目的:分析孕前炎症性肠病(IBD)患者的临床特点,特权和位置。
方法:收集北京大学第三医院妇产科2011年9月至2022年6月收治的妊娠合并IBD患者的临床资料。回顾性分析患者的临床特点。根据孕前疾病的状态,怀孕和哺乳,将患者分为活动组和缓解组,两组在孕前咨询方面进行比较,营养状况,妊娠和分娩并发症,孕周,交货方式,和新生儿结局。
结果:本研究共纳入33例IBD孕妇,其中7人生了第二个孩子,总共40次交付,36例自然妊娠(90.0%)和4例辅助生殖(10.0%)。在40个案例中,21例(52.5%)在孕前持续缓解,怀孕和哺乳,疾病活动19例(47.5%),其中8例(42.1%)是由于自我停药或未定期服药。与活动组相比,疾病缓解组孕前咨询率较高(57.1%vs.15.8%,P=0.010),和更高水平的血红蛋白[(112.67±8.53)g/Lvs.(102.84±5.23)g/L,P<0.001],血清总蛋白[(66.58±6.34)g/Lvs.(60.83±6.25)g/L,P=0.006],血清白蛋白[36.4(35.1,38.3)g/Lvs.34.3(31.1,35.6)g/L,P=0.006],血清钙[(2.25±0.10)μmol/Lvs.(2.13±0.15)μmol/L,P=0.004],但妊娠期高血压疾病的发病率较低(0vs.31.6%,P=0.007)。在40次交付中,阴道分娩27例(67.5%),剖宫产13例(32.5%)。新生儿结局分析显示足月分娩38例,早产2例;巨大儿1例,1例小于胎龄儿,低出生体质量1例,出生缺陷3例。有10名新生儿入住新生儿重症监护室,其中新生儿感染4例,新生儿黄疸2例。
结论:IBD患者的孕前咨询和评估非常重要,大多数患者在怀孕期间通过精心管理可以获得良好的妊娠结局。
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.
CONCLUSIONS: 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.