Clinical analysis of acute pancreatitis in pregnancy

Abstract

Objective To explore clinical characteristics and influences of acute pancreatitis in pregnancy (APIP). Methods A total of 32 pregnant women with APIP from January 1, 2010 to December 31, 2016 in Third People′s Hospital of Chengdu were selected as study subjects and enrolled into APIP group. Meanwhile, another 93 normal pregnant women were selected as control group. The general clinical data, laboratory test results, pregnancy outcomes, newborn outcomes, and clinical characteristics of APIP group were retrospectively analyzed. Independent-samples t test was used to compare the age, body mass index (BMI), and newborn weight between two groups. Chi-square test was used to compare the constituent ratios of types of puerperae and BMI grades, incidence rates of natural labor and cesarean section between two groups. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013. Results ① There were no significant differences between two groups in the aspects of age and the constituent ratios of primipara and pluripara (P>0.05). ② The BMI in APIP group was (29.2±2.0) kg/m2, which was significant higher than that in control group (22.3±1.2) kg/m2, and the difference was statistically significant (t=18.328, P<0.001). The proportion of normal body weight in APIP group was 6.2% (2/32), which was significant lower than that in control group 47.9%(46/96), and the difference was statistically significant (χ2=17.778, P<0.001). The proportions of grade Ⅱ obesity in APIP group was 71.9% (23/32), which was higher than that of control group [29.2% (28/96)], and the difference also was statistically significant (χ2=74.381, P<0.001). ③Among 32 pregnant women of APIP group, 17 cases (53.1%, 17/32) were gallstone acute pancreatitis, 9 cases (28.1%, 9/32) were hyperlipidemia acute pancreatitis, 3 cases (9.4%, 3/32) were acute pancreatitis caused by binge eating, and 3 cases (9.4%, 3/32) were acute pancreatitis caused by other reasons. ④ Among 32 pregnant women of APIP group, the first symptom of 31 cases (96.9%, 31/32) was upper abdominal pain or subxiphoid pain. The laboratory test results showed that their serum procalcitonin levels ranged from 0.08 ng/mL to 9.06 ng/mL. Besides, 10 cases (31.3%, 10/32) were combined with gestational diabetes mellitus (GDM), 5 cases (15.6%, 5/32) were combined with severe pre-eclampsia, 4 cases (12.6%, 4/32) were combined with intrahepatic cholestasis of pregnancy (ICP). ⑤ The incidence rate of natural labor in APIP group was 3.1% (1/32), which was lower than 75.0% (72/96) in control group, and the difference was statistically significant (χ2=50.594, P<0.001). The incidence rates of emergency cesarean section and preterm birth in APIP group were 75.0% (24/32) and 62.5% (20/96), respectively, which were higher than those of control group [3.1% (3/32) and 8.3% (8/96), respectively], and both the differences were statistically significant (χ2=74.491, 41.204; P<0.001). ⑥ The birth weights of newborns in APIP group was (2 940.0±335.9) g, which was lower than that in control group [(3 450.2±154.7) g], and the difference was statistically significant (t=-11.677, P<0.001). Conclusions GDM is the most common complications of APIP, and the incidence rate of premature birth in APIP is high. It is necessary to aware the occurence of APIP in pregnant women with upper abdominal pain. Timely cesarean section can actively improve the maternal and fetal prognosis of APIP. Key words: Pregnancy; Pancreatitis; Pregnancy complications; Pregnancy outcome; Etiology; Pregnant women