Liu Congcong, Gao Jinsong, Liu Juntao, Wang Xietong, He Jing, Sun Jingxia, Liu Xiaowei, Liao Shixiu
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
Ann Transl Med. 2020 Dec;8(23):1574. doi: 10.21037/atm-20-4879.
Previous studies have shown that intrahepatic cholestasis of pregnancy (ICP) is associated with an increased incidence of adverse perinatal outcomes, and this supports the contention that ICP is associated with increased risk for both gestational diabetes mellitus (GDM) and preeclampsia. The purpose of this study was to review adverse maternal and perinatal outcomes of ICP in the Chinese population, and to investigate the association between ICP and GDM, as well as between ICP and preeclampsia.
We conducted a retrospective cohort study in which we compared pregnancies affected by ICP with all other deliveries during the study period. Data from women with singleton pregnancies who delivered in 14 representative hospitals in China between October 1, 2016 and September 30, 2017 were collected from our database system. We then performed logistic regression analysis to determine the odds ratios (OR) and 95%CIs of the adverse pregnancy outcomes among women with or without ICP.
A total of 95,728 singleton births were included in the study, and among these, 911 pregnancies were diagnosed as having ICP, resulting in an incidence of 0.95%. Women with ICP were more likely to have GDM [adjusted odds ratio (aOR), 1.406; 95% CI, 1.179-1.677; P<0.001] and preeclampsia (aOR, 2.241; 95% CI, 1.678-2.992; P<0.001) compared with those who did not have ICP. Women in the ICP group exhibited higher rates of scheduled cesarean deliveries (aOR, 3.527; 95% CI, 2.981-4.173; P<0.001) and cesarean deliveries during labor (aOR, 4.388; 95% CI, 1.815-10.612; P=0.027). Women with ICP were also more likely to have iatrogenic preterm delivery (aOR, 2.449; 95% CI, 1.92-3.122; P<0.001) and admission to the neonatal intensive care unit (aOR, 1.572; 95% CI, 1.318-1.874; P<0.001). There was no increased risk of stillbirth in the cohort of ICP cases (aOR, 0.430; 95% CI, 0.049-3.767; P=0.259).
ICP was associated with an increased risk of GDM and preeclampsia in singleton pregnancies. Pregnancies with ICP therefore have significantly increased risks of adverse perinatal outcomes.
既往研究表明，妊娠期肝内胆汁淤积症（ICP）与不良围产儿结局的发生率增加有关，这支持了ICP与妊娠期糖尿病（GDM）和子痫前期风险增加相关的观点。本研究的目的是回顾中国人群中ICP的不良孕产妇和围产儿结局，并调查ICP与GDM以及ICP与子痫前期之间的关联。
我们进行了一项回顾性队列研究，将受ICP影响的妊娠与研究期间的所有其他分娩进行比较。从我们的数据库系统中收集了2016年10月1日至2017年9月30日在中国14家代表性医院分娩的单胎妊娠妇女的数据。然后进行逻辑回归分析，以确定有或无ICP的妇女不良妊娠结局的比值比（OR）和95%可信区间（CI）。
该研究共纳入95728例单胎分娩，其中911例妊娠被诊断为ICP，发病率为0.95%。与无ICP的妇女相比，ICP妇女更易患GDM [校正比值比（aOR），1.406；95%CI，1.179 - 1.677；P<）0.001]和子痫前期（aOR，2.241；95%CI，1.678 - 2.992；P<0.001）。ICP组妇女择期剖宫产率（aOR，3.527；95%CI，2.981 - 4.173；P<0.001）和产时剖宫产率（aOR，4.388；95%CI，1.815 - 10.612；P = 0.027）更高。ICP妇女也更易发生医源性早产（aOR，2.449；95%CI，1.92 - 3.122；P<0.001）和入住新生儿重症监护病房（aOR，1.572；95%CI，1.318 - 1.874；P<0.001）。ICP病例队列中死产风险未增加（aOR，0.430；95%CI，0.049 - 3.767；P = 0.259）。
ICP与单胎妊娠中GDM和子痫前期的风险增加有关。因此，患有ICP的妊娠不良围产儿结局风险显著增加。
