title: Intrahepatic cholestasis of pregnancy and cancer, immune-mediated and cardiovascular diseases: A population-based cohort study.
abstract: OBJECTIVE
  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.affiliation: Department of Obstetrics and Gynaecology and Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Wikström Shemer
authors.affiliation: 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.
authors.forename: Olof
authors.initials: O
authors.lastname: Stephansson
authors.affiliation: Statisticon AB, Uppsala, Sweden.
authors.forename: Marcus
authors.initials: M
authors.lastname: Thuresson
authors.affiliation: Department of Obstetrics and Gynaecology and Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Thorsell
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet and University Hospital, Stockholm, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
authors.forename: Jonas F
authors.initials: JF
authors.lastname: Ludvigsson
authors.affiliation: Sahlgrenska Academy, Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden. Electronic address: hanns-ulrich.marschall@gu.se.
authors.forename: Hanns-Ulrich
authors.initials: HU
authors.lastname: Marschall
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D002780:Cholestasis, Intrahepatic / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D011159:Population Surveillance / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011252:Pregnancy Complications, Neoplastic / Q000453:epidemiology / Q000209:etiology*; D011256:Pregnancy Outcome; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
keywords: Bile acids; Gestational diabetes; Intrahepatic cholestasis of pregnancy; Obstetric cholestasis; Preeclampsia