title: Hepatitis C infection and intrahepatic cholestasis of pregnancy: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Hepatitis C virus (HCV) infection is a major cause of cirrhosis worldwide. Several studies have linked HCV infection to a higher risk of developing intrahepatic cholestasis of pregnancy (ICP), but some data demonstrates contradictory results. To further investigate the association and estimated risk of ICP in patients with HCV infection, we conducted this meta-analysis to summarize all available evidence.
  
  
  METHODS
  This study consists of two meta-analyses. A literature search was performed using MEDLINE and EMBASE from inception to January 2016. The first study included observational studies that reported relative risks, odds ratios, or hazard ratios of the associations between HCV infection and risk of ICP. The second analysis included studies comparing the risk of later HCV infection in ICP patients with those without ICP. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using a random-effect, generic inverse variance method.
  
  
  RESULTS
  Three studies were included in the first analysis. The pooled OR of ICP in HCV-infected pregnant women compared to non-HCV pregnant women was 20.40 (95% CI, 9.39-44.33, I2=55%). Two studies were included in the second analysis. The pooled OR of later HCV infection among ICP patients compared to non-ICP patients was 4.08 (95% CI, 3.13-5.31, I2=0%).
  
  
  CONCLUSIONS
  Our meta-analysis demonstrates not only a higher risk of ICP among HCV-infected pregnant women but also an increased risk of later HCV infection among ICP patients. These findings suggest potential benefits of screening for hepatitis C in women with signs of ICP.
authors.affiliation: Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA. Electronic address: dr.karn.wi@gmail.com.
authors.forename: Karn
authors.initials: K
authors.lastname: Wijarnpreecha
authors.affiliation: Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA.
authors.forename: Charat
authors.initials: C
authors.lastname: Thongprayoon
authors.affiliation: Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA; Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
authors.forename: Anawin
authors.initials: A
authors.lastname: Sanguankeo
authors.affiliation: Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA; Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
authors.forename: Sikarin
authors.initials: S
authors.lastname: Upala
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Patompong
authors.initials: P
authors.lastname: Ungprasert
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Wisit
authors.initials: W
authors.lastname: Cheungpasitporn
mesh_terms: D002780:Cholestasis, Intrahepatic / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008403:Mass Screening; D064887:Observational Studies as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000821:virology*; D012307:Risk Factors