Hepatitis C infection and intrahepatic cholestasis of pregnancy: A systematic review and meta-analysis

Clin Res Hepatol Gastroenterol. 2017 Feb;41(1):39-45. doi: 10.1016/j.clinre.2016.07.004. Epub 2016 Aug 16.


Background/objectives: 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.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Cholestasis, Intrahepatic / complications*
  • Cholestasis, Intrahepatic / diagnosis
  • Diagnosis, Differential
  • Female
  • Hepatitis C / complications*
  • Hepatitis C / diagnosis
  • Humans
  • Mass Screening
  • Observational Studies as Topic
  • Pregnancy
  • Pregnancy Complications / diagnosis
  • Pregnancy Complications, Infectious / diagnosis
  • Pregnancy Complications, Infectious / virology*
  • Risk Factors

Supplementary concepts

  • Intrahepatic Cholestasis of Pregnancy