孕期二十二碳六烯酸补充对婴儿生长发育和体质指数影响

目的 探讨孕期二十二碳六烯酸（DHA）补充对婴儿生长发育和BMI影响。方法 采用队列研究,以2016年5-10月北京市两家区级妇幼保健院建档的1 516名孕产妇及其婴儿为研究对象,利用问卷调查在临产前获取孕产妇年龄、身高、体重、孕期体重增加量、分娩方式、孕周数、鱼类食用量及DHA补充情况。根据孕期DHA补充情况分为DHA补充组及非补充组。记录婴儿出生体重、身长、头围及BMI。随访至婴儿6月龄,监测其生长发育相关指标;其间收集产后1~3个月的母乳,用于测定脂肪酸含量。结果 孕妇DHA补充率为47.76%,其中孕早、中期即开始补充的分别占49.31%和39.64%。孕早期即开始补充DHA的孕妇母乳DHA含量高于非补充组,差异有统计学意义（P=0.006）,而DHA补充始于孕中及晚期者未能提升母乳DHA含量（P>0.05）。孕期DHA补充组婴儿出生及6月龄时身长和头围均高于非补充组,差异有统计学意义（P<0.01）,而BMI值低于非补充组,差异有统计学意义（P<0.01）。进一步发现,孕早期和中期即开始DHA补充组婴儿出生及6月龄时身长均高于非补充组及孕晚期补充组,差异有统计学意义（P<0.05）;而BMI值低于非补充组及孕晚期补充组,差异有统计学意义（P<0.01）。孕早期即开始DHA补充组婴儿出生时头围高于非补充组,差异有统计学意义（P=0.001）,而6月龄时头围及头围增量均高于其他各组,差异有统计学意义（P<0.01）。偏回归分析显示孕期DHA补充与婴儿出生及6月龄身长（r=0.324,r=0.216）、头围（r=0.221,r=0.302）及6个月内头围增量（r=0.276）呈正相关（P<0.05）,而与BMI值（r=-0.310,r=-0.371）呈负相关（P<0.05）。结论 孕期DHA补充可促进胎儿与其出生后身长和头围发育,降低BMI值,并且补充越早效果越明显;这有助于更好地保证婴儿生长发育、预防后期肥胖发生。     

孕早期脂蛋白a水平与妊娠期糖尿病的前瞻性队列研究

目的 探讨孕早期脂蛋白a（Lpa）水平与妊娠期糖尿病（GDM）的关系。方法 以“母体关键营养素与子代特应性皮炎”队列中的445名孕12~14周孕妇为研究对象,通过问卷调查收集一般人口学特征,检测孕早期空腹糖脂代谢指标,随访孕24~28周口服糖耐量试验（OGTT）结果。应用多因素logistic回归分析Lpa水平与GDM的关系,计算OR值及其95%CI。结果 孕中期GDM发病人数为78人（17.5%）。GDM孕妇孕早期Lpa水平［105.5 （92.0,122.0） mg/L］高于非GDM孕妇［97.0（87.0,109.0） mg/L］,差异有统计学意义（P<0.05）。Lpa每升高10 mg/L,GDM发生风险增加21%,OR值（95%CI）为1.21（1.08~1.36）,P<0.05;校正年龄、孕周等协变量后,关联仍有统计学意义,校正OR值（95%CI）为1.14（1.01~1.30）,P=0.03。结论 孕早期Lpa水平升高可能是GDM发生的危险因素之一,维持正常Lpa水平可能有助于GDM早期预防、提高子代健康水平。     

河南省2002-2013年HIV母婴阻断效果分析

目的 了解河南省2002-2013年感染HIV孕产妇分娩婴儿的母婴传播情况,分析其影响因素。方法 采取随访研究的方法,分别在婴儿满1、3、6、9、12、18月龄时进行随访,收集2002-2013年度孕产妇检测及感染HIV孕产妇所分娩婴儿的有关干预信息,包括一般人口学特征、妊娠分娩、抗病毒药物应用、婴儿存活及18月龄HIV检测等情况,采用logistic回归对影响HIV母婴传播的有关因素进行分析。结果 2002年1月1日至2013年12月31日,共对8 621 554名孕产妇进行了HIV抗体检测,发现阳性孕产妇共2 264人,检测阳性率0.03%,孕产妇HIV检测阳性率呈现逐年递减趋势（χ²=4.871,P=0.027）。所分娩的1 530名婴儿中,有1 384人存活且满18月龄,已死亡婴儿92人,失访54人。已经检测的满18月龄的1 384名婴儿中阳性60人,阴性1 324人,存活婴儿累计母婴传播率4.34%,校正累计母婴传播率6.33%。产妇孕早期接受预防艾滋病母婴传播服务（OR=0.26,95% CI：0.09～0.77）,产妇及婴儿进行抗病毒药物阻断（OR=0.42,95% CI：0.21～0.82）,婴儿采取人工喂养（OR=0.06,95% CI：0.02～0.21）是预防艾滋病母婴传播的保护因素,产妇分娩过程采取侧切操作（OR=3.91,95% CI：1.74～8.80）是其危险因素。结论 河南省孕产妇HIV检测阳性率保持在较低水平,并呈现逐年递减趋势,HIV的母婴传播率较高,应进一步加强并完善预防艾滋病母婴传播的综合干预措施。     

孕早期体力活动与妊娠期糖尿病关系的队列研究

目的 前瞻性地探究北京地区孕妇总体力活动和不同类型体力活动与妊娠期糖尿病（gestational diabetes mellitus,GDM）的关系。方法 以中国孕产妇队列研究·协和项目中的909名孕妇为研究对象,采用孕期身体活动问卷（pregnancy physical activity questionnaire,PPAQ）调查孕早期家务照顾、职业活动、运动锻炼和交通活动,并随访收集研究对象GDM诊断情况。采用非条件多因素logistic回归进行关联性分析。结果 共206名孕妇（22.7%）诊断为GDM,调整年龄、孕前BMI、糖尿病家族史和其他类别体力活动等因素后,logistic回归结果显示,相比于孕早期家务照顾较低水平的孕妇,中等水平的孕妇GDM发生风险较低（OR=0.654, 95% CI：0.436～0.980）;相比于不参加运动锻炼的孕妇,运动锻炼达标的孕妇GDM发生风险较低（OR=0.518, 95% CI：0.287～0.934）;总体力活动、职业活动和交通活动与GDM的发生无关。结论 孕早期运动锻炼和家务照顾是GDM的影响因素,鼓励孕妇提高孕早期运动锻炼水平、从事适度家务照顾可能有助于预防GDM。     

广东省2014-2017年HIV感染孕产妇及暴露婴儿流行病学特征分析

目的 了解广东省HIV感染孕产妇及暴露婴儿流行病学特征，分析HIV母婴传播（MTCT）相关影响因素。方法 利用"全国预防HIV MTCT信息管理系统"和"广东省婴儿HIV感染早期诊断检测信息管理平台"监测数据，收集分娩时间为2014年1月1日至2017年12月31日的HIV感染孕产妇及暴露婴儿的个案信息，比较HIV暴露婴儿感染组和未感染组孕产妇的人口学特征、孕产史、接受预防MTCT服务及婴儿早期诊断检测等的差异性。采用logistic回归模型分析HIV感染孕产妇和暴露婴儿MTCT的相关影响因素。结果 349例HIV感染孕产妇中，分别在孕前、孕期、产时/产后获知感染状态的占30.4%（106/349）、49.6%（173/349）和20.0%（70/349），性伴感染状态不明确的占39.5%（138/349），未治疗的占13.2%（46/349）；暴露婴儿中，MTCT率为4.2%（15/353），第1、第2次早诊断检测的年龄分别为44（P₂₅~P₇₅：42~50）、96（P₂₅~P₇₅：92~106）d。单因素logistic回归分析结果显示，产时/产后明确感染状态（与孕前确认感染状态相比，OR=5.72，95%CI：1.52~21.61）、孕产妇和暴露婴儿的一方或双方未抗病毒治疗（与孕产妇和暴露婴儿均抗病毒治疗相比，OR=33.56，95%CI：9.04~124.55）增加MTCT风险；人工喂养（与母乳喂养相比，OR=0.07，95%CI：0.01~0.76）可降低MTCT风险。结论 广东省孕产妇的早检测早诊断、抗病毒治疗、人工喂养的多措并举，提高预防MTCT服务能力，有效降低MTCT风险。     

孕期膳食与小于胎龄儿的关系

目的 研究孕妇不同孕期膳食摄入对小于胎龄儿（SGA）发生风险的影响。方法 收集2012年3月至2016年9月在山西医科大学第一医院产科住院分娩孕妇的一般人口学特征、孕早、中、晚期膳食摄入能量、蛋白质、脂肪、碳水化合物以及新生儿基本信息。纳入研究对象8 102例，SGA组961例，适于胎龄儿（AGA）组7 141例。按照中国食物成分表将摄入食物转化为每日膳食营养素摄入量，以AGA组膳食营养素摄入量的三分位数划分为高摄入量组、中等摄入量组及低摄入量组。通过非条件logistic回归分析孕早、中、晚期膳食摄入营养素对SGA的影响。结果 相对于中等摄入量组，孕早期（<51.60 g/d）、孕中期（<52.69 g/d）及孕晚期蛋白质摄入量低（<52.65 g/d）是SGA的危险因素（OR=1.534，95% CI：1.217～1.934；OR=1.268，95% CI：1.005～1.599；OR=1.310，95% CI：1.036～1.655）。按孕前BMI分层后，孕前BMI<18.5 kg/m²的孕妇早期蛋白质摄入量低（<51.60 g/d）及总能量摄入低（<1 146.22 kcal/d）是SGA的危险因素（OR=1.872，95% CI：1.033～3.395；OR=1.754，95% CI：1.125～2.734）；孕前18.5≤BMI<24.0 kg/m²的孕妇，孕早期膳食蛋白质摄入量低（<51.60 g/d）是SGA的危险因素（OR=1.465，95% CI：1.089～1.972）；在孕前BMI≥24.0 kg/m²的孕妇中未发现膳食摄入与SGA有关联。结论 孕期膳食摄入影响SGA的发生风险，且不同孕前BMI人群膳食摄入对SGA的影响有差异，孕早期是膳食摄入对SGA作用的关键期。     

我国孕妇孕早、中期睡眠质量及其影响因素

目的 了解我国孕妇孕早、中期睡眠质量和变化及其影响因素,为有针对性地提高孕妇睡眠质量和健康水平提供科学依据。方法 选取中国孕产妇队列研究·协和（CPWCS）孕早、中期孕妇数据。问卷调查获取一般人口学特征、怀孕意向、健康相关行为、抑郁和睡眠质量信息。描述孕早期、孕中期睡眠质量并比较其在不同人群特征下的分布情况,logistic回归探究孕早、中期睡眠质量的影响因素。结果 共调查3 618名孕妇,孕早、中期睡眠障碍发生率为28.2%和28.7%;13.0%的孕妇在孕早、中期持续存在睡眠障碍,15.2%的孕妇睡眠质量下降。睡眠质量差、入睡时间长、存在睡眠障碍、日间困倦是我国孕妇睡眠的主要问题。孕早期规律饮食（OR=0.75,95% CI：0.62~0.92）、孕期在业（OR=0.84,95% CI：0.71~0.99）是孕妇睡眠质量的保护因素;孕妇年龄≥ 30岁（OR=1.19,95% CI：1.03~1.37）、孕早期被动烟草暴露（OR=1.18,95% CI：1.02~1.36）、抑郁症状（OR=2.25,95% CI：1.95~2.61）是孕妇睡眠质量的危险因素。结论 我国孕妇孕早期、孕中期睡眠障碍发生率较高,部分孕妇存在孕早、中期睡眠质量下降或持续存在睡眠障碍的情况。关注高龄孕妇、鼓励孕妇规律饮食、减少被动吸烟,减轻抑郁症状可能有助于孕妇睡眠质量的提高。     

HBsAg阳性母亲所生婴儿乙型肝炎疫苗无/弱应答的影响因素研究

目的 探讨HBsAg阳性母亲所生婴儿乙型肝炎（乙肝）疫苗无/弱应答的影响因素。方法 收集2011年7月至2013年1月在太原市第三人民医院妇产科分娩的HBsAg阳性母亲及其新生儿286对,按我国0-1-6月免疫接种程序对新生儿进行乙肝疫苗接种并随访至12月龄。检测母亲、新生儿及婴儿外周血HBV血清标志物及HBV DNA;探讨HBsAg阳性母亲所生婴儿乙肝疫苗无/弱应答的影响因素。结果 286例婴儿中,乙肝疫苗无/弱应答率为18.53%（53/286）。非条件logistic回归显示,母亲HBV DNA ≥ 1×10⁷ copies/ml时其婴儿发生乙肝疫苗无弱应答的风险是HBV DNA阴性的2.592倍（OR=2.592,95%CI：1.121~5.996）;分娩方式为阴道产时其婴儿发生乙肝疫苗无/弱应答的风险是剖宫产的1.932倍（OR=1.932,95%CI：1.021~3.654）。二者既不存在相乘交互作用（OR=1.055,95%CI：0.209~5.321）,也不存在相加交互作用（RERI=1.617,95%CI：-4.038~7.272;AP=0.364,95%CI：-0.527~1.225;SI=1.195,95%CI：0.270~13.135）。将母亲HBV DNA分组后,剖宫产与阴道产对婴儿发生乙肝疫苗无/弱应答之间差异无统计学意义。结论 HBsAg阳性母亲HBV DNA ≥ 1×10⁷ copies/ml时,其婴儿易发生乙肝疫苗无/弱应答。     

广西壮族孕妇血红蛋白水平变化及其对新生儿体重影响的分析

目的 探讨广西壮族孕妇血红蛋白（Hb）水平及其变化对新生儿体重的影响。方法 研究对象为2013年5月至2015年5月在平果县医院孕检并分娩的壮族孕妇。采用回顾性分析方法收集孕期保健和妊娠结局的资料。运用多元线性回归方法和非条件logistic回归方法进行分析。结果 壮族孕妇分娩的新生儿平均出生体重（3 135.92±435.84）g。经调整混杂因素后,孕早期Hb水平与新生儿体重呈正相关,Hb每增加1 g/dl,新生儿体重增加17.61（95%CI：0.60~34.67）g;孕晚期Hb水平与新生儿体重呈负相关,Hb每增加1 g/dl,新生儿体重减少19.61（95%CI：-37.53~-1.70）g。孕期Hb水平变化与新生儿体重呈负相关,孕期Hb每增加1 g/dl,新生儿体重减少32.63（95%CI：-48.93~-16.32）g。孕早期贫血组小于胎龄儿发生风险比非贫血组增加58%（OR=1.58,95%CI：1.08~2.32）;孕期Hb水平下降幅度的最高组比最低组小于胎龄儿发生风险增加87%（OR=1.87,95%CI：1.24~2.81）,并且随着孕期Hb水平下降幅度降低,小于胎龄儿发生风险逐渐升高。结论 广西壮族孕妇孕早期Hb水平与新生儿体重呈正相关,孕晚期及孕期Hb水平变化与新生儿体重呈负相关。孕早期贫血以及孕期Hb水平下降幅度过低是小于胎龄儿的危险因素。     

孕期增重及总增重与妊娠期糖尿病关系的队列研究

目的 探讨孕期增重及其总增重与妊娠期糖尿病（GDM）的关系。方法 采用前瞻性队列研究,于2013年3-9月选取成都市妇幼医疗机构产前门诊829名单胎健康孕妇作为基线调查对象,通过问卷调查于首次纳入时收集孕妇孕前等基线资料,于孕第（12±1）、（28±1）、（36±1）周及分娩前分别收集孕妇锻炼习惯、膳食摄入情况等信息和测量孕妇体重,分娩后收集分娩孕周等分娩信息。GDM诊断按中国妊娠合并糖尿病防治指南（2014）,采用多因素logistic回归分析孕早、中、晚期增重和孕期总增重与GDM的关系。结果 共682名孕妇纳入数据分析。控制生育年龄、孕前BMI、糖尿病家族史、高血压家族史、孕早期锻炼、产次、文化程度、家庭人均月收入及膳食能量等混杂因素后,多因素logistic回归分析显示：与孕早期增重适宜组相比,孕早期增重不足组和增重过多组GDM发生风险均增加（分别为OR=1.23,95% CI：0.63～2.38和OR=2.20,95% CI：1.12～4.35）;与孕中期增重适宜组相比,孕中期增重不足组和过多组GDM发生风险均降低（OR=0.47,95% CI：0.18～1.19和OR=0.78,95% CI：0.43～1.42）;与孕晚期增重适宜组相比,孕晚期增重不足组GDM发生风险增加（OR=1.48,95% CI：0.77～2.84）,增重过多组GDM发生风险降低（OR=0.53,95% CI：0.28～0.99）;与孕期总增重适宜组相比,总增重不足组GDM发生风险增加（OR=2.16,95% CI：1.04～4.46）,总增重过多组GDM发生风险降低（OR=0.74,95% CI：0.38～1.46）。结论 孕早期增重不足和过多均可能增加GDM发生风险,孕早期可能是影响GDM发生的关键时期,孕中晚期增重对GDM的影响还有待进一步论证。     

Timing of Incarceration During Pregnancy and Birth Outcomes: Exploring Racial Differences

Objectives To examine whether there are racial differences in the relation between the timing of incarceration during pregnancy and birth outcomes among incarcerated pregnant women. Methods We examined the medical records associated with 360 infants born to pregnant inmates in Texas state prisons between January 1, 2002 and December 31, 2004. Weighted linear regression was used, within racial strata, to model gestational age at delivery, and infant birth weight, respectively, as functions of gestational age at maternal admission to prison. Models were adjusted for maternal age; gravidity; educational attainment; history of tobacco, substance, and alcohol use and the presence of any maternal chronic disease. Results Among Whites there was a 360.8 g lower mean birth weight for infants born to women incarcerated during weeks 14–20 relative to infants born to women incarcerated during weeks 1–13 (p < 0.10). Among Blacks and Hispanics, incarceration after the first trimester was not associated with a significant decrease in infant birth weight relative to incarceration during the first trimester. White women entering prison during the first trimester delivered infants at higher gestational ages than White women entering in the second trimester but the opposite was the case for Hispanics. Conclusions The association between the quantity of exposure to prison during pregnancy and birth outcomes appears to be different for Blacks, Whites, and Hispanic women. Future studies of the effect of incarceration on pregnancy outcomes should attempt to uncover potential racial differences in trends by obtaining racially stratified results or by assessing interaction with race.     

孕产期母亲用药、环境接触及分娩方式与婴幼儿过敏性疾病的关联性研究

目的 探讨孕产期母亲用药、环境接触及分娩方式对婴幼儿过敏性疾病的影响。方法 基于横断面调查的病例对照研究。按我国的地理和人口分布,在全国范围内选择33个城市,采用整群抽样方法在各城市的城区随机选择一个社区作为样本区,调查对象为0~24月龄婴幼儿母亲,进行面对面问卷调查。调查对象分为两组,曾出现过敏性疾病症状且被诊断为过敏性疾病的婴幼儿为过敏组（2 113例）和从未发生过敏性疾病症状的婴幼儿为对照组（6 303例）。结果 父母双方有过敏史和父母单方有过敏史均为婴幼儿发生过敏的危险因素,父母双方均有过敏史（OR=3.950）的危险关联强度高于父母单方有过敏史者（OR=2.277）;孕期使用抗生素（OR=1.396）、孕期接触消毒剂及清洁剂（OR=1.386）、孕期吸烟或接触吸烟环境（OR=1.301）、剖宫产（OR=1.255）是婴幼儿发生过敏性疾病的危险因素,各因素组间差异均有统计学意义（P<0.05）。结论 婴幼儿过敏预防重点在孕产期的一级预防,应避免无临床指征情况下剖宫产、孕期滥用抗生素和消毒剂以及接触烟草。     

Birth outcomes for Australian mother-infant pairs who received an influenza vaccine during pregnancy, 2012–2014: The FluMum study

IntroductionIn Australia, influenza vaccination is recommended for all women who will be pregnant during the influenza season. Vaccine safety and effectiveness are key concerns and influencers of uptake for both vaccine providers and families. We assessed the safety of receiving an influenza vaccination during any trimester of pregnancy with respect to preterm births and infant birthweight.MethodsWe conducted a nested retrospective cohort study of ‘FluMum’ participants (2012–2014). Our primary exposure of interest was influenza vaccination during pregnancy. The primary outcomes of interest were infant birthweight and weeks’ gestation at birth for live singleton infants. Analyses included comparisons of these birth outcomes by vaccination status and trimester of pregnancy an influenza vaccine was given. We calculated means, proportions, and relative risks and performed multivariable logistic regression for potential confounding factors.ResultsIn the 7126 mother-infant pairs enrolled in this study, mean maternal age at infant birth was 31.7 years. Influenza vaccine uptake in pregnancy was 34%. Most mothers with a known date of vaccination received a vaccine in the second trimester (51%). Those mothers with a co-morbidity or risk factor were 13% more likely to have influenza vaccine during pregnancy compared to other mothers (RR 1.13, 95% CI 1.04–1.24, p = 0.007). Mean weeks’ gestation at birth was 38.7 for the vaccinated and 38.8 for the unvaccinated group (p = 0.051). Infants in the vaccinated group weighed 15 g less in birthweight compared to the unvaccinated infants (95% CI −12.8 to 42.2, p = 0.29).ConclusionResults arising from this large Australian cohort study are reassuring with respect to two critical safety outcomes; preterm births and low infant birthweights. Studies examining a broader range of birth outcomes following influenza vaccination during pregnancy are required, particularly now that maternal vaccination in pregnancy has expanded to include pertussis as well as influenza.     

Mobile Phone Messaging to Husbands to Improve Maternal and Child Health Behavior in India

Over 90% of households in rural Uttar Pradesh, the most populous state of India, have at least one mobile phone. However, ownership of mobile phone among women is quite low. Implementation research was conducted in Uttar Pradesh to examine (a) whether providing information on selected maternal and child health (MCH) behaviors to a husband’s mobile phone would enhance the man’s knowledge and lead to discussions in their family, and (b) whether such discussions would help in the adoption of healthy practices. The m-Health intervention included biweekly voice messages in local language (Hindi) on MCH topics to the mobile phone of pregnant women’s husbands. Using a quasi-experimental design, after four months of the m-Health intervention, in 2014, 881 husbands and 956 women from the study area were interviewed. Husbands’ knowledge, controlling for their socio-demographic characteristics, were significantly higher among the listeners of the messages than the non-listeners. Multivariate logistic regression analysis showed that if husbands discussed the messages with family members, the odds of wives’ practicing health behaviors improved significantly for three behaviors. These include one antenatal checkup in last trimester of pregnancy (odds ratio 1.72, p < 0.05), receiving a postnatal checkup within 7 days of delivery (odds ratio 3.02, p < 0.05), and delayed bathing of newborn (odds ratio 1.93, p < 0.05). Thus, communicating messages using m-Health was found to be an effective intervention for behavior change. The study demonstrated that mobile phones can be used effectively to reach men with MCH information and encourage them to promote healthy behavior in their family.     

Safety of tetanus,diphtheria, and acellular pertussis vaccination among pregnant active duty U.S. military women

BackgroundThe tetanus, diphtheria, and acellular pertussis (Tdap) vaccine was approved for U.S. adults in 2005 and recommended for administration in every pregnancy in 2012, with optimal timing between 27 and 36 weeks’ gestation. In the military, however, a current Tdap vaccination status is compulsory for service, and active duty women may be inadvertently exposed in early pregnancy. Safety data in this population are limited.ObjectivesTo assess safety of inadvertent (0–13 weeks’ gestation) and recommended (27–36 weeks’ gestation) exposure to the Tdap vaccine in pregnancy.MethodsPregnancies and live births from Department of Defense Birth and Infant Health Research program data were linked with military personnel immunization records to determine pregnancy Tdap vaccine exposure among active duty women, 2006–2014. Multivariable Cox and generalized linear regression models estimated associations between Tdap vaccine exposure and adverse pregnancy or infant outcomes.ResultsOf 145,883 pregnancies, 1272 were exposed to the Tdap vaccine in the first trimester and 9438 between 27 and 36 weeks’ gestation. Neither inadvertent nor recommended vaccine exposure were associated with spontaneous abortion, preeclampsia, or preterm labor. Among 117,724 live born infants, 984 were exposed to the Tdap vaccine in the first trimester and 9352 between 27 and 36 weeks’ gestation. First trimester exposure was not associated with birth defects, growth problems in utero, growth problems in infancy, preterm birth, or low birth weight. Tdap vaccine exposure between 27 and 36 weeks’ gestation was not associated with any adverse infant outcome.ConclusionsAmong a population of active duty women in the U.S. military who received the Tdap vaccine during pregnancy, we detected no increased risks for adverse maternal, fetal, or infant outcomes. Our findings corroborate existing literature on the safety of exposure to the Tdap vaccine in pregnancy.     

Reciprocal interference of maternal and infant immunization in protection against pertussis

BackgroundBecause of the current re-emergence of pertussis, vaccination during the 3rd trimester of pregnancy is recommended in several countries in order to protect neonates by placental transfer of maternal antibodies. Here, we examined the potential reciprocal interference of mother and infant vaccination in protection against pertussis in mice.MethodsFemale mice were vaccinated with acellular pertussis vaccines and protection against Bordetella pertussis challenge, as well as functional antibodies were measured in their offspring with or without re-vaccination.ResultsMaternal immunization protected the offspring against B. pertussis challenge, but protection waned quickly and was lost after vaccination of the infant mice with the same vaccine. Without affecting antibody titers, infant vaccination reduced the protective functions of maternally-derived antibodies, evidenced both in vitro and in vivo. Protection induced by infant vaccination was also affected by maternal antibodies. However, when mothers and infants were immunized with two different vaccines, no interference of infant vaccination on the protective effects of maternal antibodies was noted.ConclusionIt may be important to determine the functionality of antibodies to evaluate potential interference of maternal and infant vaccination in protection against pertussis.     

妊娠意愿与孕中晚期妊娠相关焦虑关联的队列研究

目的 探讨妊娠意愿与孕中、晚期妊娠相关焦虑关联及其强度。方法 在马鞍山优生优育队列（MABC）中，将孕周≤ 14周、符合纳入标准的3 474名孕妇纳入队列。在首次产检时收集孕妇的一般人口学信息，并在孕中期和孕晚期收集妊娠相关焦虑量表。采用logistic回归分析妊娠意愿对孕中期和孕晚期妊娠相关焦虑的影响。结果 最终3 083人纳入分析，意外妊娠检出率为15.00%（n=461）。孕中期和孕晚期妊娠相关焦虑检出率分别为29.13%（n=898）、30.36%（n=936）。控制潜在的混杂因素后，与有充分思想准备的孕妇相比，意外妊娠的孕妇孕中期出现妊娠相关焦虑的风险增加（OR=1.85，95%CI：1.44~2.38）；孕晚期出现妊娠相关焦虑的风险也增加（OR=1.84，95%CI：1.44~2.35）；顺其自然怀孕的孕妇在孕中、晚期未增加妊娠相关焦虑发生风险。结论 意外妊娠是孕中、晚期妊娠相关焦虑危险因素。