Shoulder dystocia: nursing prevention and posttrauma care

Shoulder dystocia is a birth emergency that occurs in approximately 1% of all births. Shoulder dystocia can be followed by broken clavicle or humerus, brachial plexus injury, fetal hypoxia, or death. Although risk factors for shoulder dystocia include previous birth complicated by shoulder dystocia, maternal obesity, excessive prenatal weight gain, fetal macrosomia, gestational diabetes, and instrumental delivery, shoulder dystocia is not predictable. Perinatal nurses can reduce the risk for shoulder dystocia by teaching mothers about optimal weight gain in pregnancy and assisting mothers with diabetes to prevent hyperglycemia through diet management and medication use. During childbirth preparation or early labor, nurses can educate mothers about position changes and maneuvers used for shoulder dystocia. Nurses play a vital role in obtaining assistance during a shoulder dystocia, keeping time, assisting with maneuvers such as suprapubic pressure, and documenting the dystocia management. Nurses can assist mothers and families to review the shoulder dystocia and any newborn injuries in the postpartum period, thereby reducing confusion and anxiety. Regular drills and case reviews help build nursing shoulder dystocia management skills.     

孕期体重控制与母儿并发症的相关性研究

目的探讨孕期体重控制与母儿并发症间的相关性。方法回顾性分析我院2008年6月-2009年6月孕妇体重与母婴并发症相关性制定观察指标。选取2009年7月-2011年6月在我院建立围产期保健卡并分娩的166例BMI≥24孕妇进行前瞻性调查,根据是否实施孕期体重控制,将其分为观察组和对照组。观察并比较两组母儿并发症。结果回顾性分析表明:妊娠期高血压、妊娠期糖尿病、过期妊娠、宫缩乏力、产程阻滞、产后出血、相对性头盆不称、巨大儿、难产及肩难产的发生率与孕妇体重相关。前瞻性调查表明观察组的该9项母儿并发症的发生率明显低于对照组(P<0.05)。结论对BMI≥24孕妇实施孕期体重控制,能明显降低母儿并发症,改善母儿预后,对临床孕期保健有重要指导意义。     

Risk of congenital anomalies detected during antenatal serum screening in women with pregestational diabetes

BACKGROUND: Most studies comparing women with and without pregestational diabetes mellitus have not systematically screened for fetal anomalies in early pregnancy, potentially leading to selection bias. AIM: To evaluate the risk for certain congenital anomalies in women participating in an antenatal maternal screening program. DESIGN: Retrospective cohort study. METHODS: We studied all women who underwent antenatal maternal serum screening in Ontario from 1994 to 2000. Fetal anomalies were documented antenatally by ultrasonography or at autopsy, and postnatally diagnosed birth defects were recorded after 20 weeks gestational age for all live- and stillborn affected infants. We compared the risk of open neural tube defects and urinary tract defects among women with and without pregestational diabetes. RESULTS: Of 413,219 women screened during pregnancy, 2069 (0.5%) had diabetes. Compared to non-diabetic women, the adjusted odds ratios (95%CI) for neural tube and urinary tract defects among women with diabetes were 2.5 (0.9-6.8) and 2.6 (1.4-4.9), respectively. DISCUSSION: Among women who undergo second trimester maternal serum screening, pregestational diabetes is associated with an increased risk of having a fetus with an open neural tube defect or urinary tract disorder.     

2000-2014年浙江省舟山市孕妇孕期增重变化趋势及其影响因素

目的 描述2000-2014年浙江省舟山市孕妇孕期增重变化趋势,并分析其影响因素。方法 采用病例回顾分析方法,根据国际医学研究院（IOM）标准将孕妇分为孕期正常增重组、过多组和不足组3组,采用2趋势检验分析各组增重不足率或增重过多率随年份变化的趋势,并利用多元线性回归和多元logistic回归分析其影响因素。结果 2000-2014年,舟山市孕妇孕期平均增重16.04 kg,各年间孕妇的平均增重无太大差别,有3 886人（13.90%）增重不足,12 433人（44.40%）增重过多。多元回归分析显示,孕前期超重/肥胖（OR=14.49,95%CI:11.07~18.98）的孕妇更易导致孕期增重过多,而受孕季节为秋季（OR=2.72,95%CI:2.43~3.05）、冬季（OR=2.47,95%CI:2.21~2.77）则会导致孕期增重不足的发生。此外,孕妇年龄、文化程度、孕妇职业、分娩孕周也会影响孕期增重。结论 舟山市孕妇孕期增重趋势表现为2007年前逐渐升高,2007年后缓慢降低。孕前体质量指数、文化程度以及受孕季节是影响孕期增重的主要因素。应加强妊娠期保健的宣传教育,指导孕妇在孕前和孕期均应合理膳食,加强锻炼,控制体重,促进母婴健康。     

成都地区中老年人群体质量指数及腹型肥胖对糖尿病患病率及空腹血糖水平的影响

目的研究成都地区中老年人群体质量指数(BMI)及腹型肥胖对糖尿病患病率及空腹血糖水平的影响。方法 2007年5月,采用随机抽样方法抽取50～80岁中老年人685人进行心血管危险因素调查,其男394人,女291人,年龄(63.3±0.2)岁。结果成都地区中老年人群的超重和肥胖所占的比例较大(约44.3%),按BMI分组(BMI<24 kg/m2;24 kg/m2≤BMI<28 kg/m2;BMI≥28 kg/m2)的糖尿病患病率分别为14.0%、18.7%及23.3%,组间差异有统计学意义(P=0.031)。男女分别按腹型肥胖标准分组(男性切点=85 cm,女性切点=80 cm),男性糖尿病患病率在非腹型肥胖及腹型肥胖组分别为17.9%及18.7%组间差异无统计学意义(P=0.849),女性糖尿病患病率分别为9.7%及18.4%,组间差异有统计学意义(P=0.034)。整个人群中,空腹血糖无随BMI增加而升高的趋势(P=0.071);女性人群中,空腹血糖随腰围的增加而升高(P=0.001);而在男性人群中无此趋势。在调整相关指标后,logistic回归分析提示BMI对糖尿病患病率独立影响,以BMI正常为参照,超重及肥胖的OR值分别为:1.412[95%CI(0.818,2.437),P=0.215]及2.200[95%CI(1.034,5.178),P=0.046]。在调整相关指标后,腹型肥胖在女性人群中对糖尿病患病率独立影响,以非腹型肥胖为参考,腹型肥胖的OR值为:1.394[95%CI(1.080,3.205),P=0.041],而在男性人群中无此关系。结论成都地区中老年人群超重及肥胖所占的比重较大,BMI可影响糖尿病患病率及空腹血糖水平;腹型肥胖能够影响女性人群糖尿病患病率及空腹血糖水平,但在男性人群中无此关系。     

Prevalence and determinants of type 2 diabetes among Filipino-Americans in the Houston, Texas metropolitan statistical area.

OBJECTIVE: The few available studies suggest that Filipino-Americans have an increased risk for developing type 2 diabetes. The purpose of this study was to determine the prevalence of previously diagnosed type 2 diabetes and its major risk factors among Filipino-Americans. RESEARCH DESIGN AND METHODS: A cross-sectional survey was conducted in the Houston, Texas, metropolitan statistical area between September 1998 and March 2000. The convenience sample included 831 Filipino-American participants aged 20-74 years. The major risk factors assessed were age, sex, family history of diabetes, socioeconomic status, obesity (BMI >30), physical inactivity, acculturation, region of birth and, in women, history of gestational diabetes and delivery of a baby weighing > 9 lb. RESULTS: Overall prevalence was estimated to be 16.1% (95% CI 13.5-18.7). Multivariate logistic regression analyses identified independent risk factors: increasing age from ages 35-44 years (odds ratio [OR] 5.6, 95% CI 1.5-20.5) to 65-74 years (34.2, 7.2-163.0); male sex (1.8, 1.1-32.1); family history of diabetes (4.7, 2.6-8.5); obesity (3.6, 1.4-9.0); region of birth, Mindanao (3.2, 1.3-7.7); and, among women, gestational diabetes (21.7, 6.7-69.7) and low income (5.3, 1.4-20.2). CONCLUSIONS: The study observed a high prevalence of type 2 diabetes and supports earlier studies suggesting that Filipinos are at higher risk for type 2 diabetes than the U.S. non-Hispanic white population.     

肩难产高危因素、产程特点及并发症

  目的  探讨肩难产发生的高危因素、产程特点及其对母婴结局的影响。  方法  选择北京协和医院1993年至2012年间的81例肩难产患者作为病例组, 同期随机选取的足月、单胎、头位、阴道分娩者共6299例为对照组, 回顾性分析肩难产发生的高危因素及其对母婴结局的影响。  结果  肩难产的发生率为0.47%(81/17 287)。分娩时孕周大于40周及合并糖尿病者肩难产的发生率明显增加(P均 < 0.001)。肩难产组产程中出现宫缩乏力、胎心监护异常、羊水Ⅲ度污染的比例明显高于对照组(P均 < 0.001)。肩难产组中有更多的患者采取了助产及会阴切开(P均 < 0.001)。肩难产组的新生儿体重明显大于对照组(P=0.004), 新生儿锁骨骨折、臂丛神经损伤、新生儿窒息及会阴Ⅱ度以上裂伤的比例高于对照组(P均 < 0.001)。多因素Logistic回归分析显示巨大儿、宫缩乏力、合并糖尿病、采用助产、孕周大于40周为导致肩难产的独立危险因素(P均 < 0.001)。  结论  巨大儿、合并糖尿病、孕周大于40周是肩难产发生的高危因素, 产程中出现继发性宫缩乏力、采用助产时要高度警惕肩难产发生的可能。母婴并发症与是否使用助产及新生儿出生体重有关。     

孕妇孕前肥胖及孕期体重增长过度对分娩结局的影响

目的探讨孕妇孕前肥胖及孕期体重增长过度对分娩结局的影响。方法选择经筛选符合孕前肥胖及孕期体重增长过度的孕妇98例作为观察组,并随机抽取280例孕妇作为对照组。分别观察两组孕产妇的分娩方式,新生儿体重及产妇产后出血的发生情况。结果两组孕产妇分娩方式、新生儿体重及产妇产后出血情况比较,经统计学分析．P〈0.01,差异具有统计学意义。结论孕前肥胖及孕期体重增长过度对孕产妇和新生儿体重均产生不利影响,增加了分娩期并发症、巨大儿和剖宫产的发生率。     

Smoking status, obesity and hypertension in a general population sample: a cross-sectional study

BACKGROUND: In some studies, hypertension is more common in never and former smokers than in current smokers. AIM: To examine the associations between hypertension and smoking status, when divided into subgroups by overweight and obesity. DESIGN: Cross-sectional study. METHODS: We used data from a national health survey with a probability sample of the national population of Germany aged 18 to 79 (n = 6903 with complete data). Smoking status data were collected via questionnaire. Obesity and overweight were assessed by body mass index, hypertension by blood pressure measurement and by participants' statements about antihypertensive treatment. Analyses were adjusted for gender, age, history of coronary artery disease, serum cholesterol levels, alcohol drinking, exercise, and education. RESULTS: Obese former smokers who were abstinent for 3 or more years had an adjusted odds ratio (OR) 3.6 (95% confidence interval, CI 2.3-5.7) for mild hypertension (> or =140 mmHg systolic or > or =90 mmHg diastolic blood pressure) and an adjusted OR 6.5 (95%CI 3.6-11.8) for moderate or severe hypertension (> or =160 mmHg systolic or > or =100 mmHg diastolic). Normal weight never or former smokers did not differ from normal weight current smokers smoking > or =15 cigarettes/day with regard to likelihood of hypertension (normal weight never smokers, OR 1.1, 95%CI 0.8-1.5; normal weight former smokers, abstinent 3 or more years, OR 0.8, 95%CI 0.5-1.3). DISCUSSION: In this nationally representative sample, never or former smoking was unrelated to hypertension among normal weight individuals.     

The risk factors and clinical forms of diabetic foot infections in dependence on the type of diabetes mellitus

The aim of the work--the study of risk factors and detection of prevailing clinical form of diabetic foot infections (DFI) in dependence on type diabetes mellitus (DM). 157 patients with DM and DFI (25 type 1 DM cases and 132 type 2 DM cases) and 689 DM patients without DFI (282 type 1 DM cases and 407 type 2 DM cases) were examined. DFI cases differed from both type DM without DFI in greater number of complications. Associated with decompensated DM amputations and developing ulcerations were been mentioned in history in about a quarter of both type DM patients. DFI risk factors in type 1 DM appeared to be a combination of sensor and autonomic neuropathy (OR: 6.58; 95% CI: 2.74-14.9; a < 0.05), preprpoliferative retinopathy (RP) (OR: 4.62; 95% CI: 1.98-10.7; a < 0.05), in type 2 DM: macroangiopathy of lower extremities (OR: 4.59; 95% CI 2.98-7.1; a < 0.05), obesity (OR: 4.65; 95% CI 2.42-8.9; a < 0.05), concomitant exertional angina (OR 3.3; 95% CI 2.2-5.1; a < 0.05), a proteinuric stage of nephropathy (OR: 2.6; 95% CI: 1.74-3.9; a < 0.05), prominent sensor neuropathy (OR: 2.3; 95% CI 1.3-4.2; a < 0.05), preprpoliferative RP (OR: 2.1; 95% CI 1.41-3.13; a < 0.05). In type 1 DM and DFI neuropathic form of DFI prevailed (88%), in type 2 DM--neuroischemic form of DFI (66%). Ischemic form of DFI was determined in type 2 DM only (6%). In type 2 DM cases with DFI there was revealed a high rate of risk factors of atherosclerosis.     

Adolescent gestational weight gain: does it contribute to obesity?

Does gestational weight gain have an impact on the future weight pattern of adolescent mothers? Pregnant adolescents gain weight with childbearing, and weight retention following pregnancy potentially contributes to long-term overweight and obesity, but the literature to date has focused on the effect of gestational weight on the neonate and not on the mother. In 1990, the Institute of Medicine (IOM) released recommendations for weight gain during pregnancy. According to these recommendations, young adolescents (< or =16 years old) should gain weight at the upper end of the recommendations, while older adolescents (>16-19 years old) should gain weight similarly to adult women. The purpose of this article is to provide a current understanding of adolescent gestational weight gain and its impact on both maternal and neonatal outcomes. If adolescent weight gain during pregnancy leads to overweight and obesity without a clear benefit for the neonate, there may be resultant health implications for maternal health. This literature review demonstrates that there are no clear answers to the question of the influence of gestational weight gain on future maternal health. It is certain, however, that helping adolescents achieve good prepregnant nutritional status is an important first step in health promotion.     

Long-term impact of neonatal breast-feeding on body weight and glucose tolerance in children of diabetic mothers.

OBJECTIVE: Offspring born to women with pregnancies complicated by diabetes are at increased childhood risk of developing obesity and impaired glucose tolerance (IGT). In population-based studies, breast-feeding has been shown to be protective against obesity and diabetes later in life. To date, the role of breast-feeding on offspring of diabetic mothers (ODM) has not been investigated in this context. RESEARCH DESIGN AND METHODS: A total of 112 ODM (type 1 diabetes, n = 83; gestational diabetes, n = 29) were evaluated prospectively for impact of ingestion of either diabetic breast milk (DBM) or nondiabetic banked donor breast milk (BBM) during the early neonatal period (day 1-7 of life) on relative body weight and glucose tolerance at a mean age of 2 years. RESULTS: There was a positive correlation between the volume of DBM ingested and risk of overweight at 2 years of age (odds ratio [OR] 2.47, 95% CI 1.25-4.87). In contrast, the volume of BBM ingested was inversely correlated to body weight at follow-up (P = 0.001). Risk of childhood IGT decreased by increasing amounts of BBM ingested neonatally (OR 0.19, 95% CI 0.05-0.70). Stepwise regression analysis showed volume of DBM to be the only significant predictor of relative body weight at 2 years of age (P = 0.001). CONCLUSIONS: Early neonatal ingestion of breast milk from diabetic mothers may increase risk of becoming overweight and, consequently, developing IGT during childhood. Additional studies are needed to assess long-term consequences that might result from the type of neonatal nutrition in ODM.     

Antipsychotic Use in Early Pregnancy and the Risk of Maternal and Neonatal Complications

ObjectiveTo assess the association between antipsychotic use in early pregnancy and the risk of maternal and neonatal metabolic complications.MethodsWe conducted a population-based retrospective cohort study (January 1, 2010, to December 31, 2016) using the Health and Welfare Database in Taiwan. Pregnant women (18 to 49 years of age) were grouped as antipsychotic users (ie, received oral antipsychotic monotherapy during the first 20 weeks of pregnancy) and nonusers. Antipsychotic users were further categorized into first-generation antipsychotic and second-generation antipsychotic users. Propensity score methods, including matching and inverse probability of treatment weighting, were used to balance covariates. Conditional logistic regression and Cox proportional hazards models were used to compare risks of maternal (gestational diabetes mellitus, preterm birth) and neonatal (low birth weight [LBW], macrosomia) outcomes.ResultsAntipsychotic users had a notably higher risk of preterm birth compared with nonusers (adjusted HR, 1.29; 95% CI, 1.04 to 1.60), but the risk of gestational diabetes mellitus (HR, 1.21; 95% CI, 0.94 to 1.56), LBW (odds ratio [OR], 1.07; 95% CI, 0.84 to 1.37), and macrosomia (OR, 1.36; 95% CI, 0.63 to 2.92) did not differ between the two groups. Among women who received antipsychotics, the odds of LBW were significantly higher in second-generation antipsychotic users compared with first-generation antipsychotic users (adjusted OR, 1.32; 95% CI, 1.04 to 1.68).ConclusionThis study found that using antipsychotics in early pregnancy did not result in a greater risk of metabolic complications both for mothers and newborns. For women requiring treatment with antipsychotics during pregnancy, they should be monitored for the risk of preterm birth and low infant birth weight.     

Targeting pregnancy-related weight gain to reduce disparities in obesity: Baseline results from the Healthy Babies trial

BackgroundObesity affects African American women more than any other group in the US. Pregnancy represents a critical life stage of heightened vulnerability for new or persistent obesity, yet few interventions have been effective in reducing excessive gestational weight gain among African American women. We describe the design and baseline findings of Healthy Babies, a two-arm randomized controlled trial testing a mobile health intervention to minimize excessive gestational weight gain versus usual care in this high risk group.MethodsAfrican American women in early pregnancy were recruited from two large obstetric practices as well as Philadelphia Women, Infants, and Children's clinics. Participants randomized to the intervention received behavior change goals, daily text messages with feedback, web-based weight gain graphs, health coaching, and a Facebook support group. Data collection included baseline (<22 weeks' gestation), 36-38 weeks' gestation, and 6-month postpartum anthropometric measures and assessments of demographics, contextual factors and behavioral targets. The primary outcome was prevalence of excessive gestational weight gain.ResultsAmong participants at baseline (n = 262), the majority met criteria for obesity (63%), were multiparous (62%), single (77%), and were on average 25.6 ± 5.4 years old with a gestational age of 13.9 ± 4.1 weeks. While 82% completed high school, 61% met criteria for inadequate health literacy. Nearly 20% were food insecure. Eighty-eight percent reported a gestational weight gain goal discordant with Institute of Medicine guidelines. There were no significant differences in baseline characteristics between study arms.ConclusionsParticipants represent a high-risk group for excessive gestational weight gain with demonstrated need for intervention.     

Nocturnal awakening with headache and its relationship with sleep disorders in a population-based sample of adult inhabitants of Sao Paulo City, Brazil

Our aim was to estimate the prevalence of nocturnal awakening with headache (NAH) in the population of S?o Paulo City according to gender, age (20-80 years old) and socioeconomic classes and its relationship to sleep disorders, sleep parameters, anxiety, depression, fatigue, life quality and obesity. We used a population-based survey with a representative three-stage cluster sample. Questionnaires and scales were applied face-to-face, and polysomnography was performed in 1101 volunteers, aged 42 ± 14 years, 55% women. The complaint of NAH occurring at least once a week had a prevalence of 8.4%, mostly in women, obese subjects and those aged 50-59 years-old. We observed associations of NAH with insomnia, restless leg syndrome (RLS), nightmares and bruxism, but not obstructive sleep apnea syndrome. In a logistics regression model, risk factors for NAH were female gender, odds ratio (OR) (95% confidence interval [CI]) 4.5 (2.8-7.3); obesity, OR 1.9 (1.1-3.3); age between 50 and 59 years, OR 2.4 (1.2-4.7); severe anxiety, OR 8.1 (3.6-18.1); RLS, 2.7 (1.2-5.6); and nightmares, 2.2 (1.3-3.7). Our study shows that NAH was highly prevalent in the population of S?o Paulo and suggests that this phenomenon has specific characteristics with specific risk factors: obesity, RLS and nightmares.     

妊娠期糖尿病母体及新生儿25-羟维生素D3水平与新生儿呼吸窘迫综合征发病的关系研究

目的研究妊娠期糖尿病（GDM）母体和新生儿25-羟维生素D₃［25（OH）D₃］水平与新生儿呼吸窘迫综合征（NRDS）的关系。 方法选取2018年3月至2020年9月安徽医科大学附属阜阳医院148例GDM孕妇，记录产后NRDS发生率。分别在孕28~36周和新生儿出生时采血，检测血清25（OH）D₃水平。采用二分类Logistic回归模型分析GDM孕妇发生NRDS的独立影响因素。采用受试者工作特征（ROC）曲线分析母体和新生儿25（OH）D₃判断NRDS的价值。 结果148例新生儿中28例发生NRDS，发生率为18.92%。NRDS组和非NRDS组新生儿1 min和5 min Apgar评分、吸入羊水、胎膜早破、产前糖皮质激素治疗情况、母体和新生儿25（OH）D₃水平比较差异均有统计学意义（P＜0.05）。Logistic分析结果显示，1 min Apgar评分（OR=2.243，95%CI：1.795~2.803）、5 min Apgar评分（OR=3.662，95%CI：2.074~6.466）、吸入羊水（OR=2.893，95%CI：1.325-6.317）、新生儿25（OH）D₃（OR=0.483，95%CI：0.271~0.861）及母体25（OH）D₃（OR=0.501，95%CI：0.282~0.890）是产后NRDS的独立影响因素（P＜0.05）。ROC曲线分析结果显示，新生儿25（OH）D₃预测NRDS的AUC值为0.741，敏感度和特异度分别为86.7%和54.6%；母体25（OH）D₃预测NRDS的AUC值为0.648，敏感度和特异度分别为89.2%和35.7%。根据Logistic多因素分析结果建立预测模型：logit（P）=0.119+0.808X₁+1.298X₂+1.062X₃-0.728X₄-0.691X₅［1 min Apgar评分=X₁，5 min Apgar评分=X₂，吸入羊水=X₃，新生儿25（OH）D₃=X₄，母体25（OH）D₃=X₅］。ROC曲线分析显示，预测模型判断NRDS的AUC值为0.844（SE=0.041，95%CI：0.764~0.924，P＜0.001），敏感度为0.929，特异度为0.675。 结论GDM患者母体和新生儿25（OH）D₃水平是NRDS的独立影响因素，监测母体和新生儿25（OH）D₃水平有助于NRDS早期筛查，指导临床。     

Depressive Symptoms and Obesity/Weight Gain Factors Among Black and Hispanic Pregnant Women

This study examined the relationships between depressive symptoms and obesity/weight gain factors in 56 Black and Hispanic pregnant women and the differences in these variables between the 2 ethnic groups. Of the women, 32% were likely depressed, 66% were overweight/obese, and 45% gained excessive gestational weight. Depressive symptoms were positively correlated with prepregnancy body mass index (BMI; r = .268, p = .046), inversely related to gestational weight gain (r = –.329, p = .013), and not associated with excessive gestational weight gain. Black women were more likely to have excessive gestational weight gain than Hispanic women. Prepregnancy BMI and gestational weight gain data can be useful in identifying pregnant women with depression.     

中国女性脑卒中发病危险因素的Meta分析

目的 综合评价我国女性脑卒中发生的危险因素。方法 应用meta分析的方法对国内有关女性脑卒中发病危险因素的研究结果进行定量综合分析;运用Revman5.1进行异质性检验以及合并OR值和95%可信区间的计算。结果 被动吸烟、肥胖及口服避孕药与女性脑卒中关系的分别为OR=2.11,95%CI=1.19～3.74,P<0.05;OR=1.18;95%CI=1.01～1.38,P<0.05;OR=1.64,95%CI=1.18～2.28,P<0.05,差异有统计学意义, 敏感性分析结果提示,3个因素采用不同模型的meta分析结果均一致。结论 现有的有限证据表明,被动吸烟、肥胖及口服避孕药是中国女性脑卒中发病的危险因素。     

Preconception care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: a meta-analysis

Offspring of women with pregestational diabetes mellitus are at increased risk for congenital malformations, largely attributable to poor periconceptional glycaemic control. We assessed the effect of preconception care in reducing congenital malformations, in a meta-analysis of published studies of preconception care in women with diabetes mellitus. Articles were retrieved from Medline (1970 to June 2000) and Embase (1980 to June 2000), and data abstracted by two independent reviewers. The rates and relative risks (RR) for major and minor congenital malformations were pooled from all eligible studies using a random effects model, as were early first-trimester glycosylated haemoglobin values. In 14 cohort studies, major congenital malformations were assessed among 1192 offspring of mothers who had received preconception care, and 1459 offspring of women who had not. The pooled rate of major anomalies was lower among preconception care recipients (2.1%) than non-recipients (6.5%) (RR 0.36, 95%CI 0.22-0.59). In nine studies, the risk for major and minor anomalies was also lower among women who received preconception care (RR 0.32, 95%CI 0.17-0.59), as were the early first-trimester mean glycosylated haemoglobin values (pooled mean difference: 2.3%, 95%CI 2.1-2.4). Women who received preconception care were, on average, 1.8 years older than non-recipients, and fewer smoked (19.6% vs. 30.2%). Only one study described the routine use of periconception folic acid. Out-patient preconception care probably reduces the risk of major congenital anomalies among the offspring of women with pregestational diabetes mellitus. Because many women with diabetes neither plan their pregnancy nor achieve adequate glycaemic control before conception, strategies are needed to improve access to these programs, and to maximize those interventions associated with improved pregnancy outcome, such as smoking cessation and folic acid use.     

Do obesity and low levels of physical activity increase the risk for developing type 2 diabetes mellitus among women with prior gestational diabetes in rural China?

Moderate-to-vigorous intensity physical activity (MVPA) and obesity play important roles in the development of type 2 diabetes mellitus (T2DM) among women with prior gestational diabetes mellitus (GDM). Yet, how MVPA affects the risk of developing T2DM among women with prior GDM across the different categories of obesity indicators is unclear. This study aimed to describe the levels of postpartum abnormal glucose tolerance (AGT), obesity indicators (body mass index [BMI] and waist circumference [WC]), and MVPA and to explore the independent effect and joint effect of MVPA and obesity indicators (BMI and WC) on the risk for developing AGT among women with prior GDM in rural China. A total of 425 women with prior GDM were recruited from two county-level hospitals in Western and Eastern Hunan, China. Data were collected with self-reported measurements on sociodemographics and clinical factors as well as postpartum weight-related behaviors (physical activity and dietary intake). The 75-g oral glucose tolerance test, weight, height, and WC were measured on site. Binary logistic regression models and multiplitive interaction models were used to explore the independent and joint associations of BMI and MVPA as well as WC and MVPA on AGT, respectively. One-fifth (20.9%) of the sample women had AGT. The obesity indicators were significantly associated with an increased risk of postpartum AGT, but MVPA was not. In joint effect analyses, larger WC and insufficient MVPA were not significantly associated with increased risk of AGT compared with normal WC and sufficient MVPA (mutually adjusted odds ratio [OR], 1.43; 95% confidence interval [CI], 0.46–4.43; p > .05). In joint effect analyses of MVPA and BMI, the mutually adjusted OR for developing AGT in women who were obese and had insufficient MVPA was 4.49 (95% CI, 1.35–14.92; p < .05) compared with normal weight and sufficient MVPA. Adequate weight management and increased MVPA are warranted for Chinese women with prior GDM to prevent T2DM.