一项基于人群的研究中的肝硬化孕妇及其婴儿的结局

StephenW

Outcomes of Pregnant Women With Cirrhosis and Their Infants in a Population-Based Study

    Jennifer A. Flemming
    Monica Mullin
    Jacquie Lu
    Maria P. Velez
    Susan Brogly
    Norah A. Terrault
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Published:August 08, 2020DOI:https://doi.org/10.1053/j.gastro.2020.07.052
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Background & Aims
The incidence of cirrhosis is increasing among women of childbearing age. Contemporary outcomes of pregnant women with cirrhosis and their infants, as well as liver-related complications, have not been described in North America, to our knowledge. We investigated the association between cirrhosis and perinatal outcomes and evaluated perinatal liver-related events.
Methods
We performed a retrospective cohort study using population-based administrative health care data from Ontario, Canada (2000–2017). We identified pregnant women with compensated cirrhosis (n = 2022) using validated case definitions and routine mother-infant linkage; the women were matched to 10,110 pregnant women in the general population (1:5) based on birth year and socioeconomic status. Maternal and infant outcomes up to 6 weeks postpartum and liver-related complications up to 1 year postpartum were evaluated by using multivariate log-binomial regression.
Results
After we adjusted for demographic and metabolic risk factors, cirrhosis was independently associated with intrahepatic cholestasis of pregnancy (relative risk [RR], 10.64; 95% confidence interval [CI], 7.49–15.12), induction of labor (RR, 1.15; 95% CI, 1.03–1.28), puerperal infections (RR, 1.32; 95% CI, 1.02–1.70), preterm birth (RR, 1.60; 95% CI, 1.35–1.89), infants who were large for gestational age (RR, 1.24; 95% CI, 1.05–1.46), and neonatal respiratory distress (RR, 1.20; 95% CI, 1.02–1.42). Fewer than 2% of pregnant women with cirrhosis had liver-related complications, but these occurred in a significantly higher proportion of women with a history of hepatic decompensation (13%) than women with compensated cirrhosis (1.2%) (P < .001).
Conclusions
In a population-based study, we found that cirrhosis is an independent risk factor for adverse perinatal outcomes. However, liver-related complications are rare. Multidisciplinary teams are needed to coordinate care for pregnant women with cirrhosis during pregnancy and postpartum to optimize outcomes.

StephenW

一项基于人群的研究中的肝硬化孕妇及其婴儿的结局

    詹妮弗·弗莱明
    莫妮卡·穆林（Monica Mullin）
    卢嘉琪
    玛丽亚·P·韦莱兹
    苏珊·布罗格利（Susan Brogly）
    诺拉·A·泰拉特
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发布时间：2020年8月8日DOI：https：//doi.org/10.1053/j.gastro.2020.07.052
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背景与目标
育龄妇女的肝硬化发病率正在增加。据我们所知，北美尚未描述肝硬化孕妇及其婴儿的当代结局以及与肝有关的并发症。我们调查了肝硬化与围产期结局之间的关联，并评估了围产期肝相关事件。
方法
我们使用来自加拿大安大略省（2000-2017年）基于人群的行政医疗数据进行了一项回顾性队列研究。我们使用经过验证的病例定义和常规的母婴联系确定了代偿性肝硬化孕妇（n = 2022）。根据出生年份和社会经济状况，这些妇女与总人口中的10,110名孕妇（1：5）匹配。通过使用多元对数二项回归分析评估产后6周以内的母婴结局以及产后1年以内的肝相关并发症。
结果
在调整了人口统计学和代谢风险因素后，肝硬化与妊娠肝内胆汁淤积症独立相关（相对风险[RR]，10.64； 95％置信区间[CI]，7.49-15.12），引产（RR，1.15； 95） ％CI，1.03-1.28），产褥感染（RR，1.32； 95％CI，1.02-1.70），早产（RR，1.60； 95％CI，1.35-1.89），大胎龄儿（RR， 1.24； 95％CI，1.05-1.46）和新生儿呼吸窘迫（RR，1.20； 95％CI，1.02-1.42）。少于2％的肝硬化孕妇有与肝有关的并发症，但这些发生在有肝代偿失调史的妇女中（13％）的比例明显高于代偿性肝硬化的妇女（1.2％）（P <.001） 。
结论
在一项基于人群的研究中，我们发现肝硬化是围产期不良结局的独立危险因素。但是，与肝脏相关的并发症很少见。需要多学科团队来协调妊娠期和产后肝硬化孕妇的护理，以优化结果。