Intrahepatic Cholestasis of Pregnancy May Increase NAFLD Risk
Women with intrahepatic cholestasis of pregnancy (ICP) may have a higher likelihood of developing nonalcoholic fatty liver disease (NAFLD) compared with pregnant women without ICP, according to research presented at Digestive Disease Week (DDW).1
“Our research shows that there is a connection between impaired bile acid metabolism in both disease processes, which could have implications for future management of NAFLD,” study coauthor Erica Monrose, MD, of the Icahn School of Medicine at Mount Sinai, New York, said in a press release.2
The case-control retrospective study, which was presented Saturday, May 18, at DDW 2019 in San Diego, California, included a cohort of primarily Latinas—a population with a high prevalence of ICP—who were seen at a single center in New York City between January 2017 and December 2017.
The researchers identified 149 pregnancies complicated by ICP and matched them to 200 controls with the same delivery year. Both groups were similar for median age, nulliparity, and prevalence of hepatitis C virus infection, as well as for the prevalence of the metabolic risk factors of obesity (body mass index greater than 30 kg/m2), hypertension, hemoglobin A1c concentration greater than 5.5%, and a total cholesterol level less than 200 mg/dL.
A diagnosis of NAFLD was based on ICD-10 code or evidence of steatosis on liver imaging.
Overall, participants with ICP were 5.7 times more likely to receive an NAFLD diagnosis than their counterparts without ICP.2 Compared with the participants without ICP, participants with ICP were also more likely to have alanine aminotransferase (ALT) levels greater than 50 U/L, which is 2 times the upper limit of normal, as well as a history of biliary disease and evidence of steatosis on liver imaging.
“ICP appears to be associated with NAFLD independently of metabolic risk factors, suggesting a direct link between NAFLD and ICP,” the researchers concluded. “If findings are confirmed, ICP patients, especially those with elevated ALT, would benefit from screening for NAFLD and linkage to liver specialty care postpartum.”1
—Colleen Murphy
References:
1. Monrose E, Ramirez Zamudio A, Aristide A, et al. Intrahepatic cholestasis of pregnancy (ICP) is associated with higher prevalence of NAFLD: a case-control study. Paper presented at: Digestive Disease Week; May 18-21; San Diego, CA. https://www.gastrojournal.org/article/S0016-5085(19)40085-1/pdf?referrer=https%3A%2F%2Fwww.gastrojournal.org%2Farticle%2FS0016-5085%2819%2940085-1%2Ffulltext. Accessed May 15, 2019.
2. New connection found between non-alcoholic fatty liver disease and rare pregnancy complication [press release]. San Diego, CA: Digestive Disease Week; May 9, 2019. https://ddw.org/news/press-releases/new-connection-found-between-non-alcoholic-fatty-liver-disease-and-rare-pregnancy-complication. Accessed May 15, 2019.