Effects of single and combined exposure to lead and stress during pregnancy on offspring neurodevelopment

ObjectiveTo assess associations of single and combined exposures to lead and stress during different stages of pregnancy with offspring neurodevelopment.MethodsWe measured prenatal lead (maternal blood-lead in early-pregnancy and umbilical-cord-blood-lead) and maternal stress levels in Shanghai-Birth-Cohort from 2013 to 2016. Maternal stress was assessed using Center-for-Epidemiological-Studies-Depression-Scale and Self-Rating-Anxiety-Scale during mid-pregnancy. The Ages-Stages-Questionnaires-3 (at 6/12-months-of-age) and Bayley-III (at 24-months-of-age) were both used to assess neurodevelopment.ResultsA total of 2132 mother-child pairs with both prenatal lead and stress measurements were included. The geometric-means of blood-lead in early-pregnancy and cord-blood-lead were 1.46 μg/dL and 1.33 μg/dL, respectively. Among the study women, 1.89 % and 0.14 % were screened positive for depression and anxiety. Adjusting for related confounders, the combined exposures had stronger adverse associations with offspring social-emotional skills than single exposures; and the combined exposure in early-pregnancy was associated with greater neurodevelopmental differences than combined exposure around-birth, especially in social-emotion at 24 months-of-age [β (95 %CI): − 10.48(−17.42, −3.54) vs. − 5.95(−11.53, −0.36)].ConclusionsBoth single and combined prenatal exposures to lead/stress impaired infant neuro-development, and the effects of combined exposure may be more profound than single exposures. Combined exposure in early-pregnancy may be associated with worse neurodevelopmental outcomes than combined exposure around-birth, especially in social-emotional development.     

Syphilis in pregnancy

The incidence of syphilis is rising in the UK and more cases of syphilis in pregnancy are being reported. Mother to child transmission of syphilis can result in adverse pregnancy outcomes including miscarriage, still birth, neonatal death, low birthweight, preterm birth and congenital anomalies. These adverse outcomes can be prevented by early diagnosis and prompt treatment of syphilis in pregnancy. This article provides an overview of the condition and focuses on the management during pregnancy.     

稽留流产孕早期预测模型的构建与验证

目的构建稽留流产(missed abortion,MA)患者在孕早期流产危险因素列线图。方法纳入2017年2月至2019年10月因稽留流产于中国建筑第二工程局职工医院治疗的孕妇125例为研究组,随机纳入同时期正常孕妇126例为对照组,分析两组患者临床基本资料:年龄、环境因素、动物接触史、叶酸使用、文化程度、流产情况、疾病史、激素水平等。采用Logistic回归分析对孕早期发生稽留流产的危险因素进行分析,应用R软件建立孕早期稽留流产预测列线图,并进行验证。结果研究组孕妇年龄、睾酮(testosterone,T)水平高于对照组,而催乳素(prolactin,PRL)、雌二醇(estradiol,E2)、孕酮(progesterone,P)水平低于对照组,差异均有统计学意义(P<0.05);Logistic回归分析提示孕妇年龄(OR=1.809,P=0.003)、吸烟饮酒(OR=78.120、P=0.044)、职业暴露(OR=61.238,P=0.021)、T水平(OR=5.432,P=0.001)是孕早期发生MA的危险因素。PRL(OR=0.376,P=0.003)、E2(OR=0.258,P=0.016)、P(OR=0.396,P=0.005)是孕早期发生MA的保护因素。预测孕早期MA发生的相关危险因素的C-index为0.912(95%CI:0.874-0.943)。结论列线图中孕妇年龄、环境因素、激素水平能较准确的预测孕早期发生MA的风险。     

Health Implications and Counseling Considerations for Individuals With Piercings and Tattoos

Body art has become common and mainstream. Tattoos and body piercings represent highly individual expressions of identity and personal values. Health care services are enhanced when clinicians understand the anatomy and physiology, common discomforts, and real but rare serious risks of body modification and are prepared to provide compassionate support for individuals’ choices. Special consideration must be given to the needs of childbearing women. By opening channels of communication, clinicians can engage with clients in shared decision making to help those who possess or desire body art take steps to reduce the risk of adverse effects and obtain prompt and effective medical care when problems arise. Through respectful discussion of existing body art, the therapeutic relationship is strengthened, and greater insight into an individual’s health needs may be achieved.     

国家免费孕前优生健康检查项目试点的措施、成效与建议

出生缺陷是导致早期流产、死胎、围产儿死亡、婴幼儿死亡和先天残疾的主要原因。实施国家免费孕前优生项目,预防出生缺陷,造福子孙后代,是坚持以人为本、贯彻落实科学发展观的具体举措。该文结合所在地区国家免费孕前优生健康检查工作的开展情况,介绍了项目试点服务对象、目的和内容,阐述了项目试点的具体措施和工作成效,提出了做好下一步工作的建议。     

Respiratory disease in pregnancy

Physiological changes to the respiratory system in pregnancy make breathlessness a common symptom. However, it is still important to investigate symptoms of breathlessness to exclude pathological causes. This review illustrates some unusual cases of women presenting with breathlessness in pregnancy. Prompt recognition, investigation and management of these women is essential as delays can impact the mother and the neonate. Investigations should be used appropriately and not withheld or delayed due to pregnancy. Effects of respiratory conditions on pregnancy and the neonate are also discussed.     

Trends in Induced Abortions in Greece: A Cross-sectional Study

Study ObjectiveTeenage pregnancies and associated induced abortions represent an important public health issue. The aim of this study was to investigate the prevalence, the time trends, and associated factors of teenage induced abortions in Greece.DesignA cross-sectional study was conducted between 2018 and 2019.SettingThird Academic Department of Obstetrics and Gynecology of the Aristotle University of Thessaloniki.ParticipantsAll pregnant women who underwent a second trimester anomaly scan were eligible for the study.Interventions and Main Outcome MeasuresEpidemiological characteristics were recorded and 5 age groups were created. Trends in the rates of teenage induced abortions were analyzed and we compared several parameters between women with and without history of abortions.ResultsOverall, 3370 women were eligible and agreed to participate in the study. The prevalence of women who reported a history of at least 1 abortion at 15-19 years was 9.7% (n = 328/3370). The abortion rates across the 5 age groups were: 20-24: 7.5%; 25-29: 8.4%; 30-34: 8.2%; 35-39: 12%; and 40 years and older: 13.9%. Moreover, a history of 1 or more teenage abortions was more common in multiparous women (58.2% vs 46.5%; P < .001; odds ratio, 1.605; 95% confidence interval, 1.274-2.022) and in current smokers (27.4% vs 11%; P < .001; odds ratio, 3.066; 95% confidence interval, 2.346-4.008).ConclusionA significant decline in the teenage induced abortion rates was identified in the study population. A history of teenage induced abortion was associated with smoking and multiparity. More efforts are needed to provide appropriate education on effective contraception and family planning.     

Use,Awareness, Knowledge and Beliefs of Medication During Pregnancy in Malaysia

ObjectivesThis study aimed to assess medication use in pregnant women in Malaysia by measuring use, knowledge, awareness, and beliefs about medications.MethodsThis was an observational, cross-sectional study involving a total of 447 pregnant women who attended the Obstetrics and Gynecology Clinic, Hospital Kuala Lumpur (HKL), Malaysia. A validated, self-administered questionnaire was used to collect participant data.ResultsMost of pregnant women had taken medication during pregnancy and more than half of them (52.8%) showed a poor level of knowledge about the medication use during pregnancy. Eighty-three percent had a poor level of awareness and 56.5% had negative beliefs. Age and education level were significantly associated with the level of knowledge regarding medication use during pregnancy. Multiparous pregnant women, and pregnant women from rural areas were observed to have a higher level of awareness compared with those who lived in urban areas. Use of medication during pregnancy was determined to be significantly associated with education level, and race.ConclusionAlthough there was prevalent use of medication among pregnant women, many had negative beliefs, and insufficient knowledge and awareness about the risks of taking medication during pregnancy. Several sociodemographic characteristics were significantly associated with the use (race and education level), level of knowledge (age and education level), awareness (parity and place of residence), and beliefs (race, education level, and occupation status) towards medication use during pregnancy.     

Monoamniotic twins discordant for body stalk anomaly

Body stalk anomaly is a rare malformation. This anomaly in monozygotic twins is extremely unusual. We describe a case of monoamniotic pregnancy discordant for body stalk anomaly diagnosed at 11 weeks. Ultrasound showed a fetus with a large anterior abdominal wall defect, anomaly of the spine and no evidence of lower extremities and other with a normal morphology. As far as our concern, only three monoamniotic pregnancies discordant for this malformation were reported. Our case represents the fourth reported monoamniotic pregnancy discordant for body stalk anomaly with diagnosis made by ultrasound and the second diagnosed in the first trimester.