Steven M M, Buckley J D, Mackay I R
Q J Med. 1979 Oct;48(192):519-31.
The outcome of pregnancy in chronic active hepatitis (CAH) was studied retrospectively, together with a survival analysis of patients and a comparison of fertility with that expected from controls drawn from the normal Australian population. Clinical records of 73 cases of CAH included 37 women who were potentially fertile (aged 15-45 years) and there were 30 pregnancies among 16 of these women. Hepatic and obstetric complications and the outcome for the foetus and the mother were compared with the results from 36 reports accumulated from the literature. The results showed an incremental increase in survival of patients with CAH according to decade of diagnosis from 1950 and similar severity of liver disease in those who did, or did not, become pregnant. Fertility was reduced in patients with CAH. Relapse of CAH occurred during pregnancy in only two patients, hepatic complications were minimal, and there was no consistent pattern of alteration in liver function; 12 of 16 mothers are alive for a mean period of eight years after pregnancy. Obstetric complications included urinary tract infections (six), toxaemia of pregnancy (nine) and prematurity (seven); of the 30 pregnancies, four were terminated on medical advice in the early years of the study, three ended in spontaneous abortion, and there were four perinatal deaths giving a foetal loss rate of 33 per cent. Despite the maternal disease and use of prednisolone and azathioprine during pregnancy, the single congenital abnormality was pyloric stenosis. We conclude that in CAH fertility is reduced but pregnancies which occur can proceed without detriment to the mother provided that prednisolone treatment is maintained; that a higher than normal foetal loss can be expected; and that babies may be born prematurely but will be normal.
对慢性活动性肝炎（CAH）患者的妊娠结局进行了回顾性研究，并对患者进行了生存分析，同时将其生育能力与从澳大利亚正常人群中选取的对照组的预期生育能力进行了比较。73例CAH患者的临床记录中，有37名潜在可育女性（年龄在15 - 45岁之间），其中16名女性有30次妊娠。将肝脏和产科并发症以及胎儿和母亲的结局与从文献中积累的36份报告的结果进行了比较。结果显示，自1950年以来，根据诊断年代，CAH患者的生存率呈递增趋势，且怀孕和未怀孕患者的肝病严重程度相似。CAH患者的生育能力降低。仅两名患者在孕期出现CAH复发，肝脏并发症极少，且肝功能无一致的变化模式；16名母亲中有12名在产后平均存活8年。产科并发症包括尿路感染（6例）、妊娠中毒症（9例）和早产（7例）；在30次妊娠中，在研究早期有4次根据医学建议终止妊娠，3次自然流产，4例围产期死亡，胎儿丢失率为33%。尽管母亲患有疾病且孕期使用了泼尼松龙和硫唑嘌呤，但仅出现一例先天性异常，即幽门狭窄。我们得出结论，CAH患者生育能力降低，但只要维持泼尼松龙治疗，发生的妊娠对母亲无害；胎儿丢失率可能高于正常水平；婴儿可能早产，但会是正常的。
