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.	中华医学会肝病学分会中华医学会感染病学分会. 慢性乙型肝炎防治指南 (2015 更新版). 中华肝脏病杂志, 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, 邵建国, 朱永昌, 等. 江苏省南通地区 2005 年至 2014 年慢加急性肝功能衰竭流行病学调查分析. 中华传染病杂志, 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, 郝艳丽, 秦刚, 等. 乙型肝炎病毒携带对妊娠结局影响的队列研究. 中国病毒病杂志, 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.	杨霄, 曾蔚越. 医源性早产 1823 例临床分析. 实用妇产科杂志, 2012, 28(6): 476-478.
17.	中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南 (2015). 中华产科急救电子杂志, 2015, 4(4): 206-213.
18.	王强, 鲁重美, 郎景和. 妊娠期肝病的诊治. 中华妇产科杂志, 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, 郜艳晖, 李丽霞, 等. 非独立数据时稳健 Poisson 和 Log-binomial 随机效应模型研究. 中国卫生统计, 2014, 31(5): 804-808.
22.	中华医学会糖尿病学分会. 中国 2 型糖尿病防治指南 (2017 年版). 中华糖尿病杂志, 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.	黄玲飞, 柯冬香, 赖筱琍, 等. 妊娠期肝内胆汁淤积症孕妇总胆汁酸水平与妊娠结局的相关性. 中国妇幼保健, 2018, 33(14): 3205-3208.
28.	肖凤莲, 郑英如. 妊娠期肝内胆汁淤积症总胆汁酸水平及终止妊娠时间与围产儿结局的关系. 第三军医大学学报, 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. 中华医学会肝病学分会中华医学会感染病学分会. 慢性乙型肝炎防治指南 (2015 更新版). 中华肝脏病杂志, 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, 邵建国, 朱永昌, 等. 江苏省南通地区 2005 年至 2014 年慢加急性肝功能衰竭流行病学调查分析. 中华传染病杂志, 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, 郝艳丽, 秦刚, 等. 乙型肝炎病毒携带对妊娠结局影响的队列研究. 中国病毒病杂志, 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. 杨霄, 曾蔚越. 医源性早产 1823 例临床分析. 实用妇产科杂志, 2012, 28(6): 476-478.
17. 中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南 (2015). 中华产科急救电子杂志, 2015, 4(4): 206-213.
18. 王强, 鲁重美, 郎景和. 妊娠期肝病的诊治. 中华妇产科杂志, 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, 郜艳晖, 李丽霞, 等. 非独立数据时稳健 Poisson 和 Log-binomial 随机效应模型研究. 中国卫生统计, 2014, 31(5): 804-808.
22. 中华医学会糖尿病学分会. 中国 2 型糖尿病防治指南 (2017 年版). 中华糖尿病杂志, 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. 黄玲飞, 柯冬香, 赖筱琍, 等. 妊娠期肝内胆汁淤积症孕妇总胆汁酸水平与妊娠结局的相关性. 中国妇幼保健, 2018, 33(14): 3205-3208.
28. 肖凤莲, 郑英如. 妊娠期肝内胆汁淤积症总胆汁酸水平及终止妊娠时间与围产儿结局的关系. 第三军医大学学报, 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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