IBD会增加不良周产期结果之风险


  【24drs.com】根据在线发表于3月20日Journal of Perinatology的文献,怀孕时有发炎性肠道疾病(IBD)则其不良周产期结果风险显著增加。
  
  纽泽西Rutgers-Robert Wood Johnson医学院妇产科、加州Pasadena、南加州Kaiser Permanente医疗集团研究评估部的Darios Getahun博士等人进行了一篇回溯式世代研究,研究对象是2000-2012年间南加州Kaiser Permanente医疗体系的近400,000例病历记录。
  
  在过去几十年中,工业化国家两种亚型IBD的盛行率都持续增加。
  
  Kaiser Permanente的研究者发现,在这段研究期间,IBD的总盛行率达到130/100,000例单胞胎怀孕,但两种亚型各有不同,溃疡性结肠炎盛行率达到100/100,000,克隆氏症盛行率为30/100,000。
  
  相较于没有IBD的妇女,发生IBD的妇女倾向比较年长、白人且教育程度较高。
  
  有IBD的妇女缺血性疾病发生率较高(风险比[OR]1.39;95%信心区间[CI]1.13 - 1.72),特别是妊娠年龄小,以及自发性早产(OR,1.33;95% CI,1.10 - 1.77)和胎膜早破(PROM;OR,1.93;95% CI,1.25 - 2.99)。校正母亲年纪、种族、产前照护、怀孕期间抽菸、第一型糖尿病和教育程度之后,关联仍然显著。
  
  当研究者依据IBD亚型进行多变项分析时,他们发现溃疡性结肠炎显著增加妊娠年龄小(OR,1.38; 95% CI, 1.03 - 1.86)、自发性早产(OR,1.32;95% CI,1.00 - 1.83)以及早产PROM (OR,1.97;95% CI,1.20 - 3.26)的发生率。克隆氏症和早产之间无显著关联,但是克隆氏症和妊娠年龄小有强烈关联(OR,1.70;95% CI,1.05 - 2.74)。
  
  研究者写道,我们这篇大型多种族孕妇研究指出,母亲的IBD和缺血性胎盘与发炎发生率增加有关,影响了母婴之间的连结而导致不良周产期结果。
  
  作者们写道,虽然研究结果确认了之前的一些观察,但也有新发现,包括妊娠年龄小、自发性早产、早产PROM发生率增加等,而且两种亚型IBD的周产期结果都会受到影响。
  
  IBD和不良周产期结果之间的关联程度因各亚型而异,两个亚型各自都有独特的生物影响。
  
  研究者结论指出,这些研究结果强调了母亲发生IBD对产科与周产期的影响,特别是近来年、孕妇这两种亚型IBD的发生率都显著增加。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7071&x_classno=0&x_chkdelpoint=Y
  

IBD May Increase Risk for Adverse Perinatal Outcomes

By Larry Hand
Medscape Medical News

Pregnancies complicated by inflammatory bowel disease (IBD) may carry significantly increased risk for adverse perinatal outcomes, according to an article published online March 20 in the Journal of Perinatology.

Darios Getahun, MD, PhD, MPH, from the Department of Research and Evaluation, Kaiser Permanente Southern California Medical Group, Pasadena, California, and Department of Obstetrics and Gynecology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, and colleagues conducted a retrospective cohort study of almost 400,000 maternally linked medical records in the Kaiser Permanente Southern California system between 2000 and 2012.

The prevalence of both subtypes of IBD has been increasing in industrialized nations during the last several decades.

The Kaiser Permanente researchers found that prevalence of IBD came to 130 of every 100,000 singleton pregnancies during the study period but varied by subtype. Prevalence for ulcerative colitis came to 100/100,000, and prevalence for Crohn's disease came to 30/100,000.

Women with IBD tended to be older, white, and have more education than women without IBD.

Women with IBD had an increased incidence of ischemic disease (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.13 - 1.72), particularly small gestational age, as well as spontaneous preterm birth (OR, 1.33; 95% CI, 1.10 - 1.77) and premature rupture of membranes (PROM; OR, 1.93; 95% CI, 1.25 - 2.99). The associations remained significant after adjusting for maternal age, race/ethnicity, prenatal care, smoking during pregnancy, type 1 diabetes, and education.

When the researchers conducted multivariable analyses stratified by IBD subtypes, they found that ulcerative colitis was associated with significantly increased incidence of small gestational age birth (OR, 1.38; 95% CI, 1.03 - 1.86), spontaneous preterm birth (OR, 1.32; 95% CI, 1.00 - 1.83), and preterm PROM (OR, 1.97; 95% CI, 1.20 - 3.26). They found no statistically significant association between Crohn's disease and preterm birth, but strong associations between Crohn's disease and small gestational age (OR, 1.70; 95% CI, 1.05 - 2.74).

"Our study of a large, diverse population of pregnant women indicates that maternal IBD is associated with increased incidence of ischemic placental and inflammatory insults at the maternal–fetal interface leading to adverse perinatal outcomes," the researchers write.

Although their findings confirm some previous observations, the results regarding increased incidence of small gestational age, spontaneous preterm birth, and preterm PROM are new, as are the findings of perinatal outcomes for both subtypes of IBD, the authors write.

The magnitude of associations between IBD and adverse perinatal outcomes varied between subtypes, and both subtypes may have "unique biological roles."

The researchers conclude, "Our findings underscore the obstetrical and perinatal impact of maternal IBD, especially when considered in light of the recent marked increase of both major subtypes among pregnant women."

This study was supported by the Kaiser Permanente Direct Community Benefit Funds. The authors have disclosed no relevant financial relationships.

J Perinatol. Published online March 20, 2014.

    
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