title: Multiple pregnancies, hepatitis C, and risk for hepatocellular carcinoma in Egyptian women.
abstract: BACKGROUND
  The reasons for the worldwide sex disparity in the incidence of hepatocellular carcinoma (HCC) remain elusive. We investigated the role of multiple pregnancies on the associations between viral hepatitis C (HCV) infection and HCC risk among Egyptian women.
  
  
  METHODS
  We used data collected from blood specimens and questionnaires administered to female HCC cases and controls in Cairo, Egypt, from 1999 through 2009. HCV infection was defined as being sero-positive for either anti-HCV antibodies or HCV-RNA. Using logistic regression models we calculated odds ratios (OR) and 95% confidence intervals (CI) to estimate the associations between being HCV positive and HCC risk, and how it is modified by the number of pregnancies, after adjustment for other factors, including hepatitis B status.
  
  
  RESULTS
  Among 132 confirmed female cases and 669 controls, the risk of HCV-related HCC increased with the number of pregnancies. Women infected with HCV had higher risk for HCC if they had more than five pregnancies, as compared to those who had five or fewer pregnancies (adjusted OR (95% CI): 2.33 (1.29-4.22)). The association of HCV infection with HCC risk was significantly greater among the former (21.42 (10.43-44.00)) than among the latter (6.57 (3.04-14.25)).
  
  
  CONCLUSIONS
  Having multiple pregnancies increases the risk of HCV-related HCC among Egyptian women, raising questions about the roles of estrogens and other pregnancy-related hormones in modulating HCV infection and its progression to HCC.
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 West Redwood Street, Baltimore, MD 21201, USA. samr@epi.umaryland.edu.
authors.forename: Sania
authors.initials: S
authors.lastname: Amr
authors.forename: Emily A
authors.initials: EA
authors.lastname: Iarocci
authors.forename: Ghada R
authors.initials: GR
authors.lastname: Nasr
authors.forename: Doa'a
authors.initials: D
authors.lastname: Saleh
authors.forename: Jan
authors.initials: J
authors.lastname: Blancato
authors.forename: Kirti
authors.initials: K
authors.lastname: Shetty
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Loffredo
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000821:virology; D016022:Case-Control Studies; D004534:Egypt / Q000453:epidemiology; D005260:Female; D020073:Gravidity; D006526:Hepatitis C / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000821:virology; D011247:Pregnancy; D012307:Risk Factors; D016387:Women's Health