Predicting fetal loss in severe acute pancreatitis during pregnancy: a 5-year single-tertiary-center retrospective analysis

Abstract

Objective: To determine the factors that predict fetal loss in patients with severe acute pancreatitis. Methods: A total of 96,132 cases including 215 patients with acute pancreatitis were evaluated, and 83 cases with severe acute pancreatitis were included in the study. Clinical data and maternal complications were analyzed. Results: The incidence of acute pancreatitis during pregnancy was 2.24%, of which 38.6%had severe acute pancreatitis. The maternal mortality and fetal mortality were 3.6% and 32.5%, respectively. Hypertriglyceridemia (HTG) was the most common cause of severe acute pancreatitis during pregnancy and, along with delayed diagnosis, was related to fetal loss. The incidence of maternal complications including multiple organ failure (MOF), gestation diabetes mellitus, and preeclampsia was higher in pregnancies with fetal loss compared with those without fetal loss. In multivariable analysis, the independent predictors associated with fetal loss were gestational age (odds ratio [OR],0.183; 95% confidence interval [CI],0.049-0.677;P = 0.0112), HTG (OR,3.477; 95% CI, 2.152-6.674;P = 0.028), time from onset to diagnosis (OR,2.311; 95% CI,1.958-2.967;P = 0.032), MOF (OR,6.579; 95% CI,2.225-9.873;P = 0.039), gestational diabetes mellitus (OR,5.854; 95% CI,3.043-8.661;P = 0.024), and preeclampsia (OR,6.351; 95% CI,3.667-8.965;P = 0.013). A prediction model incorporating these factors demonstrated an area under the receiver operating characteristic curve of 0.909. Conclusion: Severe acute pancreatitis during pregnancy leads to a high rate of fetal mortality. Gestational trimester, delayed diagnosis, HTG, MOF, gestational diabetes mellitus, and preeclampsia are predictors of fetal loss. Therefore, close monitoring is essential for pregnancies complicated with HTG, diabetes mellitus, and hypertension.