35452例孕妇妊娠期肝功能异常与早产关系:前瞻性队列研究

Liver dysfunction during pregnancy in 35452 pregnancy women and its association with premature birth: a prospective cohort study

目的 探讨妊娠期肝功能异常与早产的关系。方法 采用前瞻性队列研究方法,监测2012年1月至2016年6月期间在南通大学附属妇幼保健院进行产前检查的汉族孕妇(HBV感染者和非感染者)的肝功能,使用稳健Poisson回归模型评价HBV感染和肝功能异常对孕妇早产的相对危险度。结果 共纳入35 452例孕妇,包括1 073例HBV感染者和34 379例非感染者。4 266例孕妇至少检出1次肝功能异常。使用稳健Poisson回归模型分析发现,肝功能异常(AST>1×ULN,TBIL>2×ULN和TBA≥4×ULN)是早产的独立危险因素。结论 肝功能异常是早产的独立危险因素,有必要在孕期监测高风险人群的肝功能。

Objectives To explore the association between liver dysfunction and premature birth(PTB).Methods A prospective cohort of HBV-infected or uninfected pregnant women of Han nationality attending antenatal care at Nantong Maternal and Child Health Hospital was recruited from January1st,2012to June30th,2016.Liver function tests(LFTs)were monitored through pregnancy.Robust Poisson regression was used to estimate adjusted risk ratios(RRs)on HBV infection and LFT abnormalities.Results Among35452pregnant women(1073HBV carriers and34379non-HBV women),4266(12.03%)had at least one instance of abnormal LFT results.One fold upper limit of normal aspartate aminotransferase(AST),two folds upper limit of normal total bilirubin,and four folds upper limit of normal total bile acid rather than HBsAg positivity,were identified as independent risk factors for PTB by Robust Possion regression analysis.Conclusions Abnormal LFTs among pregnant women is an independent risk factor of PTB.We suggest monitoring the LFTs results of high-risk population throughout pregnancy.