重庆市孕前生殖健康与出生结局队列：设计简介与建设概况

出生队列是研究生命早期暴露对健康结局影响的重要工具, 但目前缺乏有力支撑孕前暴露特别是父系暴露对生殖健康和妊娠结局影响研究的大型队列平台。重庆市孕前生殖健康与出生结局队列研究是起始于孕前阶段, 同等关注男女双方的环境、心理、行为等暴露因素对生殖健康和不良妊娠结局影响的前瞻性队列研究。项目于2019年正式启动, 计划招募有生育意愿的育龄夫妇20 800人。通过随访, 调查志愿者2年内是否自然受孕。对进入妊娠期的女性志愿者, 在孕早、中、晚期进一步随访, 并对分娩的子代随访至2岁, 监测早产、低出生体重、出生缺陷、神经功能发育障碍等结局发生情况。各阶段分别采集相应的数据信息和生物样本, 包括精液、外周血、尿液、胎盘、脐带、脐带血、口腔拭子等。截至2022年1月, 已纳入志愿者8 698人, 分布于重庆市所有38个区/县。本队列建设目标是成为涵盖父母双方的前瞻性大样本孕前出生队列, 将以独特的设计和更加全面的视角阐明全生育周期特别是孕前期暴露因素对生殖健康和不良出生结局的影响及机制。     

纽约上州儿童出生队列研究

纽约上州儿童研究(Upstate Kids Study)主要聚焦出生前因素(母亲孕前健康及不孕不育治疗)与儿童生长发育的关联.该研究以出生证明登记为起点来建立队列,并随访至儿童期结束,较好地阐明了孕前健康及不孕不育治疗对儿童生长发育的影响,提高了人们对影响儿童生长发育因素的新认识,并提出可能可行的干预措施.     

出生队列技术规范第2部分:长期随访(T/CPMA 015.2-2020)

出生队列研究的长期随访围绕研究人群的环境、遗传、生活行为习惯等因素和生殖健康相关结局开展孕前、孕期、产后和子代生长发育不同阶段的长期、连续、动态的追踪随访,是出生队列研究工作的重要内容,也是出生队列研究取得成功的关键。本文件就出生队列长期随访、拒访和失访处理、研究对象依从性维护以及质量控制等主要工作制定规范。     

中国出生队列研究进展

出生队列研究历经100余年发展,在探讨孕前及孕期环境暴露对婴儿、儿童、青少年、成年人及老年人健康的影响中发挥了巨大的作用。我国出生队列研究起步较晚,但发展迅速。近年来,中国大陆以及香港地区、台湾地区先后建立起一批大型出生队列研究。本文将针对中国目前已开展的出生队列研究进行简要综述。     

城市妇女孕前体质指数对孕期血糖、血压和体重变化的影响

目的观察孕前体质指数对孕期妇女血糖、血压和体重变化的影响。方法采用队列研究方法对2009年2月5日至2009年3月15日在北京海淀妇幼保健院建围产保健卡的北京市孕妇600名进行随访,监测整个孕期身高、体重、血压、血糖等指标的变化。结果孕前体质指数与不同孕期体重有显著相关性(p0.001),超重和肥胖孕妇的糖耐量受损和糖尿病、高血压患病率在不同孕期阶段均显著高于低体重和正常孕妇的患病率(P0.05)。结论孕前体质指数是影响孕期妇女血压、血糖和体重变化的重要危险因素,开展孕前健康教育是预防妊娠期并发症的重要措施。     

中国国家出生队列研究质量控制策略与措施

出生队列是研究孕前和孕期各种环境暴露因素与胎儿、婴幼儿、青少年健康之间关系的有效方法。出生队列建设周期长、环节众多,研究质量可能受到多种因素的影响。本文对中国国家出生队列建设过程中的各项质量保证和质量控制措施进行梳理,归纳总结建设经验。以期为相关队列研究提供经验,减少相关因素对队列研究的影响,提升队列研究质量。中国国家出生队列在质量保证的顶层设计方面采取一系列措施保障研究质量,包括研究中心筛选、成员管理系统开发、标准化操作流程制定及工作人员规范化培训;在质量控制方面,包括针对队列数据产生过程的实时、及时、定时质控,针对生物样本采集、处理及保存的全周期质控,以及针对参与工作人员的培训、督查和量化考核的全面立体质控。     

孕前BMI和孕期增重对产后1年内体重滞留的影响研究

目的探索妇女孕前体重及孕期增重对产后体重滞留的影响。方法采用历史-前瞻性队列研究设计,选择合肥市某区的产后妇女作为观察对象,于产后3个月建立观察队列,通过孕期保健档案和信息系统获取产前检查信息,于产后3、6、9和12个月连续观察。观察指标包括基线资料、孕前体重和孕期增重、产后一年内不同时间点的体重。结果产后3、6、9和12个月时BMI恢复到正常范围者所占的比例分别为61.92%、68.73%、78.18%和84.24%。孕前BMI不同的妇女孕期增重和体重滞留在3、6、9和12个月各个时间点上均存在差异,孕前BMI较高组与孕前BMI适中组、孕前BMI较低组分别进行比较,差异具有统计学意义。孕期增重和时间对产后体重的恢复均具有独立的效应,但两者之间不存在交互效应。结论孕前BMI、孕期体重增加是产后体重滞留的重要因素。根据孕前BMI指导孕期合理体重增加,能减少产后体重滞留,促进产后恢复。     

孕前女性牙周病与口腔菌群的关联研究

目的描述孕前女性牙周病与口腔唾液菌群的关联,探索患有牙周病的孕前妇女口腔唾液特征菌群。方法基于复旦大学公共卫生学院孕前队列,选取2016-2019年在上海市嘉定区妇幼保健院孕前体检夫妇中患有牙周病并计划备孕的妇女58例,以及60例牙周健康者作为研究对象,采用16S r DNA测序技术对118份唾液样本进行检测,比较两组口腔唾液菌群的特征和差异菌群。结果两组口腔唾液菌群在群落结构方面差异有统计学意义(F=2.739,P<0.05);与牙周健康者相比,患有牙周病的孕前妇女口腔微生物的丰富度显著更高[646.40(544.57,932.47)vs.777.26(649.64,1018.83),Z=2.740,P<0.05],提示牙周病患者口腔内富集更多微生物。差异菌群分析结果显示,患有牙周病的孕前女性口腔唾液中显著富集了牙周致病菌属如卟啉单胞菌属(Por Phyromonas)、Filifactor菌属和Parvimonas菌属,除此之外,还包括消化链球菌属(Pe Ptostre Ptococcus)、普雷沃菌_7属(Prevotella_7)等;而在健康人群中显著富集伯杰氏菌属(Bergeyella)、弯曲杆菌属(Cam Pylobacter)等(LDA得分>2.000,P<0.05)。结论育龄女性在备孕前应当重视牙周健康,保持良好的口腔环境,建议为备孕女性提供口腔检查,为牙周病患者提供及时的治疗与保健咨询服务。     

妊娠早期有机氯农药暴露与妊娠期糖尿病的关联研究

目的 研究妊娠早期血浆有机氯农药(OCPs)暴露与妊娠期糖尿病(GDM)发病的关联.方法 采用基于出生队列的巢式病例对照设计,从北京市通州区妇幼保健院自2018年6月开始建立的前瞻性队列(PKUBC-T出生队列)中随机抽取200名GDM孕妇(GDM组),以年龄和口服糖耐量试验孕周为匹配条件1:1匹配200名健康孕妇(对...     

孕前健康风险评估的基础、工具和方法

孕前健康风险评估是推广孕前保健模式的首要环节,一般采用评估量表初筛并与体格检查和实验室检查相结合。本文简单介绍了孕前健康风险评估的基础、工具和方法。我国在这方面还处于起步阶段,结合我国国情,引入疾病筛查和个体健康危险因素评价的基本原理和思路将有助于发展适用于我国的孕前健康风险评估工具和方法。     

Preconception Mental Health Predicts Pregnancy Complications and Adverse Birth Outcomes: A National Population-Based Study

Pregnancy complications and poor birth outcomes can affect the survival and long-term health of children. The preconception period represents an opportunity to intervene and improve outcomes; however little is known about women's mental health prior to pregnancy as a predictor of such outcomes. We sought to determine if and to what extent women's preconception mental health status impacted subsequent pregnancy complications, non-live birth, and birth weight using a nationally representative, population-based sample. We used pooled 1996-2006 data from the nationally-representative Medical Expenditure Panel Survey (MEPS). Poor preconception mental health was defined as women's global mental health rating of "fair" or "poor" before conception. Logistic regression was used to assess the association between preconception mental health and pregnancy complications, non-live birth, and having a low birth weight baby within the follow up period. Poor preconception mental health was associated with increased odds of experiencing any pregnancy complication (AOR 1.40, 95% CI: 1.02-1.92), having a non-live birth (AOR 1.48, 95% CI: 0.96-2.27), and having a low birth weight baby (AOR 1.99, 95% CI: 1.00-3.98), all controlling for maternal age, race/ethnicity, marital status, education, health insurance status, income, and number of children in the household. Significant racial and ethnic disparities exist for pregnancy complications and non-live births, but not for low birth weight. Women's preconception mental health is a modifiable risk factor that stands to reduce the incidence of adverse pregnancy complications and birth outcomes.     

Pregnancy Intention and Health Behaviors: Results from the Central Pennsylvania Women’s Health Study Cohort

Objective Our objective was to determine whether intention for future pregnancy affects selected preconception health behaviors that may impact pregnancy outcomes. Methods Analyses are based on data from a population-based cohort study of women ages 18–45 residing in Central Pennsylvania. A subsample of 847 non-pregnant women with reproductive capacity comprise the analytic sample. We determined the associations between intention for future pregnancy and the pattern in the following health behaviors over a 2-year period: nutrition (fruit and vegetable consumption), folic acid supplementation, physical activity, binge drinking, smoking, and vaginal douching. Multivariable analyses controlled for pregnancy-related variables, health status, health care utilization, and sociodemographic variables. Results At baseline, 9% of women were considering pregnancy in the next year, 37% of women were considering pregnancy some other time in the future, and 53% of women were not considering future pregnancy. In multivariable analyses, there were no associations between intention for future pregnancy and maintaining healthy behavior or improving behavior for any of the seven longitudinal health behaviors studied. Conclusions The importance of nutrition, folic acid supplementation, physical activity, avoiding binge drinking, not smoking, and avoiding vaginal douching in the preconception period needs to be emphasized by health care providers and policy makers.     

The Association Between Preconception Care Receipt and the Timeliness and Adequacy of Prenatal Care: An Examination of Multistate Data from Pregnancy Risk Assessment Monitoring System (PRAMS) 2009–2011

Objectives Prenatal care (PNC) is a critical preventive health service for pregnant women and infants. While timely PNC has been associated with improved birth outcomes, improvements have slowed since the late 1990s. Therefore, focus has shifted to interventions prior to pregnancy. Preconception care is recommended for all women of reproductive age. This study aimed to examine preconception care and its association with timeliness and adequacy of PNC. Methods This retrospective cohort study used data from a large sample of United States first-time mothers (n?=?13,509) who participated in the 2009–2011 Pregnancy Risk Assessment Monitoring System in ten states. Timeliness and adequacy of PNC data came from birth certificates, while preconception care receipt was self-reported. Logistic regression provided odds ratios (ORs) and 95% confidence intervals (CIs) to model the association between preconception care receipt and the two PNC outcomes. Results After adjustment, women who received preconception care had statistically significant increased odds of timely (OR 1.30, 95% CI 1.08, 1.57), but not adequate PNC (OR 1.08, 95% CI 0.94, 1.24) as compared to women who did not receive preconception care. Pregnancy intention modified these associations. Associations were strongest among women with intended pregnancies (timely PNC: OR 1.63 and adequate PNC: OR 1.22). Conclusions for Practice Given that untimely PNC is associated with adverse birth outcomes, the observed association warrants increased focus on implementing preconception care. Future studies should investigate how specific components of preconception care are associated with PNC timeliness/adequacy, health behaviors during pregnancy, and birth outcomes.     

Exploring Knowledge and Attitudes Related to Pregnancy and Preconception Health in Women with Chronic Medical Conditions

Women with chronic medical conditions are at increased risk for pregnancy-related complications, yet little research has addressed how women with diabetes, hypertension, and obesity perceive their pregnancy-associated risks or make reproductive health decisions. Focus groups were conducted with 72 non-pregnant women stratified by chronic condition (diabetes, hypertension, obesity) and by previous live birth. Participants discussed their intention for future pregnancy, preconception health optimization, perceived risk of adverse pregnancy outcomes, and contraceptive beliefs. Four major themes were identified, with some variation across medical conditions and parity: (1) Knowledge about pregnancy risks related to chronic medical conditions was limited; (2) Pregnancy intentions were affected by diabetes and hypertension, (3) Knowledge about optimizing preconception health was limited; and (4) Lack of control over ability to avoid unintended pregnancy, including limited knowledge about how medical conditions might affect contraceptive choices. Women with diabetes and hypertension, but not obesity, were generally aware of increased risk for pregnancy complications, and often expressed less intention for future pregnancy as a result. However, diabetic and hypertensive women had little knowledge about the specific complications they were at risk for, even among those who had previously experienced pregnancy complications. Neither chronic condition nor perceived risk ensured intent to engage in preconception health promotion. We observed knowledge deficits about pregnancy-related risks in women with diabetes, hypertension, and obesity, as well as lack of intent to engage in preconception health promotion and pregnancy planning. These findings have important implications for the development of preconception care for women with chronic medical conditions.     

Preconception health care: a critical task for family physicians

Health care leaders in the United States have recently advised that preconception care be made available to all prospective parents because health in pregnancy depends on health status prior to pregnancy. Prenatal care usually begins after the early critical period of pregnancy has passed, and optimal early prenatal care can be achieved only through preconception care. Family physicians, who are ideally suited to provide this care, can readily integrate it into the routine health maintenance they currently provide for their patients of childbearing age. This review highlights components of the medical, family, and social histories, current health, and physical examination that are important to preconception health. There is good evidence that attention to patients' health needs before conception is related to improved perinatal outcomes.     

Surveillance of preconception health indicators among women delivering live-born infants--Oklahoma, 2000-2003

Promoting preconception health of women is a key public health strategy in the United States to decrease morbidity and mortality associated with adverse maternal and infant outcomes. In 2006, CDC published 10 recommendations for improving the health of women before pregnancy; one recommendation proposed maximizing public health surveillance to monitor preconception health. Toward this end, data collected in Oklahoma (the only state to develop a detailed survey question on preconception health) during 2000-2003 from the Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed to 1) estimate the prevalence of women who did not report three selected preconception health indicators, (i.e., pre-pregnancy awareness of folic acid benefits, multivitamin consumption, and receipt of health-care counseling) and 2) identify those subpopulations of women who were more likely not to report these indicators. Results of this analysis indicated that 21.5% of Oklahoma women with a recent live birth were not aware of folic acid benefits before they became pregnant, 73.5% did not consume multivitamins at least four times per week during the month before pregnancy, and 84.8% did not receive preconception counseling from a health-care provider. Subpopulations of women with characteristics (at the time of conception) significantly associated (p<0.05) with not reporting at least two of the three indicators included those who were younger, were unmarried, had < or =12 years of education, had no health insurance, had an unintended pregnancy, or had a previous live birth. Other states might use this analysis to help develop preconception health questions to be included in their own PRAMS surveys; Oklahoma state and local health officials can use the results to help prioritize preconception health objectives and identify subpopulations of women in need of targeted programs.     

城乡育龄妇女孕前心理压力及妊娠结局研究

目的：对育龄妇女的基本情况、孕前心理压力和妊娠结局进行城乡比较,为改善城乡育龄妇女的孕前健康状况提供科学依据。方法选取2010—2013年参加国家免费孕前健康检查的健康、初孕育龄妇女560525人,分析城乡育龄妇女的孕前心理压力和妊娠结局分布情况,并应用 Logistic 回归分析方法分析城乡因素对育龄妇女孕前心理压力和妊娠结局的影响。结果城市育龄妇女的平均年龄显著高于农村育龄妇女;城市育龄妇女多为高学历人群,职业多为教师、公务员、职员或工人;而农村育龄妇女多为初中学历,农民。城市育龄妇女感到有心理压力的比例（40.0％）显著高于农村育龄妇女（20.0％）,孕前有心理压力的发生比是农村育龄妇女的1.35倍。城市育龄妇女不良妊娠结局比例（6.8％）高于农村育龄妇女（5.9％）,不良妊娠结局的发生比是农村育龄妇女的1.08倍。结论参加国家免费孕前优生健康检查的育龄妇女在人口学特征、孕前心理压力和妊娠结局等多方面存在城乡差异。     

孕前职业久站行为与妊娠并发症的因果效应研究

目的描述安徽省马鞍山地区孕妇在孕前和孕早期工作中站立时间以及长时间站立行为的分布特征,探索该职业暴露与妊娠高血压等常见并发症的相关性.方法于2008年10月至2010年10月在马鞍山市妇幼保健机构招募初次建卡孕妇,建立孕产妇队列并随访至分娩.分别于孕早、中、晚期在产检医生指导下由孕产妇自填问卷,收集相关信息.结果4644名孕妇孕前和孕早期持续站立时间百分位数P75值分别为4.0 h/d和3.0 h/d;孕前和孕早期久站行为主要分布于较低经济社会地位特征孕妇中;多因素分析结果显示,在调整可能混杂因素后,孕前久站行为与妊娠合并高血压和中度贫血均呈显著正相关,其OR值分别为2.05(95%CI:1.26～ 3.31)和1.38(95%CI:1.03～1.85).结论孕前职业暴露于较重体力负荷的工作如长时间站立,可增加妊娠高血压等疾病的危险.     

Chronic Stress and Preconception Health Among Latina Women in Metro Atlanta

Maternal and Child Health Journal - Underserved subgroups are less likely to have optimal health prior to pregnancy. We describe preconception health indicators (behavior, pregnancy intention, and...