Kaisa Turunen

Good pregnancy outcome despite intrahepatic cholestasis.

Abstract Objective. Pregnant women complaining of itching are screened for intrahepatic cholestasis (ICP) by laboratory tests in primary healthcare. Cases of ICP are referred to specialist care. In Finland, ICP occurs in 1% of pregnancies. The aim was to study the outcome of deliveries. Design. Retrospective study of ICP pregnancies. Data were collected from the hospital discharge register, patient records, and the labour register. Setting. The region of Tampere University Hospital in Finland. Subjects. Altogether 687 ICP cases from 1969 to 1988 and two controls for each. Main outcome measures. ICP patients were compared with controls in terms of mothers age, pregnancy multiplicity, weeks of gestation at delivery, frequency of induction and Caesarean section, length of ward period, childs weight, Apgar scores, and stillbirth. Results. For ICP patients, the risk for hospital stay of 10 days or more was eightfold (OR 8.41), for gestational weeks less than 37 at delivery sevenfold (OR 7.02), for induction threefold (OR 3.26), for babys low weight at birth almost twofold (OR 1.86), and for Caesarean section one and a half fold (OR 1.47). The possibility of the incidence of multiple pregnancy was two and a half fold (OR 2.49, 95%). ICP was not associated with mothers age, the babys risk of stillbirth, or low Apgar scores. Conclusion. ICP mothers are found and taken care of appropriately, and thus ICP is only a minor risk for mothers and their children.

Health history after intrahepatic cholestasis of pregnancy

Objective. To establish whether intrahepatic cholestasis of pregnancy (ICP) is associated with other diseases during a womans lifetime. Design. Prospective controlled cohort study. Setting. University Hospital in Finland. Population. A total of 575 women with ICP and 1374 control women, all having delivered in 1969–1988. Questionnaires were sent to 544 ICP patients and 1235 control women. Responses were received from 1178 (66.4%). Methods. Questionnaire survey in autumn 2010. Main outcome measures. Perceived health, symptoms and complaints, diseases diagnosed by a doctor and use of medicines. Results. No statistically significant differences were detected in perceived health. Differences in recent symptoms and complaints were small. Diagnoses made by a doctor showed higher frequencies in the ICP group than in control women for other hepatobiliary diseases, breast cancer and hypothyreosis. Diagnosed hypertension and high cholesterol requiring medication as well as cardiac arrhythmia were less frequent in the ICP group. Women in this group used antacid medicines more often than control women. Conclusions. There were few differences between the ICP patients and control women except for a higher frequency of later hepatobiliary disease, breast cancer and hypothyreosis. Women with a history of ICP should be screened for hypothyreosis more readily than those without. The higher frequency of breast cancer warrants further research.

Intrahepatic cholestasis of pregnancy is common among patients' first-degree relatives.

Intrahepatic cholestasis of pregnancy has been shown to have a genetic predisposition. We studied whether Finnish women who had suffered from the disorder reported their first‐degree relatives to have had liver dysfunction during their pregnancies. Questionnaires were sent in autumn 2010 to a total of 544 former intrahepatic cholestasis of pregnancy patients and 1235 controls, all having delivered during 1969–1988. The response rate was 66.2%. The incidence of intrahepatic cholestasis is 0.5–1.5% of pregnancies in Finland. In our survey, altogether 12.8% of mothers (odds ratio 9.2), 15.9% of sisters (odds ratio 5.3) and 10.3% of daughters (odds ratio 4.8) of women who had suffered from intrahepatic cholestasis of pregnancy had had liver dysfunction during pregnancy. Our findings strengthen the earlier knowledge of the genetic component in intrahepatic cholestasis of pregnancy. We suggest that all pregnant women are asked about their family history regarding liver dysfunction during pregnancy.

Unnecessary confusion about family planning after intrahepatic cholestasis of pregnancy

BACKGROUND As conceptions have changed regarding the suitability of oral contraceptives for women with a history of intrahepatic cholestasis of pregnancy (ICP), we studied whether the contraindications formerly in force had affected family planning decisions and mode of contraception among women with such a history. STUDY DESIGN ICP women and their controls who gave birth in 1969-1988 in Tampere University Hospital, Finland, were sent a questionnaire in 2010. The inquiry covered items concerning contraception, deliveries, menstruation and sex life. RESULTS ICP women had limited their number of children for health reasons more often than the controls. They also more often had a single child compared to the controls. The use of oral contraceptives was less common among ICP women. Deliveries were equally successful in both groups. CONCLUSION Physicians should provide sufficient and accurate information on ICP to the patients. Proper introduction of suitable contraception methods and successful communication with the patients would also reduce unnecessary problems and confusion regarding future family planning practices.

Men’s Health Is Not Affected by Their Mothers’ Intrahepatic Cholestasis of Pregnancy

Little is known about the effects of mother’s intrahepatic cholestasis of pregnancy (ICP) on the health of sons born to these mothers. The purpose of the present study was to explore the health of sons born to mothers with ICP. The study design was a retrospective study of ICP mothers’ sons. In the region of Tampere University Hospital in Finland, 365 sons of mothers with ICP during 1969 to 1988 and 617 sons of mothers without ICP were sent a questionnaire in 2010. The response rates were 37.8% (n = 138) and 36.6% (n = 226), respectively. Only minor differences were reported between the two groups. Self-evaluated health was similar. There were no significant differences between the groups regarding symptoms and complaints, diagnosed diseases, mental health, and use of medicines. Cough was 10.8 percentage points less common among ICP mothers’ sons than among controls (p = .034). Urticaria was more common among ICP mothers’ sons, the difference in percentage points being 2.2 (p = .026). In general, a mother’s ICP does not affect her son’s health.

Menopause after a history of intrahepatic cholestasis of pregnancy.

Objective Intrahepatic cholestasis of pregnancy is a hormone-provoked disorder that fades quickly after parturition. The aim of this study was to establish whether a history of intrahepatic cholestasis of pregnancy reduces the use of hormone therapy for menopausal symptoms and, irrespective of hormone therapy, whether intrahepatic cholestasis is associated with other health aspects after menopause. Methods In 2010, questionnaires were sent to a cohort of women who delivered in Tampere University Hospital, Finland, from 1969 to 1988. The study population comprised postmenopausal women with a history of intrahepatic cholestasis of pregnancy (n = 189) and their controls (n = 416). The main outcome measures were the use of hormone therapy and other means of alleviating menopausal symptoms, and the diseases the women reported. Results There were no differences in the use of hormone therapy between the two groups. Of the diseases reported, breast cancer, hepatobiliary diseases, and hypothyroidism were more frequent among women with a history of intrahepatic cholestasis of pregnancy, whereas cardiac arrhythmia was less frequent. With respect to other diseases, there were no differences. Conclusions A history of intrahepatic cholestasis of pregnancy does not reduce the use of hormone therapy. However, when physicians prescribe hormone therapy for these women, a history of intrahepatic cholestasis of pregnancy calls for attention in view of its association with gallstones.

Intrahepatic Cholestasis of Pregnancy and Cancer: A Cohort Study

Objective: In a previous questionnaire study, more breast cancers were reported by women with intrahepatic cholestasis of pregnancy (ICP) than by the controls. The aim of this study was to establish whether ICP is associated with cancer in the Finnish Cancer Registry data, the study population being the same cohort as in the questionnaire study. Methods: The study population comprised 571 women with ICP in at least one pregnancy and 1,333 controls from Tampere University Hospital in Finland during 1969–1988. The cancer data were obtained from the Finnish Cancer Registry. The cancers were classified by ICD-O-3 and diagnosed during the period 1953−2013. Results: In the ICP group, the odds ratio of cancers (OR 1.26, 95% CI 0.96–1.64), and breast cancer in particular (OR 1.36, 95% CI 0.91–2.03), was slightly higher than in the control group. Seven percent of the ICP group and 5.3% of the control group had breast cancer. Conclusion: Based on this study there is not a significant association between ICP and cancer. Earlier observation in the questionnaire study regarding association between ICP and breast cancer cannot be confirmed by this registry based study.