亲代出生体重对子代出生体重的影响

目的探讨亲代出生体重对子代出生体重的影响及母亲宫内发育不良的经历是否会影响子代宫内发育状况，为研究环境和遗传因素对出生体重的影响提供线索。 方法首都儿科研究所采用回顾性队列研究，于1995~2001年以1948~1954年北京协和医院出生的“宫内发育与成人疾病”队列人群为基础，利用研究对象的出生记录和回顾性问卷调查资料，分析出生体重在亲代与子代之间的关联。 结果在控制了母亲的产次、生育年龄以及配偶的身高体重等影响因素后，母亲的出生体重与其子代出生体重之间存在显著的正相关关系(r=0.38,P<0.001)，而父亲与子代之间在出生指标尚未表现出相关性；母亲为低出生体重(出生体重<2500g)，其子代中低出生体重发生的危险是对照组(亲代出生体重≥3500g)的3倍多。 结论母亲与子代在出生体重上存在明显正相关，母亲低出生体重可能会增加子代发生低出生体重的危险。     

Exposure to life-threatening stressful situations and the risk of preterm birth and low birth weight

Objective

To evaluate the association between exposure to life-threatening rocket attacks and the risks of preterm birth (PTB) and low birth weight (LBW).

Methods

The present retrospective cohort study compared the outcomes of 1851 births by women exposed to rocket attacks and 2979 births by unexposed women. The timing, frequency, and intensity of exposure were calculated for each trimester and for the entire pregnancy period. Demographic and medical data were abstracted from the patients’ records.

Results

The rates of PTB and LBW were higher among exposed than unexposed women (PTB: 9.1% versus 6.8%, P = 0.004; LBW: 7.6% versus 5.8%, P = 0.02). The rate of infants who were small for gestational age did not differ between the groups. After controlling for potential confounders, the risks for PTB and LBW remained significantly higher in the exposed group (PTB: adjusted odds ratio 1.3 [95% confidence interval, 1.1–1.7]; LBW: adjusted odds ratio 1.3 [95% confidence interval, 1.03–1.7]). There was no linear association between the intensity of exposure and the risk of PTB or LBW.

Conclusion

Maternal exposure to intermittent but repeated life-threatening rocket attacks for a prolonged period might be associated with increased risks of PTB and LBW.     

The investigation of missing paternal information in birth certificates and low birth weight

Objective.?To determine if missing paternal information in birth certificates is associated with an increased risk of low birth weight (LBW).

Methods.?This was a retrospective single cohort analysis including all live births at our institution between April 1999 and May 2002. We created two study groups, one with father's information complete (FIC) and one with father's information missing (FIM). We utilised a three-tier approach (univariate analysis, multivariate analysis and propensity matching) to determine if FIM was related to LBW.

Results.?Univariate analysis showed a significant difference in LBW rates between the FIM and FIC groups (14.6 vs. 9.1%, p < 0.001). However, this difference was not observed in the multivariate (odds ratio = 1, p = 0.858, ns) or propensity matching analysis (13.9 vs. 13.8%, p = 0.954, ns).

Conclusion.?After controlling for LBW risk factors, FIM was not an independent predictor of LBW.     

医学营养治疗对糖代谢异常妊娠期患者增重及新生儿出生体重的影响

目的 探讨医学营养治疗（MNT）对糖代谢异常妊娠期患者增重及新生儿出生体重的影响。方法 2005年5月至2005年10月对北京妇产医院诊断为糖代谢异常的单胎孕妇106例在产科营养门诊接受医学营养治疗，在进行总热量控制的基础上，使用等食品交换份结合血糖生成指数的方法，把同期未接受该方法而采用传统营养治疗方法的糖代谢异常孕妇96例作为对照组，比较两组孕妇的体重增长、体重指数（BMI）的增长及新生儿体重增长情况。结果 两组巨大儿的发生率分别为8．49％、13．54％，研究组巨大儿的发生率有所下降；两组比较孕妇妊娠期体重增长、每周体重增长、BMI增加、每周BMI增加差异均有显著性；新生儿体重有所下降，但差异无显著性。结论 对妊娠糖代谢异常患者进行科学、合理的营养治疗，妊娠期体重增加明显减少，新生儿体重在合适范围，对孕妇妊娠期体重增长的管理有提示作用。     

The influence of medical abortion compared with surgical abortion on subsequent pregnancy outcome

Seven prospective cohort studies (12 484 cases) were included in this review of the respective effects on the next pregnancy of medical and surgical abortion in early pregnancy. The incidence of miscarriage and postpartum hemorrhage was significantly lower in the pregnancy following a medical abortion. No other significant differences were found. With respect to the outcome of the next pregnancy, first-trimester medical abortions may thus be safer than the surgical option.     

Low birth weight,preterm birth and short interpregnancy interval in Sudan

Objective.?To investigate whether short interpregnancy interval (IPI) is associated with increased risk of low birth weight and preterm labour.

Methods.?The study was conducted in the labour ward of Khartoum hospital in Sudan during November 2007 through February 2008. Odds ratios (ORs) were adjusted for the confounding factors using multiple logistic regression models.

Results.?Compared with IPI of 18–30 months, those women with intervals shorter than 18 months had an increased risk of low birth weight (OR = 1.9, 95% CI = 1.0–3.5, P = 0.04) and preterm labour (OR = 2.3, 95% CI = 1.1–4.7, P = 0.01).

Conclusion.?In this study, IPI shorter than 18 months are independently associated with increased risk of adverse perinatal outcomes.     

The mediating role of placenta in the relationship between maternal exercise during pregnancy and full-term low birth weight

Objective: To explore the association of maternal exercise during pregnancy with full-term low birth weight (FT-LBW) and whether placenta mediates their association.

Study design: We investigated 326 pregnant women delivering FT-LBW weight newborns (cases) and 1644 delivering full-term normal birth weight newborns (controls) in this case-control study. Information concerning maternal exercise during pregnancy, socio-demographics and obstetric characteristics were collected at Women and Children’s Hospitals of Shenzhen and Foshan in Guangdong, China.

Results: After adjusting for the potential confounders, maternal exercise frequency and duration during pregnancy were significantly negatively associated with FT-LBW, respectively. Moreover, compared with mothers taking no exercise during pregnancy, those taking exercises were significantly negatively associated with FT-LBW except those taking low/medium frequency and short duration exercise and high-frequency and long duration exercise, and their adjusted ORs ranged from 0.30 to 0.62. Furthermore, mediation analysis illustrated that placental weight partially mediated 27.20% of the association between maternal exercise frequency during pregnancy and FT-LBW, but not the association between maternal exercise duration during pregnancy and FT-LBW.

Conclusions: Maternal exercise during pregnancy is beneficial for lowering FT-LBW risk, especially when taking appropriate and enough exercise. Placenta weight partially mediates the association between maternal exercise frequency during pregnancy and FT-LBW.     

Low first-trimester hemoglobin and low birth weight, preterm birth and small for gestational age newborns.

OBJECTIVE: To examine the relationship between first-trimester hemoglobin (Hb) concentration and risk of low birth weight (LBW), preterm birth and small for gestational age (SGA). METHODS: Data were obtained from a population-based prenatal care program in China. A total of 88,149 women who delivered during 1995-2000 and had their Hb measured in the first trimester were selected as study subjects. RESULTS: The prevalence of anemia (Hb<110 g/L) was 22.1% in the first trimester. The risk of LBW, preterm birth and SGA was increased steadily with the decrease of first-trimester Hb concentration. After controlling for confounding factors, women with Hb 80-99 g/L had significantly higher risk for LBW (OR=1.44, 95% CI 1.17-1.78), preterm birth (OR=1.34, 95% CI 1.16-1.55) and SGA (OR=1.13, 95% CI 0.98-1.31) than women with Hb 100-119 g/L. No elevated risk was noted for women with Hb> or =120 g/L. CONCLUSION: Low first-trimester Hb concentration increases the risk of LBW, preterm birth and SGA.     

Pregnancy-associated mortality after birth, spontaneous abortion, or induced abortion in Finland, 1987-2000

OBJECTIVE: To test the hypothesis that pregnant and recently pregnant women enjoy a "healthy pregnant women effect," we compared the all natural cause mortality rates for women who were pregnant or within 1 year of pregnancy termination with all other women of reproductive age. STUDY DESIGN: This is a population-based, retrospective cohort study from Finland for a 14-year period, 1987 to 2000. Information on all deaths of women aged 15 to 49 years in Finland (n=15,823) was received from the Cause-of-Death Register and linked to the Medical Birth Register (n=865,988 live births and stillbirths), the Register on Induced Abortions (n=156,789 induced abortions), and the Hospital Discharge Register (n=118,490 spontaneous abortions) to identify pregnancy-associated deaths (n=419). RESULTS: The age-adjusted mortality rate for women during pregnancy and within 1 year of pregnancy termination was 36.7 deaths per 100,000 pregnancies, which was significantly lower than the mortality rate among nonpregnant women, 57.0 per 100,000 person-years (relative risk [RR] 0.64, 95% CI 0.58-0.71). The mortality was lower after a birth (28.2/100,000) than after a spontaneous (51.9/100,000) or induced abortion (83.1/100,000). We observed a significant increase in the risk of death from cerebrovascular diseases after delivery among women aged 15 to 24 years (RR 4.08, 95% CI 1.58-10.55). CONCLUSION: Our study supports the healthy pregnant woman effect for all pregnancies, including those not ending in births.     

Leisure time physical activity during pregnancy and preterm birth in Brazil

Objective

To investigate the relationship between leisure time physical activity (LTPA) during pregnancy and preterm birth.

Methods

A cross-sectional, population-based study evaluated LTPA during pregnancy in 4147 mothers using data from the 2004 Pelotas Birth Cohort Study. Gestational age was determined by last menstrual period, or when not available, by ultrasound or the Dubowitz method. Type of LTPA, length of usual session, and frequency were determined for each trimester.

Results

A total of 14.6% of all births were considered preterm. Only 13.3% of women reported engaging in LTPA during pregnancy. After adjusting for confounders, LTPA in all 3 trimesters (prevalence ratio [PR] 0.55; 95% confidence interval [CI] 0.32-0.96), LTPA in the third trimester (PR 0.50; 95% CI 0.31-0.80), and minimum LTPA (≥ 90 min/week) in the third trimester (PR 0.58; 95% CI 0.34-0.98) showed a protective association with preterm birth in the adjusted analysis.

Conclusion

LTPA, especially throughout pregnancy and in the third trimester, was associated with a lower chance of preterm birth.     

药物流产与人工流产在终止早期妊娠的对比分析

目的:观察药物流产与人工流产在终止早期妊娠的临床比较。方法:选择450例育龄妇女妊娠8周内要求终止妊娠的孕妇,随机分成甲、乙两组。甲组用药物流产,乙组用负压吸宫流产。结果:甲组完全流产207例,完全流产率92%,乙组安全流产219例,完全流产97.3%,两组完全流产率经统计学处理无显著性差异。甲组阴道流血天数12.73±4.46天,乙组11.62±5.93天,经统计学处理无显著性差异,阴道流血量;甲组78±15.14ml,乙组72.67±9.98ml,流血量经统计学处理,有显著性差异。结论:两组完全流产效果及流血天数均无显著性差异。药物流产简单易行,局部无创伤,能避免子宫穿孔,宫腔内感染,宫腔黏连等危险因素,是一种较为简便,安全有效的理想方法。     

Lifetime and during pregnancy experience of violence and the risk of low birth weight and preterm birth

In order to assess the relationship between lifetime and during pregnancy experience of violence and low birth weight (LBW) and preterm birth outcomes, we designed a prospective cohort study in which the birth outcomes of women who experienced violence before their pregnancy or who experienced violence during pregnancy were compared to women who reported no lifetime experience of violence. We found that the risk of having a low birth weight or preterm baby was higher for women who did not experience violence. The proportion of women who had LBW babies was 7.1% for women who experienced violence during pregnancy, 7.8% for women who experienced violence before the current pregnancy, and 9.1% for nonexposed women. The proportion of preterm births was 3.5% for women exposed to violence during pregnancy, 8.5% for women exposed before the current pregnancy, and 9.7% for nonexposed women. However, married women who experienced violence had a higher proportion of LBW and preterm infants compared to the reference group of nonvictims of violence. Overall, women who experienced violence during pregnancy and before their current pregnancy did not have a greater proportion of LBW babies or preterm births. The findings suggest that married women in certain populations may experience more frequent or more severe experience of violence than unmarried women.     

Maternal birth weight in relation to plasma lipid concentrations in early pregnancy

OBJECTIVE: The purpose of this study was to determine the extent to which, if at all, maternal weight at birth is related to dyslipidemia during early pregnancy, which is a risk factor for preeclampsia. STUDY DESIGN: This hospital-based prospective cohort study included 1000 women who initiated prenatal care before 16 weeks of gestation. Participants provided information about their birth weight and other sociodemographic and reproductive covariates. Plasma triglyceride, high-density lipoprotein cholesterol, and total cholesterol concentrations were measured at approximately 13 weeks of gestation. beta coefficients and standard errors were estimated by multiple linear regression; odds ratios and 95% confidence intervals were estimated by logistic regression. RESULTS: Maternal birth weight was correlated negatively with triglycerides (r =-0.12; P =.001) and was correlated positively with high-density lipoprotein cholesterol (r =0.08; p =.02) but not statistically significantly related with total cholesterol (r =-0.004; P=.91). After adjusting for potential confounders, women who weighed <2500 g at birth had higher triglyceride and total cholesterol concentrations (beta=23.4 mg/dL [P<.001]; beta =2.6 mg/dL [P =.585], respectively) and lower high-density lipoprotein cholesterol concentrations (beta =-3.2 mg/dL; P=.105), when compared with women who weighed 3000 to 3499 g at birth. Women who were born small (<2500 g) and became overweight (body mass index, >or=25 kg/m(2)) in adulthood had less favorable lipid profiles than their counterparts who weighed >or=2500 g at birth and remained lean (body mass index, <25 kg/m(2)). CONCLUSION: Our findings suggest that factors that are related to growth in utero may help to predict the subsequent risk of altered lipid metabolism during pregnancy, which may, in turn, be causally related to the occurrence of preeclampsia.     

Expectant management of incomplete abortion in the first trimester

Objective

To evaluate the effectiveness and acceptability of expectant management of induced and spontaneous first trimester incomplete abortion.

Methods

A prospective observational trial, conducted between June 2006 and November 2007, of 2 groups of patients diagnosed with an incomplete abortion: 66 patients who had received misoprostol for an induced abortion (group 1) and 30 patients who had had a spontaneous abortion (group 2). Transvaginal ultrasound was performed weekly. The success rate (complete abortion without surgery), time to resolution, duration of bleeding and pelvic pain, rate of infection, number of unscheduled hospital visits, and level of satisfaction with expectant management were recorded.

Results

The incidence of complete abortion was 86.4% and 82.1% in groups 1 and 2 respectively at day 14 after diagnosis, and 100% in both groups at day 30 (two group 2 patients underwent curettage and were excluded from the analysis). Both groups reported 100% satisfaction with expectant management, although over 90% of the women reported feeling anxious.

Conclusion

Expectant management for incomplete abortion in the first trimester after use of misoprostol or after spontaneous abortion may be practical and feasible, although it may increase anxiety associated with the impending abortion.     

Combination of vaginal pH with vaginal sialidase and prolidase activities for prediction of low birth weight and preterm birth

OBJECTIVE: The purpose of this study was to assess if easy to measure vaginal fluid biomarkers are predictive for low birth weight (LBW, <2500 g), very LBW (VLBW, <1500 g), spontaneous preterm at <37 weeks' gestation, and total preterm deliveries (at <37, <35, <32 weeks' gestation). STUDY DESIGN: Low and high cutoffs for vaginal fluid pH, sialidase, and prolidase activities were examined in a nested case-control study of 579 Danish women (from a study population of 2846 women) with samples collected at mean 17 weeks' gestation. One hundred sixteen LBW (17 VLBW), 117 preterm deliveries (85 spontaneous), and 418 normal term deliveries were analyzed. RESULTS: Vaginal pH >/=4.7 or pH >/=5 by itself was not associated with LBW or prematurity. Conversely, combination of pH >/=5 and high sialidase activity demonstrated OR 17 (CI 1.8-150) for LBW; OR 31 (CI 1.8-516) for VLBW; along with OR 18 (CI 1.6-204) for preterm at <35 weeks'; and OR 31 (CI 1.9-542) for preterm at <32 weeks' gestation. The combination of pH >/=5 and high prolidase activity demonstrated OR 13 (CI 1.3-122) for LBW; OR 33 (CI 2.0-553) for VLBW, as well as OR 9.2 (CI 0.6-150) for preterm at <35 weeks'; and OR 35 (CI 2.0-586) for preterm at <32 weeks' gestation. In this population, no woman having high sialidase and high prolidase activity had a term birth, or a baby weighting >/=2500 g at birth. CONCLUSION: In this Danish population, mid-gestation findings of vaginal fluid elevated pH with sialidase and/or prolidase were associated with LBW, VLBW, and early preterm at <35 or <32 weeks' gestation.