Department of Obstetrics, the Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, Guangzhou, 510630, China.
BMC Pregnancy Childbirth. 2024 Apr 6;24(1):245. doi: 10.1186/s12884-024-06460-9.
To investigate the impact of intrahepatic cholestasis of pregnancy (ICP) with hepatitis B virus (HBV) infection on pregnancy outcomes.
We selected 512 pregnant women, collected the data including maternal demographics, main adverse pregnancy outcomes and maternal HBV infected markers HBeAg and HBV-DNA loads status, then have a comparative analysis.
There were 319 solitary ICP patients without HBV infection (Group I) and 193 ICP patients with HBV infection. Of the latter, there were 118 cases with abnormal liver function(Group II) and 80 cases with normal liver function(Group III). All HBV-infected pregnant women with ICP were divided into hepatitis Be antigen (HBeAg)-positive group (102 cases) and HBeAg-negative group (91 cases), according to the level of the serum HBeAg status; and into high viral load group (92 cases), moderate viral load group (46 cases) and low viral load group (55 cases) according to the maternal HBV-DNA level. Group II had a higher level of serum total bile acids, transaminase, bilirubin as well as a higher percentage of premature delivery, neonatal intensive care unit (NICU) admission and meconium-stained amniotic fluid (MSAF) compared with the other two groups(P < 0.05), but there were no significant differences in the above indicators between the Group I and Group III. Among the HBV-infected patients with ICP, HBeAg-positive group had a higher level of serum transaminase, bilirubin and bile acid as well as earlier gestational weeks of delivery, lower birth weight of new-borns and a higher rate of NICU admission than HBeAg-negative group (P < 0.05). Those with a high viral load (HBV-DNA > 10 IU/ml) had a higher level of transaminase, bilirubin, and bile acid as well as shorter gestational weeks of delivery, lower birth weight of new-borns and a higher rate of NICU admission compared with those with a low or moderate viral load (P < 0.05).
HBV-infected pregnant women with ICP combined with abnormal liver function have more severe liver damage, a higher percentage of preterm birth and NICU admission. HBeAg-positive status and a high HBV-DNA load will increase the severity of conditions in HBV-infected pregnant women with ICP. HBV-infected patients with ICP who have abnormal liver function, HBeAg-positive or a high viral load should be treated more actively.
探讨妊娠合并乙型肝炎病毒（HBV）感染的妊娠肝内胆汁淤积症（ICP）对妊娠结局的影响。
选取 512 例孕妇，收集孕妇一般资料、主要不良妊娠结局及 HBV 感染标志物 HBeAg 和 HBV-DNA 载量情况，进行对比分析。
单纯 ICP 患者无 HBV 感染 319 例（Ⅰ组），ICP 合并 HBV 感染 193 例。其中肝功能异常 118 例（Ⅱ组），肝功能正常 80 例（Ⅲ组）。所有 HBV 感染的 ICP 孕妇根据 HBeAg 水平分为 HBeAg 阳性组（102 例）和 HBeAg 阴性组（91 例），根据 HBV-DNA 水平分为高病毒载量组（92 例）、中病毒载量组（46 例）、低病毒载量组（55 例）。Ⅱ组血清总胆汁酸、转氨酶、胆红素水平较高，早产、新生儿重症监护病房（NICU）入住、羊水粪染（MSAF）发生率高于其他两组（P<0.05），但Ⅰ组与Ⅲ组上述指标比较，差异无统计学意义。ICP 合并 HBV 感染孕妇中，HBeAg 阳性组血清转氨酶、胆红素、胆汁酸水平较高，分娩孕周更早，新生儿出生体质量更低，NICU 入住率更高，与 HBeAg 阴性组比较，差异有统计学意义（P<0.05）。高病毒载量组（HBV-DNA>10 IU/ml）转氨酶、胆红素、胆汁酸水平较高，分娩孕周更早，新生儿出生体质量更低，NICU 入住率更高，与低病毒载量或中病毒载量组比较，差异有统计学意义（P<0.05）。
ICP 合并 HBV 感染孕妇肝功能异常时肝损伤更严重，早产、NICU 入住率更高。HBeAg 阳性状态和高 HBV-DNA 载量会增加 HBV 感染合并 ICP 孕妇的病情严重程度。对于合并肝功能异常、HBeAg 阳性或高病毒载量的 ICP 合并 HBV 感染孕妇应更积极地进行治疗。
