孕前肥胖及超重女性的孕期管理模式探讨及肥胖相关胎盘因子分析

目的 探讨孕前肥胖/超重女性的孕期管理模式及胎盘因子改变。方法 收集孕前体质量指数(body mass index, BMI)≥25 kg/m²的149例单胎孕妇。分为饮食指导组及常规产检组,取同期孕前BMI正常的590例孕妇作为对照,比较分娩结局,随后检测不同孕前BMI孕妇胎盘中补体C1q /肿瘤坏死因子相关蛋白6( C1q /tumor necrosis factor-related protein 6,CTRP6)及肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)的表达。结果 饮食指导后的肥胖/超重孕妇的孕期增重、产后出血、难产率均显著降低,但新生儿体质量差异无统计学意义,且剖宫产率及妊娠期糖尿病(gestational diabetes mellitus,GDM)发生率仍高于对照组,差异有统计学意义。孕前肥胖/超重孕妇胎盘中CTRP6及TNF-α的表达高于孕前BMI正常/低体质量的孕妇,差异有统计学意义,GDM者CTRP6的表达升高。结论 孕期有效饮食控制可减少肥胖/超重孕妇孕期增重,但未能降低新生儿体质量,考虑孕前体质量对母儿影响更大。CTRP6可能参与孕前肥胖女性的脂肪炎性反应及血糖代谢,进而对子代产生影响。     

妊娠期应激对大鼠子代神经行为发育的影响

目的　探索不同阶段的妊娠期应激对子代神经行为发育影响。方法　通过雌雄交配,获得40 只孕鼠,随机分为妊娠早期、中期、晚期应激组及对照组;采用被动回避反应及开场行为测验等方法对不同母孕期应激组子鼠的一般指标、体重、发育成熟指标、早期反射和感觉功能、运动和协调功能、学习和记忆功能、开场行为进行评定。结果　妊娠中期应激对子代神经行为发育产生了广泛的影响,使开眼、出牙等生长发育时间提前,使某些运动协调、学习记忆及行为反应功能降低,而妊娠早期和晚期应激对子代神经行为发育的影响相对较小。结论　妊娠期应激对子代神经行为发育的影响具有特异性,妊娠中期应激对子代神经行为发育影响最为明显。进一步研究人体妊娠期应激对子代神经行为发育的影响可望找到精神分裂症神经发育缺陷的病因病理机制及对其开展早期治疗或干预的有效措施。     

个体化营养示范餐对超重及肥胖孕妇妊娠糖尿病的预防效果

目的·探讨个体化营养示范餐对超重及肥胖孕妇的孕期体质量管理和妊娠糖尿病(gestational diabetes mellitus,GDM)预防的效果.方法·将2017年6月-2019年1月在上海健康医学院附属第六人民医院东院建卡并已知情同意的超重及肥胖孕妇随机分为干预组和对照组各100例,对照组进行孕期营养课堂集体健...     

妊娠中晚期孕妇合并焦虑/抑郁的影响因素及对子代神经发育的影响

目的 探讨影响妊娠中晚期孕妇焦虑/抑郁发生的因素,并分析妊娠中晚期孕妇发生焦虑/抑郁对子代神经发育的影响.方法 选择生理指标正常的980例孕妇为研究对象,并于妊娠中晚期采用抑郁自评量表和焦虑自评量表对其进行心理评估.在子代出生4个月内,采用婴儿神经国际测量(INFANIB)量表评估其神经行为状态,计算异常儿发生率;在子代出生后6个月、12个月及24个月采用Gesell发育诊断量表评估神经发育水平.比较产前焦虑/抑郁孕妇(研究组)与无产前焦虑/抑郁孕妇(对照组)的社会人口学资料,以及子代神经行为状态和神经发育水平.结果(1)980例孕妇中,108例孕妇存在产前焦虑/抑郁,检出率为11.02％(108/980).(2)与对照组相比,研究组孕妇的孕期压力更大,夫妻关系、婆媳关系更差,遭受家庭暴力、有自杀倾向、遭遇应激事件的比例更高,受教育水平较低(均P<0.05).(3)研究组神经行为状态异常儿发生率为46.2％(54/117),高于对照组的8.0％(75/943)(P<0.05).在出生后6个月、12个月和24个月,研究组子代的适应行为、大运动行为、精细动作行为、语言行为、个人-社交行评分均低于对照组(均P<0.05).结论 社会关系和家庭关系可能是导致妊娠中晚期孕妇出现产前焦虑/抑郁的主要原因,且产前焦虑/抑郁不利于子代婴幼儿时期的神经发育.     

妊娠期糖尿病对子代3岁时体格发育及胰岛素抵抗的影响

目的 探究妊娠期糖尿病（GDM）子代3岁时体格发育及胰岛素抵抗与正常妊娠子代的差异。方法 选择2018年1～12月在安徽省妇幼保健院临泉医院分娩,且符合纳入标准并有意愿参与研究的产妇及子代作为研究对象,其中GDM患者及子代149对纳入GDM组,健康孕产妇及子代385对纳入对照组。于2021年1～12月对子代进行体格测量及血样采集,采用自制调查问卷调查产妇身高、孕前体质量、产前体质量、孕产史、子代出生相关资料等资料。比较GDM组与对照组间子代3岁时体格发育及胰岛素抵抗的差异,并根据儿童体质量分为正常体质量组及超重或肥胖组,对相关资料进行比较及分析。结果 与对照组相比,GDM组产妇生育年龄、孕前BMI、孕前超重或肥胖占比更高,子代出生体质量、超重或肥胖占比更高,差异有统计学意义（P均<0.05）。与正常体质量组相比,3岁时超重或肥胖组儿童出生体质量更高,差异有统计学意义（P <0.05）。回归分析显示孕前肥胖（OR=2.581, 95%CI:1.199～5.557, P=0.015）、孕期患GDM(OR=2.309,95%CI:1.296～4.115,P=0.005)是3岁子代...     

孕前体重指数和孕期增重对新生儿代谢特征的影响

目的 观察孕前体重指数(BMI)和孕期增重对新生儿代谢影响,并初步探讨其可能机制。方法 选择孕妇45例,根据孕妇孕前BMI和孕期增重,分为3组,对照组：孕前BMI正常且孕期增重适宜;高BMI组：孕前超重/肥胖且孕期增重适宜;高孕期增重组：孕前BMI正常且孕期增重过度。检测孕妇及其所生新生儿的血清胰岛素和瘦素水平、以及瘦素受体、胰岛素受体、细胞因子信号转导抑制因子3(SOCS3)和信号转导与转录活化因子3(STAT3)的mRNA表达水平。结果 与对照组新生儿相比,高BMI组新生儿和高孕期增重组新生儿血清瘦素、胰岛素水平明显升高(均P<0.05)。新生儿瘦素、胰岛素水平分别与孕妇瘦素、胰岛素水平呈显著正相关(均P<0.05)。与对照组新生儿相比,高BMI组新生儿和高孕期增重组新生儿SOCS3、STAT3表达显著升高(均P<0.05),而瘦素受体、胰岛素受体表达无显著性差异(均P>0.05)。结论 孕前超重/肥胖或孕期过度增重可以通过影响胎儿STAT3-SOCS3信号通路对新生儿的代谢产生影响。     

孕妇肥胖对子代结局影响的研究进展

孕妇肥胖包括孕前肥胖和孕期过度增重,除了对母体造成直接影响外,也与子代不良健康结局密切相关。包括短期出现子代先天畸形、早产、大于胎龄儿和巨大儿,以及远期患肥胖症、冠心病、2型糖尿病及哮喘等风险均明显增加。了解这些风险,实施合理的妊娠管理,对优化子代的结局有着深远的意义。     

孕前体质指数和孕期增重对新生儿代谢特征的影响

正宫内营养环境对子代个体的生长发育、远期疾病的发生风险至关重要~([1-3])。孕前体质指数(BMI)和孕期增重是宫内营养环境的重要标志,也是易于监测控制的因素。孕前超重/肥胖和孕期增重过度不仅增加孕妇发生妊娠糖尿病、妊娠高血压和早产的风险,也是分娩大于胎龄儿和巨大儿的重要危险因素~([4-6])。     

妊娠期糖尿病合并孕前肥胖对子代18月龄神经智力发育的影响*

目的：评价母亲妊娠期糖尿病(gestational diabetes mellitus, GDM)及肥胖对子代18月龄神经行为(智力及运动)发育的影响。方法：选取2015年1月—2016年12月期间在南通市区3所医院产科建卡及生产的180例GDM孕产妇,其中GDM组中包含孕前体质量正常者90例,肥胖者90例,同时以每个病例1∶1配对正常对照组,配对的条件为母亲体质量指数接近、年龄±3岁、分娩方式相同、幼儿性别相同的正常对照组共180例,其中孕前体质量正常者90例,肥胖者90例。所有研究对象子代为单胎且胎龄≥37周,体质量2 500~4 000 g。在幼儿18月龄随访到GDM组幼儿163例,正常对照组幼儿167例,使用贝利婴幼儿发展量表进行评价,并对组间的资料进行分析比较。结果：在控制母亲年龄、母亲受教育程度、孕期增重等变量后,使用析因方差分析发现GDM对子代18月龄智力发育指数(mental development index, MDI)影响显著,孕前肥胖对子代MDI影响显著,且GDM和孕前肥胖对子代MDI影响具有交互作用。孕前肥胖对子代运动发育指数(psychomotor development index, PDI)影响不显著,GDM和孕前肥胖对子代PDI交互作用不显著。结论：母亲GDM影响子代18月龄智力发育,母亲孕前肥胖影响子代智力发育,GDM及孕前肥胖对子代智力发育的影响具有交互作用。     

孕妇肥胖和血脂水平对新生儿出生结局的影响分析

目的 调查孕妇肥胖和血脂水平对新生儿出生结局的影响.方法 随机抽取分娩的孕妇1000例作为研究对象,回顾调查孕妇的一般资料及孕期详细保健记录,并按照孕妇孕前的BMI、孕期增重情况等进行分组,比较新生儿的出生结局等,同时分析血脂相关指标与新生儿出生结局之间的相互关系.结果 孕妇孕期肥胖的情况下巨大儿的出生率、剖宫产率等均显著大于非肥胖组的孕妇,差异有统计学意义(P<0.05).经多元线性回顾分析,甘油三酯水平与巨大儿出生率呈显著正相关,而高密度脂蛋白则与其呈显著负相关,差异均有统计学意义(P<0.05).结论 孕期肥胖和空腹血脂水平都会对新生儿的发育造成影响,引起巨大儿出生率和孕妇剖宫产率的升高.     

Maternal concern and perceptions of overweight in Australian preschool-aged children

OBJECTIVE: To assess maternal concern about overweight in Australian preschool-aged children and factors predicting maternal concern about children's current and future weight status. DESIGN: Cross-sectional survey of child's body mass index and parent questionnaire. SETTING: Metropolitan Melbourne, Victoria, 2002. PARTICIPANTS: A community-based cohort of 324 4-year-old children and their parents. MAIN OUTCOME MEASURES: Mothers' reports of concern about the child's current and future weight status, and perceptions of the child's weight, diet and activity relative to their peers were compared with the child's measured weight status, and parent and child characteristics. RESULTS: The prevalence of overweight or obesity was 19%, but only 5% of mothers indicated concern about their child being currently overweight, while 16% worried their child would become overweight. Over 70% of mothers of overweight children saw them as being of similar weight to their peers. Most mothers saw their children as being equally or more active than other children and having a diet at least as healthy as their peers. Overweight daughters were more likely to elicit maternal concern about current weight than overweight sons (relative risk, 4.6; 95% CI, 1.1-19.8). Mothers were more likely to worry about their child's potential for future overweight if they or the child's father were overweight. CONCLUSIONS: Despite mounting public concern about childhood obesity in Australia, most mothers surveyed were not concerned about their child's weight, and many mothers did not perceive their overweight children as different from their peers. This may have implications for interventions that rely on acknowledgement of child overweight as a first step to change.     

237例妊娠期高血压疾病患者母婴结局分析

目的探讨妊娠期高血压疾病与母儿预后的关系。方法对2006年3月至2010年3月我院就诊的237例妊娠期高血压疾病患者的母婴并发症、分娩方式进行回顾性分析。结果胎盘早剥、FGR、围生儿死亡、早产、胎儿窘迫、新生儿死亡率等母婴并发症重度子痫前期组明显高于妊娠期高血压组。结论围产儿预后与妊娠期高血压疾病的严重程度成正比,适时选择剖宫产终止妊娠是重要的治疗措施,对提高母婴的生存率有重要意义。     

An exploratory analysis of the relationship between paternal age at pregnancy and difficulties symptomatic of specific learning disorders among Japanese undergraduate students

Objective: Causes and risk factors of neurodevelopmental disorders originate in the prenatal and perinatal periods. Several studies have demonstrated a relationship between prenatal and perinatal medical records, including maternal and paternal age at pregnancy, and the neurodevelopmental disorders, especially attention deficit/hyperactivity disorder and autism spectrum disorder. However, previous studies showed an association between specific learning disorders and environmental toxins such as lead and tobacco smoke, but not parental age.Patients and Methods: This study included 993 university freshmen, and their prenatal and perinatal medical data was collected from maternal and child handbooks. A mental health assessment questionnaire consisting of 24 items covering symptoms associated with neurodevelopmental disorders was administered, corresponding to aspects of attention deficit/hyperactivity disorder, autism spectrum disorder, and learning disorders. The relationship between prenatal and perinatal medical data and questionnaire results was statistically analyzed.Results: The number of available records was 881 (88.7%). Using Spearman’s rank correlation coefficient analysis and trend analysis, a weak but statistically significant relationship was confirmed between paternal age at pregnancy and the score for learning disorder difficulties.Conclusion: Error accumulation in meiosis during spermatogenesis may be one of the risk factors of learning disorders.     

Association between maternal psychological status and fetal hemodynamic circulation in late pregnancy

Background The prevalence reported of maternal depression from the first to the third trimester was 7.4％,12.8％,12.0％ respectively,which implies that around one-tenth of pregnant women suffer from psychological disorder during the whole pregnancy.It is assumed that during pregnancy the maternal-fetal circulation unit is also affected by maternal psychological status.The aim of this study is to explore the association between maternal psychological status and fetal dynamic blood flow circulation during pregnancy.Methods We recruited 102 singleton low risk pregnant women between 30 to 33 gestational weeks.The Symptom Checklist-90 （SCL-90） was used to assess maternal psychological status.Ultrasound Doppler was used to measure blood flow changes in maternal-fetal circulation.Pulsatility index （PI） value was measured in umbilical artery （UA）,fetal middle cerebral artery （MCA） and maternal uterine arteries （UTA）.Peak systolic velocity （PSV） was measured in MCA and velocity was measured in umbilical vein （UV）.Statistical analysis was performed with standard nonparametric MannWhitney U tests.Two-tailed P values ＜0.05 were considered statistical significance.Results Of the 102 pregnant women,12 patients show high levels of poor mental health.Women with poor mental health have higher umbilical artery PI values than good mental health patients （P=0.020）.A higher MCA PI value is found in poor mental health patients but this does not reach statistical significance （P=0.053）.Women with hostility show lower placental scores （P=0.030）.Women with somatization demonstrate higher values in UA PI,MCA PI and MCA PSV （P=0.049,0.030 and 0.035 respectively）.A higher MCA PSV value is also found in phobic anxiety patients （P=0.046）.Conclusions Poor mental health during pregnancy is found to have an adverse effect on maternal-fetal circulation.Umbilical artery and fetal cerebral circulation are more sensitive and affected by maternal psychological disorder.     

母婴分离的高危妊娠产妇心理问题分析及护理干预对策

目的：以调研的方式对处于母婴分离状态的高危妊娠产妇心理问题进行分析,以此为基础探讨护理干预对纠正该类产妇心理状态的正面意义。方法于2015年1月—6月,经便利抽样采集90例该院妇产科母婴分离的高危妊娠产妇纳入研究视野。于剖宫产术后1 d分别采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估产后焦虑和抑郁状况。随机分为研究组和对照组,对照组给予常规护理,研究组接受整体性护理,再次评价产妇心理状况,并记录护理满意率、母乳喂养率。结果新生儿出生孕周短、妊娠合并症及产妇人格特征等是母婴分离的高危妊娠产妇心理问题的独立因素。护理后7 d,研究组SAS、SDS分值分别为(36.04±9.03)、(44.96±10.21)分,对照组分别为(41.32±7.45)、(49.33±7.62)分,对比差异具有统计学意义(P﹤0.05)。结论母婴分离作为应激源会使高危妊娠产妇产生不良的应激反应,对此类产妇给予针对性的护理干预可降低其心理应激反应,提高母乳喂养率。     

Pregnancy weight gain and postpartum loss: avoiding obesity while optimizing the growth and development of the fetus

Weight gain during pregnancy may contribute to obesity development. Concerns about possible adverse effects of pregnancy weight gain on later maternal weight and on labor and delivery must be rigorously evaluated in light of possible benefits for fetal growth and development. Birth-weight rises with increased pregnancy weight gain, and perinatal and neonatal mortality fall as birthweight increases in both preterm and term infants. The lowest mortality is observed at 3500 to 4500 g in infants of white women. Although often thought to be at high risk, infants termed "macrosomic" include infants of the lowest mortality rate. Thus, restricting weight gain may be detrimental to the baby. Weight gain that is optimal for the mother and the baby differs according to the mother's prepregnancy weight. Pregnancy weight gain exceeding current recommendations is associated with increases in maternal fat gain, pregnancy complications, and delivery problems and should be discouraged. Postpartum weight loss is essential to prevent permanent weight increase. Smoking cessation during pregnancy, reduced postpartum physical activity, and other lifestyle changes can contribute to increased postpartum weight. Health care providers can help to reduce obesity risk by regularly monitoring women's weight; promoting appropriate prepregnancy weight, pregnancy weight gain, and postpartum weight less; and explicitly encouraging maintenance of an active postpartum lifestyle.     

肥胖及孕期超重对孕产妇围生期心理健康的影响

目的分析肥胖及孕期超重对孕产妇围产期心理健康的影响。方法选取2019年1月—2019年12月在湖北省妇幼保健院接受围生期心理筛查的288例孕产妇为研究对象,利用一般资料调查表、焦虑自评量表(SAS)、抑郁自评量表(SDS)和症状自评量表(SCL-90)调查孕产妇的心理健康状况,分析肥胖及孕期超重对孕产妇围生期心理健康的影响,利用多因素一般Logistic回归分析孕产妇心理健康状况的影响因素。结果回收有效调查问卷275份,肥胖和孕期超重的发生率分别为17.82%和30.18%。孕前体重为肥胖和孕期超重孕产妇的SAS、SDS和SCL-90评分均高于其他组(P <0.05)。孕产妇心理状况异常发生率为24%。不同文化程度、是否为初产妇、有无不良孕产史和是否意外怀孕孕产妇的心理健康状况比较,差异无统计学意义(P>0.05),而不同年龄、孕前体重、孕期增重和家庭人均月收入孕产妇的心理健康状况比较,差异有统计学意义(P <0.05)。多因素一般Logistic回归分析结果显示,孕前体重[■=2.152(95%CI:1.457,3.178)]、孕期增重[■=9.226(95%CI:...     

孕早期体重指数与孕期体重增长对母婴健康的影响

目的：探讨孕早期体重指数（BMI）及孕期体重增长情况对母婴健康的影响,为制定孕期体重增长正常标准提供依据。方法：根据孕早期体重指数和孕期体重增长情况将研究对象分别进行分组,比较不同组间情况对母婴健康的影响。结果：孕早期不同的BMI组间和孕期体重增长不同分组间妊娠期高血压疾病、妊娠期糖尿病、分娩方式、新生儿窒息、产后出血和巨大儿发生率的差别均有统计学意义（均P〈0．05）。结论：孕前肥胖及孕期体重增长过度对孕产妇和新生儿均产生不利影响,增加了妊娠期、分娩期并发症和增高了难产发生率。     

The prevalence and impact of overweight and obesity in an Australian obstetric population

OBJECTIVE: To assess the prevalence and impact of overweight and obesity in an Australian obstetric population. DESIGN, SETTING AND PARTICIPANTS: The Mater Mother's Hospital (MMH), South Brisbane, is an urban tertiary referral maternity hospital. We reviewed data for the 18 401 women who were booked for antenatal care at the MMH, delivered between January 1998 and December 2002, and had a singleton pregnancy. Of those women, 14 230 had an estimated pre-pregnancy body mass index (BMI) noted in their record; 2978 women with BMI < or = 20 kg/m2 were excluded from further study; the remaining 11 252 women were divided into four categories: "normal" (BMI 20.01-25 kg/m(2)), "overweight" (BMI 25.01-30 kg/m(2)), "obese" (BMI 30.01-40 kg/m(2)) and "morbidly obese" (BMI > 40 kg/m(2)). MAIN OUTCOME MEASURES: Prevalence of overweight and obesity in an obstetric population; maternal, peripartum and neonatal outcomes associated with raised BMI. RESULTS: Of the 14 230 women, 6443 (45%) were of normal weight, and 4809 (34%) were overweight, obese or morbidly obese. Overweight, obese and morbidly obese women were at increased risk of adverse outcomes (figures represent adjusted odds ratio [AOR] [95% CI]): hypertensive disorders of pregnancy (overweight 1.74 [1.45-2.15], obese 3.00 [2.40-3.74], morbidly obese 4.87 [3.27-7.24]); gestational diabetes (overweight 1.78 [1.25-2.52], obese 2.95 [2.05-4.25], morbidly obese 7.44 [4.42-12.54]); hospital admission longer than 5 days (overweight 1.36 [1.13-1.63], obese 1.49 [1.21-1.86], morbidly obese 3.18 [2.19-4.61]); and caesarean section (overweight 1.50 [1.36-1.66], obese 2.02 [1.79-2.29], morbidly obese 2.54 [1.94-3.32]). Neonates born to obese and morbidly obese women had an increased risk of birth defects (obese 1.58 [1.02-2.46], morbidly obese 3.41 [1.67-6.94]); and hypoglycaemia (obese 2.57 [1.39-4.78], morbidly obese 7.14 [3.04-16.74]). Neonates born to morbidly obese women were at increased risk of admission to intensive care (2.77 [1.81-4.25]); premature delivery (< 34 weeks' gestation) (2.13 [1.13-4.01]); and jaundice (1.44 [1.09-1.89]). CONCLUSIONS: Overweight and obesity are common in pregnant women. Increasing BMI is associated with maternal and neonatal outcomes that may increase the costs of obstetric care. To assist in planning health service delivery, we believe that BMI should be routinely recorded on perinatal data collection sheets.     

孕期体重对母婴并发症发生率的影响

目的探讨孕期体重与母婴并发症的相关性。方法回顾性分析在我院孕期保健的孕妇884例的保健资料,根据孕妇BMI水平将孕妇分为健康体重组、轻体重组、超重组和肥胖组,比较4组孕期并发症发生情况。结果超重组和肥胖组孕妇并发症发生率显著高于健康体重组和轻体重组(P<0.05或<0.01),而肥胖组在妊娠期高血压、糖尿病、宫缩乏力、相对头盆不称的发生率高于超重组(P<0.05或<0.01)。超重组和肥胖组难产儿、巨大儿发生率显著高于健康体重组和轻体重组(P<0.05),而肥胖组又显著高于超重组(P<0.05)。结论孕期体重影响母婴并发症的发生率,临床上应加强孕期保健和健康教育,从而控制孕妇体重在正常水平,减少母婴并发症。