Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy.
Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy.
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DOI：
10.1016/j.ajog.2015.06.021
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发表时间：
2015-10
影响因子：
9.8
通讯作者：
Iqbal, Sara N.
中科院分区：
文献类型：
--
作者：
Kawakita, Tetsuya;Parikh, Laura I.;Ramsey, Patrick S.;Huang, Chun-Chih;Zeymo, Alexander;Fernandez, Miguel;Smith, Samuel;Iqbal, Sara N.
我们试图确定妊娠期肝内胆汁淤积症（ICP）妇女不良新生儿结局的预测因素。本研究是一项多中心回顾性队列研究，对2009年1月至2014年12月5家医院诊断为ICP的所有女性进行研究。根据总胆汁酸（TBA）水平评估产科及新生儿并发症。建立多变量logistic回归模型来评估新生儿复合结局的预测因子（新生儿重症监护病房入院、低血糖、高胆红素血症、呼吸窘迫综合征、新生儿短暂性呼吸急促、机械通气使用、鼻插管供氧、肺炎和死产）。预测因素包括TBA水平、肝转氨酶水平、诊断时的胎龄、潜在的肝脏疾病和熊去氧胆酸的使用。233例ICP患者中TBA水平为10 ~ 39.9 μmol/L的有152例，TBA水平为40 ~ 99.9 μmol/L的有55例，TBA≥100 μmol/L的有26例。根据TBA水平，产妇年龄、种族或孕前体重指数没有差异。TBA水平升高与肝转氨酶和总胆红素水平升高相关（P < 0.05）。TBA水平≥100 μmol/L与死产风险增加相关（P< 0.01）。TBA水平升高还与诊断时胎龄较早（P< 0.01）和熊去氧胆酸使用有关（P = 0.02）。在调整混杂因素后，没有预测因子与新生儿综合发病率相关。TBA 40 ~ 99.9 μmol/L和TBA≥100 μmol/L与羊水粪染风险增加相关（校正比值比为3.55,95%可信区间为1.45 ~ 8.68，校正比值比为4.55,95%可信区间为1.47 ~ 14.08）。在ICP患者中，TBA水平≥100 μmol/L与死产风险增加相关。TBA≥40 μmol/L与羊水粪染风险增高相关。
We sought to determine predictors of adverse neonatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP). This study was a multicenter retrospective cohort study of all women diagnosed with ICP across 5 hospital facilities from January 2009 through December 2014. Obstetric and neonatal complications were evaluated according to total bile acid (TBA) level. Multivariable logistic regression models were developed to evaluate predictors of composite neonatal outcome (neonatal intensive care unit admission, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, transient tachypnea of the newborn, mechanical ventilation use, oxygen by nasal cannula, pneumonia, and stillbirth). Predictors including TBA level, hepatic transaminase level, gestational age at diagnosis, underlying liver disease, and use of ursodeoxycholic acid were evaluated. Of 233 women with ICP, 152 women had TBA levels 10-39.9 μmol/L, 55 had TBA 40-99.9 μmol/L, and 26 had TBA ≥100 μmol/L. There was no difference in maternal age, ethnicity, or prepregnancy body mass index according to TBA level. Increasing TBA level was associated with higher hepatic transaminase and total bilirubin level (P < .05). TBA levels ≥100 μmol/L were associated with increased risk of stillbirth (P< .01). Increasing TBA level was also associated with earlier gestational age at diagnosis (P< .01) and ursodeoxycholic acid use (P = .02). After adjusting for confounders, no predictors were associated with composite neonatal morbidity. TBA 40-99.9 μmol/L and TBA ≥100 μmol/L were associated with increased risk of meconium-stained amniotic fluid (adjusted odds ratio, 3.55; 95% confidence interval, 1.45–8.68 and adjusted odds ratio, 4.55; 95% confidence interval, 1.47–14.08, respectively). In women with ICP, TBA level ≥100 μmol/L was associated with increased risk of stillbirth. TBA ≥40 μmol/L was associated with increased risk of meconium-stained amniotic fluid.
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作者：
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Bull L
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