双胎妊娠合并妊娠期肝内胆汁淤积症面临更严重的不良妊娠结局

Twin pregnancy with intrahepatic cholestasis of pregnancy face more severe adverse pregnancy outcomes

摘要:

目的 探讨单胎妊娠和双胎妊娠合并妊娠期肝内胆汁淤积症（intrahepatic cholestasis of pregnancy，ICP）孕妇的不良妊娠结局。方法 收集2018年至2021年重庆医科大学附属第一医院分娩的2886例ICP孕妇的临床信息，经过纳入排除标准，选取1 992例进行后续分析。根据ICP孕妇的产胎个数进行分组后，分析两组的人群基线特征，并使用倾向性评分匹配（propensity score matching，PSM）消除两组之间人群基线差异。随后使用χ²检验分析ICP孕妇的不良妊娠结局。结果 PSM前两组的基线特征除孕前体重（P=0.064）和吸烟（P=0.129）外均具有统计学差异；PSM后两组的基线特征差异均无统计学意义。在母体结局方面，双胎ICP组的妊娠期高血压（gestational hypertension，GH；8.40%）（P=0.004）、子痫前期（preeclampsia，PE；10.9%）（P=0.035）、胎盘植入性疾病（placenta accreta spectrum，PAS；15.1%）（P=0.004）和羊水过多（5.30%）（P=0.010）的发生率均显著高于单胎ICP组；单胎ICP组的胎膜早破（premature rupture of membranes，PROM；27.0%）（P=0.002）和羊水过少（12.3%）（P=0.022）的发生率均显著高于双胎ICP组。在新生儿结局方面，双胎ICP组的早产（38.9%）（P<0.001）、胎儿畸形（3.90%）（P=0.004）、低出生体重（low birth weight，LBW；44.6%）（P<0.001）及入住新生儿重症病房（neonatal intensive care unit，NICU；24.91%）（P<0.001）的发生率显著高于单胎ICP组；单胎ICP组的巨大儿（4.91%）（P=0.007）发生率显著高于双胎ICP组。结论 双胎ICP孕妇相对于单胎ICP孕妇面临更严重的不良妊娠结局。

Abstract:

Objective To investigate the adverse pregnancy outcomes of pregnant women with a singleton or twin pregnancy diagnosed with intrahepatic cholestasis of pregnancy（ICP）.Methods Clinical data were collected from 2886 pregnant women with ICP who delivered in The First Affiliated Hospital of Chongqing Medical University from 2018 to 2021，and based on the inclusion and exclusion criteria，1992 cases were selected for subsequent analysis. The pregnant women with ICP were divided into singleton pregnancy group and twin pregnancy group based on the number of fetuses delivered. Baseline characteristics were analyzed for both groups，and propensity score matching（PSM） was used to adjust any baseline differences between the two groups. The chi-square test was used to analyze the adverse pregnancy outcomes of pregnant women with ICP.Results Before PSM，there were significant differences between the two groups in all baseline characteristics except pre-pregnancy body weight（P=0.064） and smoking（P=0.129），while there were no significant differences between the two groups after PSM. As for maternal outcomes，compared with the singleton ICP group，the twin ICP group had significantly higher incidence rates of gestational hypertension（8.40%；P=0.004），preeclampsia（10.9%；P=0.035），placenta accreta spectrum（15.1%；P=0.004），and polyhydramnios（5.30%；P=0.010）； compared with the twin ICP group，the singleton ICP group had significantly higher incidence rates of preterm rupture of membranes（27.0%；P=0.002） and oligohydramnios（12.3%；P=0.022）. In terms of neonatal outcomes，compared with the singleton ICP group，the twin ICP group had significantly higher incidence rates of preterm birth（38.9%；P<0.001），fetal anomaly（3.90%；P=0.004），low birth weight（44.6%；P<0.001），and admission to the neonatal intensive care unit（24.91%；P<0.001）；compared with the twin ICP group，the singleton ICP group had a significantly higher incidence rate of fetal macrosomia（4.91%；P=0.007）.Conclusion Compared with the pregnant women with ICP and a singleton pregnancy，the pregnant women with ICP and twin pregnancy tend to face more severe adverse pregnancy outcomes.