A new biological and clinical resource for research into pregnancy complications: The Baby Bio Bank

About 20% of pregnancies are affected by some form of complication. Research has shown that anomalies in implantation, development, and growth of the fetus; ineffective nutrient exchange between mother and fetus due to placental dysfunction; and maternal problems such as hypertension or infection during pregnancy can all lead to adverse pregnancy outcomes. However, the molecular aetiology of such events remains poorly understood. Fetal growth restriction (FGR), recurrent miscarriage (RM), preterm birth (PTB), and pre-eclampsia (PE) are the most common pregnancy complications encountered in the UK and these outcomes can result in an array of morbidities in both mother and baby, and in the most severe cases in mortality. We need to know more about normal pregnancy and where the important triggers are for failure. This prompted us to collect a large set of biological samples with matching clinical data from over 2500 normal and abnormal pregnancies, for use in research into these conditions. This paper outlines the nature of these sample sets and their availability to academia and industry, with the intention that their widespread use in research will make significant contributions to the improvement of maternal and fetal health worldwide (http://www.ucl.ac.uk/tapb/sample-and-data-collections-at-ucl/biobanks-ucl/baby-biobank).     

The impact of maternal lifestyle factors on periconception outcomes: a systematic review of observational studies

The main risk factors for important reproductive health issues such as subfertility and perinatal mortality largely originate in the periconception period. To evaluate associations between modifiable maternal lifestyle factors and periconception outcomes, a systematic search was conducted for relevant studies published from 1990 to February 2017 on Embase, Medline, Web of Science, Cochrane database, PubMed and Google Scholar. The initial search identified 6166 articles, of which 49 studies were eligible for inclusion. Fecundity (the capacity to have a live birth) showed significant inverse associations with smoking, alcohol use and poor diet. Studies regarding time to pregnancy showed a decline in fecundity ratios (the monthly conception rate among exposed relative to unexposed couples) with increasing body mass index (BMI). Furthermore, risk of first-trimester miscarriage was found to be increased in smokers, alcohol and caffeine consumers, and with increasing BMI. Vitamin supplement use showed a decrease in this risk. This review demonstrates that maternal modifiable lifestyle factors affect periconception outcomes. If couples planning a pregnancy are more aware and supported to adopt healthy lifestyles during the periconceptional ‘window of opportunity’, short-term reproductive health as well as health in later life and even of future generations can be further improved.     

体质指数对体外受精-胚胎移植结局的影响

目的探讨体质指数(BMI)对体外受精-胚胎移植(IVF-ET)或卵胞浆内单精子显微注射(ICSI)治疗过程及结局的影响。方法回顾性分析本中心2009年1月至2010年9月共1 201例应用长方案IVF/ICSI治疗的患者,按照世界卫生组织推荐的分组标准分为三组。其中低体质量组(A组)100例,正常体质量组(B组)973例,超重和肥胖组(C组)128例。比较各组超促排卵过程中各项指标及妊娠结局。结果 C组平均促性腺激素(Gn)用量较A、B两组明显增多(P<0.05),注射人绒毛膜促性腺激素(hCG)日血清雌二醇(E2)值较A、B两组明显减少(P<0.05)。C组与B组比较,受精率(81.0%vs.83.7%)和优胚率(47.08%vs.53.8%)明显降低(P均<0.017);A组的种植率(35.1%)低于B组(45.3%)(P<0.017)。三组在获卵数、临床妊娠率、自然流产率、异位妊娠率、周期取消率方面比较,差异均无统计学意义(P>0.05)。结论随着患者BMI的增加,Gn用量明显增多。本研究尚未发现BMI对IVF/ICSI妊娠结局有显著影响。     

Incomplete and inconsistent reporting of maternal and fetal outcomes in infertility treatment trials

Pregnancy outcomes and adverse outcomes in infertility trials are reported to varying extents; for example, 35% of clinical trials reported no information on pregnancy loss, only 43% reported adverse events during the preconception treatment period, and only 7% reported any serious adverse events. Incomplete reporting limits the value of these studies in counseling patients on the risk-benefit ratio of treatment to themselves and their infants.     

Prognostic value of first IVF cycle on success of a subsequent cycle

Objective

To determine whether a live birth or miscarriage in a previous IVF cycle is predictive of success in a subsequent cycle.

Design

Retrospective study

Setting

Private IVF unit

Patients

1141 couples having a second IVF cycle.

Intervention

3 groups; Group I: women who had a live birth in the first cycle, Group II those who had a miscarriage, Group III, women who had a negative pregnancy test in their first cycle.

Outcome measures

Pregnancy (PR), Live birth (LBR) & miscarriage rates in the second cycle.

Results

For women < than 40: PR was 46.4% (368/793), miscarriage rate was 29.9% and the LBR was 32.5% (258/793). Women in groups I & II had a statistically higher PR than those in group III 63.3% v 55.2% v 41.9% respectively. LBR was higher 45% v 37.8 v 29.6% respectively. Miscarriage rate was similar.For women 40 years and older: The PR was 21.0% (73/348), miscarriage rate was 52.1% (38/73) and the LBR was 10.1% (35/348).There was no significant difference in PR among women in groups I, II & III. The LBR and miscarriage rates were similar in all groups.

Conclusion

Young women who had a live birth and those who experienced an early miscarriage after IVF have a greater likelihood of achieving a live birth in a second cycle. Outcome of first IVF cycle however does not predict subsequent IVF success in older women.     

深圳市南山区女青年流产原因分析及避免意外妊娠对策

目的:了解南山区女青年流产现状及流产原因,为减少非意愿妊娠和流产发生率提供决策依据。方法:在自愿的前提下,以自填式问卷,对618名年龄小于24岁自愿要求早期流产的女青年进行问卷调查。结果:本次调查对象流产直接原因是未采取任何避孕措施(58.7%)或避孕失败(40.9%)所致。未采取避孕措施原因依次为在没有准备好避孕药具情况下发生性行为(49.3%)、知道但不想用避孕方法(20·4%)、根本不知道避孕方法(15.7%)等,避孕失败的原因为选用了安全期和体外射精等避孕效率较低方法(51.3%)和避孕方法使用不当(44.8%)。女青年的婚姻状况、文化程度、经济收入也与流产原因有关(P<0.01)。结论:应加强对未婚妇女避孕知识和流产危害性的宣传教育,提高自我保健意识,把采取避孕措施变成自觉行动。计划生育服务部门要为育龄群众提供避孕方法的知情选择,提高避孕药具的可及性、安全性,可有效降低非意愿妊娠和流产发生率。加强流产后避孕服务可有效减少重复流产的发生。     

利托君联合保胎丸治疗早产的临床研究

目的探讨利托君联合保胎丸抑制子宫收缩,治疗早产的临床效果。方法对52例先兆早产孕妇随机分为A、B两组,分别静脉滴注利托君或硫酸镁,同时服用保胎丸。结果利托君首次用药达有效抑制宫缩的显效时间为2.2h;延长周期30d,足月分娩率69%;均显著优于硫酸镁。结论利托君抑制宫缩作用强,显效快,保胎丸补肾安胎,治疗早产安全有效。     

携带9号染色体臂间倒位对不孕症患者辅助生殖技术妊娠结局的影响

目的:探讨携带9号染色体臂间倒位的不孕症患者行人类辅助生殖技术(ART)助孕后对妊娠结局的影响。方法:选取2008年1月至2009年12月在本中心完成体外受精-胚胎移植周期的不孕症患者。其中,研究组女方24例染色体G显带为46,XX,inv(9)(p11q13),男方染色体正常,共29个治疗周期。同期在本中心行体外受精-胚胎移植治疗的无染色体异常核型的不孕患者988例为对照组(1 032个治疗周期)。结果:研究组与对照组比较,其受精率、卵裂率、优质胚胎率、种植率、妊娠率、出生缺陷率等各项指标的差异均无统计学意义(P>0.05),但研究组早期流产率显著高于对照组(P<0.05),差异有统计学意义。结论:9号染色体臂间倒位对ART受精过程和早期胚胎发育没有显著影响,但可能引起ART助孕后早期流产率升高。