholangitis; SGA; Swedish Medical Birth Registry; UC; aPOR; adjusted prevalence odds ratio; confidence interval; inflammatory bowel disease; large for gestational age; portal hypertension; prevalence odds ratio; primary sclerosing cholangitis; small for gestational age; ulcerative colitis