Perinatal outcomes associated with ICP in twin pregnancies were worse than singletons: an almost 5-year retrospective cohort study.
Perinatal outcomes associated with ICP in twin pregnancies were worse than singletons: an almost 5-year retrospective cohort study.
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DOI：
10.1186/s12884-022-05160-6
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发表时间：
2022-11-05
影响因子：
3.1
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中科院分区：
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妊娠期肝内胆汁淤积症（ICP）与围产期不良结局的风险增加相关，导致围产期高发病率和死亡率。然而，很少有研究探讨双胎妊娠并发ICP。为了评估双胎妊娠ICP的围产期结局，进行了一项回顾性队列研究。共纳入633例双胎妊娠和1267例单胎妊娠ICP。同时对33例双胎孕妇血清、胎儿脐静脉血及羊水中的总胆汁酸（TBA）进行相关性分析。与单胎妊娠相比，双胎妊娠ICP有更高的剖宫产风险（96.4%对76.1%），早产（PTB）（82.6% vs. 19.7%），胎儿窘迫（2.0% vs. 1.3%）和新生儿重症监护室（NICU）入院（23.6% vs5.1%），与TBA水平升高显著相关（P <0.05）。TBA ≥ 100 μ mol/L的双胎妊娠CS、PTB、胎儿窘迫、新生儿窒息和羊水粪染的发生率分别为94.4%、100%、11.1%、5.6%和36.1%。孕妇TBA最高值与羊水（r = 0.61，P <0.05）、脐血（r = 0.44，P <0.05）及分娩时TBA水平呈正相关。脐带血与羊水中TBA水平也呈显著正相关（r = 0.52，P <0.05）。双胎妊娠ICP比单胎妊娠有更高的围产期不良结局风险，这与较高的TBA水平有关。TBA可通过胎盘转运，并参与子宫-胎盘-胎儿循环。
Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of adverse perinatal outcomes leading to high perinatal morbidity and mortality. However, few studies have examined twin pregnancies complicated by ICP. To assess the perinatal outcomes of twin pregnancies with ICP, a retrospective cohort study was conducted. A total of 633 twin pregnancies and 1267 singleton pregnancies with ICP were included. In addition, a correlation study was performed on the matched total bile acid (TBA) levels from maternal serum, fetal umbilical venous blood, and amniotic fluid of 33 twin pregnancies from twin groups. When compared to singletons, twin pregnancies with ICP had a higher risk of cesarean section (CS) (96.4% vs. 76.1%), preterm birth (PTB) (82.6% vs. 19.7%), fetal distress (2.0% vs. 1.3%), and neonatal intensive care unit (NICU) admission (23.6% vs. 5.1%), which was significantly related to increasing TBA levels (P < 0.05). In twin pregnancies with TBA ≥100 μmol/L, the incidences of CS, PTB, fetal distress, neonatal asphyxia, and meconium-stained amniotic fluid were 94.4, 100, 11.1, 5.6, and 36.1%, respectively. Furthermore, the maximum maternal TBA levels were positively correlated with TBA levels in the amniotic fluid (r = 0.61, P < 0.05) and umbilical cord blood (r = 0.44, P < 0.05), and a similar correlation was found for maternal TBA levels at delivery. TBA levels in umbilical cord blood and amniotic fluid also had a significant and positive correlation (r = 0.52, P < 0.05). Twin pregnancies with ICP had a higher risk for adverse perinatal outcomes than singletons, which was associated with higher TBA levels. TBA can be transported through the placenta and is involved in uterus-placenta-fetal circulation.
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