Epidemiology of malaria in pregnancy in central India.

Analysis of three years of data from a malaria clinic operated by the Indian Council of Medical Research (ICMR) in the Government Medical College Hospital in Jabalpur, central India, showed a high malaria prevalence among pregnant women, which was statistically highly significant (P < 0.0001) compared with the situation among nonpregnant women. Cerebral malaria was a common complication of severe Plasmodium falciparum infection, with a high mortality during pregnancy, requiring immediate attention. The study also showed that malaria infection was more frequent in primigravidae, falling progressively with increasing parity. Mean parasite densities were significantly higher in pregnant women compared with nonpregnant women for both P. falciparum (P < 0.001; df = 137) and P. vivax (P < 0.05; df = 72) infection. Pregnant women with falciparum or vivax malaria were significantly more anaemic than noninfected pregnant women or infected nonpregnant women. The average weight of 155 neonates from infected mothers was 350 g less than that of 175 neonates from noninfected mothers. This difference in birth weight was statistically significant for both P. falciparum (P < 0.0001; df = 278) and P. vivax (P < 0.0001; df = 223) infection. Congenital malaria was not recorded. We conclude that pregnant women from this geographical area require systematic intervention owing to their high susceptibility to malaria during pregnancy and the puerperium.     

The effects of malaria chemoprophylaxis given by traditional birth attendants on the course and outcome of pregnancy

A trial of malaria chemoprophylaxis given by traditional birth attendants was undertaken in a rural area of The Gambia where access to antenatal clinics is difficult. Women received one or more doses of Maloprim or placebo from a traditional birth attendant during 1049 of 1208 pregnancies (87%) recorded in 16 villages over a 3-year period. Primigravidae who received Maloprim had a lower parasite rate and a significantly higher mean packed cell volume than primigravidae who received placebo, and their babies were significantly heavier (6% low birth weight vs 22%). In multigravidae chemoprophylaxis reduced malaria parasitaemia but it had no beneficial effect on haemoglobin level and much less effect on birth weight than was observed in primigravidae. However, the mean birth weight of babies born to grandemultigravidae who received chemoprophylaxis was significantly higher than that of babies born to grandemultigravidae who did not.     

Importance and prevention of malaria in pregnancy

Malaria in pregnancy is one of the most important preventable causes of low birthweight deliveries worldwide. It is also a major cause of severe maternal anaemia contributing to maternal mortality. It is estimated that 40% of the world's pregnant women are exposed to malaria infection during pregnancy. The clinical features of Plasmodium falciparum malaria in pregnancy depend to a large extent on the immune status of the woman, which in turn is determined by her previous exposure to malaria. In pregnant women with little or no pre-existing immunity, such as women from non-endemic areas or travellers to malarious areas, infection is associated with high risks of severe disease with maternal and perinatal mortality. Women are at particular risk of cerebral malaria, hypoglycaemia, pulmonary oedema and severe haemolytic anaemia. Fetal and perinatal loss has been documented to be as high as 60-70% in non-immune women with malaria. Adults who are long-term residents of areas of moderate or high malaria transmission, including large parts of sub-Saharan Africa, usually have a high level of immunity to malaria. Infection is frequently asymptomatic and severe disease is uncommon. During pregnancy this immunity to malaria is altered. Infection is still frequently asymptomatic, so may go unsuspected and undetected, but is associated with placental parasitization. Malaria in pregnancy is a common cause of severe maternal anaemia and low birthweight babies, these complications being more common in primigravidae than multigravidae. Preventative strategies include regular chemoprophylaxis, intermittent preventative treatment with antimalarials and insecticide-treated bednets.     

Impact of El Niño and malaria on birthweight in two areas of Tanzania with different malaria transmission patterns

BACKGROUND: Malaria infection increases low birthweight especially in primigravidae. Malaria epidemics occur when weather conditions favour this vector borne disease. Forecasting using the El Ni?o Southern Oscillation (ENSO) may assist in anticipating epidemics and reducing the impact of a disease which is an important cause of low birthweight. The aim of the present study was to determine the impact of the malaria epidemic in East Africa during 1997-1998 on birthweights in two different areas of Tanzania and to explore ESNO's potential for forecasting low birthweight risk in pregnant women. METHOD: A retrospective analysis of birthweight differences between primigravidae and multigravidae in relation to malaria cases and rainfall for two different areas of Tanzania: Kagera, which experiences severe outbreaks of malaria, and Morogoro which is holoendemic. Birthweight and parity data and malaria admissions were collected over a 10-year period from two district hospitals in these locations. RESULTS: The risk of delivering a low birthweight baby in the first pregnancy increases approximately 5 months following a malaria epidemic. An epidemic of marked reduced birthweight in primigravidae compared with multigravidae occurred, related to the ENSO of 1997-1998. In Kagera this birthweight difference and the risk of low birthweight were significantly lower compared with Morogoro, except after the ENSO when the two areas had similar differences. No significant interaction was noted between secundigravidae and any of the risk periods. The results indicate that the pressure of malaria is much greater on pregnant women, especially primigravidae, living in the Morogoro location. CONCLUSIONS: Surveillance of birthweight differences between primigravidae and multigravidae is a useful indicator of malaria exposure.     

Hookworms, malaria and vitamin A deficiency contribute to anemia and iron deficiency among pregnant women in the plains of Nepal

Anemia and iron deficiency during pregnancy are prevalent in developing countries, but their causes are not always known. We assessed the prevalence and severity of anemia and iron deficiency and their association with helminths, malaria and vitamin A deficiency in a community-based sample of 336 pregnant women in the plains of Nepal. Hemoglobin, erythrocyte protoporphyrin (EP) and serum ferritin were assessed in venous blood samples. Overall, 72.6% of women were anemic (hemoglobin < 110 g/L), 19.9% had moderate to severe anemia (hemoglobin < 90 g/L) and 80.6% had iron deficiency (EP > 70 micromol/mol heme or serum ferritin < 10 microg/L). Eighty-eight percent of cases of anemia were associated with iron deficiency. More than half of the women (54.2%) had a low serum retinol concentration (<1.05 micromol/L), 74.2% were infected with hookworms and 19.8% had Plasmodium vivax malaria parasitemia. Hemoglobin, EP and serum ferritin concentrations were significantly worse and the prevalence of anemia, elevated EP and low serum ferritin was increased with increasing intensity of hookworm infection. Hookworm infection intensity was the strongest predictor of iron status, especially of depleted iron stores. Low serum retinol was most strongly associated with mild anemia, whereas P. vivax malaria and hookworm infection intensity were stronger predictors of moderate to severe anemia. These findings reinforce the need for programs to consider reducing the prevalence of hookworm, malaria infection and vitamin A deficiency where indicated, in addition to providing iron supplements to effectively control anemia.     

Varicose veins of lower extremities in pregnant women and birth outcomes

The objective of the study was to estimate the association of pregnant women with varicose veins of lower extremities (VVLE) and the possible risk for adverse birth outcomes and among them different congenital abnormalities (CAs) in their children. Prospectively and medically recorded VVLE were evaluated in 332 pregnant women who delivered infants with CA (case group) and 566 pregnant women with VVLE who delivered infants without CA (control group) and matched to cases were compared in the population-based data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980-1996. About one-quarter of pregnant women had chronic VVLE while new onset VVLE occurred in the rest of pregnant women. There was no higher risk for adverse birth outcomes of pregnant women with VVLE, in fact the rate of preterm birth and low birth weight was somewhat lower than in the newborns of pregnant women without VVLE. The comparison of VVLE occurrence in pregnant women who had offspring with 21 different CA groups and in pregnant women who later delivered babies without CA showed a higher risk only for pectus excavatum, a mild CA. In conclusion, VVLE in pregnant women does not associate with obvious hazard for their fetuses.     

妊娠合并甲状腺功能减退对妊娠及胎儿的影响

目的:探讨妊娠合并甲状腺功能减退(以下简称甲减)对妊娠和胎儿的影响。方法:对住院分娩的88例甲减孕产妇(临床甲减组38例、亚临床甲减组50例)及正常对照组100例分别统计其不良妊娠发生率。结果:临床甲减组早产、妊娠期高血压疾病、贫血、胎窘、低出生体重发生率均高于正常对照组(P<0.05);亚临床甲减组的妊娠期高血压疾病、贫血、胎窘发生率亦高于正常对照组(P<0.05)。结论:妊娠合并甲减的不良妊娠发生率与甲减的程度有关。因此有必要在孕前或孕早期筛查,做到早诊断、早治疗,严密监测孕妇、胎儿情况,以改善甲减孕妇母儿结局。     

Low birth weight: an outcome of poor socio-obstetric interaction

Factors contributing to low birth weight (LBW) include poverty, ignorance, and inability to use health care services. Early marriage and low family income lead to poor maternal nutrition reserves, which lead to reduced fetal nutrition. Poor maternal nutrition is also the result of ignorance, short birth intervals, multi-parity, and lack of prenatal care. Both heavy manual labor and smoking contribute to placental ischemia, which, along with reduced fetal nutrition, leads to intrauterine growth retardation (IUGR). In developing countries, IUGR accounts for over 66% of all LBW neonates. About 7 million Indian babies annually are LBW. This study examined the incidence of LBW among 178 mothers delivering single births at the maternity hospital associated with the Department of Community Medicine of SKIMS, Srinagar, Kashmir, India, during 1989-90. 26.40% (47) of the 178 births were LBW (2500 g). Among 71 first-borns, marriage age was found to be statistically significantly associated with LBW. 31.82% of mothers younger than 20 years had LBW babies, compared to only 6.12% of mothers older than 20 years. The impact ratio, which measured excess LBW, was 4.20. Birth interval was statistically significantly associated with LBW outcome. 55.81% of women with a birth interval of less than 18 months had LBW babies, compared to 20.31% of mothers with longer birth intervals. The impact ratio was 1.75. Gravidity was also statistically associated with LBW babies. 34.58% of multigravida mothers had LBW babies, compared to 14.08% of primigravidae. The impact ratio was 1.46. Presence of prenatal care was statistically associated; the impact ratio was 1.42. 31.30% of illiterate women had LBW babies, compared to only 17.46% among literate women, which indicated significant associations with LBW. Other significant factors were manual labor, maternal smoking, and monthly family income. Reduction of LBW by 10-30% nationally by the year 2000 will be difficult and best accomplished by a high risk approach supplemented by health and nutrition education.     

Preventing malaria in pregnancy: a study of perceptions and policy implications in Mukono district, Uganda

Although the efficacy of insecticide-treated nets (ITNs) in malaria prevention is well documented, the low coverage of ITNs in malaria endemic countries necessitates investigation on factors that limit access to this intervention. An exploratory study was conducted in Mukono district, Uganda, to assess perceptions and use of ITNs. Results show that malaria is perceived as a serious illness among pregnant women and children, and there is high awareness on the benefits of ITNs. However, ITNs are used by few people, mainly because of their high cost and the perception that the chemicals used to treat them have dangerous effects on pregnancy and the foetus. Other factors that influence the use of ITNs include low utilization of antenatal care, husband's lack of interest in malaria prevention and the perception that adolescent girls and primigravidae are at a low risk of getting malaria. The policy implications of these findings include demystifying the negative perceptions on the chemicals used to treat nets and subsidizing the cost of ITNs in order to increase access to them. These findings provide important lessons for malaria control programmes that aim at increasing access to ITNs by pregnant women in developing countries.     

The effect of timing and frequency of Plasmodium falciparum infection during pregnancy on the risk of low birth weight and maternal anemia

Plasmodium falciparum infection during pregnancy causes maternal anemia and low birth weight (LBW), but the effect of frequency and timing of infection on the severity of these adverse effects is unknown. We conducted a cohort study recruiting 2462 pregnant women in Malawi. Microscopy was used to diagnose malaria at enrollment, follow-up and delivery. Birth weight and maternal hemoglobin were measured at delivery. The association between timing and frequency of infection and LBW and maternal anemia was analyzed using a binomial regression model. Compared with uninfected women, (i) the risk of LBW increased with the number of malaria episodes [one episode: prevalence ratio (PR) 1.62 (95% CI 1.07-2.46); two episodes: PR 2.41 (95% CI 1.39-4.18)]; (ii) the risk for maternal anemia increased with the number of malaria episodes [one episode: PR 1.15 (95% CI 0.86-1.54); two episodes: PR 1.82 (95% CI 1.28-2.62)]; and (iii) the risk of LBW was higher with infection in the second (PR 1.71; 95% CI 1.06-2.74) than third trimester or at delivery (PR 1.55; 95% CI 0.88-2.75). The timing and frequency of P. falciparum infection during pregnancy affected the risk of LBW but only frequency of infection had an effect on the risk of maternal anemia. Identification of gestational periods when malaria causes most adverse outcomes will facilitate effective targeting of interventions.     

Malaria in pregnancy as an indirect cause of infant mortality in sub-Saharan Africa

Although randomized controlled trials of interventions to reduce malaria in pregnancy have demonstrated an increase in the birthweight of the newborn in primigravidae, the subsequent impact on infant mortality in all-parities has not been assessed. The aim of this paper was to model the possible impact of placental malarial infection on infant mortality through reduced birthweight. An extensive literature search was undertaken to define a series of parameters describing the associations between placental infection, birthweight and premature mortality in sub-Saharan Africa. It was shown that a baby is twice as likely to be born of low birthweight if the mother has an infected placenta at the time of delivery (all-parities: 23% vs 11%, primigravidae only: 32% vs 16%), and that the probability of premature mortality of African newborns in the first year of life is 3 times higher in babies of low birthweight than in those of normal birthweight (16% vs 4.6%). Assuming 25% of pregnant women in malaria-endemic areas of Africa harbour placental malarial infection, it is suggested that 5.7% of infant deaths in malarious areas could be an indirect cause of malaria in pregnancy. This would imply that, in 1997, malaria in pregnancy could have been responsible for around 3700 infant deaths under the diverse epidemiological conditions in Kenya. Placental infection with Plasmodium falciparum appears to have a more significant role in infant survival in Africa than has been previously assumed. This may explain the high reduction in infant mortality rates from interventions aimed at reducing transmission, over and above that expected from a decline in direct malaria-specific mortality alone.     

Influence of placental malaria infection on foetal outcome in the Gambia: twenty years after Ian Mcgregor

Malaria infection in pregnancy has serious health consequences among mothers and offspring. The influence of placental malaria infection on foetal outcome was studied in a Gambian rural setting where few pregnant women take antimalarial chemoprophylaxis. During July-December 1997, three hundred thirteen mother-newborn pairs (singletons only) were consecutively recruited into a study of the effects of placental malaria infection on the outcome of pregnancy. Placental blood and tissue were collected at delivery. Babies were clinically assessed until discharge. The overall prevalence of placental malaria infection was 51.1% by placental histology and 37.1% by blood smear. The primigravid women were more susceptible to placental malaria than the multigravidae (65.3% vs 44.7%, p=0.01). Placental malaria was significantly associated with pre-term deliveryand intrauterine growth retardation (p<0.01), and there was a four-fold risk of delivering low-birth-weight babies if mothers had parasitized placentae [OR=4.42, 95% confidence interval (CI) 2.10-9.27]. A reduction of mean birth-weight of babies by 320 g was associated with placental malaria infection (p<0.001). Similarly, a two-fold risk of stillbirth delivery (OR=2.22, 95% CI 1.04-4.72) was observed among the infected mothers. The findings showed that there was still an overall poor foetal outcome associated with placental malaria infection. The findings of this study confirm the findings of an earlier study by McGregor in the Gambia that the low birth-weight rate is significantly higher if the placenta is parasitized. In addition, this study observed that the high stillbirth and prematurity rates were associated with placental malaria infection. The findings of the present study suggest undertaking of effective malaria-control strategies during pregnancy, such as use of insecticide-impregnated bednets, intermittent and early treatment for malaria, and antimalarial chemoprophylaxis, in the Gambia.     

Iron deficiency anemia: Pregnancy outcomes with or without iron supplementation

Objective

To estimate the efficacy of iron supplementation in anemic pregnant women on the basis of occurrence of pregnancy complications and birth outcomes.

Methods

Comparison of the occurrence of medically recorded pregnancy complications and birth outcomes in pregnant women affected with medically recorded iron deficiency anemia and iron supplementation who had malformed fetuses/newborns (cases) and who delivered healthy babies (controls) in the population-based Hungarian Case-Control Surveillance System of Congenital Abnormalities.

Results

Of 22 843 cases with congenital abnormalities, 3242 (14.2%), while of 38 151 controls, 6358 (16.7%) had mothers with anemia. There was no higher rate of preterm births and low birth weight in the newborns of anemic pregnant women supplemented by iron. However, anemic pregnant women without iron treatment had a significantly shorter gestational age at delivery with a somewhat higher rate of preterm births but these adverse birth outcomes were prevented with iron supplementation. The rate of total and some congenital abnormalities was lower than expected and explained mainly by the healthier lifestyle and folic acid supplements. The secondary findings of the study showed a higher risk of constipation-related hemorrhoids and hypotension in anemic pregnant women with iron supplementation.

Conclusion

A higher rate of preterm birth was found in anemic pregnant women without iron treatment but this adverse birth outcome was prevented with iron supplementation. There was no higher rate of congenital abnormalities in the offspring of anemic pregnant women supplemented with iron and/or folic acid supplements.     

Association of anemia,pre-eclampsia and eclampsia with seasonality: A realist systematic review

Seasonal patterns influencing maternal health have been documented globally and are of particular importance for women in developing countries who disproportionately suffer from anemia, pre-eclampsia and eclampsia. This paper adopts a realist systematic approach to investigate the maternal outcome of anemia and eclampsia in relation to seasonality. A review of 23 published studies shows a statistically significant link between these maternal disorders and seasonality in developing countries in Sub-Saharan Africa and Central and South Asia. Anemia and eclampsia tend to decrease during the dry season, only to increase with greater rainfall, low and cold temperatures. Numerous studies suggest that the seasonality of anemia and eclampsia is associated with changes in malaria transmission. This was observed during the rainy season, suggesting a potential seasonal relationship with malaria as a driver of these disorders in Sub-Saharan Africa. Anemia and eclampsia were principally exacerbated among primigravidae and young women. Food insecurity, access to antenatal care, poverty, and environmental factors may also play a crucial role in the predisposition to these disorders. More research is required to identify the seasonal link between malaria and eclampsia particularly as climate change may exacerbate the rate of the disorders in tropical and sub-tropical areas.     

Perinatal Depression and Birth Outcomes in a Healthy Start Project

Given the risk of adverse perinatal outcomes associated with a depressive disorder, the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) from 2001–2005 devoted resources through the Federal Healthy Start Initiative to screen pregnant women for depression and link them with services. In this report, we present the evaluation of a program that screened for depression and provided services for women with depressive symptoms or psychiatric distress in pregnancy to assess whether the program was associated with a reduction in babies born low birth weight, small for gestational age, or preterm. The program impact was examined among 1,100 women in three cohorts enrolled from 2001–2005 that included: (1) subjects recruited prior to the inception of the Healthy Start Initiative; (2) subjects enrolled in the Healthy Start Initiative; and (3) a comparison group recruited during the project period but not enrolled in the Healthy Start Initiative. After adjustment for covariates, women with probable depression were over one and a half times more likely to give birth to a preterm baby than non depressed women. Neither adjusted nor unadjusted risks for delivery of preterm, low birth weight or small for gestational age infants were significantly lower for women enrolled in Healthy Start as compared to women not enrolled in Healthy Start. However, regardless of enrollment in Healthy Start, women who delivered babies after the Healthy Start program began were 85% less likely to deliver preterm babies than women giving birth before the program began. Depression status conferred increased risk of adverse birth outcomes, results that were not altered by participation in the Healthy Start program. We cannot exclude the possibility that the community activities of the Healthy Start program promoted increased attention to health issues among depressed women and hence enhance birth outcomes.     

Childbearing characteristics of U.S.- and foreign-born Hispanic mothers

This study compares maternal and infant health and sociodemographic characteristics of U.S.-born and foreign- or Puerto Rican-born Hispanic mothers and their babies, using data from the national vital statistics system and the 1980 National Natality Survey. While nearly half of all Hispanic mothers and Mexican and Puerto Rican mothers were born in the United States, less than 10 percent of Cuban and other Hispanic mothers were U.S. born. Compared with foreign- or Puerto Rican-born Hispanic mothers, U.S.-born mothers tended to be younger, to have had fewer high-order births, to be less likely to receive delayed or no prenatal care, to have higher educational attainment, and to be more likely to be unmarried. The incidence of low birth weight among infants born to Hispanic mothers, particularly Mexican and Cuban women, was relatively low. When the proportions of low birth weight were examined by nativity status, infants born to foreign- or Puerto Rican-born women were consistently less likely to be of low birth weight. In an effort to account for these findings, the mother's smoking status before and during pregnancy is examined. Compared with non-Hispanic mothers, Hispanic mothers were much less likely to have smoked before or during pregnancy. These data are examined to see if they account for the better outcome as measured by birth weight for Hispanic births, especially those to foreign- or Puerto Rican-born women.     

Maternal dietary diversity and odds of low birth weight: Empirical findings from India

India has the highest proportion of low birth weight (LBW) babies born in the developing world. Poor maternal nutrition during pregnancy is associated with adverse infant health outcomes. The main objective of this paper was to assess the socioeconomic factors associated with dietary diversity among pregnant women and to investigate the association between maternal dietary diversity and LBW among their babies. The data for these analyses were derived from a survey conducted in November and December, 2014 among 230 women who had newly delivered in hospitals in Uttar Pradesh, the largest Indian state that has the poorest maternal outcomes in the country. The results from multivariate binary logistic regression model indicated that low maternal education and economic status was significantly associated with poor dietary diversity among participants. Also, women with low maternal dietary diversity had a significantly higher proportion of LBW babies compared to those in the medium to high dietary diversity categories. From a policy perspective, these findings suggest that continuous tracking of pregnant women’s nutritional needs through existing monitoring systems, e.g., the Nutrition Resource Platform and Health Management Information System, and necessary interventions through Integrated Child Development Services may yield better results, thereby, addressing maternal under-nutrition and LBW.     

妇女孕期社会经济状态与新生儿体重的关系

目的:分析妇女孕期的社会经济状态与不良妊娠结局关系,为筛查可能生育不良体重儿的高风险孕妇提供依据。方法:利用2002年中国居民营养与健康调查数据,根据妊娠结局以及孕妇年龄、社会经济状态、体力活动模式和营养补充情况建立8个研究模型,以多元logistic回归分析4159例乳母样本。结果:低出生体重儿和巨大儿的发生率分别为5.8%和11.4%。通过建立不同模型对比分析发现,生活在中小城市、小学及以下教育程度、低收入、步行出行方式的妇女生育低出生体重儿风险更高;小学及以下教育程度、轻体力活动、自行车或公交车出行、服用碘制剂的妇女生育巨大儿的风险更高。结论:社会经济状态处于劣势的妇女生育异常体重新生儿的风险更高,应有针对性地筛查风险人群。     

Towards child health: through mother's health and education

In India, mothers and children constitute 62% of the population, but they are also a special risk group as regards their childbearing and survival, respectively. The States of Bihar, Rajasthan, Madhya Pradesh, and Uttar Pradesh account for about 50% of the girls who are married off before age 16. Low levels of female literacy (ranging from 11.4% in Rajasthan to 65.7% in Kerala, with an all India average of 39.4%) are associated with early marriages, which expose girls to pregnancy in their teen years. Many studies report higher rates of low birth weight, prematurity, and neonatal and infant mortality in children of young mothers than in children born to women 20-29 years old. In a study conducted in a slum area of Bombay, teenage pregnancy appeared to be a risk factor for low birth weight when compared with pregnancies of women 21-30 years old. The incidence of low birth weight babies in India ranges from 30% to 40%, and they account for over 80% of neonatal deaths. The incidence of premature labor in teenagers in various Indian studies ranges from 11% to 31%. Perinatal mortality rates for Indian teenager pregnancies vary between 6% and 11%. Poverty associated with adverse sociocultural practices and the low status of women aggravates malnutrition and anemia in pregnant women. Female literacy is particularly important both for utilization and for provision of medical, health, and social welfare services. A national survey has indicated that the number of children born to couples was 4.03 when the husband was illiterate, declining to 2.16 when the husband had intermediate or higher level education. But the number was 3.8 when the wife was illiterate, dropping to 1.6 when the wife had intermediate or higher level education. If the mother is educated she will provide better child care, nutrition, and cleanliness, the factors which affect the health of her child.     

孕期规范化体重指导对妊娠结局影响的研究

目的 研究孕期个体规范化体重指导对分娩方式、妊娠结局及新生儿体重的影响.方法 选取2019年1-12月天津市北辰区建册并分娩的566例单胎孕妇作为研究对象,随机分为对照组和观察组各283例.对照组进行常规产前检查及相关体重管理健康宣教,观察组在对照组基础上给予个体规范化体重指导.比较两组单胎足月新生儿平均出生体重、巨大...