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Article(id=1240977223394579027, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240977214964036360, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412408, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1734969600000, receivedDateStr=2024-12-24, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773801626298, onlineDateStr=2026-03-18, pubDate=1748102400000, pubDateStr=2025-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773801626298, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773801626298, creator=13701087609, updateTime=1773801626298, updator=13701087609, issue=Issue{id=1240977214964036360, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='10', pageStart='1729', pageEnd='1920', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773801624289, creator=13701087609, updateTime=1773825591019, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241077738770068227, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240977214964036360, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241077738770068228, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240977214964036360, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1808, endPage=1812, ext={EN=ArticleExt(id=1240977223738511971, articleId=1240977223394579027, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between newly developed non-alcoholic fatty liver disease in the third trimester of pregnancy and adverse pregnancy outcomes, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association between newly developed non-alcoholic fatty liver disease (NAFLD) in the third trimester of pregnancy and adverse pregnancy outcomes, and to evaluate the necessity of prevention, monitoring, and health education for NAFLD during pregnancy.

Methods

This retrospective study included 3 505 singleton primiparous pregnant women without NAFLD in early pregnancy, registered at Beijing Friendship Hospital, Capital Medical University, from March 2020 to December 2022. Logistic regression analysis was used to investigate the association between newly developed NAFLD in the third trimester and adverse pregnancy outcomes, including cesarean section, preterm birth, small-for-gestational-age infants, large-for-gestational-age infants, and postpartum hemorrhage.

Results

After adjusting for factors such as maternal age, gravidity, pre-pregnancy body mass index (BMI) level, gestational weight gain level, relevant medical histories, and educational level, the risk of postpartum hemorrhage was found to be increased in women with newly developed NAFLD in the third trimester (OR=2.136, 95%CI: 1.009-4.080, P=0.031). No statistically significant associations were found with cesarean section, preterm birth, small-for-gestational-age infants, or large-for-gestational-age infants.

Conclusion

A positive association between newly developed NAFLD in the third trimester of pregnancy and postpartum hemorrhage was revealed, highlighting the importance of strengthening surveillance and prevention for NAFLD during pregnancy to reduce the risk of postpartum hemorrhage.

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目的

探究孕晚期新发非酒精性脂肪性肝病（non-alcoholic fatty liver disease，NAFLD）与不良妊娠结局间的相关性，评估孕期NAFLD预防监测及健康教育的必要性。

方法

采用回顾性研究方法，纳入2020年3月至2022年12月在首都医科大学附属北京友谊医院建档且孕早期无NAFLD的单胎初产孕妇3 505例。运用logistic回归分析方法探究孕晚期新发NAFLD与剖宫产、早产、小于胎龄新生儿、大于胎龄新生儿和产后出血之间的相关性。

结果

调整孕妇年龄、初次怀孕、孕前身体质量指数（body mass index，BMI）分级、孕期增重分级、相关病史及文化程度等因素后，孕晚期新发NAFLD与产后出血风险呈正相关（OR=2.136，95% CI：1.009～4.080，P=0.031），未发现其与剖宫产、早产、小于胎龄新生儿和大于胎龄新生儿发病风险的相关性。

结论

孕晚期新发NAFLD与孕妇产后出血风险呈正相关，这一结果提示加强孕期NAFLD监测与预防，或许对降低产后出血风险具有重要意义。

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王辉和杨磊为共同通信作者。王辉，E-mail：；
杨磊，E-mail：
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杨树涵（2000—），女，硕士在读，研究方向：孕期非酒精性脂肪性肝病与不良妊娠结局关联

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杨树涵（2000—），女，硕士在读，研究方向：孕期非酒精性脂肪性肝病与不良妊娠结局关联

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杨树涵（2000—），女，硕士在读，研究方向：孕期非酒精性脂肪性肝病与不良妊娠结局关联

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New England Journal of Medicine, 2021, 384(17): 1635-1645., articleTitle=Postpartum hemorrhage, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1240996912434836016, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977223394579027, xref=1., ext=[AuthorCompanyExt(id=1240996912439030321, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977223394579027, companyId=1240996912434836016, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China), AuthorCompanyExt(id=1240996912472584756, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977223394579027, companyId=1240996912434836016, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.北京大学公共卫生学院妇幼卫生学系，北京 100191)]), AuthorCompany(id=1240996912585830973, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977223394579027, xref=2., ext=[AuthorCompanyExt(id=1240996912594219582, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977223394579027, companyId=1240996912585830973, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.首都医科大学附属北京友谊医院妇产科)])], figs=[ArticleFig(id=1240996916675277625, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977223394579027, language=EN, label=Table 1, caption=

Basic characteristics and incidence of adverse pregnancy outcomes in participants

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孕晚期无NAFLD组
（n=3 415)		孕晚期新发NAFLD组
(n=90)		χ2/H值P值
年龄（岁）31.2(29.1, 33.2)31.9(29.7, 33.9)2.4990.114
身高（cm）163(160, 166)163(160, 165)0.6710.413
孕前体重（kg）56.5(51.0, 60.0)62.3(55.0, 69.0)23.724<0.001
孕前BMI（kg/m2）20.8(19.4, 22.8)22.9(20.7, 26.3)38.632<0.001
正常或消瘦2 901(84.95%)54(60.00%)72.863<0.001
超重443(12.97%)23(25.56%)
肥胖71(2.08%)13(14.44%)
分娩前体重（kg）70.0(64.0, 75.0)77.5(70.0, 84.5)33.002<0.001
孕期增重（kg）13.4(10.4, 16.0)15.5(11.0, 19.0)9.2780.002
不足391(11.45%)6(6.67%)21.150<0.001
正常1 542(45.15%)23(25.56%)
过多1 482(43.40%)61(67.78%)
肝脏超声检查孕周（周）36+2(35+6, 36+5)36+2(35+5, 36+4)0.5510.458
分娩孕周（周）39+6(39+0, 40+4)39+5(39+0, 40+3)0.3530.553
文化程度
大学本科以下672(19.68%)16(17.78%)0.5500.459
大学本科及以上2 743(80.32%)74(82.22%)
初次怀孕3 319(97.19%)88(97.78%)<0.0010.992
慢性高血压病史37(1.08%)2(2.22%)0.2580.612
2型糖尿病病史90(2.64%)0(0.00%)--
妊娠相关高血压161(4.71%)12(13.33%)12.110<0.001
妊娠期糖尿病630(18.45%)17(18.89%)<0.0011.000
不良妊娠结局
剖宫产1 329(38.92%)47(52.22%)5.9640.015
早产54(1.58%)3(3.33%)0.7660.382
小于胎龄新生儿472(13.82%)15(16.67%)0.3790.538
大于胎龄新生儿250(7.32%)7(7.78%)<0.0011.000
产后出血206(6.03%)10(11.11%)3.0830.079
), ArticleFig(id=1240996916775940930, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977223394579027, language=CN, label=表1, caption=

研究对象的基本情况及不良妊娠结局发病情况

, figureFileSmall=null, figureFileBig=null, tableContent=
孕晚期无NAFLD组
（n=3 415)		孕晚期新发NAFLD组
(n=90)		χ2/H值P值
年龄（岁）31.2(29.1, 33.2)31.9(29.7, 33.9)2.4990.114
身高（cm）163(160, 166)163(160, 165)0.6710.413
孕前体重（kg）56.5(51.0, 60.0)62.3(55.0, 69.0)23.724<0.001
孕前BMI（kg/m2）20.8(19.4, 22.8)22.9(20.7, 26.3)38.632<0.001
正常或消瘦2 901(84.95%)54(60.00%)72.863<0.001
超重443(12.97%)23(25.56%)
肥胖71(2.08%)13(14.44%)
分娩前体重（kg）70.0(64.0, 75.0)77.5(70.0, 84.5)33.002<0.001
孕期增重（kg）13.4(10.4, 16.0)15.5(11.0, 19.0)9.2780.002
不足391(11.45%)6(6.67%)21.150<0.001
正常1 542(45.15%)23(25.56%)
过多1 482(43.40%)61(67.78%)
肝脏超声检查孕周（周）36+2(35+6, 36+5)36+2(35+5, 36+4)0.5510.458
分娩孕周（周）39+6(39+0, 40+4)39+5(39+0, 40+3)0.3530.553
文化程度
大学本科以下672(19.68%)16(17.78%)0.5500.459
大学本科及以上2 743(80.32%)74(82.22%)
初次怀孕3 319(97.19%)88(97.78%)<0.0010.992
慢性高血压病史37(1.08%)2(2.22%)0.2580.612
2型糖尿病病史90(2.64%)0(0.00%)--
妊娠相关高血压161(4.71%)12(13.33%)12.110<0.001
妊娠期糖尿病630(18.45%)17(18.89%)<0.0011.000
不良妊娠结局
剖宫产1 329(38.92%)47(52.22%)5.9640.015
早产54(1.58%)3(3.33%)0.7660.382
小于胎龄新生儿472(13.82%)15(16.67%)0.3790.538
大于胎龄新生儿250(7.32%)7(7.78%)<0.0011.000
产后出血206(6.03%)10(11.11%)3.0830.079
), ArticleFig(id=1240996916910158667, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977223394579027, language=EN, label=Table 2, caption=

Logistic regression analysis of newly developed NAFLD in the third trimester and adverse pregnancy outcomes

, figureFileSmall=null, figureFileBig=null, tableContent=
不良妊娠结局孕晚期无NAFLD组孕晚期新发NAFLD组
模型1模型2模型3
OR值（95%CI）P值OR值（95%CI）P值OR值（95%CI）P值
剖宫产1.0001.716(1.128～2.616)0.0121.451(0.937～2.245)0.0941.342(0.864～2.084)0.189
早产1.0002.146(0.516～5.970)0.2051.896(0.444～5.498)0.3031.638(0.379～4.832)0.433
小于胎龄新生儿1.0001.247(0.684～2.126)0.4421.202(0.629～2.127)0.5501.264(0.659～2.245)0.450
大于胎龄新生儿1.0001.068(0.444～2.174)0.8700.851(0.349～1.770)0.6940.832(0.341～1.731)0.653
产后出血1.0001.947(0.935～3.639)0.0522.184(1.038～4.144)0.0252.136(1.009～4.080)0.031
), ArticleFig(id=1240996917052765013, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240977223394579027, language=CN, label=表2, caption=

孕晚期新发NAFLD与不良妊娠结局的logistic回归分析

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不良妊娠结局孕晚期无NAFLD组孕晚期新发NAFLD组
模型1模型2模型3
OR值（95%CI）P值OR值（95%CI）P值OR值（95%CI）P值
剖宫产1.0001.716(1.128～2.616)0.0121.451(0.937～2.245)0.0941.342(0.864～2.084)0.189
早产1.0002.146(0.516～5.970)0.2051.896(0.444～5.498)0.3031.638(0.379～4.832)0.433
小于胎龄新生儿1.0001.247(0.684～2.126)0.4421.202(0.629～2.127)0.5501.264(0.659～2.245)0.450
大于胎龄新生儿1.0001.068(0.444～2.174)0.8700.851(0.349～1.770)0.6940.832(0.341～1.731)0.653
产后出血1.0001.947(0.935～3.639)0.0522.184(1.038～4.144)0.0252.136(1.009～4.080)0.031
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孕晚期新发非酒精性脂肪性肝病与不良妊娠结局关系研究
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杨树涵 1 , 王佑新 1 , 杨磊 2 , 王辉 1
现代预防医学 | 儿少卫生与妇幼保健 2025,52(10): 1808-1812
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现代预防医学 | 儿少卫生与妇幼保健 2025, 52(10): 1808-1812
孕晚期新发非酒精性脂肪性肝病与不良妊娠结局关系研究
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杨树涵1, 王佑新1, 杨磊2 , 王辉1
作者信息
  • 1.北京大学公共卫生学院妇幼卫生学系，北京 100191
  • 2.首都医科大学附属北京友谊医院妇产科

    • 杨树涵（2000—），女，硕士在读，研究方向：孕期非酒精性脂肪性肝病与不良妊娠结局关联

通讯作者:

王辉和杨磊为共同通信作者。王辉，E-mail：；
杨磊，E-mail：
Association between newly developed non-alcoholic fatty liver disease in the third trimester of pregnancy and adverse pregnancy outcomes
Shu-han YANG1, You-xin WANG1, Lei YANG2 , Hui WANG1
Affiliations
  • Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
出版时间: 2025-05-25 doi: 10.20043/j.cnki.MPM.202412408
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摘要
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目的

探究孕晚期新发非酒精性脂肪性肝病（non-alcoholic fatty liver disease，NAFLD）与不良妊娠结局间的相关性，评估孕期NAFLD预防监测及健康教育的必要性。

方法

采用回顾性研究方法，纳入2020年3月至2022年12月在首都医科大学附属北京友谊医院建档且孕早期无NAFLD的单胎初产孕妇3 505例。运用logistic回归分析方法探究孕晚期新发NAFLD与剖宫产、早产、小于胎龄新生儿、大于胎龄新生儿和产后出血之间的相关性。

结果

调整孕妇年龄、初次怀孕、孕前身体质量指数（body mass index，BMI）分级、孕期增重分级、相关病史及文化程度等因素后，孕晚期新发NAFLD与产后出血风险呈正相关（OR=2.136，95% CI：1.009～4.080，P=0.031），未发现其与剖宫产、早产、小于胎龄新生儿和大于胎龄新生儿发病风险的相关性。

结论

孕晚期新发NAFLD与孕妇产后出血风险呈正相关，这一结果提示加强孕期NAFLD监测与预防，或许对降低产后出血风险具有重要意义。

非酒精性脂肪性肝病  /  孕晚期  /  不良妊娠结局  /  产后出血
Objective

To investigate the association between newly developed non-alcoholic fatty liver disease (NAFLD) in the third trimester of pregnancy and adverse pregnancy outcomes, and to evaluate the necessity of prevention, monitoring, and health education for NAFLD during pregnancy.

Methods

This retrospective study included 3 505 singleton primiparous pregnant women without NAFLD in early pregnancy, registered at Beijing Friendship Hospital, Capital Medical University, from March 2020 to December 2022. Logistic regression analysis was used to investigate the association between newly developed NAFLD in the third trimester and adverse pregnancy outcomes, including cesarean section, preterm birth, small-for-gestational-age infants, large-for-gestational-age infants, and postpartum hemorrhage.

Results

After adjusting for factors such as maternal age, gravidity, pre-pregnancy body mass index (BMI) level, gestational weight gain level, relevant medical histories, and educational level, the risk of postpartum hemorrhage was found to be increased in women with newly developed NAFLD in the third trimester (OR=2.136, 95%CI: 1.009-4.080, P=0.031). No statistically significant associations were found with cesarean section, preterm birth, small-for-gestational-age infants, or large-for-gestational-age infants.

Conclusion

A positive association between newly developed NAFLD in the third trimester of pregnancy and postpartum hemorrhage was revealed, highlighting the importance of strengthening surveillance and prevention for NAFLD during pregnancy to reduce the risk of postpartum hemorrhage.

NAFLD  /  Third trimester of pregnancy  /  Adverse pregnancy outcomes  /  Postpartum hemorrhage
杨树涵, 王佑新, 杨磊, 王辉. 孕晚期新发非酒精性脂肪性肝病与不良妊娠结局关系研究. 现代预防医学, 2025 , 52 (10) : 1808 -1812 . DOI: 10.20043/j.cnki.MPM.202412408
Shu-han YANG, You-xin WANG, Lei YANG, Hui WANG. Association between newly developed non-alcoholic fatty liver disease in the third trimester of pregnancy and adverse pregnancy outcomes[J]. Modern Preventive Medicine, 2025 , 52 (10) : 1808 -1812 . DOI: 10.20043/j.cnki.MPM.202412408
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非酒精性脂肪性肝病（non-alcoholic fatty liver disease，NAFLD）已成为目前成人中最常见的慢性肝病之一[1]，特征为在没有过度饮酒或其他病因产生的脂肪肝（例如病毒性肝炎）的情况下发生的肝脏脂肪变性，其发生与脂质蓄积、氧化应激和脂毒性有关[2]。美国流行病学数据显示，妊娠期NAFLD的患病率持续上升，从2007年至2015年增长超过3倍[3]。20~40岁育龄女性的NAFLD患病率达到10%[4]。该疾病与胰岛素抵抗状态相关，这种代谢异常通过影响胰岛素信号转导导致糖脂代谢紊乱[5]，并引起内皮细胞一氧化氮分泌减少，增加血管硬度，造成心血管疾病风险升高[6]。现有研究表明，孕期NAFLD与剖宫产[7-8]、早产[3，8]、胎儿生长异常[3，8]及产后出血[3]等多种不良妊娠结局相关。同时，产后出血是我国孕产妇死亡的主要原因[9]，明确其可干预危险因素具有重要临床价值。孕晚期是妊娠过程中生理和代谢变化最为显著的阶段，此时，孕妇的凝血功能、内分泌系统和肝脏代谢等均发生显著变化[10-12]。此时存在NAFLD可能会进一步放大上述病理过程，对孕妇及胎儿的健康构成双重威胁。但目前关于孕晚期新发NAFLD与不良妊娠结局的相关性分析较为缺乏，为进一步优化孕期保健策略、降低不良妊娠结局发生率，本研究针对孕晚期新发NAFLD，探究其与多种不良妊娠结局风险的相关性，为在妊娠期间开展NAFLD预防及健康教育工作提供理论支撑。
1　对象与方法
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1.1　研究对象
本研究为回顾性研究，选取2020年3月至2022年12月在首都医科大学附属北京友谊医院建档、妊娠年龄为20~49周岁的单胎初产孕妇为研究对象。排除存在过量饮酒（每日饮酒量>20 g）和其他慢性肝病病史、产前检查结果和妊娠结局等关键数据缺失的孕妇。具有完整肝脏超声检查结果的孕妇共3 806人，其中孕早期未患NAFLD的孕妇共3 505人纳入本研究。根据孕晚期的NAFLD诊断结果，将研究对象分为两组：90名孕晚期患NAFLD的孕妇纳入孕晚期新发NAFLD组，其余3 415名孕妇作为对照组（孕晚期无NAFLD组）。本研究已获北京友谊医院医学伦理委员会批准（批件号：2023-P2-175-02）。由于数据已进行了匿名化处理，伦理委员会批准豁免知情同意。
1.2　研究方法
1.2.1　基本信息及体格检查
孕产妇基本信息（年龄、学历、职业等）和既往病史在建档时由工作人员询问并记录。身高、体重、血压等体格指标在建档及产前检查时由统一培训的工作人员测量，并计算身体质量指数（body mass index，BMI）。妊娠期糖尿病及妊娠相关高血压患病情况由产科医师诊断并记录。其中，妊娠相关高血压包括妊娠期高血压、先兆子痫和子痫。
1.2.2　妊娠期分期标准
根据孕周不同，妊娠期被分为三个阶段：妊娠不足14周为孕早期，第14~27+6周为孕中期，第28周及以后为孕晚期[13]。
1.2.3　孕前BMI分级
根据中国卫生行业标准《成人体重判定》（WS/T 428-2013）[14]对研究对象的孕前BMI进行分级。BMI<24 kg/m2为正常或消瘦，24 kg/m2≤BMI<28 kg/m2为超重，BMI≥28 kg/m2为肥胖。
1.2.4　孕期增重水平计算及分组
参与者孕期增重由孕前体重和孕晚期超声检查时体重计算得到。参照中国卫生行业标准《妊娠期妇女体重增长推荐值标准》（WS/T 801-2022）[15]，将参与者孕期增重水平分为不足、正常、过多三组。
1.2.5　肝脏超声检查和NAFLD的判定
所有孕妇在妊娠不足14周及28周后分别进行肝脏超声检查，检查前一天晚上要求孕妇清淡饮食，当天测定前空腹禁水禁食。肝脏超声检查由专业技术人员使用飞利浦iU Elite版四维彩色超声机进行，并根据检查结果进行脂肪肝的诊断[16]。存在脂肪肝，且不存在过量饮酒和其他慢性肝病病史的孕妇被诊断为NAFLD[16]。
1.2.6　不良妊娠结局定义
本研究的不良妊娠结局包括剖宫产、早产、小于胎龄新生儿、大于胎龄新生儿、产后出血五种疾病。早产定义为妊娠20+0~36+6周分娩[17]；小于胎龄新生儿指出生体重低于同胎龄儿体重的第10百分位数的新生儿[18-19]；大于胎龄新生儿指出生体重高于同胎龄儿体重的第90百分位数的新生儿[18-19]；产后出血指产妇在阴道分娩后的24小时内出血量超过500 ml，或剖宫产后24小时内出血量超过1 000 ml[20]。
1.3　统计学分析
采用Shapiro-Wilk检验方法对连续变量进行正态分布检验，结果显示各项连续变量不符合正态分布。非正态分布的连续变量以中位数和四分位数表示，分类变量以频数和百分比（%）表示，组间比较采用Wilcoxon秩和检验或χ2检验。建立模型1，运用单因素logistic回归分析方法计算两组间不良妊娠结局发病风险的比值比（odds ratio，OR），该模型未调整协变量；建立模型2及模型3，运用多因素logistic回归分析方法计算调整协变量后两组间的不良妊娠结局发病风险，其中，模型2调整年龄（岁）、初次怀孕（是/否）、孕前BMI分级（正常或消瘦/超重/肥胖）和文化程度（大学本科以下/大学本科及以上），模型3在模型2的基础上进一步调整孕期增重分级（不足/正常/过多）、2型糖尿病病史（是/否）、慢性高血压病史（是/否）、妊娠期糖尿病（是/否）和妊娠相关高血压（是/否）。所有分析采用R 4.3.3软件完成，双侧检验水准α=0.05。
2　结果
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2.1　研究对象基本情况及不良妊娠结局发病情况
本研究共纳入孕妇3 505人，其中孕晚期新发NAFLD组共有孕妇90人，占比2.64%。两组研究对象的基本情况及不良妊娠结局发病情况如表1所示。两组间年龄、身高、分娩孕周、文化程度、初次怀孕孕妇比例和肝脏超声检查孕周均未观察到统计学差异。孕晚期新发NAFLD组孕妇孕前体重（62.3 kg vs 56.5 kg）、孕前BMI（22.9 kg/m2 vs 20.8 kg/m2）和分娩前体重（77.5 kg vs 70.0 kg）均高于孕晚期无NAFLD组（P均<0.001）。孕晚期新发NAFLD组孕期增重中位数为15.5 kg，其中67.78%的孕妇孕期增重过多；孕晚期无NAFLD组孕期增重中位数为13.4 kg（P=0.002），仅43.40%孕期增重过多（P<0.001）。孕晚期新发NAFLD组患妊娠相关高血压的孕妇比例高于孕晚期无NAFLD组（13.33% vs 4.71%，P<0.001）。
孕晚期新发NAFLD组的剖宫产率为52.22%，高于孕晚期无NAFLD组（38.92%，P=0.015）。两组孕妇的产后出血发病率分别为11.11%和6.03%，仅存在边缘统计学差异（P=0.079）。早产、小于胎龄新生儿和大于胎龄新生儿的发病率在两组间未观察到统计学差异。
2.2　孕晚期新发NAFLD与不良妊娠结局风险的关联
表2展示了不同回归模型中孕晚期新发NAFLD与各不良妊娠结局风险的相关性分析结果。在模型1中，与孕晚期无NAFLD组相比，孕晚期新发NAFLD组的剖宫产风险升高（OR=1.716，95% CI：1.128～2.616，P=0.012），然而，在调整协变量（模型2和模型3）后，该关联不再具有统计学意义。孕晚期新发NAFLD组的产后出血风险在模型1中呈现升高趋势，但差异无统计学意义（OR=1.947，95% CI：0.935～3.639，P=0.052）；在调整年龄、是否初孕、孕前BMI分级和文化程度后（模型2），产后出血的风险升高（OR=2.184，95% CI：1.038～4.144，P=0.025）；进一步调整孕期增重分级、慢性疾病史、妊娠相关高血压和妊娠期糖尿病患病情况后，孕晚期新发NAFLD与产后出血的关联仍保持显著，孕晚期新发NAFLD组的产后出血风险约为孕晚期无NAFLD组的2倍（OR=2.136，95% CI：1.009～4.080，P=0.031）。两组间的早产、小于胎龄新生儿和大于胎龄新生儿发生风险未观察到差异。
3　讨论
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本研究发现孕晚期新发NAFLD仅与产后出血发生风险呈正相关，孕晚期新发NAFLD孕妇发生产后出血的风险为孕晚期无NAFLD孕妇的2.136倍。
本研究中两组孕妇的剖宫产发病率存在差异，但在调整相关协变量后，未观察到孕晚期新发NAFLD与剖宫产风险升高存在相关性。既往研究[7-8，21]已证实肥胖与NAFLD的发生及剖宫产风险升高相关，本研究中孕晚期新发NAFLD组的孕前BMI水平同样支持该观点，提示孕前BMI可能是增加剖宫产风险的危险因素。Qian等[8]的研究得到了类似的结果，在未调整孕前BMI时，NAFLD与剖宫产风险升高相关，但对孕前BMI水平进行分层分析后，各分层中NAFLD与剖宫产未观察到统计学关联。此外，本研究内孕晚期新发NAFLD组的孕期增重过多占比达67.78%，既往研究提示孕期增重过多与胎儿生长过度及巨大儿的发生相关[22]，易导致剖宫产的发生[21]。故在本研究模型3调整孕前BMI和孕期增重后，未发现孕晚期新发NAFLD与剖宫产存在统计学关联。
Sarkar等的研究[3]提示孕期NAFLD与产后出血风险风险升高相关，但该研究使用病案首页数据进行分析，孕妇的NAFLD诊断时间并不明确。周德霞等[23]探究了孕晚期NAFLD与包含产后出血在内的多种不良妊娠结局间的关联，但未发现相关性。然而，该研究仅对孕晚期NAFLD状态进行了筛查，未控制孕早期NAFLD的疾病状态。本研究在控制所有研究对象孕早期均无NAFLD的情况下，探究孕晚期新发NAFLD与不良妊娠结局间的关联，发现孕晚期新发NAFLD与产后出血风险呈正相关，避免了孕早期NAFLD疾病状态对不良妊娠结局风险的影响，进一步补充了已有的研究结果。
此前的研究表明，妊娠相关高血压，尤其是先兆子痫，是已知的产后出血的危险因素[24]。本研究中，孕晚期新发NAFLD组的孕妇发生妊娠相关高血压的比例高于孕晚期无NAFLD组，但是在控制了妊娠相关高血压的影响后，孕晚期新发NAFLD与产后出血间的相关性依然具有统计学意义。Sarkar等[3]的研究也观察到，在排除了存在先兆子痫、子痫和HELLP综合征（hemolysis, elevated liver enzymes, and low platelet count syndrome, HELLP Syndrome，一种先兆子痫的严重并发症）的孕妇后，NAFLD仍与产后出血风险升高相关。因此，尽管妊娠相关高血压可能是产后出血的一个重要危险因素，本研究提示孕晚期新发NAFLD亦有可能是产后出血的危险因素。
在孕中晚期，胎儿的生长速度加快，为保证能量和营养的供应，胎盘尺寸及表面积会相应增加[25]。在此过程中，胎盘螺旋动脉生长加快，此时若发生NAFLD，可能会导致血管生长异常，螺旋动脉植入子宫肌层[26-27]。这种异常的植入易影响子宫肌层的正常收缩功能，导致孕妇分娩时子宫收缩乏力，易发生产后出血[28]。此外，NAFLD孕妇因代谢紊乱引起的内分泌水平变化同样易导致子宫肌层收缩乏力[28]，增加了产后出血的风险。
本研究填补了目前对孕晚期新发NAFLD与不良妊娠结局关系研究的空白，并发现孕晚期新发NAFLD与产后出血风险增加相关。这一发现提示了加强孕期NAFLD预防及监测的必要性，应加强孕期健康教育，预防NAFLD的发生，改善不良妊娠结局的发生风险；同时可通过孕晚期NAFLD筛查发现产后出血高危人群并实施预防性措施，切实保障孕妇及胎儿的健康。然而，本研究存在一定的局限性。首先，由于孕期新发NAFLD的样本较少，尽管本研究纳入超过三千名研究对象，孕晚期新发NAFLD组的人数仍有限；其次，本研究为单中心研究，样本覆盖范围及人群代表性存在一定的局限性；第三，本研究采用病例对照研究的研究设计，无法直接推断孕晚期新发NAFLD与产后出血间的因果关系；最后，由于数据来源于医院治疗记录系统，无法获得孕妇的生活习惯、饮食状况、身体活动情况等因素，这些因素可能会对研究结果产生影响。尽管如此，本研究提示孕晚期新发NAFLD对产后出血风险的影响具有重要意义，未来需要通过多中心、大样本量的前瞻性队列研究，完善相关数据的收集，对本研究所得结论进行进一步验证。
综上所述，本研究表明孕晚期新发NAFLD可能增加产后出血风险，提示孕期加强NAFLD预防和监测存在必要性。今后应开展NAFLD预防及健康教育工作，并通过孕晚期NAFLD监测发现产后出血高危人群并实施预防性措施，提高孕期保健服务的针对性和有效性。
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doi: 10.20043/j.cnki.MPM.202412408
  • 接收时间：2024-12-24
  • 首发时间：2026-03-18
  • 出版时间：2025-05-25
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  • 收稿日期：2024-12-24
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    1.北京大学公共卫生学院妇幼卫生学系，北京 100191
    2.首都医科大学附属北京友谊医院妇产科

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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