Cui Donghua, Zhong Yongxing, Zhang Lin, Du Hechun
Department of Clinical Laboratory, Shaoxing Women and Children Hospital, Shaoxing, China.
Department of Pediatrics, Shaoxing Women and Children Hospital, Shaoxing, China.
J Obstet Gynaecol Res. 2017 Sep;43(9):1411-1420. doi: 10.1111/jog.13399. Epub 2017 Jul 10.
We aimed to determine the association between maternal total bile acid (TBA) levels and the risks of adverse perinatal outcomes in pregnant women with intrahepatic cholestasis of pregnancy (ICP) based on a meta-analysis study.
We searched PubMed for articles published from 2000 to 2015 with a focus on ICP and restriction to the English language. The main perinatal outcomes were preterm birth (PTB), meconium-stained amniotic fluid (MSAF), asphyxia, or respiratory distress syndrome (RDS). Relative risk (RR) with 95% confidence intervals (CI) was the summary statistic. We used a random- or fixed-effects model to calculate the pooled RR according to the heterogeneity test. Subgroup analyses were performed by region and study design.
Nine eligible related citations fulfilled the inclusion criteria and were included in this study. Compared with pregnant women with a serum TBA < 40 μmol/L, severe ICP (TBA ≥ 40 μmol/L) was associated with a significantly increased risk of adverse fetal outcomes (pooled RR, 1.96; 95%CI, 1.63-2.35), PTB (pooled RR, 2.23; 95%CI, 1.51-3.29), MSAF (pooled RR, 2.27; 95%CI, 1.81-2.85), and asphyxia or RDS (pooled RR, 1.67; 95%CI, 1.18-2.36). Sensitivity analysis suggested that the study design difference may be a major source of heterogeneity. No publication bias was demonstrated by Begg's test (P > 0.05).
This meta-analysis indicates that maternal elevated bile acid levels are significantly associated with increased risks of overall adverse perinatal outcomes, PTB, MSAF, and asphyxia or RDS. Serum TBA levels seem to be a useful predictor for the risk of adverse perinatal outcomes.
基于一项荟萃分析研究，我们旨在确定妊娠肝内胆汁淤积症（ICP）孕妇的母体总胆汁酸（TBA）水平与不良围产期结局风险之间的关联。
我们在PubMed上搜索了2000年至2015年发表的文章，重点关注ICP且仅限英文文献。主要围产期结局为早产（PTB）、羊水胎粪污染（MSAF）、窒息或呼吸窘迫综合征（RDS）。相对危险度（RR）及其95%置信区间（CI）为汇总统计量。我们根据异质性检验使用随机或固定效应模型计算合并RR。按地区和研究设计进行亚组分析。
九篇符合条件的相关文献满足纳入标准并纳入本研究。与血清TBA < 40 μmol/L的孕妇相比，重度ICP（TBA≥40 μmol/L）与不良胎儿结局风险显著增加相关（合并RR，1.96；95%CI，1.63 - 2.35）、早产（合并RR，2.23；95%CI，1.51 - 3.29）、羊水胎粪污染（合并RR，2.27；95%CI，1.81 - 2.85）以及窒息或呼吸窘迫综合征（合并RR，1.67；95%CI，1.18 - 2.36）。敏感性分析表明研究设计差异可能是异质性的主要来源。Begg检验未显示发表偏倚（P > 0.05）。
这项荟萃分析表明，母体胆汁酸水平升高与总体不良围产期结局、早产、羊水胎粪污染以及窒息或呼吸窘迫综合征风险增加显著相关。血清TBA水平似乎是不良围产期结局风险的有用预测指标。
