Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK.
Academic Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
BJOG. 2020 Jun;127(7):876-884. doi: 10.1111/1471-0528.16119. Epub 2020 Mar 8.
To determine maternal, obstetric and neonatal outcomes in a cohort of women with primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC).
Retrospective cohort study.
Ten specialist centres managing pregnant women with liver disease.
Women with a diagnosis of PBC and PSC and a pregnancy of ≥20 completed weeks of gestation.
Retrospective case notes review.
Adverse outcomes were defined as: maternal - development of ascites, variceal bleeding, encephalopathy and jaundice; obstetric events - gestational hypertension, pre-eclampsia and postpartum haemorrhage; and neonatal - stillbirth, preterm delivery and admission to neonatal unit. The relationship of alanine transferase (ALT) and bile acid levels with gestation at delivery was studied.
The first recorded pregnancies of 34 women with PSC and 27 women with PBC were analysed. There were 60 live births and one intrapartum stillbirth that did not occur in the context of maternal cholestasis. The overall median gestation of delivery was 38 weeks but the rate of preterm birth was 28% (17/61 deliveries), 76% (13/17) of which were spontaneous. Gestation at birth negatively correlated with maternal serum ALT concentration at booking (P = 0.017) and serum bile acid concentration during pregnancy (P = 0.016). There were no other significant correlations and maternal and neonatal outcomes were good.
Pregnancy in PBC and PSC is well tolerated, but women should be counselled regarding the increased risk of preterm birth. Measurement of maternal ALT and bile acids may help identify women at risk of preterm delivery.
Pregnancy in women with PBC and PSC is well tolerated; however, rates of preterm birth are high and are related to maternal bile acid levels.
确定原发性胆汁性胆管炎（PBC）和原发性硬化性胆管炎（PSC）患者队列中的孕产妇、产科和新生儿结局。
回顾性队列研究。
管理肝病孕妇的 10 个专科中心。
诊断为 PBC 和 PSC 且妊娠≥20 周的孕妇。
回顾性病历审查。
不良结局定义为：母体 - 腹水、静脉曲张出血、肝性脑病和黄疸的发展；产科事件 - 妊娠期高血压、子痫前期和产后出血；新生儿 - 死胎、早产和新生儿病房入住。研究了丙氨酸转移酶（ALT）和胆汁酸水平与分娩时妊娠的关系。
分析了 34 例 PSC 患者和 27 例 PBC 患者的首次记录妊娠。共有 60 例活产和 1 例产时死胎，后者并非发生在母体胆汁淤积的情况下。分娩的总体中位孕龄为 38 周，但早产率为 28%（61 次分娩中的 17 次），其中 76%（17 次中的 13 次）为自发性。出生时的孕龄与孕早期母体血清 ALT 浓度（P=0.017）和妊娠期间血清胆汁酸浓度（P=0.016）呈负相关。没有其他显著相关性，母婴结局良好。
PBC 和 PSC 孕妇妊娠耐受良好，但应告知患者早产风险增加。测量母体 ALT 和胆汁酸水平可能有助于识别有早产风险的妇女。
PBC 和 PSC 孕妇妊娠耐受良好；然而，早产率较高，与母体胆汁酸水平相关。
