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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (2): 260-266. doi: 10.19723/j.issn.1671-167X.2024.02.009

• 论著 • 上一篇    下一篇

妊娠合并炎症性肠病的临床特点

马会超1,3,李军2,王永清1,*()   

  1. 1. 北京大学第三医院妇产科，国家妇产疾病临床医学研究中心，辅助生殖教育部重点实验室，生殖内分泌与辅助生殖技术北京市重点实验室，北京 100191
    2. 北京大学第三医院消化科，北京 100191
    3. 河北省宁晋县医院妇产科，河北邢台 055550
  • 收稿日期:2022-12-03 出版日期:2024-04-18 发布日期:2024-04-10
  • 通讯作者: 王永清 E-mail:mddoctor@163.com
  • 基金资助:
    国家重点研发计划(2022YFC2703504)

Clinical characteristics of pregnancy complicated with inflammatory bowel disease

Huichao MA1,3,Jun LI2,Yongqing WANG1,*()   

  1. 1. Department of Obstetrics and Gynecology, Peking University Third Hospital; National Clinical Research Center for Obstetrics and Gynecology; Key Laboratory of Assisted Reproduction, Ministry of Education; Beijing Key Laboratory of Reproductive Endocrinolgy and Assisted Reproductive Technology, Beijing 100191, China
    2. Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
    3. Department of Obstetrics and Gynecology, Ningjin County Hospital of Hebei, Xingtai 055550, Hebei, China
  • Received:2022-12-03 Online:2024-04-18 Published:2024-04-10
  • Contact: Yongqing WANG E-mail:mddoctor@163.com
  • Supported by:
    the National Key Research and Development Program of China(2022YFC2703504)

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摘要：

目的: 分析炎症性肠病(inflammatory bowel diseases，IBD)病例妊娠前、妊娠期及哺乳期的临床特点。方法: 收集2011年9月至2022年6月北京大学第三医院产科收治的妊娠合并IBD并分娩的病例资料，回顾分析其临床特点；按照妊娠前、妊娠期及哺乳期的疾病状态分为疾病活动组和缓解组，比较两组妊娠前咨询、营养状况、妊娠及分娩并发症、分娩孕周、分娩方式及新生儿结局。结果: 共纳入妊娠合并IBD 33位，其中7位分娩二胎，共40例分娩，包括自然受孕36例(90.0%)和辅助生殖4例(10.0%)。40例分娩中，妊娠前、妊娠期及哺乳期IBD持续处于缓解期21例(52.5%)，活动期19例(47.5%)，其中8例(42.1%)因自行停用药物或未按医嘱规律服药疾病发生活动。疾病缓解组与活动组相比，妊娠前咨询率更高(57.1% vs. 15.8%，P=0.010)，血红蛋白[(112.67±8.53) g/L vs. (102.84±5.23) g/L，P＜0.001]、血清总蛋白[(66.58±6.34) g/L vs. (60.83±6.25) g/L，P=0.006]、血清白蛋白[36.4(35.1，38.3) g/L vs. 34.3(31.1，35.6) g/L，P=0.006]、血钙[(2.25±0.10) μmol/L vs. (2.13±0.15) μmol/L，P=0.004]水平更高，妊娠期高血压疾病发生率更低(0 vs. 31.6%，P=0.007)。40例中经阴道分娩27例(67.5%)，剖宫产13例(32.5%)。新生儿结局分析结果表明，足月产38例，早产2例；巨大儿1例，小于胎龄儿1例，低出生体重儿1例，出生缺陷3例；转入新生儿重症监护病房10例，其中新生儿感染4例，新生儿黄疸2例。结论: 妊娠前咨询和评估对IBD患者至关重要，经过妊娠期精细管理，大多数病例可以得到良好的妊娠结局。

关键词: 炎症性肠病, 妊娠结局, 疾病管理, 妊娠营养

Abstract:

Objective: To analyze the clinical characteristics of patients with inflammatory bowel diseases (IBD) in pre-pregnancy, pregancy and loctation. Methods: The clinical data of pregnancy complicated with IBD in Department of Obstetrics and Gynecology of Peking University Third Hospital and deli-very from September 2011 to June 2022 were collected. The clinical characteristics of the patients were analyzed retrospectively. According to the state of diseases during pre-pregnancy, pregnancy and lactation, the patients were divided into active and remission group, and the two groups were compared interms of pre-pregnancy counseling, nutritional status, pregnancy and delivery complications, gestational week, mode of delivery, and neonatal outcome. Results: A total of 33 pregnant women with IBD were included in this study, of which 7 delivered a second child, for a total of 40 deliveries, with 36 natural pregnancies (90.0%) and 4 assisted reproductions (10.0%). Among the 40 cases, 21 cases (52.5%) were sustained in remission in pre-pregnancy, pregnancy and lactation, and 19 cases (47.5%) in disease activity, of which 8 cases (42.1%) were due to self-withdrawal of drugs or failure to take medicine regularly. Compared with the activity group, the disease remission group had a higher rate of pre-pregnancy counseling (57.1% vs. 15.8%, P=0.010), and higher levels of hemoglobin [(112.67±8.53) g/L vs. (102.84±5.23) g/L, P < 0.001], serum total protein [(66.58±6.34) g/L vs. (60.83±6.25) g/L, P=0.006], serum albumin [36.4 (35.1, 38.3) g/L vs. 34.3 (31.1, 35.6) g/L, P=0.006], serum calcium [(2.25±0.10) μmol/L vs. (2.13±0.15) μmol/L, P=0.004], but a lower incidence of gestational hypertensive disorders (0 vs. 31.6%, P=0.007). In 40 deliveries, there were 27 cases of vaginal delivery (67.5%), 13 cases of cesarean section (32.5%). The analysis of neonatal outcomes showed 38 full-term deliveries and 2 preterm deliveries; 1 case of macrosomia, 1 case of small-for-gestational-age, 1 case of low birth weight and 3 cases of birth defects. There were 10 newborns admitted to neonatal intensive care unit, including 4 cases of neonatal infections and 2 cases of neonatal jaundice. Conclusion: Pre-pregnancy counseling and evaluation of IBD patients are very important, and good pregnancy outcomes can be obtained through careful management during pregnancy in the most of the patients.

Key words: Inflammatory bowel diseases, Pregnancy outcome, Disease management, Pregnancy nutrition

中图分类号: 

  • R714

表1

33位IBD患者妊娠前的临床特点"

Items Data
Age of illness/years 27.18±4.42
Montreal classification of UC
  E1 16 (48.49)
  E2 7 (21.21)
  E3 8 (24.24)
Montreal classification of CD
  A2L3B3 1 (3.03)
  A2L3B2 1 (3.03)
Family hereditary history
  Yes 3 (9.09)
  No 30 (90.91)
Smoking history
  Yes 4 (12.12)
  No 29 (87.88)
Previous extraintestinal manifestations
  Yes 6 (18.18)
  No 27 (81.82)
Bad history of pregnancy and birth
  Yes 3 (3.03)
  No 30 (96.97)

表2

40例妊娠的一般情况"

Items Data
Age of childbirth/years 32.58±3.54
Course of IBD/years 4 (3, 8)
Pre-pregnancy counseling
  Yes 15 (37.5)
  No 25 (62.5)
Assisted reproduction
  Yes 4 (10.0)
  No 36 (90.0)
State of the disease before pregnancy
  Remission period 33 (82.5)
  Active period 7 (17.5)
Drug treatment before pregnancy
  5-ASA (oral/topical/enema) 34 (85.0)
  Glucocorticoids 0
  Immunosuppressant 0
  Biological preparation 2 (5.0)
  Enteral nutrition or probiotics 7 (17.5)

表3

IBD缓解组和活动组妊娠前咨询及孕期营养状态"

Items Remission group (n=21) Active group (n=19) Statistics P
Pre-pregnancy counseling 12 (57.1) 3 (15.8) 0.010
Pre-pregnancy BMI/(kg/m2) 20.84±3.23 21.74±3.08 t=-0.892 0.378
Weight gain during pregnancy/kg 14.0 (10.0, 15.0) 15.0 (11.0, 16.5) Z=1.346 0.187
Hemoglobin/(g/L) 112.67±8.53 102.84±5.23 t=4.434 ＜0.001
Serum total protein/(g/L) 66.58±6.34 60.83±6.25 t=2.883 0.006
Serum albumin/(g/L) 36.4 (35.1, 38.3) 34.3 (31.1, 35.6) Z=-2.723 0.006
Blood calcium/(μmol/L) 2.25±0.10 2.13±0.15 t=3.025 0.004

表4

IBD缓解组和活动组妊娠及分娩并发症情况"

Items Total (n=40) Remission group (n=21) Active group (n=19) P
Premature rupture of membranes 5 (12.5) 3 (14.3) 2 (10.5) ＞0.999
Gestational diabetes mellitus 7 (17.5) 4 (19.0) 3 (15.8) ＞0.999
Hypertensive disorders of pregnancy 6 (15.0) 0 6 (31.6) 0.007
Fetal distress in uterus 4 (10.0) 2 (9.5) 2 (10.5) ＞0.999
Postpartum hemorrhage 6 (15.0) 5 (23.8) 1 (5.3) 0.186
Chorioamnionitis 2 (5.0) 0 2 (10.5) 0.219

表5

IBD缓解组和活动组妊娠结局及哺乳情况"

Items Remission group (n=21) Active group (n=19) Statistics P
Average length of stay/d 4.0 (3.0, 6.0) 8.0 (4.0, 14.0) Z=1.881 0.065
Gestational week of delivery 39.57 (38.71, 40.00) 39.18 (38.71, 39.86) Z=-0.978 0.333
Mode of delivery χ2=1.522 0.127
  Vaginal delivery 16 (76.19) 11 (57.90)
  Cesarean section 5 (23.81) 8 (42.10)
Neonatal condition
  Body mass/g 3 460 (3 320, 3 630) 3 250 (2 930, 3 450) Z=-1.924 0.054
  Body length/cm 49.86±1.77 48.47±2.88 t=-1.743 0.088
  Birth defect 2(9.52) 1 (5.26) ＞0.999
  Admitted to NICU 3 (14.29) 7 (36.84) 0.148
  Infection 1 (4.76) 3 (15.79) 0.331
  Normal growth and development 21 (100) 18 (97.74) 0.475
Lactation condition χ2=1.061 0.592
  Breast-feeding 15 (71.43) 12 (63.16)
  Mixed feeding 4 (19.05) 6 (31.58)
  Artificial feeding 2 (9.52) 1 (5.26)
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