ABSTRACT
Objective To investigate the influence of intrahepatic cholestasis of pregnancy (ICP) on adverse pregnancy outcomes of hepatitis B virus (HBV)-infected pregnant women. Methods A retrospective analysis was performed for 232 pregnant women with chronic HBV infection who were admitted to Beijing YouAn Hospital, Capital Medical University, from March 2018 to March 2021. According to the presence or absence of ICP, the patients were divided into HBV infection group with 100 patients and HBV+ICP group with 132 patients; according to the severity of ICP, the patients in the HBV+ICP group were further divided into HBV+mild ICP group with 86 patients and HBV+severe ICP group with 46 patients. The above groups were compared in terms of the incidence rates of maternal complications during pregnancy, such as premature delivery, premature rupture of membranes, gestational diabetes mellitus, hypertensive disorder complicating pregnancy, and postpartum hemorrhage (PPH), as well as the adverse outcomes of fetus/neonate, such as intrauterine fetal death, neonatal asphyxia, amniotic fluid pollution degree Ⅲ(AFⅢ), neonatal respiratory distress syndrome, small-for-gestational-age (SGA), admission to the neonatal intensive care unit, pneumonia, and mother-to-child transmission (MTCT) of HBV. A one-way analysis of variance was used for comparison between multiple groups; the chi-square test, the chi-square test with continuity correction or the Fisher's exact test was used for comparison of categorical data between multiple groups. Results Compared with the HBV infection group in terms of maternal complications in late pregnancy, the HBV+ICP group had significantly higher incidence rates of premature delivery and PPH ( χ 2 =4.169 and 5.448, P =0.041 and 0.020), and in terms of the adverse outcomes of neonates, the HBV+ICP group had significantly higher incidence rates of neonatal asphyxia, AFⅢ, and SGA than the HBV infection group ( χ 2 =5.448, 16.567, and 11.053, P =0.020, P < 0.001, and P =0.002). In terms of the adverse outcomes of neonates, the HBV+severe ICP group had significantly higher incidence rates of AFⅢ and SGA than the HBV+mild ICP group ( χ 2 =4.200 and 4.511, P =0.040 and 0.034). Conclusion Compared with the pregnant women with HBV infection alone, the pregnant women with HBV infection and ICP have significantly higher incidence rates of adverse pregnancy outcomes in mothers and neonates, and the incidence rate of adverse outcomes in neonates increases with the increase in the severity of ICP. However, ICP has no influence on HBV MTCT.
ABSTRACT
We present a case report of a healthy neonate born by vaginal delivery to a woman who had recovered from COVID-19 after 37 days of discharge. The pregnant woman had fever, cough, and chills at 33 +1 gestational weeks and was diagnosed with COVID-19 by coronavirus nucleic acid test one day later. She recovered and was discharged after a series of treatment, and the 2019 novel coronavirus nucleic acid test and pulmonary CT were negative at the 2nd and 4th weeks after being discharged. The patient was admitted in early labor at 38 +4 gestational weeks and delivered a healthy newborn vaginally at that day. Both the mother and the baby were in good condition. All the maternal or neonatal specimens taken immediately after birth in the delivery room for 2019 novel coronavirus nucleic acid tests were negative, including the maternal pharynx, rectal and cervical secretions, amniotic fluid, an neonatal pharynx and rectal swabs. The qualitative examination of 2019 novel coronavirus antibodies in the maternal venous blood test showed that both IgG and IgM were positive. While the same test for neonatal cord blood and femoral vein blood showed negative results. No inflammatory reaction was found in the placenta and immunohistochemistry detection of novel coronavirus N protein was negative. The mother and newborn were observed postnatally and treated in the same ward, neither of them had fever, cough or fatigue, and were discharged three days after delivery. The qualitative examination of 2019 novel coronavirus antibodies (IgM and IgG) in the femoral vein blood of the nenonate 27 days old showed negative results.