IBD patients at increased risk of intrahepatic cholestasis of pregnancy

Pregnant women with inflammatory bowel disease (IBD), especially those with thiopurine exposure, face a heightened risk of intrahepatic cholestasis of pregnancy (ICP), according to the results of a systematic review and meta-analysis.

Researchers searched multiple online databases for studies on ICP and involving pregnant women with a confirmed diagnosis of IBD. A random effects model was used to pool the prevalence and event numbers of ICP.

Two case reports, a case series involving eight patients, and three cohort studies met the eligibility criteria and were included in the meta-analysis. In 1,603 pregnancies with IBD, the pooled prevalence of ICP was 3 percent (95 percent confidence interval [CI], 1.0–7.0). Notably, ICP prevalence in IBD was significantly higher than that in the general population (odds ratio [OR], 3.08, 95 percent CI, 1.11–8.56; p=0.039), as reported in one cohort study.

Meta-analysis indicated that thiopurine exposure was associated with a more than sixfold increased odds of ICP (OR, 6.65, 95 percent CI 3.10–14.25). One cohort study indicated that for pregnancies with IBD, the odds of ICP were significantly increased in thiopurine-exposed pregnancies (OR, 7.55, 95 percent CI, 2.52–22.57; p<0.001) but not in nonexposed pregnancies (OR, 1.41, 95 percent CI, 0.40–4.92; p=0.75) compared with non-IBD controls.

The findings underscore the importance of monitoring pregnant patients with IBD exposed to thiopurines for symptoms of ICP, the researchers said.