Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, Nantong, China.
Department of Obstetrics and Gynaecology, Nantong Maternal and Child Health Hospital Affiliated to Nantong University, Nantong, China.
EBioMedicine. 2017 Dec;26:152-156. doi: 10.1016/j.ebiom.2017.11.014. Epub 2017 Nov 21.
Liver dysfunction is common in pregnancy but its association with adverse pregnancy outcomes such as preterm birth (PTB) remains unclear.
A prospective cohort of HBV-infected or uninfected pregnant women attending antenatal care was recruited at Nantong Maternal and Child Health Hospital between January 1, 2012, and June 30, 2016. Liver function tests (LFTs) were monitored through pregnancy. The primary outcomes were PTB and very PTB (delivery prior 37 and 32weeks' gestation respectively). Poisson regression was used to estimate adjusted risk ratios (RR) for women with HBV infection and LFT abnormalities.
Among 36,755 pregnant women (1,113 HBV carriers and 35,642 non-HBV subjects), 3,519 (9.57%) had abnormal LFTs. The commonest cause for liver dysfunction during pregnancy was non-alcoholic fatty liver diseases (NAFLD, 51.3%). Abnormal aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT) and two folds upper limit of normal total bilirubin (RR and 95%CI: 2.73, 1.30-5.76; 2.24, 1.35-3.31; 2.01, 1.22-3.31 respectively), rather than HBsAg positivity, were identified as independent risk factors for preterm birth. Besides, GGT abnormality was associated with increased risk of very PTB.
We suggest that surveillance of LFTs among pregnant women should be warranted, given the increased risk of PTB.
肝功能异常在妊娠中较为常见，但与早产（PTB）等不良妊娠结局的关系尚不清楚。
2012 年 1 月 1 日至 2016 年 6 月 30 日，在南通市妇幼保健院招募了接受产前保健的 HBV 感染或未感染的孕妇进行前瞻性队列研究。通过妊娠期间监测肝功能检查（LFTs）。主要结局为早产（PTB，分娩前 37 周）和极早产（非常早产，VBPTB，分娩前 32 周）。使用泊松回归估计 HBV 感染和 LFT 异常妇女的校正风险比（RR）。
在 36755 名孕妇中（1113 名 HBV 携带者和 35642 名非 HBV 孕妇），有 3519 名（9.57%）存在 LFT 异常。妊娠期间肝功能异常最常见的原因是非酒精性脂肪性肝病（NAFLD，占 51.3%）。异常天冬氨酸转氨酶（AST）、γ-谷氨酰转移酶（GGT）和两倍正常上限的总胆红素（RR 和 95%CI：2.73，1.30-5.76；2.24，1.35-3.31；2.01，1.22-3.31），而非 HBsAg 阳性，是早产的独立危险因素。此外，GGT 异常与极早产风险增加相关。
鉴于早产风险增加，我们建议对孕妇的 LFTs 进行监测。
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