Influence Of Hepatitis B Carriers With Intrahepatic Cholestasis Of Pregnancy On Maternal And Fetal Condition In Perinatal Period

Objective:To investigate the influence of hepatitis B virus carriers combined with intrahepatic cholestasis of pregnancy(ICP)on pregnant women and perinatal infants.Method:(1)Methods: the clinical data of 1123 pregnant women with regular prenatal examination and delivery from January 2017 to December 2020 in Chengdu Fifth People’s Hospital Affiliated to Chengdu University of traditional Chinese medicine were retrospectively analyzed.Among them,76 cases were hepatitis B carriers with ICP,32 cases were HBe Ag positive(HBe Ag positive group),44 cases were HBe Ag negative(HBe Ag negative group),189 cases of HBV negative ICP(referred to as simple ICP group for short)(2)the general clinical data of three groups of pregnant women,including age,parity,gestational weeks at admission,were recorded and compared,and the clinical data of three groups of pregnant women were collected,including clinical symptoms(itching,jaundice time,itching severity),the time of diagnosis of intrahepatic cholestasis of pregnancy(ICP)and the time of termination of pregnancy,The changes of liver function indexes(alt,AST)and bile acid(TBA),the incidence of severe ICP and the rate of cesarean section,and adverse pregnancy events(fetal distress,III)were observed at admission and 1 week after delivery ° Meconium stained amniotic fluid,spontaneous premature birth,stillbirth,neonatal asphyxia,low birth weight infants)and postpartum hemorrhage(3)The severity of clinical symptoms,biochemical indexes and adverse pregnancy events were analyzed.Result:(1)There was no significant difference between the simple ICP group and the HBe Ag positive /negative group in the age of pregnant women,times of pregnancy and delivery,and the incidence of pruritus and jaundice(P > 0.05),but there was significant difference between the HBe Ag positive group and the simple ICP group in the gestational weeks at admission(P < 0.05)(2)The severity of clinical symptoms: the severity of pruritus in HBe Ag positive group was significantly higher than that in simple ICP group and HBe Ag negative group(P < 0.05);There was no significant difference in pruritus severity between simple ICP group and HBe Ag negative group(P > 0.05).(3)the gestational weeks of onset and termination of pregnancy in HBe Ag positive group were earlier than those in simple ICP group and HBe Ag negative group(P < 0.05).There was no significant difference between the gestational weeks of onset and termination of pregnancy in HBe Ag negative group and simple ICP group(P > 0.05),(4)The levels of liver function indexes(alt,AST,TBA)in HBe Ag positive group before and after delivery were significantly higher than those in simple ICP group and HBe Ag negative group(P < 0.05),There was no significant difference(P > 0.05)(4)adverse pregnancy events in HBe Ag positive group compared with simple ICP group and HBe Ag negative group: fetal distress,III ° The incidence of meconium stained amniotic fluid,spontaneous preterm birth,postpartum hemorrhage,low birth weight infants and neonatal asphyxia in HBe Ag positive group was significantly higher than that in simple ICP group and HBe Ag negative group(P < 0.05).The incidence of adverse pregnancy events in HBe Ag negative group was higher than that in ICP group ° The incidence of meconium stained amniotic fluid,spontaneous preterm birth,postpartum hemorrhage,low birth weight infants and neonatal asphyxia had no significant difference(P > 0.05).There was no significant difference in adverse pregnancy events of fetal death among the three groups(P > 0.05),Logistic regression analysis showed that serum bile acid level and HBe Ag positive were independent factors of adverse pregnancy events.ConclusionHepatitis B virus infection is related to the occurrence and development of ICP.HBV infection and ICP form a vicious spiral,leading to adverse pregnancy events.Therefore,active attention should be paid to the perinatal management of hepatitis B carriers and ICP patients,and early intervention should be taken to reduce the incidence of adverse pregnancy events.