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/Lvs.(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(0vs.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.
Abstract
Objective:To analyze the clinical characteristics of patients with inflammatory bowel disea-ses(IBD)in pre-pregnancy,pregancy and loctation.Methods:The clinical data of pregnancy compli-cated 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 pregnan-cies(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 ac-tivity,of which 8 cases(42.1％)were due to self-withdrawal of drugs or failure to take medicine regu-larly.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],se-rum 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-gesta-tional-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 preg-nancy outcomes can be obtained through careful management during pregnancy in the most of the pa-tients.
维普
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