丙型肝炎病毒感染患者的妊娠结局。
Pregnancy Outcomes in Patients With Hepatitis C Virus Infection.
机构信息
Departments of Obstetrics and Gynecology, Brown University, Providence, Rhode Island, University of Texas Medical Branch, Galveston, Texas, The Ohio State University, Columbus, Ohio, Case Western Reserve University, Cleveland, Ohio, University of Alabama at Birmingham, Birmingham, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, University of Utah Health Sciences Center, Salt Lake City, Utah, Columbia University, New York, New York, Boston Medical Center, Boston, Massachusetts, University of Pittsburgh, Pittsburgh, Pennsylvania, Duke University, Durham, North Carolina, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas, Northwestern University, Chicago, Illinois, Stanford University, Stanford, California, University of Texas Southwestern Medical Center, Dallas, Texas, University of Pennsylvania, Philadelphia, Pennsylvania, and University of Texas at Austin, Austin, Texas; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
出版信息
Obstet Gynecol. 2024 Oct 1;144(4):501-506. doi: 10.1097/AOG.0000000000005703. Epub 2024 Aug 22.
OBJECTIVE
To evaluate the risks of adverse maternal and neonatal outcomes associated with pregnancies complicated by hepatitis C virus (HCV) infection.
METHODS
This is a secondary analysis of a multicenter prospective cohort study of HCV infection in pregnancy. Participants were screened for HCV infection with serum antibody tests, and each participant with a positive HCV result (case group) was matched with up to two individuals with negative HCV results (control group) prospectively by gestational age (±2 weeks) at enrollment. Maternal outcomes included gestational diabetes, abruption, preeclampsia or gestational hypertension, cholestasis, and preterm delivery. Neonatal outcomes included hyperbilirubinemia, admission to neonatal intensive care (NICU); small-for-gestational-age (SGA) birth weight; and neonatal infection , defined as sepsis or pneumonia. Models were adjusted for maternal age, body mass index, injection drug use, and maternal medical comorbidities.
RESULTS
The 249 individuals in the case group were prospectively matched to 486 individuals in the control group who met eligibility criteria. There were significant differences in demographic characteristics between the groups, including race, socioeconomic markers, education, insurance status, and drug and tobacco use. The frequencies of maternal outcomes of gestational diabetes, preeclampsia, and abruption were similar between the case and control groups. Preterm birth was similar between groups, but neonates born to individuals in the case group were more likely to be admitted to the NICU (45.1% vs 19.0%, adjusted odds ratio [aOR] 2.6, 95% CI, 1.8-3.8) and to have SGA birth weights below the 5th percentile (10.6% vs 3.1%, aOR 2.9, 95% CI, 1.4-6.0). There were no increased odds of hyperbilirubinemia or neonatal infection.
CONCLUSION
Despite no increased odds of preterm birth or other adverse maternal outcomes in adjusted analyses, maternal HCV infection was associated with twofold increased odds of NICU admission and nearly threefold increased odds of SGA birth weight below the 5th percentile.
目的
评估丙型肝炎病毒（HCV）感染合并妊娠不良母婴结局的风险。
方法
这是一项丙型肝炎病毒感染妊娠多中心前瞻性队列研究的二次分析。参与者接受血清抗体检测筛查 HCV 感染，每例 HCV 阳性结果者（病例组）与最多 2 例 HCV 阴性结果者（对照组）按入组时的孕周（±2 周）前瞻性匹配。母婴结局包括妊娠期糖尿病、胎盘早剥、子痫前期或妊娠期高血压、胆汁淤积和早产。新生儿结局包括高胆红素血症、新生儿重症监护病房（NICU）入住；小于胎龄儿（SGA）出生体重；以及新生儿感染，定义为败血症或肺炎。模型调整了产妇年龄、体重指数、注射吸毒和产妇合并症。
结果
249 例病例组前瞻性匹配符合入选标准的 486 例对照组。两组人群的人口统计学特征存在显著差异，包括种族、社会经济标志物、教育、保险状况以及药物和烟草使用情况。病例组与对照组的妊娠期糖尿病、子痫前期和胎盘早剥等母婴结局的发生率相似。两组早产发生率相似，但病例组新生儿更有可能入住 NICU（45.1% vs 19.0%，调整后的优势比[aOR]2.6，95%置信区间，1.8-3.8）和出生体重低于第 5 百分位数（SGA）（10.6% vs 3.1%，aOR 2.9，95%置信区间，1.4-6.0）。两组高胆红素血症或新生儿感染的发生率均无增加。
结论
尽管在调整分析中早产或其他不良母婴结局的发生几率没有增加，但产妇 HCV 感染与 NICU 入住几率增加两倍以及 SGA 出生体重低于第 5 百分位数的几率增加近三倍相关。
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