环境镉暴露对妊娠结局和胎儿生长发育的影响

目的　评价环境镉暴露对妊娠结局和胎儿生长发育的可能影响。方法　于 2 0 0 2年 11月～ 2 0 0 3年 1月选择湖北省大冶市镉污染地区和对照地区的待产孕妇 ,进行问卷调查和体格检查。同时采集孕妇静脉血、脐带血和胎盘标本测定镉含量。比较镉污染地区和对照地区早产发生率、新生儿窒息发生率、新生儿出生身长和体重差异有无显著性。结果　镉污染地区早产发生率为 2 0 8% ,新生儿窒息发生率为 2 9 2 % ;对照地区分别为 10 0 %和 15 0 % ,两者间差异无显著性。污染地区新生儿出生身长为 ( 4 7 88± 4 15 )cm ,低于对照地区 ( 5 0 65± 2 41)cm (P <0 0 1)。多因素线性回归分析表明 ,脐血镉水平与新生儿出生身长呈显著负相关。结论　环境镉暴露可以显著降低新生儿出生身长。     

B超对胎儿四肢的诊断与评估

目的:了解胎儿四肢的超声影像特征、检查手法及影响因素。方法:应用B超检查中晚期妊娠孕妇800例,共807人胎儿的四肢显像情况,分析不显示或部分显示的影响因素及对策。结果:①从孕12周~18周胎儿四肢显示率逐渐升高,孕19周~26周的显示率为100%,27周~42周随孕周的增大,显示率逐渐降低。②四肢不显示或部分显示的影响因素依次为羊水、四肢位置、孕周过大或过小、握拳不松、手脚合抱成团、孕妇肥胖,判定胎位有助于寻找胎儿肢体,但不影响肢体的显示率。结论:①孕19周~26周为观察胎儿四肢发育的最佳时期,孕12周~15周一般经腹部超声检查仪无法完全分辨手指及脚趾。②影响胎儿肢体观察的最主要因素为羊水及胎儿肢体在宫内的放置位置。③根据不同的胎位综合使用多种扫查方法,选择分辨率较高的超声诊断仪,可提高胎儿的肢体显示率。     

Social factors associated with nitrogen dioxide (NO2) exposure during pregnancy: the INMA-Valencia project in Spain

Numerous studies have focused on the effects of exposure to air pollution on health; however, certain subsets of the population tend to be more exposed to such pollutants depending on their social or demographic characteristics. In addition, exposure to toxicants during pregnancy may play a deleterious role in fetal development as fetuses are especially vulnerable to external insults. The present study was carried out within the framework of the INMA (Infancia y Medio Ambiente or Childhood and the Environment) multicenter cohort study with the objective of identifying the social, demographic, and life-style factors associated with nitrogen dioxide (NO(2)) exposure in the subjects in the cohort. The study comprised 785 pregnant women who formed part of the INMA cohort in Valencia, Spain. Outdoor levels of NO(2) were measured at 93 sampling sites spread over the study area during four different sampling periods lasting 7 days each. Multiple regression models were used for mapping outdoor NO(2) throughout the area. Individual exposure was assigned as: 1) the estimated outdoor NO(2) levels at home, and 2) the average of estimated outdoor NO(2) levels at home and work, weighted according to the time spent in each environment. The subjects' socio-demographic and life-style information was obtained through a questionnaire. In the multiple linear analyses, the outdoor NO(2) levels assigned to each home were taken to be the dependent variable. Other variables included in the model were: age, country of origin, smoking during pregnancy, parity, season of the year, and social class. These same variables remained in the model when the dependent variable was changed to the NO(2) levels adjusted for the subjects' time-activity patterns. We found that younger women, those coming from Latin American countries, and those belonging to the lower social strata were exposed to higher NO(2) levels, both as measured outside their homes as well as when time-activity patterns were taken into account. These subgroups also have a higher probability of being exposed to NO(2) levels over 40 μg/m(3), which is the annual limit for maximum safe exposure, as established by European Directive 2008/50/EC.     

Recasting Hope: A process of adaptation following fetal anomaly diagnosis

Recent decades have seen ultrasound revolutionise the management of pregnancy and its possible complications. However, somewhat less consideration has been given to the psychosocial consequences of mass screening resulting in fetal anomaly detection in low-risk populations, particularly in contexts where termination of pregnancy services are not readily accessible. A grounded theory study was conducted exploring forty-one women's experiences of ultrasound diagnosis of fetal abnormality up to and beyond the birth in the Republic of Ireland. Thirty-one women chose to continue the pregnancy and ten women accessed termination of pregnancy services outside the state. Data were collected using repeated in-depth individual interviews pre- and post-birth and analysed using the constant comparative method. Recasting Hope, the process of adaptation following diagnosis is represented temporally as four phases: ‘Assume Normal’, ‘Shock’, ‘Gaining Meaning’ and ‘Rebuilding’. Some mothers expressed a sense of incredulity when informed of the anomaly and the ‘Assume Normal’ phase provides an improved understanding as to why women remain unprepared for an adverse diagnosis. Transition to phase 2, ‘Shock,’ is characterised by receiving the diagnosis and makes explicit women's initial reactions. Once the diagnosis is confirmed, a process of ‘Gaining Meaning’ commences, whereby an attempt to make sense of this ostensibly negative event begins. ‘Rebuilding’, the final stage in the process, is concerned with the extent to which women recover from the loss and resolve the inconsistency between their experience and their previous expectations of pregnancy in particular and beliefs in the world in general. This theory contributes to the theoretical field of thanatology as applied to the process of grieving associated with the loss of an ideal child. The framework of Recasting Hope is intended for use as a tool to assist health professionals through offering simple yet effective interventions grounded in women's experiences of this event.     

Nine-year exposure to residential greenness and the risk of metabolic syndrome among Luxembourgish adults: A longitudinal analysis of the ORISCAV-Lux cohort study

Growing evidence shows a beneficial effect of exposure to greenspace on cardiometabolic health, although limited by the cross-sectional design of most studies. This study examined the long-term associations of residential greenness exposure with metabolic syndrome (MetS) and MetS components within the ORISCAV-LUX study (Wave 1: 2007–2009, Wave 2: 2016–2017, n = 395 adults). Objective exposure to residential greenness was measured in both waves by the Soil-Adjusted Vegetation Index (SAVI) and by Tree Cover Density (TCD). Linear mixed models were fitted to estimate the effect of baseline levels and change in residential greenness on MetS (continuous score: siMS score) and its components (waist circumference, triglycerides, HDL-cholesterol, fasting plasma glucose and systolic blood pressure), respectively. This study provides evidence that an increase in SAVI, but not TCD, may play a role in preventing MetS, as well as improving HDL-cholesterol and fasting plasma glucose levels. Greater baseline SAVI was also associated with lower fasting plasma glucose levels in women and participants living in municipalities with intermediate housing price, and greater baseline TCD was associated with larger waist circumference. Overall, findings suggest a mixed impact of increased greenness on cardiometabolic outcomes. Further longitudinal research is needed to better understand the potential effects of different types of greenness exposure on cardiometabolic outcomes.     

胎儿鼻骨超声检查在胎儿筛查中的作用

目的:探讨宫内胎儿鼻骨的超声表现与显示手法,提高对正常胎儿鼻骨结构的认识,评价其在胎儿筛查中的应用价值。方法:收集2004年6月~2004年12月在我院行彩超检查的孕妇613例,孕龄14~40周,对每一胎儿面部进行冠状、矢状及横切面扫查,并测量鼻骨长度。结果:中孕期正常胎儿鼻骨显示率为100%,613例筛查中1例无鼻且眼距近,有染色体异常,1例鼻骨短并有少量胸腹腔积液及大胎盘,为基因异常。3例均未见其他较大畸形并均经产后及行中期引产后证实。结论:超声测量胎儿鼻骨长度方法简单、可靠,容易掌握,再结合孕妇血清AFP和Free-β-HCG,对胎儿先天缺陷进行产前筛查有实用价值。     

Urban greenspace and mental health in Chinese older adults: Associations across different greenspace measures and mediating effects of environmental perceptions

This study aimed to contrast the associations of street view-, land use- and satellite-derived greenspace measures with older adults' mental health and to examine the mediating effects of neighborhood environmental perceptions (i.e., noise, aesthetics and satisfaction with recreational opportunities) to explain potential heterogeneity in the associations. Data of 879 respondents aged 60 or older in Dalian, China were used, and multilevel regression models were conducted in Stata. Results indicated that the Normalized Difference Vegetation Index (NDVI), vegetation coverage, park coverage and streetscape grasses were positively correlated with older adults' mental health. The associations of exposure metrics measured by overhead view were stronger than those measured by the street view. Streetscape grasses had a stronger association with older adults' mental health than streetscape trees. Noise, aesthetics and satisfaction with recreational opportunities mediated these associations, but the strength of the mediating effects differed across the greenspace measures. Our findings confirm the necessity of multi-measures assessment for greenspace to examine associations with older adults’ mental health in Chinese settings and can contribute to the realization of health benefits of urban greenspace.     

大鼠妊娠期糖尿病影响胎鼠发育及仔鼠生长的研究

目的建立SD大鼠妊娠期糖尿病（GDM）模型,研究妊娠糖尿病对胎鼠发育及仔鼠生长的影响。方法40mg／kg链脲佐菌素（STZ）腹腔注射怀孕第1天大鼠复制GDM,5d后空腹检测血糖、尿糖和体质量。对照组注射等量柠檬酸钠缓冲液。孕鼠第13天、第19天剖宫产,观察其死胎、吸收胎、畸胎及存活胎数等,并测量胎鼠体质量。取4周龄仔鼠检测其血糖和体质量,并进行行为学观察。结果受孕第13天、第19天剖宫产,GDM组死胎、吸收胎、畸心胎数明显多于对照组;4周龄GDM组仔鼠体质量明显低于对照组,记忆力试验也低于对照组。8周龄GDM组仔鼠空腹血糖值显著高于对照组。结论大鼠妊娠糖尿病影响胎鼠正常发育,并导致仔鼠记忆力下降和血糖值升高。     

不同分娩方式对足月胎儿生长受限孕妇妊娠结局的影响

目的:通过比较不同分娩方式对胎儿生长受限(FGR)孕妇妊娠结局的影响,为胎儿生长受限孕妇选择合适的分娩方式。方法:将2006～2008年在郑州大学第三附属医院分娩的145例足月FGR孕妇作为研究对象,比较不同分娩方式新生儿不良妊娠结局(窒息或羊水污染发生)的比例;比较不同指征行剖宫产的FGR孕妇不良妊娠结局发生比例;比较发生不良妊娠结局组及妊娠结局正常组新生儿的体重。结果:①剖宫产组较阴道分娩组新生儿不良结局的发生率低,但差异没有统计学意义。②以羊水过少或胎窘为指征的FGR孕妇新生儿不良妊娠结局发生率高。③不良妊娠结局组新生儿体重更低。结论:影响生长受限胎儿预后的主要是新生儿的出生体重而不是分娩方式,伴有羊水过少或是疑诊胎窘的FGR病例选择性的剖宫产相对安全。     

产前超声筛查诊断胎儿畸形的价值

目的初步探讨超声筛查的方法及在诊断胎儿畸形中的价值。方法回顾性分析14 951例胎儿行超声筛查的结果。结果 14 951例行超声筛查的胎儿发现各类畸形154例,占1.03%。结论通过超声筛查可对胎儿结构或其他异常得到初步的诊断,是产前诊断的重要方法。     

Measures of Perceived Neighborhood Food Environments and Dietary Habits: A Systematic Review of Methods and Associations

Access to healthy food is a necessity for all people. However, there is still a lack of reviews on the assessment of respondent-based measures of neighborhood food environments (perceived food environments). The aim of this systematic review was to evaluate the measurement tools for perceived food environments by five dimensions of food access and to obtain the overview of their associations with dietary habits among people aged 18 years and older in middle- and high-income countries. Observational studies using perceived food environment measures were identified through a systematic review based on two databases for original studies published from 2010 to 2020. A total of 19 final studies were extracted from totally 2926 studies. Pertaining to the five dimensions of food access, 12 studies dealt with accessibility, 13 with availability, 6 with affordability, 10 with acceptability, 2 with accommodation, and 8 with a combination of two or more dimensions. Perceived healthy food environments were positively associated with healthy dietary habits in 17 studies, but 8 of them indicated statistically insignificant associations. In conclusion, this review found accessibility and availability to be major dimensions of perceived food environments. The relationship between healthy food environments and healthy diets is presumably positive and weak.     

孕期补充钙、铁、锌对胎儿生长发育的影响

目的以孕妇为对象,研究孕中期单纯补钙和补钙同时补铁和/或锌对婴儿生长发育的影响.方法选择初产健康孕妇313名,分别强化维生素D(VD)、钙、铁和锌, 从孕5月至分娩时止.分娩时测量胎盘重量、胎盘和脐带血中微量元素的含量、新生儿的出生体重和身长.结果对照组胎盘重量最大,钙和多种微量元素的含量较低,而钙+铁+锌+VD组相反,并且对照组的胎盘重量(551.1±64.2) g显著大于钙 +铁+锌+VD组(467.1±36.6) g.脐血中血红蛋白含量显著高于母血,碱性磷酸酶活性差异无显著性,脐血血浆中钙、铁、锌含量均高于母血.婴儿的生长发育结果显示,钙+铁+ 锌 +VD组新生儿的出生体重(3.53±0.33) kg和身长值最大,并且出生体重显著大于对照组的(3.28±0.54) kg.结论孕期联合补充钙、铁、锌, 使其达到或接近每日膳食中营养素供给量,这是改善婴儿生长发育的最佳方式.     

超声及血清学检测在胎儿巨细胞病毒感染预测中的应用价值

目的 研究超声及血清学检查在胎儿巨细胞病毒感染预测中的应用价值.方法 选择2010年10月-2011年9月医院就诊及住院的孕妇168例,其中先天性巨细胞病毒感染胎儿26例,对孕妇每2周进行1次超声扫描,监测胎儿的发育情况；另采用酶联免疫吸附法(ELISA)对血清中特异性的CMV-IgM进行检测；比较分析超声及血清学检测异常的发生例数.结果 胎儿巨细胞病毒感染的发生率为15.48％;超声发现异常9例,异常率为34.62％,血清中CMV-IgM阳性14例,阳性率为53.85％,差异有统计学意义(P＜0.05).结论 超声及血清学检测在胎儿巨细胞病毒感染的预测中均具有重要的作用,在临床中,可根据孕妇的具体情况,综合多方面检查的结果进行确诊.     

Non-occupational exposure to paint fumes during pregnancy and fetal growth in a general population

Occupational exposure to organic solvents during pregnancy has been associated with reduced fetal growth. Though organic solvents in the form of paint fumes are also found in the home environment, no studies have investigated the effect of such exposure in a general population. We studied associations between residential exposure to paint fumes during pregnancy and fetal growth within the Danish National Birth Cohort which consecutively recruited pregnant women from 1996 to 2002 from all over Denmark. Around the 30th pregnancy week, 19,000 mothers were interviewed about use of paint in their residence during pregnancy. The mothers were also asked about smoking habits and alcohol consumption during pregnancy, pre-pregnancy weight, height, parity and occupation. Information on birth weight and gestational age was obtained from national registers. We found that 45% of the mothers had been exposed to paint fumes in their residence during pregnancy. We found a statistically significant inverse relationship between exposure to paint fumes and the risk of being small for gestational age. There were no statistically significant associations between exposure to paint fumes and birth weight and risk of preterm birth after adjustment for potential confounders. Our results suggest that there are no causal relationship between non-occupational exposure to paint fumes in the residence during pregnancy and fetal growth.     

产前超声检查在胎儿泌尿系统异常中的应用价值

目的：探讨超声在胎儿泌尿系统异常中的应用价值。方法：通过分析18例胎儿泌尿系统异常的声像图特征,结合后续复查随访,判断病变的性质。结果：18例异常中,多数病例为功能性病变,器质性病变如无其他系统合并症,大多为非致死性。结论：超声对胎儿泌尿系统异常的检出及性质的判断有较大的优势,但也存在一定的客观局限性。     

Gender differences in fetal growth of newborns exposed prenatally to airborne fine particulate matter

Our primary purpose was to assess sex-specific fetal growth reduction in newborns exposed prenatally to fine particulate matter. Only women 18-35 years of age, who claimed to be non-smokers, with singleton pregnancies, without illicit drug use and HIV infection, free from chronic diseases were eligible for the study. A total of 481 enrolled pregnant women who gave birth between 37 and 43 weeks of gestation were included in the study. Prenatal personal exposure to fine particles over 48 h during the second trimester was measured using personal monitors. To evaluate the relationship between the level of PM_2.5 measured over 48 h in the second trimester of pregnancy with those in the first and the third trimesters, a series of repeated measurements in each trimester was carried out in a random subsample of 85 pregnant women. We assessed the effect of PM_2.5 exposure on the birth outcomes (weight, length and head circumference at birth) by multivariable regression models, controlling for potential confounders (maternal education, gestational age, parity, maternal height and prepregnancy weight, sex of infant, prenatal environmental tobacco smoke, and season of birth). Birth outcomes were associated positively with gestational age, parity, maternal height and prepregnancy weight, but negatively with the level of prenatal PM_2.5 exposure. Overall average increase in gestational period of prenatal exposure to fine particles by about 30 μg/m³, i.e., from 25th percentile (23.4 μg/m³) to 75th percentile (53.1 μg/m³) brought about an average birth weight deficit of 97.2 g (95% CI: −201, 6.6) and length at birth of 0.7 cm (95% CI: −1.36, −0.04). The corresponding exposure lead to birth weight deficit in male newborns of 189 g (95% CI: −34.2, −343) in comparison to 17 g in female newborns; the deficit of length at birth in male infants amounted to 1.1 cm (95% CI: −0.11, −2.04). We found a significant interrelationship between self-reported ETS and PM_2.5, however, none of the models showed a significant interaction of both variables. The joint effect of various levels of PM_2.5 and ETS on birth outcomes showed the significant deficit only for the categories of exposure with higher component of PM_2.5. Concluding, the results of the study suggest that observed deficits in birth outcomes are rather attributable to prenatal PM_2.5 exposure and not to environmental tobacco smoke. The study also provided evidence that male fetuses are more sensitive to prenatal PM_2.5 exposure and this should persuade policy makers to consider birth outcomes by gender separately while setting air pollution guidelines.     

妊高征胎盘功能变化及其与胎儿预后关系的探讨

测定妊高征患者尿E/C比值、血SP_1值、HPL值及PZP值,旨在探讨妊高征患者的胎盘功能变化及其对胎儿预后的影响。结果表明,妊高征患者尿E/C比值、血SP_1及HPE值随病变加重而逐渐下降,当其低值时,低Apgar评分及低体重儿的发生率明显增加(P<0.01);但PZP下降幅度不明显,并与胎儿预后无明显关系。多指标联合测定表明,当E/C比值、血SP_1和HPL值均低时,低Apgar评分的发生率可达83.3％,低体重儿的发生率可达66.7％。据此认为,监测妊高征患者胎盘功能的变化,对预测胎儿预后有重要的参考价值,若能进行多指标测定分析则可提高判定胎儿预后的准确性。     

妊娠相关蛋白-A与胎儿生长发育的关系

目的:探讨孕早期母血清妊娠相关蛋白-A(pregnancy-associated plasma protein-A,PAPP-A)与胎儿生长发育的关系。方法:选择2007年8～12月在南京市妇幼保健院产前诊断中心接受孕早期唐氏综合征血清筛查的102例孕妇,随访其妊娠结局,排除双胎及各种先天畸形,分析PAPP-A与胎儿出生体重、胎龄的关系。结果:①小于胎龄儿组(small for ges-tational age infant,SGA组)、适于胎龄儿组(appropriate for gestational age infant,AGA组)和大于胎龄儿组(large for gestationalage infant,LGA组)之间PAPP-A水平(MoM值)差异无统计学意义(F=0.775,P>0.05)。②孕早期母血清PAPP-A水平(MoM值)与胎儿出生体重、胎龄呈正相关(相关系数r为0.375和0.215,P均<0.05)。结论:母孕早期血清PAPP-A水平(MoM值)与胎儿宫内生长发育有关,但尚不能作为预测SGA的客观指标。     

Misoprostol for termination of pregnancy with intrauterine fetal demise in the second and third trimester of pregnancy — a systematic review

Background

A systematic review was conducted to compare with other methods, using the best available evidence, the benefits and risks associated with the administration of misoprostol to terminate pregnancy with fetal demise in the second and third trimesters (defined as gestational age of more than 14 weeks).

Study Design

We assessed all published randomized controlled trials identified from the Cochrane Pregnancy and Childbirth Group Trials Register, MEDLINE, POPLINE, LILACS and CINHAL from 1987 to 2008 comparing misoprostol alone (vaginal, oral or sublingual administration) with placebo or no treatment or any other method of uterine evacuation (including cervical ripening with other prostaglandins administered vaginally or extra-amniotically, oxytocin, as well as mechanical methods of evacuation including extra-amniotic Foley catheter or laminaria placement) in women with diagnosis of intrauterine fetal death in the second and third trimester of pregnancy. We also evaluated the use of misoprostol alone with misoprostol plus other adjuncts such as intravenous oxytocin. Meta-analyses were performed using relative risks (RRs) as the measure of effect size for binary outcomes and weighted mean differences for continuous outcome measures. For all data, 95% confidence intervals (CIs) were also computed.

Results

Fourteen studies comparing different interventions were included. The induction regimens varied considerably in the number of applications of medication, dosages and time intervals between doses. The main outcome was uterine evacuation at 48 h. In all studies evaluated, both vaginal and oral misoprostol showed 100% success rate in achieving uterine evacuation at 48 h. We also evaluated the success at achieving uterine evacuation at 24 h. Although the differences were not statistically significant and heterogeneity was observed, vaginal misoprostol was as effective as oral administration, achieving uterine evacuation within 48 h (RR=0.96, 95% CI=0.85 to 1.09). Oral administration was associated with more side effects than vaginal administration. The mean time intervals from induction to delivery were not significantly different between the vaginal and oral treatment groups [−1.97 (95% CI=−3.22 to 0.72)], so that the clinical benefit of oral administration and avoidance of repeated vaginal administration is probably marginal. Vaginal misoprostol alone was less effective in achieving uterine evacuation at 24 h compared with vaginal misoprostol plus oxytocin. However, there was no statistically significant difference (RR=1.00, 95% CI=0.89 to 1.12) in uterine evacuation at 48 h for vaginal misoprostol either with or without oxytocin administration.

Conclusions

Overall, the body of evidence regarding induction of labor and delivery for second and third trimester of pregnancy is limited and the studies vary in methodology and selected outcome measures, making direct comparisons difficult. Vaginal misoprostol was less effective than oral misoprostol for effecting delivery within 24 h, but not within 48 h.     

Comparison of personal radio frequency electromagnetic field exposure in different urban areas across Europe

Background

Only limited data are available on personal radio frequency electromagnetic field (RF-EMF) exposure in everyday life. Several European countries performed measurement studies in this area of research. However, a comparison between countries regarding typical exposure levels is lacking.

Objectives

To compare for the first time mean exposure levels and contributions of different sources in specific environments between different European countries.

Methods

In five countries (Belgium, Switzerland, Slovenia, Hungary, and the Netherlands), measurement studies were performed using the same personal exposure meters. The pooled data were analyzed using the robust regression on order statistics (ROS) method in order to allow for data below the detection limit. Mean exposure levels were compared between different microenvironments such as homes, public transports, or outdoor.

Results

Exposure levels were of the same order of magnitude in all countries and well below the international exposure limits. In all countries except for the Netherlands, the highest total exposure was measured in transport vehicles (trains, car, and busses), mainly due to radiation from mobile phone handsets (up to 97%). Exposure levels were in general lower in private houses or flats than in offices and outdoors. At home, contributions from various sources were quite different between countries.

Conclusions

Highest total personal RF-EMF exposure was measured inside transport vehicles and was well below international exposure limits. This is mainly due to mobile phone handsets. Mobile telecommunication can be considered to be the main contribution to total RF-EMF exposure in all microenvironments.