孕期膳食营养状况对新生儿出生及母婴血生化指标的影响

目的探讨孕期膳食营养状况对新生儿出生及母婴血生化指标的影响。方法选取454例产前检查的孕妇,对其孕期膳食营养状况进行调查,随访新生儿结局及母婴血生化指标。结果新生儿的体质量与孕期摄入营养物质相关,且其体质量随着摄入量增加而增加,差异有统计学意义（P〈0.05）。脐血脂蛋白α水平较高的孕期脂肪摄入较多,差异有统计学意义（P〈0.05）;脐血胰岛素、C肽较高的孕期总能量及碳水化合物摄入较多,差异有统计学意义（P〈0.05）。结论孕期膳食营养状况对新生儿出生即脐血生化指标产生一定的影响。加强孕妇的营养指导对于促进胎儿正常发育具有重要意义。     

淄博市不同孕期女性尿碘水平及甲状腺功能状况调查

目的:研究淄博市孕期女性碘营养状况、不同妊娠阶段甲状腺功能变化及妊娠期甲状腺疾病种类分布,制定淄博地区孕期女性特异的血清甲状腺功能指标参考值,为孕期实施碘营养监测及甲状腺功能筛查提供理论依据。方法:选取2013年3月至2014年2月在淄博市妇幼保健院门诊行产检的1268例孕妇。采用化学发光法测定妊娠早、中、晚期孕妇的血清促甲状腺素(TSH)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(即TPOAb)。采用酸消化砷一铈接触法测定尿碘水平。结果:1268例孕妇中,孕早、中、晚期尿碘中位数分别为100.3、110.5、105.2,孕早期尿碘水平最低,孕中期尿碘中位数高于孕晚期。孕期FT4参考值范围设定:孕早期12.50~25.10pmmol/L,孕中期12.10~23.10pmmol/L,孕晚期11.20~20.16pmmol/L;孕期TSH参考值范围设定:孕早期0.15~3.20m IU/L,孕中期0.40~3.90m IU/L,孕晚期0.50~4.12m IU/L。正常尿碘组、低尿碘组及高尿碘组的FT4、TSH均在正常范围,高尿碘组、低尿碘组的FT4均低于正常尿碘组(P0.05),3组的TSH值比较差异均无统计学意义(P0.05)。1268例孕妇中,甲状腺功能异常者368例(29.02%),孕早期的甲状腺功能异常发生率高于孕中期及孕晚期,甲状腺功能异常以亚临床型甲减为主,其次为单纯TPOAb阳性。结论:淄博市孕期女性碘营养缺乏严重,需定期监测尿碘水平。随着孕周的增加,FT4值逐渐下降,而TSH值则呈上升趋势;尿碘异常早期可引起FT4的改变,对TSH影响不大。建议在妊娠早期对有甲状腺疾病危险因素的女性积极筛查甲状腺功能。     

孕妇亚临床型甲状腺功能减退症的预防与治疗

甲状腺激素是胎儿神经发育的必需激素。胎儿甲状腺激素缺乏可以导致神经系统发育障碍，严重者可发生呆小症。对孕妇进行碘营养监测和恰当的补碘治疗以保证妊娠期间甲状腺激素的足量供应．产后及时筛查和治疗新生儿先天性甲状腺功能减退症，均是保障儿童智力健康的有效手段。值得注意的是，孕妇自身甲状腺功能异常也可能对胎儿神经发育有不利的影响，但相关的研究一直没有受到足够的重视。近年来，随着对亚临床甲状腺疾病认识不断深入和激素检测技术水平的提高，防治孕妇的甲状腺功能减退症、特别是亚临床型甲状腺功能减退症，保护胎儿正常的神经发育和提高后代智力水平正在成为产科学、优生学和内分泌学界的一个研究热点。     

妊娠合并甲状腺功能减退症孕妇的新生儿脐血甲状腺功能筛查的意义

目的 研究妊娠合并甲状腺功能减退症(甲减)者新生儿脐静脉血甲状腺功能检测的临床意义及其影响因素.方法 对67例在北京协和医院产科分娩的妊娠合并甲减行脐血甲状腺功能检查者进行回顾性分析.比较脐血与新生儿生后5～7 d静脉血的甲状腺功能及甲状腺自身抗体(抗-TGAb/抗-TPOAb)结果;分析甲状腺自身抗体水平在母血、脐血和新生儿生后5～7 d静脉血之间的相关性;并进一步分析脐血促甲状腺激素(thyroid stimulating hormone,TSH)的影响因素.TSH结果以中位数(第25～75百分位)表示.结果 (1)母亲患甲减时,新生儿脐血中TSH升高的比例为9.0%(6/67).(2)脐血TSH水平与新生儿生后5～7 d静脉血TSH水平无相关性.阴道分娩组脐血TSH显著高于剖宫产组[10.20 mU/L(6.10～12.80 mU/L)和5.86 mU/L(4.02～7.74 mU/L),P=0.001],胎儿窘迫或早产者脐血TSH分别高于无胎儿窘迫或足月产者[胎儿窘迫:10.36 mU/L(6.61～13.37 mU/L)和6.89 mU/L(4.18～9.70 mU/L),P=0.046;早产:8.90 mU/L(7.60～10.33 mU/L)和6.84 mU/L(4.17～9.80 mU/L),P=0.049].(3)脐血抗-TGAb和抗-TPOAb水平与新生儿5～7 d静脉血水平分别呈正相关(r分别=0.960和0.975,P均=0.000).母血抗-TGAb和抗-TPOAb水平对脐血的抗体结果有显著影响(P=0.003和0.000),但与新生儿TSH水平无关(P>0.05).结论 脐血TSH受多种分娩因素的影响,使其预测新生儿先天性甲减的意义受到影响.但母亲甲减时其新生儿脐血TSH水平升高和抗-TGAb及抗-TPOAb阳性的风险明显增加,成为其发生甲减的危险因素,因此,对这些新生儿需要进一步随访.     

妊娠早期孕妇母体碘营养与甲状腺功能异常的研究

目的研究妊娠早期孕妇母体碘营养与甲状腺功能异常的关系。方法选取2012年1月~2014年6月在我院进行产检的妊娠早期孕妇1200例,采集孕妇的清晨空腹静脉血及尿液,测定孕妇尿液中碘含量,并采取常规电化学发光法测定孕妇血清中的游离甲状腺素及促甲状腺激素,研究碘营养与甲状腺功能异常的关系。结果碘摄入量异常患者有168例,而碘摄入适量患者有66例,碘摄入量异常患者患病率高于碘摄入适量患者,差异有统计学意义(P0.05)。结论妊娠期应加强保健教育,控制碘摄入,需要避免碘缺乏以及过量的摄入,同时定期进行尿碘的监测,及时进行纠正,防止甲状腺功能异常的发生。     

孕产妇碘营养状况调查

目的探索不同孕期、哺乳期妇女和新生儿是否存在碘缺乏和碘缺乏病（iodinedeficiencydisorder,IDD），为妊娠期和哺乳期是否需要补碘提供依据。方法对孕产妇尿碘水平及孕母、新生儿甲状腺功能进行测定。结果孕产妇缺碘发生率达24．48％，明显高于非妊娠妇女（714％），且多集中于34孕周后及哺乳期。缺碘孕妇血清TSH、脐血清TSH、T4水平均有改变，其中脐血清TSH≥10mU／L，提示甲状腺功能处于代偿性状态。结论上海杨浦地区孕产妇存在一定缺碘状况，因此孕期有必要作尿碘筛查，低者及时补碘，避免碘缺乏给母儿带来不良影响。     

孕妇长链多不饱和脂肪酸代谢水平与胎儿发育的关系

目的:了解孕妇长链多不饱和脂肪酸对胎儿的影响.方法:用毛细管气相色谱法测定56例正常孕妇静脉血及其分娩的新生儿脐血血浆及红细胞膜长链多不饱和脂肪酸水平,同时测量新生儿出生体重.结果:足月儿和早产儿脐血中亚油酸(LA)、亚麻酸(ALA)水平低于母血,花生四烯酸(从)、22-碳六烯酸(DHA)水平则高于母血.脐血亚油酸、亚麻酸、花生四烯酸、22-碳六烯酸水平与母血呈正相关.母血中花生四烯酸水平与新生儿出生体重呈正相关.结论:母亲营养和胎盘功能与胎儿长链多不饱和脂肪酸水平及其生长发育密切相关.     

我国部分地区孕妇和哺乳妇女适宜的尿碘参考值范围的制定

目的:对我国部分地区正常孕妇和哺乳妇女的尿碘值进行测定,以期对尿碘值范围提供一定的参考.方法:收集我国6个地区孕妇和哺乳妇女的尿碘和甲状腺功能数据,对甲状腺功能正常的141例孕妇和170例哺乳妇女的尿碘值进行统计分析.结果:我国部分地区孕妇和哺乳妇女适宜的尿碘值范围分别为90～500 μg/L和70～450μg/L.结论:本研究为孕妇和哺乳妇女碘营养状况的个体诊断提供了一种思考方法.     

乌鲁木齐市三家医院妊娠早期孕妇缺碘与甲状腺功能的流行病学调查

妊娠合并甲状腺功能减退症(简称甲减)可并发妊娠期高血压疾病、早产、流产、胎盘早剥、死胎及新生儿低出生体重等,并可影响胎儿的神经系统发育,导致后代智力水平降低[1-2].妊娠前半期母亲甲状腺激素不足的主要原因是自身免疫甲状腺炎和碘缺乏.在碘缺乏地区,妊娠妇女会出现甲状腺激素产生不足,表现为亚临床甲减或低甲状腺素血症.本研究通过收集新疆乌鲁木齐市3家医院孕8周以内的妇女的临床资料,研究本地区孕妇的碘营养状况与孕期甲减和甲状腺自身抗体的关系.     

妊娠期碘营养状况及其与甲状腺功能关系研究

目的探讨广州地区孕妇碘营养状况及其与甲状腺功能的关系。方法选择2012年3月至2014年2月在中山大学孙逸仙纪念医院产检的孕妇815为研究对象,进行甲状腺功能、抗甲状腺过氧化物酶抗体(TPO-Ab)和尿碘的检测,结果异常者定期复查,密切监测母胎情况,追踪至妊娠终止。结果 815例无甲状腺疾病史孕妇尿碘中位数(median urinary iodine,MUI)为197.0μg/L;其中碘缺乏者39.6%(323/815);碘适宜者20.9%(170/815);碘超足量者27.4%(223/815);碘过量者12.1%(99/815)。早中晚孕期MUI分别为208、182.5、174.5μg/L。不同碘营养状况下甲状腺功能、甲状腺疾病的患病率及TPO-Ab阳性率的差异无统计学意义,均P0.05。结论孕妇碘营养状态为碘适宜,但个体间差异较大。不同碘营养状况下甲状腺疾病的患病率无明显差异,即轻度碘缺乏或碘过量不增加甲状腺疾病的患病率。随着孕周的增加,尿碘值逐渐下降,但都在碘适宜的范围内。     

Prolonged pregnancy: surveillance of the fetus and the neonate and the course of labor and delivery

The perinatal events in 184 term control pregnancies and 129 prolonged pregnancies were prospectively compared. Fetal surveillance consisted of weekly biophysical profile testing. Thirty-two infants were dysmature, and 10 of these had advanced dysmaturity. The incidence of advanced dysmaturity rose quickly after 44 weeks. This group was at greater risk for fetal distress, lower Apgar scores, and emergency cesarean section. The combination of oligohydramnios, a suboptimal nonstress test, and a low profile score was highly predictive of a neonate with advanced dysmaturity. In the control pregnancies, the rate of induction of labor was 13.81% compared with 39.84% in the prolonged pregnancies. The induced labor group had a 51.32% cesarean section rate. Our approach to prolonged pregnancy consists of elective induction of labor when the cervix is favorable and biweekly profile testing when it is not; however, the high incidence of advanced dysmaturity after 44 weeks warrants delivery.     

Early- and late-onset preeclampsia and the tissue-specific epigenome of the placenta and newborn

IntroductionPreeclampsia (PE) carries increased risks of cardiovascular- and metabolic diseases in mothers and offspring during the life course. While the severe early-onset PE (EOPE) phenotype originates from impaired placentation in early pregnancy, late-onset PE (LOPE) is in particular associated with pre-existing maternal cardiovascular- and metabolic risk factors. We hypothesize that PE is associated with altered epigenetic programming of placental and fetal tissues and that these epigenetic changes might elucidate the increased cardiovascular- and metabolic disease susceptibility in PE offspring.MethodsA nested case-control study was conducted in The Rotterdam Periconceptional Cohort comprising 13 EOPE, 16 LOPE, and three control groups of 36 uncomplicated pregnancies, 27 normotensive fetal growth restricted and 20 normotensive preterm birth (PTB) complicated pregnancies. Placental tissue, newborn umbilical cord white blood cells (UC-WBC) and umbilical vein endothelial cells were collected and DNA methylation of cytosine-guanine dinucleotides was measured by the Illumina HumanMethylation450K BeadChip. An epigenome-wide analysis was performed by using multiple linear regression models.ResultsEpigenome-wide tissue-specific analysis between EOPE and PTB controls revealed 5001 mostly hypermethylated differentially methylated positions (DMPs) in UC-WBC and 869 mostly hypomethylated DMPs in placental tissue, situated in or close to genes associated with cardiovascular-metabolic developmental pathways.DiscussionThis study shows differential methylation in UC-WBC and placental tissue in EOPE as compared to PTB, identifying DMPs that are associated with cardiovascular system pathways. Future studies should examine these loci and pathways in more detail to elucidate the associations between prenatal PE exposure and the cardiovascular disease risk in offspring.     

Histomorphology of the placenta and the placental bed of growth restricted foetuses and correlation with the Doppler velocimetries of the uterine and umbilical arteries

The aim of the present study was to evaluate the histomorphology of the placenta and the placental bed and to correlate this with the Doppler study of the uterine and umbilical arteries of intrauterine growth restricted pregnancies. The study group consisted of 47 women with intrauterine growth restricted foetuses. Twenty-five uneventful pregnancies with appropriate for gestational age foetuses were selected as controls. Doppler studies of umbilical and uterine arteries were performed within the last week before delivery. Placental bed biopsies were obtained at Caesarean section with direct visualization of the placental site. The incidence of pathologic bed biopsies in control, IUGR with normal uterine artery Doppler velocimetry and IUGR with abnormal uterine artery Doppler velocimetry was 0 per cent, 16.6 per cent and 79.3 per cent respectively (P< 0.001). Placentae from IUGR cases with abnormal umbilical artery Doppler velocimetries had a significantly increased number of villous infarcts, cytotrophoblast proliferation and thickening of the villous trophoblastic basal membrane (P=0.001, P=0.038 and P=0.02 respectively). Abnormal placental bed biopsy pathology was significantly associated with abnormal uterine artery velocimetry (OR 33.7, 6.5-173.6; P< 0.001). Abnormal placental pathology was significantly associated with abnormal umbilical artery Doppler velocimetry (OR 21.04, 3.8-115.9;P< 0.001). Women with both abnormal uterine and umbilical artery Doppler velocimetries were delivered earlier and their babies had lower mean birth and placental weight (P< 0.001). In conclusion, placental bed biopsy and placental pathologies are best reflected by abnormal uterine and umbilical artery velocity waveforms, respectively. The most severe clinical outcomes and perinatal mortality are present when both uterine and umbilical districts are altered.     

Ultrasound and the receptivity of the endometrium

Ultrasound imaging can be used to assess the endometrium in a number of ways. In particular, time-lapse video recordings can show that the lining of the uterus undergoes rhythmical contractions that vary in strength and intensity throughout the ovarian cycle. These contractions appear to assist in sperm transport at the time of ovulation, but can decrease the chances of a fertilized egg implanting in the uterus if they persist later in the cycle. They are also the cause of ectopic pregnancies occurring in IVF treatment cycles. In order to reduce these uterine contractions and therefore increase the chances of a successful uterine pregnancy, IVF treatment cycles should incorporate minimal stimulation so as to make them as close to natural cycles as possible.