Maternal Medical Complexity: Impact on Prenatal Health Care Spending among Women at Low Risk for Cesarean Section

BackgroundObstetric procedures are among the most expensive health care services, yet relatively little is known about health care spending among pregnant women, particularly the commercially-insured.ObjectiveThe objective of this study was to examine the association between maternal medical complexity, as a result of having one or more comorbid conditions, and health care spending during the prenatal period among a national sample of 95,663 commercially-insured women at low risk for cesarean delivery.MethodsWe conducted secondary analyses of 2010–2011 inpatient, outpatient, and professional claims for health care services from the Health Care Cost Institute. Allowed charges were summed for the prenatal and childbirth periods. Ordinary least squares regressions tested associations between maternal health conditions and health care expenditures during pregnancy.ResultsThirty-four percent of pregnant women had one or more comorbidities; 8% had two or more. Pregnant women with one or more comorbidities had significantly higher allowed charges than those without comorbidities (p < .001). Spending during the prenatal period was nearly three times higher for women with preexisting diabetes compared with women with no comorbid conditions. Average levels of prenatal period spending associated with maternal comorbidities were similar for women who had vaginal and cesarean deliveries. Patient characteristics accounted for 30% of the variance in prenatal period expenditures.ConclusionsThe impact of maternal comorbidities, and in particular preexisting diabetes, on prenatal care expenditures should be taken into account as provider payment reforms, such as pay-for performance incentives and bundled payments for episodes of care, extend to maternal and child health-related services.     

獐铅暴露对脑干听觉诱发电位的影响

目的 探讨低水平铅暴露是否对儿童听觉发育产生影响。方法 分别采用石墨炉原子吸收法和肌电／诱发电位仪测定儿童血铅值以及脑干听觉诱发电位。比较低血铅组和高血铅组之间脑干听觉诱发电位的潜伏期和波间期是否有差异。结果 有效样本８８例儿童中低血铅组４６例,血铅值０．１７－０．４５μｍｏｌ／Ｌ,平均０．３０μｍｏｌ／Ｌ。高血铅组４２例,血铅值０．５８－１．４２μｍｏｌ／Ｌ,平均０．７８μｍｏｌ／Ｌ,平均０．３     

同型半胱氨酸对鸡胚早期心血管发育的影响

目的探讨同型半胱氨酸与胚胎早期心血管发育的关系,了解叶酸和维生素Ｂ１２是否能缓解同型半胱氨酸的心血管发育毒性。方法采用鸡胚孵化、电镜观察、甲基绿派洛宁染色、原位ＤＮＡ片段末端标记、叶酸和维生素Ｂ１２的干预试验等方法。结果同型半胱氨酸（０～１６．０μｍｏｌ／胚胎）能干扰２天和４天龄胚胎心脏发育和血管分化,其作用随着剂量的增加而增强,呈剂量反应关系;８．０μｍｏｌ／胚胎同型半胱氨酸诱发的心脏缺陷率分别为２４．１％和２５．０％,对卵黄囊血管的抑制率达６０７％。≥４．０μｍｏｌ／胚胎同型半胱氨酸能损伤心肌细胞及其细胞器结构,并抑制细胞ＤＮＡ和ＲＮＡ的合成。首次发现８．０μｍｏｌ／胚胎同型半胱氨酸可诱导早期心肌细胞发生过度凋亡（２．７％）,明显高于正常对照组（０．０８％）。叶酸能拮抗同型半胱氨酸的心血管毒性,其效果大于维生素Ｂ１２。结论同型半胱氨酸是一种新的能损害心血管发育的危险因素;叶酸能有效地拮抗同型半胱氨酸的发育毒性;细胞凋亡可能与心血管畸形的发生有关。     

小儿脑性瘫痪的病例对照研究

目的　确定脑瘫的危险因素。方法　１９９７ 年５ ～６ 月在江苏南部进行了以人群为基础的１∶２ 病例对照研究。结果　将脑瘫的危险因素分为４ 类：胎儿发育迟缓、早产和低出生体重;出生窒息、颅内出血、缺血缺氧性脑病及高胆红素脑病;胎头吸引和脑外伤;其他（ 主要是产前因素） 。结论前２ 类因素与脑瘫的关联程度强并且重复性好。应加强产前保健,预防低出生体重等因素的发生;对出生窒息应积极治疗、密切观察;对于第３ 类因素应以产科实践和教育家长为关键措施;对第４ 类因素的认识程度还比较匮乏,可能与第１ 和第２ 类因素密切关联。     

儿童铅暴露对脑干听觉诱发电位的影响

目的　探讨低水平铅暴露是否对儿童听觉发育产生影响。方法　分别采用石墨炉原子吸收法和肌电／ 诱发电位仪测定儿童血铅值以及脑干听觉诱发电位。比较低血铅组（ 血铅＜ ０ ．４８３μｍｏｌ／Ｌ） 和高血铅组（ 血铅≥０ ．４８３ μｍｏｌ／Ｌ） 之间脑干听觉诱发电位的潜伏期和波间期是否有差异。结果　有效样本８８ 例儿童中低血铅组４６ 例,血铅值０ ．１７ ～０ ．４５ μｍｏｌ／Ｌ,平均０ ．３０ μｍｏｌ／Ｌ。高血铅组４２例,血铅值０ ．５８ ～１ ．４２ μｍｏｌ／Ｌ,平均０ ．７８ μｍｏｌ／Ｌ。ｔ 检验结果表明,低血铅组和高血铅组的脑干听觉诱发电位测试中右耳Ⅲ波、左右耳Ⅴ波潜伏期、左右耳ⅠⅤ、左耳ⅢⅤ波间期差异有显著性。偏相关分析结果提示血铅与脑干听觉诱发电位的右耳Ⅲ波、左右耳Ⅴ波潜伏期及ⅠⅤ波间期存在正相关关系。协方差分析也表明高、低血铅组右耳Ⅲ波、左右耳Ⅴ波潜伏期、左右耳ⅠⅤ和右耳ⅢⅤ波间期差异有显著性,高血铅组比低血铅组的潜伏期和波间期延长。结论　血铅升高可能使脑干听觉诱发电位的潜伏期和波间期延长,使神经传导速度减慢,从而影响听觉系统发育。