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- Stokkeland, Knut, et al.
(författare)
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Increased risk of preterm birth in women with autoimmune hepatitis : a nationwide cohort study
- 2016
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Ingår i: Liver international (Print). - : Wiley. - 1478-3223 .- 1478-3231. ; 36:1, s. 76-83
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Tidskriftsartikel (refereegranskat)abstract
- Background & Aims: The aim of our study was to investigate the risks of pregnancy and childbirth complications in women with autoimmune hepatitis compared to the population controls. Methods: In a nationwide cohort study of all pregnancies between 2006 and 2011 we investigated the risks of adverse pregnancy outcome in 171 births in women with diagnosed autoimmune hepatitis using the data from the Swedish Medical Birth and Patient Registries. Births to women without autoimmune hepatitis served as population controls (n = 576 642). Relative risks (RR) with 95% confidence intervals (CI) were calculated using Poisson regression models adjusting for potential confounders. Results: Women with AIH had an increased risk of gestational diabetes (RR = 4.35, 95% CI 2.21-8.57), of preterm birth (RR = 3.21, 95% CI 1.97-4.92) and of low-birth-weight child (RR = 2.51, 95% CI 1.51-4.19). We found no statistically significant association between autoimmune hepatitis and pre-eclampsia, caesarean section, low 5-min Apgar score, small for gestational age birth, congenital malformation and neonatal mortality. Conclusions: Autoimmune hepatitis is a risk factor for adverse pregnancy outcomes. High quality prenatal and antenatal care is important for women with autoimmune hepatitis and their infants.
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- Stokkeland, Knut, et al.
(författare)
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Pregnancy outcome in more than 5000 births to women with viral hepatitis : a population-based cohort study in Sweden
- 2017
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Ingår i: European Journal of Epidemiology. - : Springer. - 0393-2990 .- 1573-7284. ; 32:7, s. 617-625
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies have shown inconsistent results with respect to hepatitis B (HBV), hepatitis C (HCV) and pregnancy outcome. The aim of this study was to investigate pregnancy outcome in women with HBV or HCV. In a nationwide cohort of births between 2001 and 2011 we investigated the risks of adverse pregnancy outcomes in 2990 births to women with HBV and 2056 births to women with HCV using data from Swedish healthcare registries. Births to women without HBV (n = 1090 979), and births without HCV (n = 1091 913) served as population controls. Crude and adjusted relative risks (aRR) were calculated using Poisson regression analysis. Women with HCV were more likely to smoke (46.7 vs. 8.0%) and to have alcohol dependence (18.9 vs. 1.3%) compared with population controls. Most women with HBV were born in non-Nordic countries (91.9%). Maternal HCV was associated with a decreased risk of preeclampsia (aRR: 0.39, 95% CI: 0.24-0.64), but an increased risk of preterm birth (aRR: 1.32, 95% CI: 1.08-1.60) and late neonatal death (7-27 days: aRR: 3.79, 95% CI: 1.07-13.39) Preterm birth were also more common in mothers with HBV, aRR: 1.21 (95% CI: 1.02-1.45). Both HBV and HCV are risk factors for preterm birth, while HCV seems to be associated with a decreased risk for preeclampsia. Future studies should corroborate these findings.
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- Stokkeland, Knut
(författare)
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Studies on alcoholic liver disease
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to explore the impact of alcoholic cirrhosis in Sweden, and the relation between drinking patterns and beverage types and alcoholic cirrhosis, and to evaluate the possible role of autoantibodies in the pathogenesis of alcohol related liver disease. We found that rats had appearance of IgG against rat CYP3A 1 and CYP2E 1 during chronic ethanol feeding We found that patients had reactivity against CYP3A4 and CYP2E I in about 20 to 30% and 10 to 20% of the alcoholic sera. Western blotting confirmed anti-human CYP2E 1 reactivity in 8 of 85 alcoholic sera, and 3 of 58 control sera. Anti-CYP3A4 reactivity was detected in 18 of 85 alcoholic sera and 4 of 58 control sera. The results suggest that autoantibodies toward both CYP2E I and CYP3A could be generated after exposure to alcohol in both humans and experimental animals and it may contribute to the development of liver cirrhosis. We found that the liver disease mortality increase from 1969 to 1976 coincided with the increase in spirit sales. Both mortality and spirit sales decreased thereafter, whereas there was no decrease in beer or wine sales. Hospitalization rates were reduced after 1987. Depending on age and sex there was a 30-80 percent five-year mortality following discharge. The same patients could be diagnosed as having both alcoholic and non-alcoholic liver disease in the Hospital Discharge Register and the Cause of Death Register. This was most often found among men. The results suggest that liver diseases in Sweden during the last thirty years have a reduced mortality that may be associated with the reduction in spirit consumption on the aggregate level of the Swedish population. There are difficulties in differing between alcoholic and non-alcoholic liver disease using register data. We investigated and followed up 12 281 patients who were hospitalized with esophageal varices. There was an increase in five-year survival between 1990 and 2002 compared to the years between 1969 and 1979 for all patients. There was a better survival for women than men, for younger patients compared to older and for patients hospitalized in the latest decade compared to the earlier decades. We found a significant decrease in mortality due to esophageal varices during the years studied but no decrease due to other causes. An improved prognosis for patients with esophageal varices may be related to improvement in therapeutic strategies towards acute variceal bleeding and secondary prophylactic treatment. We interviewed 140 patients (50 with alcoholic cirrhosis, 50 with alcohol dependence without cirrhosis and 40 with non-alcoholic cirrhosis). We found that women drank less than men, and patients with alcoholic cirrhosis did not drink more than patients with alcohol dependence without cirrhosis. Women with alcoholic cirrhosis drank 14 009 drinks of alcohol during their lifetime compared to 45 658 drinks consumed by men with alcoholic cirrhosis. Women with alcoholic cirrhosis reported 9 198 drinks consumed as binge drinking compared to 25 890 drinks for women with alcohol dependence. Women with alcoholic cirrhosis drank less beer compared to women with alcohol dependence. The results suggest that patients with alcoholic cirrhosis seem to be predisposed to the hepatotoxic effects of alcohol - with a more pronounced sensitivity in women.
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- Törner, Anna, et al.
(författare)
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The underreporting of hepatocellular carcinoma to the Cancer Register and a log-linear model to estimate a more correct incidence
- 2017
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Ingår i: Hepatology. - Hoboken, USA : John Wiley & Sons. - 0270-9139 .- 1527-3350. ; 65:3, s. 885-892
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Tidskriftsartikel (refereegranskat)abstract
- The Cancer Register (CR) in Sweden has reported that the incidence of primary liver cancer (PLC) has slowly declined over the last decades. Even though all cancers, irrespective of diagnostic method, should be reported to the CR, the PLC incidence may not reflect the true rate. Improved diagnostic tools have enabled diagnosis of hepatocellular carcinoma (HCC) based on non-invasive methods without histological verification, possibly associated with missed cancer-reports or misclassification in the CR. Our objective was to study the completeness and assess the underreporting of PLC to the CR, and to produce a more accurate estimate based on three registers. The CR, the Cause of Death and the Patient Register were investigated. Differences and overlap were examined, the incidence was estimated by merging data from the registers, and the number reported to none of the registers was estimated using a log-linear capture-recapture model. The results show that 98% of the PLCs reported to the CR were histologically verified; 80% were HCC and 20% intrahepatic cholangiocarcinoma. Unspecified liver cancer decreased over time and constituted <10% of all reported liver cancers. The CR may underestimate the liver cancer incidence by 37% - 45%, primarily due to missed cancer-reports. The estimated annual number of liver cancers increased over time, but the standardized incidence was stable around 11 per 100,000. Hepatitis C associated liver cancer increased and constituted 20% in 2010.Conclusion: There was an underreporting of PLC diagnosed by non-invasive methods. The incidence was considerably higher than estimated by the CR, with a stable incidence over time. Reporting needs to improve and combining registers is recommended when studying incidence. This article is protected by copyright. All rights reserved.
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