Malarkiewicz Paulina, Nowacka Urszula, Januszaniec Aleksandra, Mankiewicz Alicja, Kozłowski Szymon, Issat Tadeusz
Department of Obstetrics and Gynecology, School of Medicine, Collegium Medicum of the University of Warmia and Mazury, al. Warszawska 30, 10-082 Olsztyn, Poland.
Department of Obstetrics and Gynecology, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland.
Medicina (Kaunas). 2024 Apr 22;60(4):676. doi: 10.3390/medicina60040676.
: Intrahepatic cholestasis of pregnancy (ICP) stands as one of the most prevalent concerns in maternal-fetal medicine, presenting a significant risk to fetal health and often associated with liver dysfunction. Concurrently, the coronavirus-19 (COVID-19) infection can lead to hepatic cell injury through both direct and indirect pathways. Hypothetically, these two conditions may coincide, influencing each other. This study aimed to comparatively assess the incidence and severity of ICP before and during the COVID-19 pandemic. : A retrospective cohort study was conducted, comparing the incidence and severity of ICP between January 2018 and February 2020 (pre-COVID-19 period) and March 2020 to March 2022 (COVID-19 period) across two hospitals, encompassing 7799 deliveries. The diagnosis of ICP was established using the ICD-10 code and defined as total bile acids (BA) levels ≥ 10 μmol/L. Statistical analysis included descriptive statistics, Chi-square and Mann-Whitney U tests, as well as multiple or logistic regression analysis. : A total of 226 cases of ICP were identified. The incidence of mild cholestasis (BA < 40 μmol/L) was lower during the pandemic compared to before (3% before versus 2%, < 0.05), while the incidence of moderate and severe ICP remained unchanged (0.6% before vs. 0.4%, = 0.2). Overall, the total incidence of ICP was lower during the pandemic (3.6% before versus 2.4%, = 0.01). No significant differences were observed in severity (as defined by BA and liver function test levels), rates of caesarean section, or neonatal birth weights. : During the COVID-19 pandemic, the total incidence of ICP appeared to be lower. However, this reduction was primarily observed in cases of mild ICP, potentially indicating challenges in detection or reduced access to medical services during this period. The incidence of moderate and severe ICP remained unchanged, suggesting that these forms of the condition were unaffected by the pandemic's circumstances.
妊娠肝内胆汁淤积症（ICP）是母胎医学中最常见的问题之一，对胎儿健康构成重大风险，且常与肝功能障碍相关。同时，新型冠状病毒19（COVID-19）感染可通过直接和间接途径导致肝细胞损伤。从理论上讲，这两种情况可能同时出现并相互影响。本研究旨在比较评估COVID-19大流行之前和期间ICP的发病率及严重程度。
开展了一项回顾性队列研究，比较了2018年1月至2020年2月（COVID-19大流行之前）与2020年3月至2022年3月（COVID-19大流行期间）两家医院7799例分娩中ICP的发病率及严重程度。ICP的诊断采用国际疾病分类第十版（ICD-10）编码，定义为总胆汁酸（BA）水平≥10μmol/L。统计分析包括描述性统计、卡方检验和曼-惠特尼U检验，以及多元或逻辑回归分析。
共确诊226例ICP病例。与大流行之前相比，轻度胆汁淤积（BA<40μmol/L）的发病率在大流行期间较低（之前为3%，而期间为2%，<0.05），而中度和重度ICP的发病率保持不变（之前为0.6%，而期间为0.4%，=0.2）。总体而言，ICP的总发病率在大流行期间较低（之前为3.6%，而期间为2.4%，=0.01）。在严重程度（由BA和肝功能测试水平定义）、剖宫产率或新生儿出生体重方面未观察到显著差异。
在COVID-19大流行期间，ICP的总发病率似乎较低。然而，这种降低主要出现在轻度ICP病例中，这可能表明在此期间检测存在挑战或获得医疗服务的机会减少。中度和重度ICP的发病率保持不变，表明这些病情形式不受大流行情况的影响。
