IBD會增加不良周產期結果之風險


  【24drs.com】根據線上發表於3月20日Journal of Perinatology的文獻,懷孕時有發炎性腸道疾病(IBD)則其不良周產期結果風險顯著增加。
  
  紐澤西Rutgers-Robert Wood Johnson醫學院婦產科、加州Pasadena、南加州Kaiser Permanente醫療集團研究評估部的Darios Getahun博士等人進行了一篇回溯式世代研究,研究對象是2000-2012年間南加州Kaiser Permanente醫療體系的近400,000例病歷記錄。
  
  在過去幾十年中,工業化國家兩種亞型IBD的盛行率都持續增加。
  
  Kaiser Permanente的研究者發現,在這段研究期間,IBD的總盛行率達到130/100,000例單胞胎懷孕,但兩種亞型各有不同,潰瘍性結腸炎盛行率達到100/100,000,克隆氏症盛行率為30/100,000。
  
  相較於沒有IBD的婦女,發生IBD的婦女傾向比較年長、白人且教育程度較高。
  
  有IBD的婦女缺血性疾病發生率較高(風險比[OR]1.39;95%信心區間[CI]1.13 - 1.72),特別是妊娠年齡小,以及自發性早產(OR,1.33;95% CI,1.10 - 1.77)和胎膜早破(PROM;OR,1.93;95% CI,1.25 - 2.99)。校正母親年紀、種族、產前照護、懷孕期間抽菸、第一型糖尿病和教育程度之後,關聯仍然顯著。
  
  當研究者依據IBD亞型進行多變項分析時,他們發現潰瘍性結腸炎顯著增加妊娠年齡小(OR,1.38; 95% CI, 1.03 - 1.86)、自發性早產(OR,1.32;95% CI,1.00 - 1.83)以及早產PROM (OR,1.97;95% CI,1.20 - 3.26)的發生率。克隆氏症和早產之間無顯著關聯,但是克隆氏症和妊娠年齡小有強烈關聯(OR,1.70;95% CI,1.05 - 2.74)。
  
  研究者寫道,我們這篇大型多種族孕婦研究指出,母親的IBD和缺血性胎盤與發炎發生率增加有關,影響了母嬰之間的連結而導致不良周產期結果。
  
  作者們寫道,雖然研究結果確認了之前的一些觀察,但也有新發現,包括妊娠年齡小、自發性早產、早產PROM發生率增加等,而且兩種亞型IBD的周產期結果都會受到影響。
  
  IBD和不良周產期結果之間的關聯程度因各亞型而異,兩個亞型各自都有獨特的生物影響。
  
  研究者結論指出,這些研究結果強調了母親發生IBD對產科與周產期的影響,特別是近來年、孕婦這兩種亞型IBD的發生率都顯著增加。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7071&x_classno=0&x_chkdelpoint=Y
  

IBD May Increase Risk for Adverse Perinatal Outcomes

By Larry Hand
Medscape Medical News

Pregnancies complicated by inflammatory bowel disease (IBD) may carry significantly increased risk for adverse perinatal outcomes, according to an article published online March 20 in the Journal of Perinatology.

Darios Getahun, MD, PhD, MPH, from the Department of Research and Evaluation, Kaiser Permanente Southern California Medical Group, Pasadena, California, and Department of Obstetrics and Gynecology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, and colleagues conducted a retrospective cohort study of almost 400,000 maternally linked medical records in the Kaiser Permanente Southern California system between 2000 and 2012.

The prevalence of both subtypes of IBD has been increasing in industrialized nations during the last several decades.

The Kaiser Permanente researchers found that prevalence of IBD came to 130 of every 100,000 singleton pregnancies during the study period but varied by subtype. Prevalence for ulcerative colitis came to 100/100,000, and prevalence for Crohn's disease came to 30/100,000.

Women with IBD tended to be older, white, and have more education than women without IBD.

Women with IBD had an increased incidence of ischemic disease (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.13 - 1.72), particularly small gestational age, as well as spontaneous preterm birth (OR, 1.33; 95% CI, 1.10 - 1.77) and premature rupture of membranes (PROM; OR, 1.93; 95% CI, 1.25 - 2.99). The associations remained significant after adjusting for maternal age, race/ethnicity, prenatal care, smoking during pregnancy, type 1 diabetes, and education.

When the researchers conducted multivariable analyses stratified by IBD subtypes, they found that ulcerative colitis was associated with significantly increased incidence of small gestational age birth (OR, 1.38; 95% CI, 1.03 - 1.86), spontaneous preterm birth (OR, 1.32; 95% CI, 1.00 - 1.83), and preterm PROM (OR, 1.97; 95% CI, 1.20 - 3.26). They found no statistically significant association between Crohn's disease and preterm birth, but strong associations between Crohn's disease and small gestational age (OR, 1.70; 95% CI, 1.05 - 2.74).

"Our study of a large, diverse population of pregnant women indicates that maternal IBD is associated with increased incidence of ischemic placental and inflammatory insults at the maternal–fetal interface leading to adverse perinatal outcomes," the researchers write.

Although their findings confirm some previous observations, the results regarding increased incidence of small gestational age, spontaneous preterm birth, and preterm PROM are new, as are the findings of perinatal outcomes for both subtypes of IBD, the authors write.

The magnitude of associations between IBD and adverse perinatal outcomes varied between subtypes, and both subtypes may have "unique biological roles."

The researchers conclude, "Our findings underscore the obstetrical and perinatal impact of maternal IBD, especially when considered in light of the recent marked increase of both major subtypes among pregnant women."

This study was supported by the Kaiser Permanente Direct Community Benefit Funds. The authors have disclosed no relevant financial relationships.

J Perinatol. Published online March 20, 2014.

    
相關報導
小型研究指出飲食可改善IBD症狀
2017/1/12 上午 11:09:38
歐洲在腸道疾病的生物仿製藥方面傲視同儕
2016/3/30 下午 04:23:39
憂鬱和焦慮會縮短IBD突發時間
2016/2/26 上午 10:55:00

上一頁
   1   2   3   4   5   6  




回上一頁