Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, New York.
Department of Gastroenterology and Hepatology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
Clin Gastroenterol Hepatol. 2014 Jan;12(1):95-100.e1. doi: 10.1016/j.cgh.2013.07.011. Epub 2013 Jul 23.
BACKGROUND & AIMS: Studies of primary sclerosing cholangitis (PSC) and pregnancy outcomes have been limited in size and have been inadequate to rule out excess risks. We examined pregnancy outcomes among women with PSC.
Women with PSC were identified from inpatient and hospital-based outpatient data in the Swedish National Patient Register. Through linkage with the Medical Birth Register, we identified 229 singleton births, from 1987 through 2009, to women with PSC before delivery. These were compared with 2,304,863 births to women without a diagnosis of PSC. We used logistic regression, adjusted for maternal age, smoking, education, parity, and year of birth, to calculate adjusted prevalence odds ratios (aPORs) for adverse pregnancy outcomes.
Maternal PSC was associated with a 3.63-fold increase in preterm birth (95% confidence interval [CI] for aPOR, 2.35-5.61) as well as an increased risk of cesarean section (aPOR, 2.18; 95% CI, 1.50-3.17). We found no increased risk based on analyses of the 5-minute Apgar score, small for gestational age, stillbirths, or neonatal deaths. Maternal PSC was not a risk factor for congenital abnormalities (aPOR, 1.12; 95% CI, 0.56-2.22). Stratification by inflammatory bowel disease status did not affect the risk estimates more than marginally.
Maternal PSC is associated with both preterm birth and cesarean section but not with congenital malformation or other adverse outcomes of pregnancy. Pregnancy should not be discouraged in women with PSC.
原发性硬化性胆管炎（PSC）和妊娠结局的研究规模有限，不足以排除过高的风险。我们研究了 PSC 患者的妊娠结局。
在瑞典国家患者登记处的住院和医院门诊数据中确定了 PSC 女性。通过与医疗出生登记处的链接，我们确定了 1987 年至 2009 年期间分娩前患有 PSC 的 229 名单胎分娩，与 2304863 名未诊断为 PSC 的女性分娩进行了比较。我们使用逻辑回归，调整了母亲年龄、吸烟、教育、产次和出生年份，计算了不良妊娠结局的调整患病率比值比（aPOR）。
母体 PSC 与早产的风险增加 3.63 倍（aPOR 的 95%置信区间为 2.35-5.61），剖宫产的风险也增加（aPOR，2.18；95%CI，1.50-3.17）。我们没有发现基于 5 分钟 Apgar 评分、小于胎龄儿、死产或新生儿死亡的分析的风险增加。母体 PSC 不是先天性异常的危险因素（aPOR，1.12；95%CI，0.56-2.22）。按炎症性肠病状态分层不会对风险估计产生实质性影响。
母体 PSC 与早产和剖宫产有关，但与先天性畸形或其他妊娠不良结局无关。不应该劝阻 PSC 女性怀孕。
