Liver dysfunction during pregnancy in 35 452 pregnancy women and its association with premature birth: a prospective cohort study_Chinese Journal of Evidence-Based Medicine

Authors：

ZHU Lin ¹ , CUI Aimin ² , CHENG Xiaoyan ² , LI Haibo ³ ,  QIN Gang ¹

1. Center for Liver Diseases, Nantong Third People's Hospital Affiliated to Nantong University, Nantong, 226006, P.R.China;
2. Department of Obstetrics and Gynaecology, Nantong Maternal and Child Health Hospital Affiliated to Nantong University, Nantong, 226019, P.R.China;
3. Department of Clinical Laboratory, Nantong Maternal and Child Health Hospital Affiliated to Nantong University, Nantong, 226019, P.R.China;

Corresponding?author：

QIN Gang, Email: tonygqin@ntu.edu.cn

Keywords：

Pregnancy; Liver dysfunction; Premature birth; Cohort study

DOI：

10.7507/1672-2531.201810093

Video：

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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 January 1^st, 2012 to June 30^th, 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 Among 35 452 pregnant women (1 073 HBV carriers and 34 379 non-HBV women), 4 266 (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.

Citation： ZHU Lin, CUI Aimin, CHENG Xiaoyan, LI Haibo, QIN Gang. Liver dysfunction during pregnancy in 35 452 pregnancy women and its association with premature birth: a prospective cohort study. Chinese Journal of Evidence-Based Medicine, 2019, 19(4): 387-391. doi: 10.7507/1672-2531.201810093 Copy

1.	Goldenberg RL, Culhane JF, Iams JD, et al. Epidemiology and causes of preterm birth. Lancet, 2008, 371(9606): 75-84.
2.	中華醫學會肝病學分會中華醫學會感染病學分會. 慢性乙型肝炎防治指南 (2015 更新版). 中華肝臟病雜志, 2015, 23(12): 888-905.
3.	Zhang S, Li RT, Wang Y, et al. Seroprevalence of hepatitis B surface antigen among pregnant women in Jiangsu, China, 17 years after introduction of hepatitis B vaccine. Int J Gynaecol Obstet, 2010, 109(3): 194-197.
4.	汪徐林, 邵建國, 朱永昌, 等. 江蘇省南通地區 2005 年至 2014 年慢加急性肝功能衰竭流行病學調查分析. 中華傳染病雜志, 2016, 34(9): 530-535.
5.	Chen J, Zhang S, Zhou YH, et al. Minimal adverse influence of maternal hepatitis B carrier status on perinatal outcomes and child's growth. J Matern Fetal Neonatal Med, 2015, 28(18): 2192-2196.
6.	Connell LE, Salihu HM, Salemi JL, et al. Maternal hepatitis B and hepatitis C carrier status and perinatal outcomes. Liver Int, 2011, 31(8): 1163-1170.
7.	Cui AM, Cheng XY, Shao JG, et al. Maternal hepatitis B virus carrier status and pregnancy outcomes: a prospective cohort study. BMC Pregnancy Childbirth, 2016, 16: 87.
8.	Salemi JL, Whiteman VE, August EM, et al. Maternal hepatitis B and hepatitis C infection and neonatal neurological outcomes. J Viral Hepat, 2014, 21(11): e144-e153.
9.	Sirilert S, Traisrisilp K, Sirivatanapa P, et al. Pregnancy outcomes among chronic carriers of hepatitis B virus. Int J Gynaecol Obstet, 2014, 126(2): 106-110.
10.	化雨, 郝艷麗, 秦剛, 等. 乙型肝炎病毒攜帶對妊娠結局影響的隊列研究. 中國病毒病雜志, 2016, 6(6): 448-452.
11.	Cui AM, Shao JG, Li HB, et al. Association of chronic hepatitis B virus infection with preterm birth: our experience and meta-analysis. J Perinat Med, 2017, 45(8): 933-940.
12.	Liu J, Zhang S, Liu M, et al. Maternal pre-pregnancy infection with hepatitis B virus and the risk of preterm birth: a population-based cohort study. Lancet Glob Health, 2017, 5(6): e624-e632.
13.	Huang QT, Wei SS, Zhong M, et al. Chronic hepatitis B infection and risk of preterm labor: a meta-analysis of observational studies. J Clin Virol, 2014, 61(1): 3-8.
14.	Ma X, Sun D, Li C, et al. Chronic hepatitis B virus infection and preterm labor(birth) in pregnant women-an updated systematic review and meta-analysis. J Med Virol, 2018, 90(1): 93-100.
15.	Than NN, Neuberger J. Liver abnormalities in pregnancy. Best Pract Res Clin Gastroenterol, 2013, 27(4): 565-575.
16.	楊霄, 曾蔚越. 醫源性早產 1823 例臨床分析. 實用婦產科雜志, 2012, 28(6): 476-478.
17.	中華醫學會婦產科學分會妊娠期高血壓疾病學組. 妊娠期高血壓疾病診治指南 (2015). 中華產科急救電子雜志, 2015, 4(4): 206-213.
18.	王強, 魯重美, 郎景和. 妊娠期肝病的診治. 中華婦產科雜志, 2011, 46(3): 222-226.
19.	Ch'ng CL, Morgan M, Hainsworth I, et al. Prospective study of liver dysfunction in pregnancy in Southwest Wales. Gut, 2002, 51(6): 876-880.
20.	WHO: WHO Recommendations on Interventions to Improve Preterm Birth Outcomes. Geneva, 2015.
21.	周舒冬, 郜艷暉, 李麗霞, 等. 非獨立數據時穩健 Poisson 和 Log-binomial 隨機效應模型研究. 中國衛生統計, 2014, 31(5): 804-808.
22.	中華醫學會糖尿病學分會. 中國 2 型糖尿病防治指南 (2017 年版). 中華糖尿病雜志, 2018, 10(1): 4-67.
23.	Joshi D, James A, Quaglia A, et al. Liver disease in pregnancy. Lancet, 2010, 375(9714): 594-605.
24.	Pan C, Perumalswami PV. Pregnancy-related liver diseases. Clin Liver Dis, 2011, 15(1): 199-208.
25.	Marra F, Tacke F. Roles for chemokines in liver disease. Gastroenterology, 2014, 147(3): 577-594.
26.	Wei SQ, Fraser W, Luo ZC. Inflammatory cytokines and spontaneous preterm birth in asymptomatic women: a systematic review. Obstet Gynecol, 2010, 116(2 Pt 1): 393-401.
27.	黃玲飛, 柯冬香, 賴筱琍, 等. 妊娠期肝內膽汁淤積癥孕婦總膽汁酸水平與妊娠結局的相關性. 中國婦幼保健, 2018, 33(14): 3205-3208.
28.	肖鳳蓮, 鄭英如. 妊娠期肝內膽汁淤積癥總膽汁酸水平及終止妊娠時間與圍產兒結局的關系. 第三軍醫大學學報, 2018, 40(11): 1028-1032.

1. Goldenberg RL, Culhane JF, Iams JD, et al. Epidemiology and causes of preterm birth. Lancet, 2008, 371(9606): 75-84.
2. 中華醫學會肝病學分會中華醫學會感染病學分會. 慢性乙型肝炎防治指南 (2015 更新版). 中華肝臟病雜志, 2015, 23(12): 888-905.
3. Zhang S, Li RT, Wang Y, et al. Seroprevalence of hepatitis B surface antigen among pregnant women in Jiangsu, China, 17 years after introduction of hepatitis B vaccine. Int J Gynaecol Obstet, 2010, 109(3): 194-197.
4. 汪徐林, 邵建國, 朱永昌, 等. 江蘇省南通地區 2005 年至 2014 年慢加急性肝功能衰竭流行病學調查分析. 中華傳染病雜志, 2016, 34(9): 530-535.
5. Chen J, Zhang S, Zhou YH, et al. Minimal adverse influence of maternal hepatitis B carrier status on perinatal outcomes and child's growth. J Matern Fetal Neonatal Med, 2015, 28(18): 2192-2196.
6. Connell LE, Salihu HM, Salemi JL, et al. Maternal hepatitis B and hepatitis C carrier status and perinatal outcomes. Liver Int, 2011, 31(8): 1163-1170.
7. Cui AM, Cheng XY, Shao JG, et al. Maternal hepatitis B virus carrier status and pregnancy outcomes: a prospective cohort study. BMC Pregnancy Childbirth, 2016, 16: 87.
8. Salemi JL, Whiteman VE, August EM, et al. Maternal hepatitis B and hepatitis C infection and neonatal neurological outcomes. J Viral Hepat, 2014, 21(11): e144-e153.
9. Sirilert S, Traisrisilp K, Sirivatanapa P, et al. Pregnancy outcomes among chronic carriers of hepatitis B virus. Int J Gynaecol Obstet, 2014, 126(2): 106-110.
10. 化雨, 郝艷麗, 秦剛, 等. 乙型肝炎病毒攜帶對妊娠結局影響的隊列研究. 中國病毒病雜志, 2016, 6(6): 448-452.
11. Cui AM, Shao JG, Li HB, et al. Association of chronic hepatitis B virus infection with preterm birth: our experience and meta-analysis. J Perinat Med, 2017, 45(8): 933-940.
12. Liu J, Zhang S, Liu M, et al. Maternal pre-pregnancy infection with hepatitis B virus and the risk of preterm birth: a population-based cohort study. Lancet Glob Health, 2017, 5(6): e624-e632.
13. Huang QT, Wei SS, Zhong M, et al. Chronic hepatitis B infection and risk of preterm labor: a meta-analysis of observational studies. J Clin Virol, 2014, 61(1): 3-8.
14. Ma X, Sun D, Li C, et al. Chronic hepatitis B virus infection and preterm labor(birth) in pregnant women-an updated systematic review and meta-analysis. J Med Virol, 2018, 90(1): 93-100.
15. Than NN, Neuberger J. Liver abnormalities in pregnancy. Best Pract Res Clin Gastroenterol, 2013, 27(4): 565-575.
16. 楊霄, 曾蔚越. 醫源性早產 1823 例臨床分析. 實用婦產科雜志, 2012, 28(6): 476-478.
17. 中華醫學會婦產科學分會妊娠期高血壓疾病學組. 妊娠期高血壓疾病診治指南 (2015). 中華產科急救電子雜志, 2015, 4(4): 206-213.
18. 王強, 魯重美, 郎景和. 妊娠期肝病的診治. 中華婦產科雜志, 2011, 46(3): 222-226.
19. Ch'ng CL, Morgan M, Hainsworth I, et al. Prospective study of liver dysfunction in pregnancy in Southwest Wales. Gut, 2002, 51(6): 876-880.
20. WHO: WHO Recommendations on Interventions to Improve Preterm Birth Outcomes. Geneva, 2015.
21. 周舒冬, 郜艷暉, 李麗霞, 等. 非獨立數據時穩健 Poisson 和 Log-binomial 隨機效應模型研究. 中國衛生統計, 2014, 31(5): 804-808.
22. 中華醫學會糖尿病學分會. 中國 2 型糖尿病防治指南 (2017 年版). 中華糖尿病雜志, 2018, 10(1): 4-67.
23. Joshi D, James A, Quaglia A, et al. Liver disease in pregnancy. Lancet, 2010, 375(9714): 594-605.
24. Pan C, Perumalswami PV. Pregnancy-related liver diseases. Clin Liver Dis, 2011, 15(1): 199-208.
25. Marra F, Tacke F. Roles for chemokines in liver disease. Gastroenterology, 2014, 147(3): 577-594.
26. Wei SQ, Fraser W, Luo ZC. Inflammatory cytokines and spontaneous preterm birth in asymptomatic women: a systematic review. Obstet Gynecol, 2010, 116(2 Pt 1): 393-401.
27. 黃玲飛, 柯冬香, 賴筱琍, 等. 妊娠期肝內膽汁淤積癥孕婦總膽汁酸水平與妊娠結局的相關性. 中國婦幼保健, 2018, 33(14): 3205-3208.
28. 肖鳳蓮, 鄭英如. 妊娠期肝內膽汁淤積癥總膽汁酸水平及終止妊娠時間與圍產兒結局的關系. 第三軍醫大學學報, 2018, 40(11): 1028-1032.

Chinese Journal of Evidence-Based Medicine

Liver dysfunction during pregnancy in 35 452 pregnancy women and its association with premature birth: a prospective cohort study

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