Nutrition for pregnancy after metabolic and bariatric surgery: literature review and practical guide

When pregnancy follows metabolic and bariatric surgery (MBS), there are many important considerations related to nutritional status that may impact maternal and infant outcomes. Although evidence-based nutrition guidelines for pregnancy exist for the general population, there are limited practical recommendations that specifically address pregnancy after MBS. A literature search was conducted to investigate outcomes of women with a history of MBS and pregnancy. Search criteria focused on women 18 years of age and older who became pregnant after MBS. Search terms included “laparoscopic sleeve gastrectomy,” “Roux-en-Y gastric bypass,” “laparoscopic adjustable gastric banding,” “biliopancreatic duodenal switch,” and gestation terminology, and they were paired with the nutrition outcomes of interest. A total of 167 publications were identified; 46 articles were included in the final review. Data relating to gestation and fetal weight and nutrition and cardiometabolic data were extracted from the studies. Based on this review, women of childbearing age with a history of MBS should be evaluated and monitored for nutritional status before conception, during pregnancy, and postpartum.     

维生素D和PLGF在妊娠期糖尿病患者中的表达及对妊娠结局及新生儿的影响

目的:探讨维生素D、胎盘生长因子(PLGF)在妊娠期糖尿病患者中的表达及对妊娠结局及胎儿的影响。方法:以2018年1月-2019年3月本院产科分娩的妊娠期糖尿病(GDM)孕妇85例为GDM组,同期定期产前检查的健康孕妇80例为对照组,检测两组血清维生素D和PLGF水平,Westem blot检测与免疫组织化检测分娩后胎盘组织中PLGF相对表达,比较两组维生素D和PLGF水平变化;以妊娠期糖尿病患者维生素D、血清PLGF水平分为正常组(33例,维生素D≥30ng/ml、PLGF>100pg/ml)与不足组(53例,维生素D<29ng、PLGF<100pg/ml),比较两组妊娠结局与新生儿情况。结果:GDM组血清维生素D和PLGF水平均低于对照组(P<0.05),胎盘中PLGF蛋白相对表达(1.02±0.76)高于对照组(0.78±0.64),PLGF阳性表达(2.97±1.12)高于对照组(1.75±0.97)(均P<0.05);不足组不良妊娠结局发生率(74.5%)高于正常组(21.2%),新生儿并发症发生率(67.9%)高于正常组(18.2%)(均P<0.05)。结论:GDM孕妇血清维生素D、PLGF水平较低,其不足与不良妊娠结局与胎儿并发症可能有关。     

A case of VIPoma

This case report addresses the management of a pregnant woman in the peripartum period with a VIPoma. This rare and highly malignant neuroendocrine tumour secretes vasoactive intestinal peptide (VIP), a substance that may cause potentially life-threatening disruption to physiology.A 36-year-old woman presented for induction of labour with a three-year history of chronic diarrhoea, hypophosphataemia, palpitations and skin flushing. Raised VIP levels indicated presence of a VIPoma, however despite extensive investigation prior to pregnancy by neuroendocrine specialists, the tumour location remained unidentified.The patient delivered a healthy boy with the aid of forceps in theatre following an epidural top-up. Key features of management were a multidisciplinary approach, avoidance of triggers for VIP secretion, strict management of electrolytes and avoidance of severe changes in sympathetic tone during labour with epidural analgesia.     

体外受精－胚胎移植术后子痫前期患者临床特点分析

目的探讨体外受精与胚胎移植(in vitro fertilization-embryo transfer, IVF-ET)术后单胎妊娠与子痫前期的关系及临床特点。 方法回顾性分析2012年6月至2018年12月郑州大学第一附属医院产科收治的通过IVF-ET受孕的单胎子痫前期患者58例(IVF-ET组)，同期自然受孕的单胎子痫前期患者100例(自然受孕组)的临床资料。比较两组孕妇的临床特点和妊娠结局。 结果IVF-ET组患者的平均住院日(8.74±4.98) d较自然受孕组(7.26±3.07) d长，t＝－2.314，P<0.05；发病时间(28.6±5.63)周和诊断孕周(32.0±6.07)周均早于自然受孕组(28.6±5.63)周和(33.9±4.28)周，t＝4.02和2.04，P<0.05；IVF-ET组尿蛋白(＋＋＋)的发生率34.5%、胸腹水发生率48.3%、胎儿宫内生长受限发生率41.4%均高于自然受孕组20%，29%和26%，P<0.05。 结论IVF-ET术后单胎子痫前期患者以严重尿蛋白和胸腹水为主要临床症状，胎儿不良结局主要为胎儿宫内生长受限。     

Guía de actuación para el manejo de la infección por COVID-19 durante en el embarazo

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) has caused a large global outbreak and has had a major impact on health systems and societies worldwide. The generation of knowledge about the disease has occurred almost as fast as its global expansion. Very few studies have reported on the effects of the infection on maternal health, since its onset. The mother and foetus do not seem to be at particularly high risk. Nevertheless, obstetrics and maternal-foetal medicine practice have made profound changes in order to adapt to the pandemic. In addition, there are aspects specific to COVID-19 and gestation that should be known by specialists. In this review an evidenced-based protocol is presented for the management of COVID-19 in pregnancy.     

运用六经辨证治疗子嗽探析

妊娠期间,咳嗽不已,称"妊娠咳嗽",亦称"子嗽",孕妇咳嗽日久未见好转,咳嗽胸痛甚则咳而呕吐,或咳嗽剧烈或久咳不愈,可损伤胎气,导致堕胎、小产。笔者运用六经辨证治疗外感型中表寒里热证子嗽,认为此类患者病在太阳阳明,属于寒热错杂之表寒里热,采用《伤寒论》中方证麻杏甘石汤合止嗽散,使热从外泄,宣发卫气,散寒不助热、解表不伤正,故辨证论治取得了显著的疗效。同时子嗽治疗还需注意健脾固肾安胎,应将顾护胎元贯穿治疗妊娠咳嗽的始终。     

炔雌醇环丙孕酮片用于PCOS不孕治疗中的效果

目的 分析炔雌醇环丙孕酮片(达英-35)、二甲双胍联合克罗米芬序贯用于治疗多囊卵巢综合征不孕的临床效果.方法 选取在医院接受治疗的多囊卵巢综合征不孕患者88例,选取时间为2017年10月—2018年12月,随机将所有患者分为2组,即对照组(44例)、观察组(44例),对照组患者行炔雌醇环丙孕酮片、克罗米芬序贯治疗,观察组患者行达英-35、二甲双胍联合克罗米芬序贯治疗.结果 经过治疗后,观察组患者的妊娠率为86.36%,明显高于对照组患者的妊娠率,数据差异显著,P<0.05;治疗后,两组患者的LH、FSH、T、E2等激素水平与治疗前对比,差异显著,P<0.05;治疗后,观察组患者的LH、FSH、T、E2等激素水平与对照组对比,数据差异较明显,P<0.05.结论 多囊卵巢综合征不孕患者接受炔雌醇环丙孕酮片、二甲双胍联合克罗米芬序贯治疗,可以改善患者的激素水平,提高患者的妊娠几率.