Department of Prenatal Diagnosis and Screening Center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), No. 369, Kunpeng Road, Shangcheng District, Hangzhou, 310008, Zhejiang, China.
The Fourth School of Clinical Medical, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.
BMC Gastroenterol. 2023 Jan 18;23(1):16. doi: 10.1186/s12876-023-02652-3.
This study analyzed the pregnancy outcomes of patients with intrahepatic cholestasis of pregnancy (ICP) in Hangzhou, China.
Cases of pregnant women monitored by antepartum testing at Hangzhou Women's Hospital from January 2018 to December 2020 were reviewed. Subjects were classified into two groups according to whether they had ICP: 688 cases of ICP were assigned to an exposure group while 38,556 cases of non-ICP were assigned to a non-exposed group. Univariate analysis was performed on qualitative or quantitative data using the Chi-Squared test or Mann-Whitney U test, and the adjusted odds ratio (aOR) and 95% confidence interval (CI) of the two groups of related variables were calculated by multivariate binary logistic regression analysis.
The incidence rate of ICP was 1.75%. Pregnant women with hepatitis B virus were correlated with ICP. Hepatitis B carriers (aOR = 3.873), preeclampsia (PE, aOR = 3.712), thrombocytopenia (aOR = 1.992), gestational hypertension (GH, aOR = 1.627), hyperlipidemia (aOR = 1.602) and gestational diabetes mellitus (GDM, aOR = 1.265) were all risk factors for ICP. In contrast, Body Mass Index (BMI) ≥ 30 kg/m (aOR = 0.446), 25 m < maternal BMI < 29.9 kg/m (aOR = 0.699) and parity ≥ 1 (aOR = 0.722) were protective factors for ICP. Pregnant women in the ICP group had an increased risk of gestation days < 259 days (aOR = 4.574) and cesarean delivery (aOR = 1.930) after ICP, and a decreased risk of longer gestational days (aOR = 0.105), premature rupture of membranes (aOR = 0.384) and fetal macrosomia (aOR = 0.551).
By analyzing a Chinese population with ICP, we identified that pregnant women who are hepatitis B carriers or with PE, thrombocytopenia, GH, hyperlipidemia, and GDM are at higher risk of ICP. Moreover, ICP is associated with adverse pregnancy outcomes; in particular, ICP may increase the incidence of shorter gestational days and non-vaginal delivery methods such as cesarean section but reduce the incidence of premature rupture of membranes and fetal macrosomia.
本研究分析了中国杭州妊娠期肝内胆汁淤积症（ICP）患者的妊娠结局。
回顾 2018 年 1 月至 2020 年 12 月在杭州市妇产科医院进行产前检查的孕妇病例。根据是否患有 ICP 将受试者分为两组：688 例 ICP 患者为暴露组，38556 例非 ICP 患者为非暴露组。对定性或定量数据使用卡方检验或曼-惠特尼 U 检验进行单变量分析，使用多变量二项逻辑回归分析计算两组相关变量的调整优势比（aOR）和 95%置信区间（CI）。
ICP 的发病率为 1.75%。乙型肝炎病毒携带者与 ICP 相关。乙型肝炎携带者（aOR=3.873）、子痫前期（PE，aOR=3.712）、血小板减少症（aOR=1.992）、妊娠高血压（GH，aOR=1.627）、高脂血症（aOR=1.602）和妊娠期糖尿病（GDM，aOR=1.265）均为 ICP 的危险因素。相比之下，体重指数（BMI）≥30 kg/m（aOR=0.446）、25 m<maternal BMI<29.9 kg/m（aOR=0.699）和产次≥1（aOR=0.722）是 ICP 的保护因素。ICP 组孕妇发生妊娠天数<259 天（aOR=4.574）和剖宫产（aOR=1.930）的风险增加，而妊娠天数较长（aOR=0.105）、胎膜早破（aOR=0.384）和胎儿巨大儿（aOR=0.551）的风险降低。
通过分析中国的 ICP 人群，我们发现乙型肝炎携带者或患有 PE、血小板减少症、GH、高脂血症和 GDM 的孕妇患 ICP 的风险较高。此外，ICP 与不良妊娠结局相关；特别是 ICP 可能增加较短妊娠天数和剖宫产等非阴道分娩方法的发生率，但降低胎膜早破和胎儿巨大儿的发生率。
