妊娠期维生素D水平与母婴结局的相关性

[目的] 探讨妊娠期妇女血清维生素D(VD)水平与母婴结局的相关性.[方法] 选择2015年1月至2016年1月在本院行产检的中晚期妊娠孕妇100例(观察组),另外选择同期健康体检正常女性(非妊娠)60例(对照组),采用酶联免疫吸附法检测两组血清25羟维生素D3[25(OH)D3] 水平,观察组根据25(OH)D3水平将其分为缺乏组、不足组与正常组,比较各组母婴结局.[结果] 观察组血清平均25(OH)D3水平为(42.58±11.34)nmol/L,显著低于对照组的(53.36±10.82)nmol/L,差异有统计学意义(P<0.05).观察组中VD正常组、不足组、缺乏组胎儿窘迫(3.85% vs 11.67% vs 35.71%)、流产(3.85% vs 10.00% vs 35.71%)、细菌性阴道病(0.00% vs 10.00% vs 28.57%)、分娩孕周[(39.50±1.42)vs(38.10±2.00)vs(37.28±0.50)周] 比较差异均有统计学意义(P<0.05),各组妊娠期糖尿病、妊娠期高血压、剖宫产、贫血、新生儿出生体质量、身长及头围比较差异均无统计学意义(P<0.05).[结论] 妊娠期妇女血清VD不足或缺乏会增加胎儿窘迫、流产及细菌性阴道病发生风险,明显缩短分娩孕周,但妊娠期VD水平与新生儿出生体格生长无关.     

瑞芬太尼和异丙酚对高危妊娠剖宫产产妇和新生儿的影响

目的观察瑞芬太尼和异丙酚全身麻醉对高危妊娠剖宫产产妇及新生儿的影响。方法选择2010年5月~2012年5月高危妊娠剖宫产产妇52例,按随机数字表法随机分为观察组和对照组各26例。观察组采用瑞芬太尼和异丙酚进行全身麻醉,对照组采用氯胺酮进行麻醉。比较两组新生儿Apgar评分、脐带血血气分析及两组产妇血流动力学变化。结果两组产妇插管、拔管时收缩压、舒张压、心率比较,差异有统计学意义(P<0.05),切皮时差异无统计学意义(P>0.05)。两组新生儿脐带血血气分析PaCO2、PaO2、pH、SaO2均在正常范围内,两组比较差异无统计学意义(P>0.05)。结论瑞芬太尼和异丙酚用于高危妊娠剖宫产产妇全身麻醉安全、平稳,循环稳定,对新生儿影响不大。     

妊娠肝内胆汁淤积症患者血清总胆汁酸水平与母体并发症及围产儿的关系

【目的】探讨妊娠肝内胆汁淤积症 (ICP)患者血清总胆汁酸 (TBA)水平与母体并发症及围产儿的关系。【方法】采用第五代循环酶法测定 118例ICP产妇 (ICP组 ,其中轻度 5 2例、中度 4 8例、重度 18例 )和5 4例正常晚期妊娠妇女 (对照组 )的血清TBA水平。【结果】ICP产妇血清TBA水平明显高于对照组 ,差异有显著 (P <0 .0 1) ,ICP患者母体并发症及围产儿患病率也明显高于对照组 ,差异有显著性 (P <0 .0 5 ) ,重度组患者与中度、轻度组比较差异有显著性 (P <0 .0 5 )。【结论】血清TBA测定对ICP患者早期诊断和治疗、母体并发症及围产儿病情观察及预后有重要意义     

妊娠高血压综合征对早期新生儿血液细胞的影响

目的：妊娠高血压综合征对早期新生儿血液细胞的影响及预后。方法：对230例患妊娠高血压综合征的产妇与132例未患妊娠高血压综合征的产妇,分别于产后24 h采集新生儿静脉血,进行化验分析对比。结果：妊娠高血压综合征组新生儿血小板、红细胞、血红蛋白、红细胞压积的数值与对照组存在差异;白细胞及中性粒细胞的数值与对照组相比无差异性。结论：妊娠高血压综合征未导致新生儿相关疾病（如新生儿出血症、红细胞增多症、败血症）的发生。     

Maternal Glycemic Dysregulation During Pregnancy and Neonatal Blood DNA Methylation: Meta-analyses of Epigenome-Wide Association Studies

OBJECTIVEMaternal glycemic dysregulation during pregnancy increases the risk of adverse health outcomes in her offspring, a risk thought to be linearly related to maternal hyperglycemia. It is hypothesized that changes in offspring DNA methylation (DNAm) underline these associations.RESEARCH DESIGN AND METHODSTo address this hypothesis, we conducted fixed-effects meta-analyses of epigenome-wide association study (EWAS) results from eight birth cohorts investigating relationships between cord blood DNAm and fetal exposure to maternal glucose (N_maximum = 3,503), insulin (N_maximum = 2,062), and area under the curve of glucose (AUC_gluc) following oral glucose tolerance tests (N_maximum = 1,505). We performed lookup analyses for identified cytosine-guanine dinucleotides (CpGs) in independent observational cohorts to examine associations between DNAm and cardiometabolic traits as well as tissue-specific gene expression.RESULTSGreater maternal AUC_gluc was associated with lower cord blood DNAm at neighboring CpGs cg26974062 (β [SE] −0.013 [2.1 × 10⁻³], P value corrected for false discovery rate [P_FDR] = 5.1 × 10⁻³) and cg02988288 (β [SE]−0.013 [2.3 × 10⁻³], P_FDR = 0.031) in TXNIP. These associations were attenuated in women with GDM. Lower blood DNAm at these two CpGs near TXNIP was associated with multiple metabolic traits later in life, including type 2 diabetes. TXNIP DNAm in liver biopsies was associated with hepatic expression of TXNIP. We observed little evidence of associations between either maternal glucose or insulin and cord blood DNAm.CONCLUSIONSMaternal hyperglycemia, as reflected by AUC_gluc, was associated with lower cord blood DNAm at TXNIP. Associations between DNAm at these CpGs and metabolic traits in subsequent lookup analyses suggest that these may be candidate loci to investigate in future causal and mediation analyses.     

An Early Pregnancy Unit in the United States: An Effective Method for Evaluating First‐Trimester Pregnancy Complications

In the United Kingdom, early pregnancy assessment clinics have existed since the early 1990s and have become the reference standard for evaluating and treating women with first‐trimester pregnancy complications. These units have now been established in many countries and have been found to be effective and efficient, saving money and unnecessary emergency department visits and hospital admissions. To our knowledge, no such model has been described in the United States. A PubMed search using a combination of “early pregnancy unit,” “early pregnancy assessment clinic,” and “United States,” “U.S.,” and “America” on May 14, 2017, yielded no results. Denver Health, a safety net hospital in Denver, Colorado, has established the first known early pregnancy unit in the United States. Patients with positive urine pregnancy test results who are in their first trimester by best estimation, have not had a prior ultrasound examination, and present to their primary care providers with pain, bleeding, history of an ectopic pregnancy, history of a tubal ligation, or conception with an intrauterine device in place are eligible to be evaluated in the early pregnancy unit. This article describes our clinical setup, methods, and findings in the first 2 years of the unit's inception with the intention of serving as a model for the establishment of more early pregnancy units throughout the United States.     

7931名早孕期女性营养素补充剂使用状况调查

  目的  了解我国早孕期女性营养素补充剂的使用现状,并分析其影响因素。  方法  本研究数据来自中国孕产妇队列研究(Chinese Pregnant Women Cohort Study,CPWCS),该项目于2017年7月25日至2018年7月24日招募早孕期女性,应用在线问卷的方式调查孕妇营养素补充剂使用状况,包括是否使用营养素补充剂及使用种类。采用多因素Logistic回归分析各种营养补充剂使用的影响因素。  结果  共入选7931名符合纳入标准的早孕期女性。其中使用营养素补充剂7431名(93.7%,7431/7931),各类营养素补充剂使用率由高至低依次为叶酸(88.7%,7034/7931)、复合维生素(43.5%,3451/7931)、钙(29.0%,2297/7931)、维生素D(23.8%,1891/7931)、益生菌(22.4%,1778/7931)、铁(21.9%,1739/7931)、膳食纤维(18.9%,1497/7931)及二十二碳六烯酸(17.0%,1350/7931)。使用2种及以上营养素补充剂者最多(60.0%,4678/7931),其次为使用1种营养素补充剂者(34.7%,2753/7931),未使用营养素补充剂者最少(6.3%,500/7931)。多因素Logistic回归分析表明,孕妇年龄、孕妇及其配偶文化程度是影响早孕期孕妇使用营养素补充剂的主要因素。  结论  早孕期女性使用营养素补充剂较普遍,其种类以叶酸、复合维生素为主,存在同时使用多种营养素补充剂的现象。孕妇及其配偶的社会经济地位与营养素补充剂的使用有关。     

自然妊娠和辅助生殖技术妊娠母婴不良结局及其危险因素分析

目的探讨自然妊娠和辅助生殖技术(ART)妊娠母婴不良结局及其危险因素,为母婴不良结局的预防提供依据。方法随机选取2014年4月~2015年4月期间广东省清远市妇幼保健院产检及跟踪妊娠结局的ART妊娠妇女100例作为ART组,另选取500例同期自然妊娠妇女为对照组。比较两组母婴不良结局及其危险因素。结果 ART组早产、流产、剖宫产等不良母婴结局的总发生率(87.0%)高于对照组(59.2%)(P0.05)。单因素分析结果显示,ART妊娠母婴不良结局的相关因素为多胎妊娠、年龄、妊娠期糖尿病(GDM)、体质量指数(BMI)高、流产史,自然妊娠母婴不良结局的相关因素为年龄、妊娠期高血压疾病、GDM、BMI高、流产史(P0.05或P0.01)。Logistic多元回归分析结果显示,年龄、GDM、流产史、妊娠期高血压疾病和年龄、GDM、流产史、多胎妊娠亦分别为自然妊娠和ART妊娠母婴不良结局的危险因素(P0.05或P0.01)。结论 ART妊娠母婴不良结局发生率较高且其发生与年龄、GDM、流产史和多胎妊娠有关,自然妊娠母婴不良结局则与年龄、GDM、流产史和妊娠期高血压疾病有关。应根据不同妊娠方式的不良母婴结局危险因素进行相应的干预处理,避免高龄妊娠或流产、积极防治GDM和尽早行多胎妊娠干预有助于改善ART妊娠母婴结局。