妊娠合并炎症性肠病的临床特点

doi:10.19723/j.issn.1671-167X.2024.02.009

Abstract

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

CLC Number:

R714

Huichao MA,Jun LI,Yongqing WANG. Clinical characteristics of pregnancy complicated with inflammatory bowel disease[J].Journal of Peking University (Health Sciences), 2024, 56(2): 260-266.

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References 28

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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)

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)

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

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

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)

Clinical characteristics of pregnancy complicated with inflammatory bowel disease

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