Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX.
Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
J Pediatr. 2022 Jul;246:89-94.e2. doi: 10.1016/j.jpeds.2022.03.038. Epub 2022 Mar 30.
To identify key epidemiologic factors relevant to fetal development that are associated with biliary atresia.
This population-based registry study examined infants born in Texas between 1999 and 2014. Epidemiologic data relevant to fetal development were compared between cases of biliary atresia identified in the Texas Birth Defects Registry (n = 305) vs all live births (n = 4 689 920), and Poisson regression was used to calculate prevalence ratios (PRs) and 95% CIs.
The prevalence of biliary atresia over the study period was 0.65 per 10 000 live births. Biliary atresia was positively associated with female sex (adjusted PR, 1.68; 95% CI, 1.33-2.12), delivery before 32-37 weeks of gestation (adjusted PR, 1.64; 95% CI, 1.18-2.29), delivery before 32 weeks of gestation (adjusted PR, 3.85; 95% CI, 2.38-6.22), and non-Hispanic Black vs non-Hispanic White maternal race/ethnicity (adjusted PR, 1.54, 95% CI, 1.06-2.24), while biliary atresia was inversely associated with season of conception in the fall relative to spring (adjusted PR, 0.62; 95% CI, 0.45-0.86). In addition, biliary atresia was associated with maternal diabetes (adjusted PR, 2.34; 95% CI, 1.57-3.48), with a stronger association with pregestational diabetes compared with gestational diabetes. In subgroup analyses, these associations were present in isolated biliary atresia cases that do not have any additional birth defects.
Biliary atresia is associated with multiple factors related to fetal development, including pregestational maternal diabetes, female sex, and preterm birth. These associations also were observed in isolated cases of biliary atresia without other malformations or laterality defects. Our results are consistent with early life events influencing the pathogenesis of biliary atresia, and support further studies investigating in utero events to better understand etiology and time of onset.
确定与胆道闭锁相关的与胎儿发育相关的关键流行病学因素。
本基于人群的登记研究检查了 1999 年至 2014 年期间在德克萨斯州出生的婴儿。在德克萨斯州出生缺陷登记处（n=305）发现的胆道闭锁病例与所有活产儿（n=4689920）之间比较了与胎儿发育相关的流行病学数据，并使用泊松回归计算了患病率比（PR）和 95%CI。
研究期间胆道闭锁的患病率为每 10000 例活产儿 0.65 例。胆道闭锁与女性性别（校正后 PR，1.68；95%CI，1.33-2.12）、32-37 周前分娩（校正后 PR，1.64；95%CI，1.18-2.29）、32 周前分娩（校正后 PR，3.85；95%CI，2.38-6.22）和非西班牙裔黑人与非西班牙裔白人母亲种族/民族（校正后 PR，1.54，95%CI，1.06-2.24）呈正相关，而胆道闭锁与秋季受孕相对于春季受孕呈负相关（校正后 PR，0.62；95%CI，0.45-0.86）。此外，胆道闭锁与母亲糖尿病有关（校正后 PR，2.34；95%CI，1.57-3.48），与妊娠前糖尿病相比，与妊娠期糖尿病的相关性更强。在亚组分析中，这些关联存在于没有任何其他畸形或侧位缺陷的孤立胆道闭锁病例中。
胆道闭锁与与胎儿发育相关的多种因素有关，包括妊娠前母亲糖尿病、女性性别和早产。这些关联也存在于没有其他畸形或侧位缺陷的孤立胆道闭锁病例中。我们的结果与早期生活事件影响胆道闭锁发病机制的观点一致，并支持进一步研究宫内事件以更好地了解病因和发病时间。
