母亲不良孕产史对早产发生的影响

目的探讨母亲不良孕产史与单胎活产早产儿发生的相关性。方法选取2011年1月-2012年12月甘肃省妇幼保健院产科分娩的753例单胎活产早产儿为病例组,另选择同期本院分娩的单胎活产足月儿6505例作为对照组,应用非条件Logistic回归分析的方法探讨母亲不良孕产史与早产及不同亚型早产的关系。结果母亲既往早产史与早产(OR 16.29,95%CI 9.51-27.90)及不同亚型早产的发生强烈相关联。既往死产史(OR 1.87,95%CI 1.17-2.99)与既往自然流产史(OR 1.41,95%CI 1.09-1.82)是早产发生的危险因素,且主要与早期早产的发生相关。既往自然流产史与医源性早产(OR 1.69,95%CI 1.15-2.49)及自发性早产(OR 1.39,95%CI 1.02-1.89)的发生相关,且其与自发性早产的相关性主要局限于无胎膜早破自发性早产(OR 2.59,95%CI 1.38-4.87)。既往人工流产史与早期早产(OR 1.70,95%CI1.11-2.59)的发生相关。既往宫外孕史与早产发生无相关性。结论既往早产史、死产史、自然流产史、人工流产史均是早产发生的危险因素,并且多数可以导致早期早产。对于合并以上危险因素的孕龄期女性,应给予额外关注,做好孕前、孕期宣教,从而降低早产的发生。     

产妇孕期被动吸烟与低出生体重病例对照研究

为分析母亲孕期被动吸烟与低出生体重的关系,采用群体匹配病例对照研究方法,对1999年3月-2000年4月间在沈阳市妇婴医院等14家医院分娩的非主动吸烟的产妇孕期被动吸烟情况与低出生体重关系进行分析.结果表明孕期被动吸烟可能是低出生体重危险因素,且孕期被动吸烟的时间与低出生体重发生存在剂量反应关系(x2趋势=32.42;P＜0.01).在控制产妇不良孕产史等因素后,被动吸烟孕妇分娩出低出生体重儿的危险性为非被动吸烟孕妇的3.176倍(OR95%,CI,1.868-5.401),且被动吸烟与孕妇文化程度对出生体重可能存在协同作用(协同作用指数为3.16).     

产妇孕期被动吸烟与低出生体重症例对照研究

为分析母亲孕期被动吸烟与低出生体重的关系，采用群体匹配病例对照研究方法，对1999年3月－2000年4月间在沈阳市妇婴医院等14家医院分娩的非主动吸烟的产妇孕期被动吸烟情况与低出生体重关系进行分析。结果表明：孕期被动吸烟可能是低出生体重危险因素，且孕期被动吸烟的时间与低出生体重发生存在剂量反应关系（x^2趋势＝32．42；P＜0．01）。在控制产女不良孕产史等因素后，被动吸烟孕妇分娩出低出生体重儿的危险性为非被动吸烟孕妇的3．176倍（OR95％CI，1．868－5．401），且被动吸烟与孕妇文化程度对出生体重可能存在协同作用（协同作用指数为3．16）。     

4909例活产儿低体重情况分析

目的通过对4909例活产儿的出生低体重分析，找出影响出生低体重的相关因素，为降低出生低体重儿的发生提供有力数据。方法通过对4902例活产儿中385例出生低体重儿的住院病历及起母亲的住院病历进行详细分析，并进行相关调查。结果出生低体重与母亲居住地区、母亲文化程度等有关。结论提高母亲文化程度，降低母亲并发症，从而降低早产是降低出生低体重的关键。     

非麻疹疫苗免疫目标人群麻疹发病相关危险因素配对病例对照研究

目的探讨非麻疹疫苗免疫目标人群麻疹发病相关危险因素,为预防控制该人群麻疹发病提供依据。方法对2008—2009年广州市白云区的麻疹病例进行1：1配对,配对因素为性别、年龄和居住地,对相关危险因素进行条件Logistic回归分析及多因素非条件Logistic回归分析。结果调查病例中71．43％的病例为流动人口;28．57％的病例或其监护人为初中以下文化程度;32．80％的病例或其监护人月均收入低于1000元;15岁以上病例既往有麻疹疫苗接种史的仅占4．65％;24．87％的病例病前3周曾与麻疹病人有过接触;32．80％患者病前3周曾去医院就诊．就诊医院级别中省市级、区县级、卫生院分别占62．29％、20．97％和17．74％,就诊科别中以儿科、内科为主,分别占70．97％和25．81％;38．10％的病例病前3周内曾乘坐公共交通工具。单因素分析显示。经济水平低（OR=0．59,OR95%CI=0．37～0．94）、未种麻疹疫苗（OR=0．32,OR95%CI=0．19～0．52）、有麻疹病例接触史（OR=0．22,OR95%CI=0．13—0．36）、流动人口（OR=0．22,OR95%CI=0．13-0．36）、就诊史（OR=0．30,OR95%CI=0．18-0．51）、就诊医院类型（OR=0．33,OR95%CI=0．18～0．51）和就诊科别（OR=0．34,OR95%CI=0．22—0．52）等因素与麻疹发病有明显的相关性。多因素Logistic分析显示,经济水平低（OR=0．49,OR95%CI=0．28-0．87）、未接种麻疹疫苗（OR=0．67,OR95%CI=0．52～0．86）、有麻疹病例接触史（OR=0．14,OR95%CI=0．08-0．25）、流动人口（OR=0．25,OR95％CI=0．15-0．43）、就诊史（OR=8．51,OR95%CI=2．65～27．30）、就诊科别（OR=0．15,OR95%CI=0．05～0．46）等因素与麻疹的发病密切相关。结论经济水平低、未接种麻疹疫苗、病前3周内有麻疹病例接触史、流动人口、病前3周内有就诊史和就诊科别等因素可能是影响非麻疹疫苗免疫目标人群麻疹发病的主要危险因素。     

胎儿畸形相关环境因素统计分析

目的探讨胎儿畸形发生的危险因素,为孕前咨询、孕期保健、遗传咨询提供参考。方法通过问卷调查,采用1∶2病例对照研究,对胎儿畸形的可能危险因素进行单因素和多因素非条件Logistic回归分析,计算所观察危险因素对于胎儿畸形的相对危险度（OR）及95%的可信区间（C I）。结果胎儿畸形发生的主要危险因素有：孕期感冒发热（OR=6.959）、病毒感染（OR=23.261）、孕期服用药物（OR=5.380）、孕期工作压力大（OR=9.764）、居住农村地区（OR=4.921）、家族史（OR=2.754）、不良孕产史（OR=2.297）、孕前后半年家庭装修或购置新家具（OR=4.883）、工作中接触有毒物质（OR=9.389）,而增补叶酸（OR=0.125）为保护性因素。结论胎儿畸形发生的高危因素有：孕期感冒发热、病毒感染、孕期服用药物、孕期工作压力大、家族史、居住农村地区、不良孕产史、孕前后半年家庭装修或购置家具、工作中接触有毒物质;早期补充叶酸、加强孕期保健、普及产前筛查和及时产前诊断是减少先天畸形儿出生的有效措施。     

体外受精（IVF）活产双胎性别对于出生体重的影响

目的探究经辅助生殖活产双胎性别对于出生体重的影响。方法回顾性分析2003年1月1日至2009年6月30南方医院生殖中心经体外受精（IVF）及其衍生技术出生的762名活产双胎新生儿资料,比较男婴与女婴平均出生体重差别;比较男婴组和女婴组中低出生体重儿发生率;将双胎体重之和分为3组,体重和小于3000g组,体重和大于等于3000g且小于5000g组、体重和大于或等于5000g组,比较各组中同性别双胎男婴（女婴）与异性双胎男婴（女婴）平均出生体重差别。结果双胎中男婴平均出生体重显著高于女婴,（2 564±430）g VS,95%CI（76,199）。女婴低出生体重比例显著高于男婴。在低出生体重儿中,男婴平均出生体重与女婴平均出生体重无显著差异,（2 142±310）g VS（2 116±329）g,P=0.46,95%CI（-44,96）。在双胎体重之和大于或等于5000g的双胎组中,异性双胎男婴平均出生体重显著高于同性双胎男婴平均出生体重,（2 878±318）g VS（2 781±266）g,P=0.015,95%CI（19175）。结论经辅助生殖技术获得的双胎中,男婴出生体重明显高于女婴。在双胎体重和大于等于5000g组胎儿中,异性双胎中男婴平均出生体重显著高于同性双胎中男婴平均出生体重,另一胎为女性能显著提高男婴的出生体重。     

305例低出生体重儿发生的相关因素回顾性分析

目的探讨低出生体重儿发生率及相关因素，为有关部门制定政策和预防措施提供依据。方法对我院2003年1月～2008年12月出生的305例低出生体重儿进行回顾性分析。结果低出生体重儿发生率3．07％（305／9948）。2003年-2008年6年间各年度低出生体重儿的发生率没有明显变化，其中早产发生率36．72％，是低出生体重儿发生的第一因素，而双胎、妊高征、胎盘和胎膜因素等是造成胎儿宫内发育迟缓从而引发低出生体重的重要因素。结论降低早产的发生加强孕晚期保健管理是降低低出生体重儿的发生，提高儿童生命早期质量，降低婴儿死亡率的重要环节之一。     

十年间482例低出生体重儿死因分析及干预措施

十年间我院共分娩33190例，低出生体重儿的发生率为70.08‰。，死亡率互83．76‰，占围产儿死亡总数的61．4％，低体重儿死亡率是正常足月儿死亡率的M．5倍，2623例低出生体重）种，早产低体重）儿占43．53％，A亡率为309．11％，是足月死亡率（87．10‰）的3．5倍，以上各组经统计学处理均有显著差异。死因顺位：早产及小村儿；畸形；母亲合并症；硬肿症；窒息移胎；胎盘因素；脐带因素。笔者认为：降低低出生体重儿出生率及加强生后监护是降低日产儿死亡率的重要措施。     

天津地区340例低出生体重儿临床分析

通过对340例出生体重儿(LBW)的临床资料分析,孕妇胎膜早破、妊娠高血压综合征是LBW儿发生的主要因素。LBW儿原发病为呼吸系统疾病、硬肿症、神经系统疾病等。胎龄越小,体重越轻,死亡率越高。因此应减少和预防早产、胎儿宫内发育迟缓及围产儿窒息的发生。     

口服益生菌预防早产儿严重坏死性小肠结肠炎疗效和安全性的Meta分析

目的评价口服益生菌预防早产儿严重坏死性小肠结肠炎（NEC）的疗效和安全性。方法制定原始文献的纳入标准、排除标准及检索策略,检索PubMed、EMBASE、Ovid、Springer、中国期刊全文数据库、万方数据库、维普中文科技期刊数据库及中国生物医学文献光盘数据库等。应用Cochrane协作网推荐的方法评价文献质量。采用RevMan 4.22软件对满足纳入标准的有关口服益生菌预防早产儿严重NEC（Ⅱ期及以上）的RCT研究进行Meta分析。主要观察指标为严重NEC的发生率、总病死率、NEC相关病死率和院内感染导致脓毒症的发生率。结果共检索到107篇文献,符合纳入标准的10项RCT研究（共2 117例早产儿）进入Meta分析,文献质量评价8篇为A级,1篇为B级,1篇为C级。各研究间的基线水平差异较大,出生体重,胎龄,益生菌应用的种类、剂量、开始应用时间和治疗持续时间等均有差异。Meta分析结果表明,益生菌组可显著降低严重NEC的发生率和总病死率,OR分别为0.34（95%CI：0.22～0.55,P〈0.000 1）和0.36（95%CI：0.22～0.58,P〈0.000 1）。无证据表明预防性口服益生菌可减少院内感染导致脓毒症的发生率和NEC相关的病死率,OR分别为0.94（95%CI：0.62～1.42）和0.48（95%CI：0.16～1.47）。所有研究均未见口服益生菌导致相应菌株全身感染的发生。结论预防性口服益生菌可显著降低早产儿严重NEC的发生率和总病死率。对低出生体重儿可给予口服益生菌预防NEC的发生。现有的研究尚不能证实预防性口服益生菌对超低出生体重儿的疗效和安全性。有关超低出生体重儿预防性口服益生菌的安全性和疗效仍有待大规模的临床多中心RCT研究予以明确。     

静脉应用小剂量红霉素防治早产儿喂养不耐受的Meta分析

目的对静脉应用小剂量红霉素防治早产儿喂养不耐受的疗效和安全性的相关文献进行Meta分析,为早产儿喂养不耐受的治疗提供参考依据。方法检索Cochrane图书馆、PubMed、EMBASE、在研试验数据库、中国生物医学文献数据库、中国期刊全文数据库、万方数据库和维普中文科技期刊数据库等。检索红霉素防治早产儿喂养不耐受的RCT文献。按Cochrane系统评价方法进行文献质量评价,采用RevMan5．0．17软件进行Meta分析。结果共纳入18篇RCT文献,文献质量评价A级1篇,B级3篇,C级14篇。共纳入1200例早产儿。Meta分析结果显示：①达到全肠内喂养时间：红霉素预防组加权均数差值（WMD）=-4．18（95％CI：-6．29～-2．08）,红霉素治疗组WMD=-4．69（95％CI：-6．38～-3．00）,两组均可较早实现全肠内喂养;胎龄≤32周亚组WMD=-5．15（95％CI：-12．60—2．30）,与对照组差异无统计学意义。剔除低质量文献行敏感度分析,WMD=～5．48（95％CI：-11．66～0．69）,红霉素治疗组与对照组差异无统计学意义。②红霉素预防组住院时间（WMD=-1．10,95％CI：-3．65～1．37）和NEC发生率（OR=1．01,95％CI：0．24～4．22）与对照组差异无统计学意义;红霉素治疗组13均体重增加（WMD=4．29,95％CI：-2．06～10．64）和NEC发生率（OR=0．68,95％CI：0．18—2．56）与对照组差异无统计学意义;红霉素治疗组恢复至出生体重时间（WMD=-2．45,95％CI：-2．87～-2．04）、症状消失时间（WMD=-1．22,95％CI：-1．33--1．11）及住院时间（WMD=-9．70,95％CI：-11．92～-7．49）与对照组差异有统计学意义。结论对于喂养不耐受高危儿及胎龄≤32周的喂养不耐受早产儿,静脉应用小剂量红霉素的证据尚不足;对于胎龄〉32周的喂养不耐受早产儿,今后研究应确定是否存在一个最佳剂量以缩短静脉营养时间及住院时间,在改善喂养不耐受的症状中红霉素可能起一定的作用。     

高危晚期早产儿脑损伤病因学及其磁共振发现

目的探讨以弥散加权成像（DWI）结合常规磁共振成像（T1WI-T2WI）诊断的高危晚期早产儿脑损伤的相关危险因素及临床特点,并分析不同时间MRI序列的信号特点及DWI的早期诊断价值。方法首先对符合纳入标准的649例晚期早产儿的MRI片重新阅片,按照脑损伤评估标准得出诊断,其次收集相关的临床资料,分析不同类型脑损伤的危险因素和临床特点,并对其中271例确诊脑白质损伤（CWMD）的MRI序列进行分析,探讨不同类型CWMD的信号特点、损伤部位及结局。结果①晚期早产儿发生脑损伤332例（51．2％）,其中CWMD271例（41．8％）,以局灶性CWMD为主（62．7％,170例）;颅内出血112例（17．3％）,主要为蛛网膜下腔出血55．4％（62／112）。②非出血性脑损伤的危险因素是男性（OR=1．510,95％CI：1．067～2．136,P=0．020）、阴道分娩（OR：2．367,95％CI：0．251～22．294,P=0．000）、早发型败血症（OR=2．194,95％CI：1．159—4．155,P=0．016）及抢救复苏史（OR=3．784,95％CI：1．908～7．506,P：0．000）。出血性脑损伤的危险因素是阴道分娩（OR=7．195,95％CI：4．249～t2．184,P=0．000）和早发型败血症（OR：2．692,95％CI：1．185～6．117,P=0．018）。低钙血症（OR=2．593,95％CI：1．343—5．005,P=0．005）、晚发型败血症（OR=1．533,95％CI：1．012～2．323,P=0．044）和抽搐（OR=4．006,95％CI：1．790—8．970,P=0．001）是非出血性脑损伤组的主要临床特点。出血性脑损伤组主要表现为高血糖和抽搐。③局灶性CWMD65．3％仅累及一处损伤,主要集中在侧脑室后脚（53．5％）,有97．1％病灶消失或病灶范围减少;广泛性CWMD79．2％累及胼胝体和内囊;弥漫性CWMD50％合并灰质损伤,全部发生软化。④生后2周内,DWI具有较高的敏感性,98．0％表现为高信号,T1WI信号无变化或稍高信号,伴或不伴T2WI低信号。局灶性CWMDDWI高信号持续时间长达5周以上,弥漫性CWMDDWI高信号持续时间2周以内。结论晚期早产儿仍然容易受产前产时因素影响而发生不同类型的脑损伤。对有高危因素,或早期出现临床表现或电解质紊乱的患儿应选择生后2周内（1周内最佳）进行DWI和常规MRI检查,以早期发现病变。局灶性CWMD预后较好,合并有灰质损伤或弥漫性CWMD预后极差,需要动态随访,并进行早期康复训练。     

Effect of maternal HIV and malaria infection on pregnancy and perinatal outcome in Zimbabwe

OBJECTIVE: To investigate the effect of isolated or concomitant infection with malaria and HIV on pregnancy and neonatal outcome. METHODS: Data were collected on pregnant women admitted during the rainy seasons in the obstetric division of a district referral hospital in northern Zimbabwe in 2000 and 2001. The effects of malaria and HIV infection were determined by multivariate analysis. RESULTS: The prevalence of HIV seropositivity and symptomatic malaria in 986 pregnant women was 8.3% and 14.7%, respectively. HIV-infected women were more likely to develop malaria attacks during pregnancy than seronegative women (odds ratio [OR] = 3.96, 95% confidence interval (CI): 2.42-6.46). Malaria and HIV infections were associated with increased risk of stillbirth (OR = 4.74, 95% CI: 1.34-16.78) and preterm delivery (OR = 4.10, 95% CI: 2.17-7.75), respectively. They were independently associated with increased risk of low birth weight (malaria: OR = 10.09, 95% CI: 6.50-15.65; HIV: OR = 3.16, 95% CI: 1.80-5.54) and very low birth weight (malaria: OR = 5.04, 95% CI: 1.00-25.43; HIV: OR = 10.74, 95% CI: 2.12-54.41), low Apgar score (malaria: OR = 4.45, 95% CI: 1.42-13.94; HIV: OR = 5.94, 95% CI: 1.66-21.30), and fetal growth restriction (malaria: OR = 3.98, 95% CI: 2.51-6.30; HIV: OR = 4.07, 95% CI: 2.40-6.92). Dual infection with malaria and HIV was associated with increased risk of maternal, perinatal, and early infant death. CONCLUSIONS: Women with single HIV or malaria infection have a significantly increased risk of adverse outcomes of pregnancy and childbirth. Dual infection has additional detrimental effects on maternal and infant survival in an area where HIV and malaria coexist.     

系统评价胎龄小于32周早产儿预防性经鼻持续气道正压通气的作用

目的评价早产儿早期应用经鼻持续气道正压通气（NCPAP）预防呼吸窘迫综合征（RDS）,减少呼吸机应用、病死率和并发症的发生。方法以（prophylactic nasal CPAP OR early nasal CPAP）AND （preterm infants OR low birth weightinfants） ,经鼻持续气道正压通气AND（早产儿OR低出生体重儿）为英中文关键词,检索PubMed、EMBASE、Cochrane临床对照试验库、维普中文科技期刊数据库、中国知网和万方数据库,检索时间均从建库至2011年12月,并辅以手工检索。应用RevMan5．0软件进行Meta分析,根据异质性结果选择相应的效应模型分析;无法进行Meta分析时采用描述性分析。结果8篇RCT文献进入分析。Meta分析结果显示：NCPAP组未能显著降低早产儿气管插管呼吸机应用率（RR=-0．09,95％CI：-0．19～0．02,P=0．09）、RDS发生率（RR=0．81,95％CI：0．59—1．1,P=0．18）和病死率（RR=0．88,95％CI：0．72～1．09,P=0．25）;NCPAP组能显著减少早产儿肺表面活性物质应用率（RR=0．72,95％CI：0．64—0．80,P〈0．00001）。NCPAP组未能显著减少气管插管呼吸机通气时间（MD=-1．91d,95％CI：-6．47～4．45d,P=0．72）及氧气应用时间（MD=-0．46d,95％CI：-6．55—5．63d,P=0．88）。NCPAP组除增加气胸的发生率外,并未明显增加支气管肺发育不良、颅内出血、早产儿视网膜病、败血症、新生儿坏死性小肠结肠炎和动脉导管未闭等并发症的发生率。结论目前的证据表明早期应用NCPAP可减少肺表面活性物质应用,但增加了气胸的发生率;未能减少早产儿呼吸机应用、RDS发生率和病死率,未增加除气胸外的其他并发症发生率。     

MTHFR和CBS基因多态性与低出生体重的关系研究

目的探讨母亲亚甲基四氢叶酸还原酶（MTHFR）基因C677T、胱硫醚β-合酶（CBS）基因T833C与子代低出生体重发生之间的关系。方法运用聚合酶链反应（PCR）-限制性片段长度多态性与PCR-扩增阻滞突变体系技术分别检测母亲的MTHFR、CBS基因型,对MTHFR基因型、CBS基因型、基因型的交互作用与低出生体重的关系进行分析。结果MTHFR基因突变型、CBS基因突变型对低出生体重影响无统计学意义（P〉0．05）,但MTHFR基因突变型与CBS基因突变型对低出生体重的影响存在交互作用（OR=3．155,95％CI：1．229—8．528）。结论母亲MTHFR基因C677T、CBS基因T833C,与子代低出生体重发生无关,但MTHFR基因突变型与CBS基因突变型存在交互作用,其能增加子代低出生体重发生的危险。     

Risk of Pregnancy Complications and Low Birth Weight Offsprings in Korean Women With Rheumatic Diseases: A Nationwide Population-Based Study

BackgroundTo determine the risk of pregnancy complications and adverse offspring outcomes in Korean women with rheumatic diseases (RDs).MethodsWomen aged 20–44 years with pregnancies ending in delivery were identified from the National Health Insurance Service-National Health Information Database (2009–2016). Women with RD including systemic lupus erythematosus (SLE), seropositive rheumatoid arthritis (SPRA), and ankylosing spondylitis (AS) (n = 4,284) were age-matched with controls (n = 26,023). Outcome variables included threatened abortion (TA), preterm birth (PB), preeclampsia/eclampsia (PE/E), intrauterine growth retardation (IGR), urinary tract infection, low birth weight (LBW) offsprings, and offspring death within 1 year of birth.ResultsWomen with RDs had increased risks for cesarean section delivery (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.4–1.6), TA (OR, 1.4; 95% CI, 1.2–1.5), PB (OR, 2.4; 95% CI, 1.9–3.2), PE/E (OR, 4.4; 95% CI, 3.3–5.9), and IGR (OR, 2.4; 95% CI, 2.0–3.1) than the controls. The risk of pregnancy complications was increased in SLE and SPRA pregnancies but not in AS pregnancies. Offsprings of women with RDs had an increased risk of LBW (OR, 4.0; 95% CI, 3.2–4.9). The offspring mortality rate within 1 year of birth was higher in women with RDs (6.2/10,000 persons) than in the controls (4.9/10,000 persons).ConclusionWomen with RDs are at a risk of developing pregnancy complications, and the risk of LBW offsprings and offspring death within 1 year of birth is increased in these women. Therefore, this population requires special attention during their childbearing years.     

Maternal early second trimester pregnancy weight in relation to birth outcome among Bengalee Hindus of Kolkata, India

OBJECTIVE: The study examined to what degree maternal early second trimester pregnancy weight is useful and efficient in predicting birth outcome of Bengalee women. SUBJECTS AND METHODS: The cross-sectional retrospective study was conducted in a government general hospital in South Kolkata, India. This hospital serves the needs of people belonging to lower and lower middle class socio-economic groups. Data were collected by one-to-one interview for confirmation of age, history of last menstrual period (LMP) including medical disorders. Mother's weight was recorded at 14-18 weeks of pregnancy from the history of LMP. Birth weight was measured within 24h of delivery and gestational age was assessed by Ballard's method using newborn physical and neurological maturity scoring. Of the 331 Bengalees, 295 mother-baby pairs met the recruitment criteria and were included in this study. RESULT: Mean +/- SD maternal early second trimester pregnancy weight and birth weight were 45.9+/-7.0kg and 2612+/-371g, respectively. The difference in mean weight (3.74kg) between mothers who delivered low birth weight (LBW) and normal birth weight (NBW) babies was statistically significant (t = 4.497, p < 0.001). Overall, the prevalence of LBW was nearly 34%. A higher incidence of LBW and lower mean birth weight was observed in first quartile or low weight (< or =40 kg) mothers. The rate of LBW decreased (chi2 =14.47, p<0.01) and mean birth weight increased significantly with increasing maternal weight (F=9.218, p<0.001). Risk ratio (RR) for LBW, intrauterine growth retardation (IUGR) and preterm birth in low weight (first quartile or <40.0 kg) mothers were 2.72 (95% confidence interval (CI): 1.45-5.10), 3.54 (95% CI: 1.17-10.74) and 1.97 (95% CI: 0.56-6.90), respectively, compared with heavier (>50.0kg) mothers. Finally, the present data showed that the maternal weight of <46.0 kg is the best cut-off for detecting LBW with 66% sensitivity and 75% negative predictive power. CONCLUSION: The findings suggest a positive association between maternal early second trimester pregnancy weight and birth outcome. The present study provided an efficient cut-off point for detecting LBW. Antenatal caregivers in health institutions and community health workers in the field can use this cut-off value for screening pregnant women at early second trimester.     

Low birth weight,very low birth weight rates and gestational age-specific birth weight distribution of korean newborn infants

To obtain the low birth weight (LBW) rate, the very low birth weight (VLBW) rate, and gestational age (GA)-specific birth weight distribution based on a large population in Korea, we collected and analyzed the birth data of 108,486 live births with GA greater than 23 weeks for 1 yr from 1 January to 31 December 2001, from 75 hospitals and clinics located in Korea. These data included birth weight, GA, gender of the infants, delivery type, maternal age, and the presence of multiple pregnancy. The mean birth weight and GA of a crude population are 3,188 +/-518 g and 38.7+/-2.1 weeks, respectively. The LBW and the VLBW rates are 7.2% and 1.4%, respectively. The preterm birth rate (less than 37 completed weeks of gestation) is 8.4% and the very preterm birth rate (less than 32 completed weeks of gestation) is 0.7%. The mean birth weights for female infants, multiple births, and births delivered by cesarean section were lower than those for male, singletons, and births delivered vaginally. The risk of delivering LBW or VLBW infant was higher for the teenagers and the older women (aged 35 yr and more). We have also obtained the percentile distribution of GA-specific birth weight in infants over 23 weeks of gestation.     

Effects of posttraumatic stress disorder on pregnancy outcomes

BACKGROUND: The purpose of this study was to determine the association between posttraumatic stress disorder (PTSD), diagnosed prospectively during pregnancy, and the risk of delivering a low birth weight (<2500 g) or preterm (<37 weeks gestational age) infant. METHODS: Pregnant women were recruited from obstetrics clinics and screened for major and minor depressive disorder, panic disorder, PTSD, and substance use. Current episodes of PTSD were diagnosed according to the MINI International Neuropsychiatric Interview, and pregnancy outcomes were abstracted from hospital records. RESULTS: Among the 1100 women included in analysis, 31 (3%) were in episode for PTSD during pregnancy. Substance use in pregnancy, panic disorder, major and minor depressive disorder, and prior preterm delivery were significantly associated with a diagnosis of PTSD. Preterm delivery was non-significantly higher in pregnant women with (16.1%) compared to those without (7.0%) PTSD (OR=2.82, 95% C.I. 0.95, 8.38). Low birth weight (LBW) was present in 6.5% of women and was not significantly associated with a diagnosis of PTSD in pregnancy after adjusting for potential confounders. However, LBW was significantly associated with minor depressive disorder (OR=1.82, 95% C.I. 1.01, 3.29). LIMITATIONS: There was a low prevalence of PTSD in this cohort, resulting in limited power. CONCLUSIONS: These data suggest a possible association between PTSD and preterm delivery. Coupled with the association found between LBW and a depressive disorder, these results support the utility of screening for mental health disorders in pregnancy.