Study Of Impact Of Thalassemia Companying With Chronic HBV Infection In Pregnant Women On Pregnancy Adverse Outcomes

Objective:In Guangdong Province,hepatitis B virus infection and thalassemia are the two major diseases that may also be happened in women during pregnancy.However,whether the two diseases together will induce more and/or severe pregnancy adverse events and outcomes in pregnant women and their newborns remains to confirm.The aims of this study are to explore whether the pregnant women with the two diseases combined together should be at the increased risk for pregnancy adverse outcomes in the mothers and their newborns,and then to establish the models for identifying and calculating the probability of the adverse events.Methods:The study subjects were screened from 17 774 pregnant women who had delivery and follow-up during pregnancy at the first Affiliated Hospital of Jinan University between September 1,2011 and May 31,2016.According to both inclusion criteria and exclusion criteria of thalassaemia and chronic hepatitis B virus infection,57 cases of pregnant women with thalassaemia and chronic hepatitis B virus infection?named as thalassaemia+HBV group?;57cases selected randomly from the sample of pregnant women with thalassaemia?named as thalassaemia group?,57 cases selected randomly from the sample of pregnant women with chronic hepatitis B virus infection?named as HBV group?and 114 cases selected randomly from the sample of pregnant women with neither thalassaemia nor hepatitis B virus infection?named as double non group?.The data such as liver and kidney functions,blood routine test,complications during pregnancy,fetal and neonatal parameters,adverse events in mothers and their newborns were collected.The difference of the above indexes among the different groups and the high risk factors related to pregnancy adverse events and outcomes were analyzed.Logistic regression analysis was used to show the risk factors of adverse events associated with thalassaemia and hepatitis B virus infection in pregnant women?regression coefficient,P value,OR,95%CI?;if logistic regression model had a high predictive value?C index>0.7?,then the predictive model should be done.Results:There were no statistical differences in the baseline data of age,gestational week,gravidity,parity,primipara,the elderly,and caesarean section among the four groups.It meant that the analysis among the four groups should be comparable.Plasma glucose concentration at1h post-meal between the 24^th.and 28^th.gestational weeks was significantly higher in the thalassaemia+HBV group than that in double non group?8.45±1.68 vs.7.44±1.56,P=0.001?.The bleeding volume at 24h after delivery was significantly higher in the thalassaemia group than that in the double non group,HBV group,and thalassaemia+HBV group?381.49±151.24 vs.305.39±100.56,P<0.001;381.49±151.24 vs.314.64±102.16,P=0.003;381.49±151.24 vs.329.39±126.75,P=0.019;respectively?.There was the significant difference in the incidence rate of gestational diabetes?GDM?among the four groups.Compared with the double no group,the incidence rate of GDM was significantly higher in the thalassaemia group,HBV group,and thalassaemia+HBV group?21.05%vs.2.63%,P<0.001;10.53%vs.2.63%,P=0.012;17.54%vs.2.63%,P<0.001;respectively?.There were no statistically significant differences in fetal development parameters by the ultrasound examination during pregnancy and basic data such as birth weight,body length and head circumference at birth among the four groups.There were no statistical differences in the incidence rate of neonatal adverse events among the four groups.However,the incidence rate of neonatal hypoxic-ischemic myocardial damage disease in neonatal inpatient diseases was higher in the thalassaemia+HBV group than that in the other three groups?12.07%vs.5.22%,P=0.001;12.07%vs.0%,P<0.001;12.07%vs.5.17%,P=0.001;respectively?.The study showed that age,thalassemia,HBV,thalassemia plus HBV,pregnancy hypertension should be the independent risk factors for GDM by logistic regression analysis.This logistic analysis model showed a highly positive predictive value?89.96%?,and 99.13%of the specificity for GDM in pregnant women but a lower sensitivity?14.29%?.The C-index is0.759,which might have a good predictive value.Further more,thalassemia plus chronic HBV infection and gestational age were the risk factors for total adverse events in neonates.This logistic analysis model can correctly predict whether 57.29%of total adverse events in neonates,but the sensitivity and the specificity of the model were 53.80%and 61.54%,respectively.The C index was 0.587,so the prediction ability of the model was poor.Conclusions:1.Plasma glucose level at one hour after meal between the 24^th.and 28 ^th.gestational weeks in the group of thalassemia+HBV group was the highest,and it was higher than that in the double non group.Pregnant women with thalassemia combined with chronic HBV infection might have impaired glucose tolerance,which resulting in the glucose metabolic disturbance.It should be at increased risk for GDM.2.The pregnant women with thalassemia may not only have anemia before delivery,but also they should have high risk for bleeding at delivery which can further result in aggravation of anemia.We should pay more attention to antepartum and postpartum management for avoiding from postpartum massive hemorrhage.3.Chronic HBV infection and thalassemia combined together should not be at an increased risk for affecting the fetal development and the incidence rate of neonatal adverse events if these pregnant women do not have severe liver dysfunction and anemia.But thalassemia plus chronic hepatitis B virus infection might increase the incidence rate of neonatal ischemic myocardial damage disease.4.Age,thalassemia,HBV chronic infecion,and thalassemia plus HBV chronic infecion should be the independent risk factors for GDM.A logistic analysis model has been set up to predict the possibility of development of GDM in pregnant women in this study.This type of pregnant women should strengthen the monitoring of blood glucose during pregnancy,so as to detect GDM as early as possible and give lifestyle intervention as soon as possible,and give medical treatment if necessary.