Trends in alcohol consumption by pregnant women. 1985 through 1988

To examine trends in alcohol consumption among pregnant women, we examined data collected from 21 states participating in the Behavioral Risk Factor Surveillance System for 4 consecutive years: 1985 through 1988. Overall, 429 (25%) of 1712 pregnant women and 19,903 (55%) of 36,057 nonpregnant women 18 to 45 years of age reported using alcohol in the previous month. Pregnant women who used any alcohol reported consuming a median of four drinks per month, whereas nonpregnant women who used any alcohol reported nine. The prevalence of alcohol consumption among pregnant women declined steadily, from 32% in 1985 to 20% in 1988, but the median number of drinks per month for pregnant women who drank did not change. No decline was observed among the less educated or those under the age of 25 years. In 1988, the prevalence of alcohol use among pregnant women remained highest among smokers (37%) and the unmarried (28%). Although the overall consumption of alcohol by pregnant women in the United States appears to be declining, special efforts are needed to reduce alcohol use among pregnant women who are smokers, unmarried, less educated, or younger, women who may already be at high risk of a poor pregnancy outcome.     

Comparing the prevalence of smoking in pregnant and nonpregnant women, 1985 to 1986

The 1990 health objectives for the nation state that pregnant women should be only half as likely to smoke as nonpregnant women. To assess progress toward meeting this objective, we used cross-sectional data from the 26 states in the Behavioral Risk Factor Surveillance System in 1985 and 1986. We compared the prevalence of self-reported smoking among pregnant (N = 836) and nonpregnant (N = 18,025) women aged 18 to 45 years. Overall, pregnant women were 70% as likely to be current smokers as nonpregnant women (prevalence ratio, 0.7; 95% confidence interval, 0.6 to 0.8), while blacks showed the largest pregnancy-associated reduction in the prevalence of smoking (prevalence ratio, 0.5; 95% confidence interval, 0.3 to 0.9). Most of the difference in smoking prevalence occurred not because pregnant women were less likely to have ever smoked, but because pregnant women were more likely to have quit smoking than nonpregnant women. However, unmarried pregnant white women were 40% more likely to smoke than their nonpregnant counterparts (prevalence ratio, 1.4; 95% confidence interval, 1.1 to 1.7). We conclude from this analysis that the 1990 health objective for smoking among pregnant women is unlikely to be achieved. Clinicians providing care to pregnant women need to pay increased attention to smoking cessation.     

Neurodevelopment of adopted children exposed in utero to cocaine.

OBJECTIVE: To assess the neurodevelopment of adopted children who had been exposed in utero to cocaine. DESIGN: A case-control observational study. PARTICIPANTS: Twenty-three children aged 14 months to 6.5 years exposed in utero to cocaine and their adoptive mothers, and 23 age-matched control children not exposed to cocaine and their mothers, matched with the adoptive mothers for IQ and socioeconomic status. SETTING: The Motherisk Programme at The Hospital for Sick Children, Toronto, a consultation service for chemical exposure during pregnancy. MAIN OUTCOME MEASURES: Height, weight and head circumference at birth and at follow-up, and achievement on standard tests of cognitive and language development. RESULTS: Compared with the control group, children exposed in utero to cocaine had an 8-fold increased risk for microcephaly (95% confidence interval 1.5 to 42.3); they also had a lower mean birth weight (p = 0.005) and a lower gestational age (p = 0.002). In follow-up the cocaine-exposed children caught up with the control subjects in weight and stature but not in head circumference (mean 31st percentile v. 63rd percentile) (p = 0.001). Although there were no significant differences between the two groups in global IQ, the cocaine-exposed children had significantly lower scores than the control subjects on the Reynell language test for both verbal comprehension (p = 0.003) and expressive language (p = 0.001). CONCLUSIONS: This is the first study to document that intrauterine exposure to cocaine is associated with measurable and clinically significant toxic neurologic effects, independent of postnatal home and environmental confounders. Because women who use cocaine during pregnancy almost invariably smoke cigarettes and often use alcohol, it is impossible to attribute the measured toxic effects to cocaine alone.     

妊娠期需氧菌性阴道炎对妊娠结局的影响

目的探讨需氧菌性阴道炎（AV）孕妇阴道菌群分布及与妊娠结局的相关性。方法选取2010年7月至2012年7月于深圳市南山医院产科门诊常规产检建册、诊断为AV的孕妇150例为研究组,选取同期于门诊常规产检的正常孕妇100例为对照组。取阴道分泌物涂片及微生物培养,AV阳性依患者意愿治疗。分析AV孕妇阴道菌群分布情况,随访妊娠结局。结果 AV孕妇分泌物一般为黄色或黄绿色、稀薄脓性。阴道菌群主要以GBS（B族链球菌,group B streptococcus）、大肠埃希氏菌、金黄色葡萄球菌及粪肠球菌为主。AV孕妇胎膜早破、绒毛膜羊膜炎、产后出血发生率均高于对照组（P〈0.05）。应用克林霉素治疗后,以上妊娠结局发生率明显降低。结论孕期AV可导致胎膜早破、绒毛膜羊膜炎、产后出血等,规范治疗可改善妊娠结局。值得临床推广应用。     

ToRCH感染与异常妊娠结局的关系

目的 探讨ToRCH系列感染与异常妊娠结局的关系，为做好优生优育提供有价值的实验依据。方法 采用间接ELISA对45例有异常妊娠结局妇女作ToRCH4种病原体检测，并对部分IgM(或IgG)阳性者作了PCR检测，对其中的21例与ToRCH感染有关的异常妊娠结局胚胎组织块作了PCR检测和对10例异常新生儿作了母子配对血清学诊断。结果 45例异常妊娠结局妇女中ToX、RubV、CMV、HSV 的IgM阳性率分别为20％、51％、44．4％和29．7％，并发现同一病例有2种或2种以上病原体同时感染的情况，血清PCR结果与之基本一致。21例异常妊娠结局者（流产、早产、死胎、先天缺陷），其胚胎组织中（人流混合物、死胎脑组织块）PCR检测均有ToRCH系列中的1种、2种或2种以上病原体感染，与上述ELISA结果吻合。10对新生儿脑炎血清与对应母亲血清抗体检测表明，垂直传播率ToX与CMV分别为50％和40％。结论 妇女ToRCH系列感染是造成异常 妊娠结局的重要原因之一，必须进行检测和有效控制。     

妊娠高血压妇女甲状腺功能和微量白蛋白尿的关系

[目的]分析妊娠高血压妇女甲状腺功能和微量白蛋白尿(MAU)的关系.[方法]选取2018年5月至2020年5月某院收治的168例妊娠高血压妇女的临床资料进行回顾性分析,依据是否出现MAU将其分为MAU组(n=31)和对照组(n=137).比较两组妇女甲状腺激素水平、单因素和Logistic多因素分析妊娠高血压妇女微量白...     

妊娠期糖尿病孕妇与正常孕妇的夏季和冬季血清维生素D水平对比研究

目的 探讨妊娠期糖尿病(GDM)孕妇和正常孕妇夏季和冬季血清维生素D水平的差异.方法 选取2014年6～8月(夏季)和2014年12月至2015年2月(冬季)就诊的孕妇各100例,其中每个季节GDM孕妇(GDM组)和正常孕妇(对照组)各50例.测定各组血清中25-羟维生素D[25-(OH) D]的水平.结果 夏季GDM组、夏季对照组、冬季GDM组、冬季对照组血清25-(OH)D水平分别为(20.2 ±7.0) ng/ml、(24.1±8.6)ng/ml、(16.0±7.5)ng/ml和(19.7 ±5.8) ng/ml,均未达到维生素D的正常标准.冬季及夏季GDM组的25-(OH)D水平分别低于冬季及夏季对照组(P＜0.05);两组夏季的25-(OH)D水平均明显高于冬季(P＜0.05).4组维生素D缺乏和不足的比例在84 ～ 96％,但4组维生素D正常、不足和缺乏的构成比比较,差异无统计学意义(P＞0.05).结论 孕妇普遍存在维生素D缺乏或不足,GDM孕妇维生素D缺乏比正常妊娠孕妇更为严重,冬季比夏季严重.冬季时孕妇尤其是GDM孕妇要更加注意维生素D的补充.     

产妇精神状态与分娩方式关系的探讨

①目的 探讨产妇精神状态（焦虑和抑郁）与分娩方式的关系.为产前、产时实施心理护理提供临床依据.②方法 对190 例健康产妇以焦虑自评量表（SAS）和抑郁自评量表（SDS）评定精神状态.所有产妇以产科常规、家属陪伴进行分娩而不进行干预,观察其分娩方式;按分娩方式分为正常产组、产钳助产组和剖宫产组.采用SPSS软件进行统计学分析,卡方检验.③结果 190例产妇中存在心理障碍的占57.39%,其中焦虑发生率为19.89%,抑郁发生率为21.56%,焦虑并抑郁发生率为14.03%,剖宫产组、产钳助产组的焦虑评分及抑郁评分明显高于正常产组.④结论 不同的分娩方式影响产妇的精神状态.     

妊娠期孕妇营养状况与胎儿发生出生缺陷的相关性研究

目的:通过对山西省部分县(市)出生缺陷现状的调查,探讨妊娠期孕妇营养状况与胎儿发生出生缺陷的相关性,为预防胎儿出生缺陷的发生提供理论依据。方法:在山西省6县(市)对符合条件的已生育妇女及其出生儿采取问卷方式进行回顾性调查,通过Epidata3.1软件建立数据库,SAS 9.21软件进行统计描述,随机效应logistic回归分析,了解孕期孕产妇摄食肉类、蔬菜类及增补叶酸情况与出生缺陷发生率之间的关系。结果:共收回有效问卷36 716份,调查对象发生出生缺陷的比例为134.55/万。出生缺陷种类以先天性心脏病最为常见,其次为唇腭裂、指/趾畸形,分别占总出生缺陷人数的42.1%、27.1%和11.3%。调查显示被调查对象不吃肉类的占7.7%,其出生缺陷发生率为1.87%;偶尔吃肉类的占68.1%,出生缺陷发生率为1.33%;经常吃肉类的占24.2%,出生缺陷发生率为1.21%。被调查对象不吃蔬菜的占1.7%,出生缺陷发生率为1.62%;偶尔吃蔬菜的占33.6%,出生缺陷发生率为1.43%;经常吃蔬菜的占64.7%,出生缺陷发生率为1.30%;被调查对象无叶酸增补的占60.6%,出生缺陷发生率为1.35%;有叶酸增补的占39.4%,出生缺陷发生率为1.34%。固定效应参数估计和Ⅲ型假设检验均显示蔬菜和增补叶酸计数有统计学意义(P0.001)。结论:妊娠期孕妇营养状况与出生缺陷的发生率直接相关,营养的不均衡会明显增加出生缺陷发生概率,所以孕期孕妇的饮食指导至关重要。     

妊娠期细菌性阴道病与围产结局的关系

目的探讨妊娠期筛查细菌性阴道病(BV)的安全性,了解妊娠期BV患者的微环境改变及妊娠期治疗对围产结局的影响。方法收集于北京妇产医院进行产前检查的无孕前合并症的孕妇共1 000例,分为观察组800例和对照组200例,比较妊娠期流产率的差异、BV阴性组与BV阳性未治疗组孕妇的围产结局以及BV阳性治疗组与BV阳性未治疗组孕妇的围产结局;随机抽取BV阳性组和BV阴性组孕妇各100例,使用酶联免疫吸附测定法测定阴道分泌物中白细胞介素-8(IL-8)的水平。结果观察组与对照组孕妇的妊娠期流产率比较差异无统计学意义(P>0.05);BV阳性组孕妇阴道分泌物中IL-8水平高于BV阴性组孕妇(P<0.01);BV阴性组孕妇流产、早产、胎膜早破、低出生体质量儿、新生儿感染及产褥感染的发生率均低于BV阳性未治疗组(P<0.05);BV阳性治疗组孕妇流产、早产、胎膜早破、低出生体质量儿、新生儿感染及产褥感染的发生率均低于BV阳性未治疗组,但差异无统计学意义(P>0.05)。结论妊娠合并BV会增加不良围产结局的发生率;妊娠期BV筛查不会增加流产率;抗BV治疗对BV阳性孕妇围产结局的影响有待进一步观察研究。     

劳务女工孕期血铅水平与血压相关性研究

目的 探讨劳务女工孕期血铅水平与其血压的关系,为改善围生期工作,促进孕妇健康提供参考.方法 对2008年3月至2009年11月在深圳市宝安区妇幼保健院产前门诊建卡的劳务女工孕妇进行问卷调查、血压及血微量元素浓度测定.随机选取其中897例资料完整并在深圳居住满2年者作为研究对象,采用简相关和回归方法评价血铅与血压的关系.结果 孕妇血铅均值为(45±23)μg/L;家族史、体质量指数(BMI)、血铅浓度对血压升高有预测作用;在血铅56 μg/L分界点时,两组舒张压比较差异有统计学意义(P＜0.05);高铅组(血铅浓度≥100 μg/L)收缩压、舒张压均显著高于低铅组(P＜0.05).结论 低铅暴露是致孕妇血压升高的危险因素之一,铅对血压的影响以舒张压更为敏感. Abstract： Objective To observe the degree of blood lead in pregant women and the influence of different levels of blood lead on blood pressure under environmental lead exposure, in order to previde basic evidences for taking the further measures. Methods A quesionnaire survey was administed, blood pressure and the serum of microelements were tested for the pregnant women who took the prenatal examinationin the Maternal and Child Care Service Centre of Baoan between March 2008 and November 2009, gathered 897 pregnant women whose materials were complete and stayed in Shenzhen more than one year as the study objects. Compare the differences between groups distributed by quartileand carried out the pair matching study. Correlation, stepwise regression analysis and T test were usedto statistic. Results The average of blood lead was (45±23)μg/L;The Bivriate correlations showed the association between blood lead and blood pressure was positive. Stepwise regression analysis indicated family history, BMI,blood lead were predictors of increasing blood pressure. After excluding the confounding factors, on the 56 μg/L the diastolic pressure(DBP) with statistical significance (P＜0.05);Blood pressure of case group was higher than that of control group with significant difference (P＜0.05). Blood calcium of case group was lower than that of control group without statistical significance (P＞0.05). Conclusions The results indicate the degree of blood lead of pregnant women in Shenzhen is low. Environmental lead exposure is one of the dangerous factors of increasing blood pressure .DBP is more sensitive to lead.     

乙型肝炎孕妇HBV-M和HBV-DNA关系分析

目的分析孕妇乙型肝炎血清学标志物（HBV-M）与乙型肝炎病毒DNA（HBV-DNA）的关系,以便指导免疫干预,为阻断乙型肝炎病毒母婴传播提供科学依据。方法分离240名乙肝携带孕妇的血清样本,用酶联免疫吸附方法（ELISA）测定HBV-M,用实时荧光定量PCR（FQ-PCR）测定HBV-DNA含量。结果不同HBV-M模式的HBV-DNA阳性率和含量有差异。大三阳[HBsAg（＋）、HBeAg（＋）、抗-HBc（＋）]模式的HBV-DNA阳性率和含量最高,显著高于其他3种模式（P〈0.05）;小三阳[HBsAg（＋）、抗-HBe（＋）、抗-HBc（＋）]、[HBsAg（＋）、抗-HBc（＋）]及[HBsAg（＋）]3种模式的HBV-DNA阳性率分别为49.1%、29.5%和16.7%。HBeAg阳性的乙肝孕妇血清HBV-DNA含量明显高于HBeAg阴性的乙肝孕妇（P〈0.05）,HBeAg阳性与HBV-DNA含量呈正相关关系。结论乙型肝炎孕妇HBV-M和HBV-DNA含量之间存在联系,联合检测HBV-M及HBV-DNA对阻断HBV母婴传播及指导临床诊治具有重要意义。     

孕妇乙型肝炎病毒感染与血清自身抗体的相关性研究

目的探讨孕妇乙型肝炎病毒(HBV)感染与自身抗体的相关性。方法采用ELISA、荧光定量PCR对108例乙肝孕妇的HBV标志物(HBVM)、HBVDNA进行检测,同时采用间接免疫荧光法(IIF)、免疫印迹法(WB)分别对HBV孕妇及40例健康孕妇行抗核抗体(ANA)、抗线粒体抗体(AMA)、抗平滑肌抗体(ASMA),可提取核抗原抗体谱(ENA)、肝抗原自身抗体谱(anti-LKM1、anti-LC1、anti-SLA/LP、anti-A-MAM2)检测,采用速率散射法检测RF,采用金标法检测抗-dsDNA。结果108例HBV孕妇检出多种自身抗体,总阳性率为31.48%,显著高于健康孕妇对照组的12.50%(P<0.05),检出的自身抗体以低滴度为主且以ANA,RF为多见。HBV阳性孕妇自身抗体阳性组与自身抗体阴性组的年龄、妊娠周期及ALT水平无明显差异(P>0.05),而HBeAg或/和HBVDNA阳性组自身抗体的检出率显著高于HBeAg或/和HBVDNA阴性组(P<0.01)。108例HBV孕妇检出1例ANA、ASMA同时阳性且滴度较高,2例anti-SLA/LP阳性,1例anti-LKM1阳性,其肝功能明显损害。结论孕妇HBV感染可引发机体自身免疫反应,产生多种以低滴度为主的自身抗体,这种免疫反应与HBV复制水平有关,而与孕妇年龄、孕周及ALT无关,且部分HBV孕妇可能重叠自身免疫性肝炎(AIH)。     

孕妇特质应对方式与睡眠质量的关联性研究

目的探究孕妇特质应对方式和睡眠质量的现状及两者间的关联性。方法采用横断面研究设计,在2018年12月1日—2019年6月30日期间招募同济大学附属妇产科医院建档产检的孕妇309名,通过自设问卷收集研究对象的一般人口学资料,用国际量表评估孕妇的睡眠质量及特质应对方式。采用Logistic回归分析孕妇特质应对与睡眠质量之间的关联性。结果研究纳入孕妇308名,根据匹兹堡睡眠质量量表(Pittsburgh sleep quality index, PSQI),研究对象的得分为5.77±2.93,其中睡眠质量差（PSQI>5）的孕妇共140名（45.5%）,在主观睡眠质量、入睡时间、实际睡眠时间、睡眠效率、睡眠紊乱、睡眠药物使用和日间功能障碍7个维度上存在特定睡眠问题的人数分别有66（21.4%）、102（33.1%）、33（10.7%）、44（14.3%）、60（19.5%）、1（0.3%）、102（33.1%）。睡眠质量的7个维度中主观睡眠质量（1.07±0.67）、入睡时间（1.23±0.84）、睡眠紊乱（1.13±0.55）、日间功能障碍（1.37±0.83）4个维度的平均分均>1。积极应对与PSQI得分、主观睡眠质量、入睡时间、睡眠紊乱和日间功能障碍具有相关性,消极应对与PSQI得分、主观睡眠质量、入睡时间、睡眠紊乱和日间功能障碍具有相关性。结论妊娠期妇女的睡眠质量与特质应对之间存在关联性,且积极的应对方式有助于孕妇睡眠质量的提高。     

妊娠早期孕妇尿碘水平与甲状腺功能的相关性研究

目的 研究孕早期母体碘营养状况对甲状腺功能的影响。方法 选取199 例孕早期妇女作为研究对象,采用生化比色法测定尿碘,电化学发光法检测促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）及游离甲状腺素（FT4）,研究母体碘营养状况与甲状腺功能的关系。结果 ①尿碘缺乏组、尿碘适量组、尿碘超足量组及尿碘过量组的构成比依次为59.3%、21.1%、9.5% 及10.1% ;②不同尿碘营养水平组甲状腺功能减退症（甲减）、亚临床甲减、甲状腺功能亢进症（甲亢）及亚临床甲亢的患病率比较,差异无统计学意义（P >0.05）;碘过量组低甲状腺素血症（低T4 血症）的患病率较高,差异有统计学意义（χ2=11.593,P =0.009）;③碘营养水平>500 μg/L 时,尿碘水平与TSH 呈正相关;④碘适量组FT3 水平高于碘过量组,差异有统计学意义（P <0.05）,碘缺乏组、碘超足量组及碘过量组间差异无统计学意义（P >0.05）;不同碘营养水平组FT4 比较,差异无统计学意义（F =2.454,P =0.064）;碘过量组TSH 水平高于碘缺乏组、碘适量组及碘超足量组,差异有统计学意义（P <0.05）。碘缺乏组、碘适量组与碘超足量组间比较,差异无统计学意义（P >0.05）。结论 大部分孕早期妇女存在碘缺乏,应适量补碘,但应避免碘过量及碘缺乏。