[Intrahepatic cholestasis of pregnancy and fetal outcomes: a prospective birth cohort study].
[Intrahepatic cholestasis of pregnancy and fetal outcomes: a prospective birth cohort study].
复制标题
DOI：
10.3760/cma.j.issn.0254-6450.2016.02.007
复制
发表时间：
2016-02-01
影响因子：
--
通讯作者：
Tao, F B
中科院分区：
文献类型：
--
作者：
Ge, X;Xu, Y Q;Tao, F B
目的：探讨妊娠中晚期肝内胆汁淤积症（ICP）与胎儿结局的关系，为早期发现和干预ICP提供医学建议。方法：在中国安徽马鞍山进行一项前瞻性队列研究（马鞍山出生队列，MABC）。在符合标准的情况下，连续招募怀孕14周内的孕妇。在妊娠早期收集人体测量数据。在妊娠中期和晚期采集产妇血清总胆汁酸水平（TBA），如果结果与临床诊断一致，则视为病例。进行了逻辑回归来检查妊娠中期和晚期ICP与胎儿结局的关系。结果：本研究共纳入2 978名孕妇。ICP发生率为6.5% (n=196)，妊娠中期和晚期发生率分别为1.4% （n=43）和5.1% （n=153）。在控制了潜在的混杂因素后，我们发现妊娠中期和晚期的ICP都可能增加早产、低出生体重（LBW）、胎儿窘迫和羊水粪染色的风险。早产的OR值（95% CI）分别为6.42（2.59 ~ 15.93）和3.73 (2.07 ~ 6.72)，LBW的OR值分别为6.52（2.19 ~ 19.45）和4.90(2.43 ~ 9.90)，胎儿窘迫的OR值分别为2.91（1.27 ~ 6.67）和1.88(1.11 ~ 3.19)，胎粪染色羊水的OR值分别为2.34（1.19 ~ 4.61）和1.66（1.11 ~ 2.48）。妊娠中期ICP导致胎儿不良结局的风险明显高于妊娠晚期ICP。结论：妊娠中晚期ICP明显增加胎儿不良结局的风险，提示临床医生应重视妊娠中期ICP。早期发现和干预对减少不良胎儿结局具有重要意义。
OBJECTIVE: To evaluate the relations between the second and third trimesters intrahepatic cholestasis of pregnancy (ICP) and the fetal outcomes, in order to provide medical advice for early detection and intervention on ICP.METHODS: A prospective cohort study was conducted in Ma' anshan, Anhui, China (Ma'anshan Birth Cohort, MABC). Pregnant women within 14 weeks of gestation were consecutively recruited when standards were met. Anthropometrics were collected in early pregnancy. Maternal serum total bile acid level (TBA) was collected in the second and third trimesters, and women were viewed as cases if the results were accorded with clinical diagnosis. Logistic regressions were conducted to examine the associations of the second and third trimester ICP, and fetal outcomes.RESULTS: A total of 2 978 pregnant women were included in this study. The rate of ICP was 6.5% (n=196), and the rates of the second and third trimesters were 1.4% (n=43) and 5.1% (n=153) respectively. After controlling for potential confounders, we found that ICP from both the second and third trimesters could increase the risks of preterm birth, low birth weight (LBW), fetal distress and meconium-stained amniotic fluid.OR values (95% CI) were 6.42 (2.59-15.93) and 3.73 (2.07-6.72) for preterm birth while 6.52 (2.19-19.45) and 4.90 (2.43-9.90) for LBW, 2.91 (1.27-6.67) and 1.88 (1.11-3.19) for fetal distress and 2.34 (1.19-4.61) and 1.66 (1.11-2.48) for meconium-stained amniotic fluids, respectively. The risk of adverse fetal outcomes caused by the second trimester ICP appeared significantly higher than the third trimester ICP.CONCLUSION: ICP from the second and third trimesters significantly increased the risk of adverse fetal outcomes, suggesting that clinicians should put more attention to the second trimester ICP. Both early detection and intervention were of great importance in reducing the adverse fetal outcomes.