Supplement use among a culturally diverse group of low-income pregnant women

Among a culturally diverse group of 344 low-income pregnant women, self-reported rates of supplement use prior to confirmation of pregnancy were much lower than those reported for young women in national surveys (16% vs. up to 40%, respectively). Prenatal vitamins, prescribed routinely for all patients, were reportedly taken at least four times a week by 86% of the subjects and two to three times a day by 5%. About 5% of the sample reported consuming highly fortified cereal at least once daily. There is a possibility of higher than recommended use of supplemental vitamins among these women resulting from misunderstanding of the number of pills to be taken and/or high consumption of highly fortified cereals.     

围孕期患病及心理状态与婴儿出生缺陷的关系

目的 了解陕西省出生缺陷患病水平及其主要危险因素,分析母亲围孕期患病及其心理状态与出生缺陷患病的关系。方法 采用多阶段分层随机抽样方法调查陕西省30个区（县）2010年1月至2013年11月怀孕且明确结局的育龄妇女及婴幼儿。采用多阶段复杂抽样logistic回归分析孕期患病及心理状态和出生缺陷的关系。结果 陕西省出生缺陷患病率为195.04/万。在29 121例调查对象中,围孕期患病者占51.1%,围孕期发生心理状态改变者占6.8%。控制混杂后,围孕期患感冒（OR=1.33,95% CI：1.10~1.61）、发热（OR=1.54,95% CI：1.09~2.16）、肝内胆汁淤积症（OR=32.77,95% CI：4.08~263.04）等疾病及存在情绪低落、烦躁易怒、焦虑等精神状态（OR=1.60,95% CI：1.19~2.15）及家庭关系不和（OR=2.07,95% CI：1.12~3.79）等心理因素与出生缺陷的发生有关。对各时期（孕前及孕早中晚期）患病分析发现：孕早期患感冒（OR=1.59,95% CI：1.28~1.98）、孕早期发热（OR=1.43,95% CI：1.48~4.00）、孕中期情绪不良（OR=1.52,95% CI：1.05~2.19）、孕晚期情绪不良（OR=1.63,95% CI：1.05~2.19）、孕晚期关系不和（OR=2.89,95% CI：1.16~7.20）与出生缺陷相关。对患病频率分析发现：4个时期只有1个时期患感冒（OR=1.24,95% CI：1.02~1.52）、有2个时期患感冒（OR=2.06,95% CI：1.30~3.26）、1个时期有发热（OR=1.49,95% CI：1.04~2.13）、1个时期存在情绪不良（OR=1.71,95% CI：1.19~2.45）、1个时期关系不和（OR=2.67,95% CI：1.32~5.39）与出生缺陷相关。结论 陕西省出生缺陷患病率处于较高水平,围孕期感冒、发热、情绪问题及关系不和可能增加出生缺陷的罹患风险。     

杭州市孕妇产前血液传染性标志物的分析研究

目的:探讨孕妇产前血液检测传染性标志物的临床意义。方法:采用微粒子化学发光技术检测乙型肝炎病毒标志物;酶联免疫法(ELISA)检测丙型肝炎病毒抗体(HCV)、梅毒螺旋体抗体(TP)、人类免疫缺陷病毒抗体(HIV)。结果:6170名孕妇中HBsAg阳性总人数593例,HBsAg阳性率9.61%;梅毒感染人数39例,梅毒抗体阳性率0.63%;丙肝感染人数18例,丙肝抗体阳性率0.29%;未检测出HIV阳性者。结论:孕妇产前血液传染性标志物的检测,能为阻断和降低母婴传播,确保母婴安全健康提供保障;减少和避免医疗纠纷、预防医院感染提供可靠的实验室依据。     

Characteristics of diet among a culturally diverse group of low-income pregnant women

This study reports on diet quality and variety in food selection among a culturally diverse group of 335 low-income pregnant Massachusetts women. The Index for Nutritional Quality (INQ), which is the observed nutrient density divided by the recommended nutrient density, was estimated for seven nutrients from data reported on food frequency questionnaires and diet recalls. Mean INQs for protein and vitamin C were above the recommended level of 1.0, whereas INQ for iron was 0.6 or less. Mean INQ for calcium was 1.2 for whites and between 0.9 and 1.0 for non-whites. When comparisons were made among ethnic groups by site of prenatal care, significant differences in INQ were found for all nutrients except iron and vitamin B-6. WIC participants had higher diet quality for protein, calcium, iron, and vitamin B-6 than did non-participants. Employed women had higher protein and zinc INQs than did unemployed women, and non-smokers had higher iron and vitamin B-6 INQs than did smokers. Variety was not significantly correlated with diet quality but differed (p less than .001) among site-specific ethnic groups. We conclude that there is a need for investigation of factors influencing dietary practices that are associated with sites of prenatal care.     

Measuring health utility in varying pregnancy contexts among a diverse cohort of pregnant women

ObjectiveTo contribute to decision analysis by estimating utility, defined as an individual's valuation of specific health states, for different pregnancy contexts.Study designCross-sectional analysis of data from pregnant women recruited at pregnancy testing clinics during June 2014–June 2015. Utility was measured using the visual analog scale (VAS), PROMIS GSF-derived utility, standard gamble (SG), and time-trade-off (TTO) approaches. Six dimensions of pregnancy context were assessed including: intention, desirability, planning, timing, wantedness, and happiness. Multivariable regression modeling was used to examine the associations between pregnancy context and utility while controlling for women's sociodemographic and health characteristics.ResultsAmong 123 participants with diverse characteristics, aged 27±6 years, with mean gestation of 7.5±3 weeks, few reported optimal pregnancy contexts. Mean utility of the pregnancy state varied across contexts, whether measured with VAS (0.28–0.91), PROMIS GSF-derived utility (0.66–0.75), SG (0.985–1.00) or TTO (0.9990–0.99999). The VAS-derived mean utility score for unintended pregnancy was 0.68 (95% CI 0.59, 0.77). Multivariable regression analysis demonstrated significant disutility of unintended pregnancy, as well as all other unfavorable pregnancy contexts, when measured by VAS. In contrast, PROMIS GSF-derived utility only detected a significant reduction in utility among ambivalent compared to wanted pregnancy, while SG and TTO did not show meaningful differences in utility across pregnancy contexts.ConclusionsUnintended pregnancy is associated with significant patient-reported disutility, as is pregnancy occurring in other unfavorable contexts. VAS-based measurements provide the most nuanced measures of the utility for pregnancy in varying contexts.ImplicationsDecision analyses, including assessments of the cost-effectiveness of pregnancy related interventions, should incorporate measures of the utility of pregnancy in various contexts.     

Engagement: an indicator of difference in the perceptions of antenatal care for pregnant women from diverse socioeconomic backgrounds

Background Socioeconomically deprived women are at greater risk of adverse pregnancy outcomes. Research tends to focus on access of services. Yet access may not equate with the equity of services for women from different socioeconomic backgrounds. Objectives To determine whether pregnant women’s perceptions of antenatal provision differed in relation to their socioeconomic deprivation ranking (determined by the Scottish Index of Multiple Deprivation 2006). Design A longitudinal, qualitative study with comparative antenatal case studies between January 2007 and April 2009. Setting/Participants Cases were primigravida women from ‘least deprived’ (n = 9) and ‘most deprived’ (n = 12) geographical areas within one local authority in Scotland. Analysis Data were analysed using case study replication analysis. Results There was little difference in access to antenatal services between the ‘least’ and ‘most’ deprived groups. Perception of care differed in relation to the level of ‘engagement’ (defined using constructs of: language and personalization of care; power and relationships; and health literacy). Engagement was evidenced in most of the ‘least deprived’ cases and almost none of the ‘most deprived’ cases. Specifically, socioeconomically deprived women described less evidence of personal connection to their own care, effective communication and the opportunity for shared decision making. Conclusion In women from socioeconomically deprived areas, access may be a less useful indicator than engagement when assessing antenatal service quality. As engagement levels may be one method by which to predict and improve health outcomes, a more equitable antenatal service may need to be developed through the early identification of those women at risk of non‐engagement.     

缺铁性贫血对孕妇免疫功能及感染性疾病的影响

目的探讨妊娠期缺铁性贫血(IDA)特别是边缘性铁缺乏对妇女免疫功能和感染易感性的影响。方法从孕检的280名孕30～38周第一胎妇女中,通过测定血红蛋白、红细胞内游离原卟啉和血清铁蛋白诊断出69名IDA孕妇、随机抽取52名正常孕妇和50名婚检非孕妇女作为研究对象,检测其细胞免疫的T淋巴细胞亚群CD+3、CD+4、CD+8和自然杀伤(NK)细胞CD16活性及IL2水平,以及体液免疫的IgA、IgG、IgM和补体C3水平;记录妇女妊娠期和分娩1周内感染性疾病的患病情况,SAS软件进行统计分析。结果本调查IDA孕妇Hb值均数为(102.00±6.00)gL,其CD+3、CD+4细胞的百分比、CD+4CD+8比值及IL2水平低于正常孕妇(P<0.01,P<0.05,P<0.05,P<0.01),IDA孕妇IgG水平低于正常孕妇(P<0.01),且随孕妇Hb值的下降,这些指标水平呈下降趋势;孕中期开始IDA孕妇感染性疾病的总发病率高于正常孕妇(P<0.05)。结论IDA孕妇T细胞亚群数量及因子水平和部分免疫球蛋白水平改变,感染性疾病发病率增高;对NK细胞活性和产褥期感染易感性的影响,尚需增加样本数进一步观察。     

Nutritional factors and infectious disease contribute to anemia among pregnant women with human immunodeficiency virus in Tanzania

The objective of this cross-sectional study was to identify risk factors for anemia among human immunodeficiency virus (HIV)-positive pregnant women in Dar es Salaam, Tanzania. Baseline data from 1064 women enrolled in a clinical trial on the effect of vitamin supplementation in HIV infection were examined to identify potential determinants of anemia. The mean hemoglobin (Hb) level was 94 g/L, and the prevalence of severe anemia (Hb < 85 g/L) was 28%; 83% of the women had Hb < 110 g/L. Iron deficiency and infectious disease appeared to be the predominant causes of anemia. Significant independent associations with severe anemia were observed for women with body mass index (BMI) < 19 kg/m(2) compared with women with BMI > 24 kg/m(2) [odds ratio (OR) 3.13, 95% confidence interval (CI): 1. 37-7.14); malaria parasite densities > 1000/mm(3) (OR 2.70, CI: 1. 58-4.61) compared with women with no parasites; eating soil during early pregnancy (OR 2.47, CI: 1.66-3.69); CD4+ cell count < 200/microL compared with CD4+ count > 500/microL (OR 2.70, CI: 1. 42-5.12); and serum retinol levels < 70 micromol/L (OR 2.45, CI: 1. 44-4.17) compared with women with retinol levels > 1.05 micromol/L. The most significant risk factors associated with severe anemia in this population are preventable. Public health recommendations include increasing the effectiveness of iron supplementation and malaria management during pregnancy, and providing health education messages that increase awareness of the potentially adverse nutritional consequences of eating soil during pregnancy.     

血清可溶性CD163水平与子痫前期孕妇病情程度的关系

目的 分析子痫前期(PE)孕妇和正常孕妇血清中可溶性CD163(sCD163)和肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-8、IL-10的相关性,评价PE中sCD163的表达水平及其临床意义。方法 选择2019年1月-2019年6月在郑州大学第三附属医院住院的轻症PE孕妇为子痫前期轻症组、重症PE孕妇为子痫前期重症组和正常孕妇为对照组,各20例。比较三组孕妇间的一般临床资料,采用酶联免疫吸附试验(ELISA)检测三组孕妇血浆中TNF-α、IL-6、IL-8、IL-10和sCD163的浓度,利用Pearson相关性分析三组孕妇sCD163与TNF-α、IL-6、IL-8和IL-10的相关性。结果 子痫前期轻症组和子痫前期重症组的收缩压、舒张压和24 h尿蛋白高于对照组,且子痫前期重症组收缩压和24 h尿蛋白高于子痫前期轻症组(P<0.05)。子痫前期轻症组和子痫前期重症组血浆中TNF-α、IL-6、IL-8的浓度高于对照组,sCD163和IL-10的浓度低于对照组(P<0.05)。对照组孕妇sCD163与IL-10呈正相关(r=0.569,P=0.00...     

HBeAg阴性的HBV感染产妇与母婴传播关系

目的 探讨HBeAg检测阴性的乙型肝炎病毒(HBV)感染产妇及其存在的前C区1896位终止变异株与母婴传播的关系.方法 采用实时荧光定量PCR方法测定产妇血中HBV-DNA载量,对HBV-DNA阳性者及其感染的婴儿,利用错配PCR限制性片段长度多态性分析,测定HBV前C区1896位终止变异.结果 HBeAg阴性产妇HBV的母婴传播率为5.75%,而且母婴传播概率与产妇血中HBV载量密切相关,高载量组(≥106拷贝/ml)的传播率为34.7%,明显高于低载量组(104～106拷贝/ml)的17.1%和低于检测值组的0.46%(P<0.01),进一步对存在HBV前C区终止变异的产妇及其所感染的新生儿的HBV基因分析,发现5例野生株占优势的HBV感染产妇,所感染的婴儿均为野生株,4例变异株占优势的产妇,其感染的婴儿2例为变异株感染,2例为野生株感染.结论 HBeAg阴性的HBV感染产妇存在母婴传播的危险性与其体内的HBV-DNA载量密切相关,对于存在前C区终止变异的HBV感染产妇,在母婴传播过程中,野生株比变异株更容易感染胎儿.     

Exposure to mercury in pregnant women from Alta Floresta-Amazon basin, Brazil

The region of Alta Floresta in the South of the Amazon basin, close to the Teles Pires River, was one of the main prospecting gold areas in the Amazon Basin until the beginning of the 1990s. The economic growth was accompanied by a considerable increase in the population, due to a massive influx of migrants from the southern region of the country. Women had an important role during that process. They worked in the "garimpos" in different activities, such as cooking or managing, where they were exposed mainly to indoor elemental mercury during burning of amalgam. They also worked in gold dealers' shops, where a great amount of amalgam was burned daily. Fish consumption was an important dietary protein source and also a possible exposure pathway, due to the high Hg concentrations reported in carnivorous species. The present study evaluates the mercury uptake and consequent risks involved for pregnant women from Alta Floresta at the end of the gold rush period. The survey included women at different pregnancy stages and it was supported by clinical exams, followed by an interview with a specific questionnaire. Mercury hair concentrations ranging from 0.05 to 8.2 microg/g were found among women, with 13% of them showing concentrations above 2 microg/g. According to the results, mean differences in hair mercury concentration were statistically higher for pregnant women if they had worked in gold mining areas, they had consumed alcohol, their husbands had worked as "garimpeiros," they ate fish, and/or they had malaria before and/or during pregnancy Copyright 2000 Academic Press.     

2010-2017年上海市浦东新区发热伴出疹性疾病病原学分析

目的  分析2010年1月~2017年12月浦东新区发热伴出疹性疾病(rash and fever illness,RFIs)的病原谱构成及流行特征,为RFIs防控提供科学依据。 方法  采用酶联免疫吸附法和实时荧光定量聚合酶链反应对2 381例临床标本进行肠道、麻疹、风疹等病毒的病原学检测,并进行统计分析。 结果  2 381例样本中RFIs检测阳性1 633例(68.59%)。病原谱构成前4位病毒分别是肠道(52.54%)、麻疹(28.54%)、风疹(13.04%)、水痘-带状疱疹(3.37%)。男性风疹病原体检出率高于女性,差异有统计学意义(P=0.026)。年龄组分布中,肠道病毒集中在3~6岁年龄组,水痘-带状疱疹病毒集中在6~18岁年龄段,麻疹病毒、风疹病毒、登革热病毒、小DNA病毒集中在18岁以上年龄段,不同年龄组的病原体检出率差异均有统计学意义(均有P < 0.05)。RFIs发病集中在春季(41.52%),冬季最少(15.00%),其中肠道、麻疹、风疹、登革热病毒在不同季节的病原体检出率差异有统计学意义(P < 0.05)。 结论  肠道和麻疹病毒是本地RFIs感染的主要病原体,应长期监测RFIs病原体的活动水平。     

Vitamin A or beta-carotene supplementation reduces symptoms of illness in pregnant and lactating Nepali women

The contribution of nutritional interventions to the reduction in maternal morbidity rates in developing countries is not well known. We assessed the impact of weekly vitamin A and beta-carotene supplementation on the prevalence of pregnancy and postpartum illness symptoms among 15,832 Nepali women in a placebo-controlled, double-masked, cluster-randomized trial. There was no impact of either supplement on morbidity rates reported up to 28 wk of gestation, inclusive. However, in late pregnancy (>28 wk), symptoms of nausea, faintness and night blindness were reduced with vitamin A, but not beta-carotene, supplementation. Vitamin A supplementation shortened the length of labor by 1.5 h 50 min among nulliparous and multiparous women, respectively. Both interventions reduced the postpartum prevalence of at least four loose stools and night blindness. beta-Carotene supplementation also reduced symptoms of high fever postpartum. The mean number of days of any reported illness symptoms was 3-4 per wk throughout pregnancy. Among women receiving vitamin A, the total number of days of illness symptoms accrued over the last 12 wk of pregnancy was lower by 5 d compared with the placebo recipients. We found the burden of pregnancy-related illness symptoms to be high in this rural area of Nepal where antenatal care is poor and most deliveries occur at home. Maternal vitamin A or beta-carotene supplementation resulted in a reduction in the prevalence of selected illness symptoms during late pregnancy, at the time of birth and during 6 mo postpartum, suggesting that a diet adequate in vitamin A may be important for improving women's reproductive health.     

少数民族地区孕妇弓形虫感染免疫学检测研究

目的:调查少数民族地区弓形虫感染状况及其对胎儿的影响。方法:用酶联免疫吸附法(ELISA)检测孕妇血清弓形虫循环抗原(CAg)、IgM及IgG抗体水平。结果:86例病理妊娠的孕产妇中,3项指标阳性40例,阳性率为46.5%,血清中CAg阳性7例,阳性率为8.13%;IgM阳性12例,阳性率为13.95%;IgG阳性21例,阳性率为24.41%。结论:弓形虫感染对胎儿有较大危害,是引起胎儿流产、死胎及畸形的主要原因之一。少数民族地区不同民族孕产妇弓形虫感染率比较差异无统计学意义,孕产妇弓形虫感染率与猫、犬接触史明显相关。基层地区加大孕妇弓形虫感染检测对民族优生优育有较大帮助。     

六盘水市疑似麻疹病例的发热伴出疹性疾病病原检测结果分析

目的探讨贵州省六盘水市疑似麻疹病例异常增高的病原原因。方法收集疑似麻疹病例血清标本,用ELISA方法检测麻疹IgM抗体、风疹IgM抗体、人细小病毒B19 IgM抗体和EB病毒VCA IgM抗体检测。结果 805份血清标本中检测出麻疹IgM抗体阳性12份,阳性率为1.5%;风疹IgM抗体阳性5份,阳性率为0.6%;人细小病毒B19 IgM抗体阳性23份,阳性率为2.9%;OA值处于灰区的标本14份,阳性率为1.8%;未检测到EB VCA IgM抗体阳性的标本。结论疑似麻疹病例中存在其他发热伴出疹性疾病病原感染,了解本省发热伴出疹性疾病的本底值有利于消除麻疹策略的制定。     

秭归县1991～2005年孕产妇死亡分析

降低孕产妇死亡率,是《中国妇女发展纲要(2001~2010)》提出的新时期战略目标。为实现这一目标,掌握和分析秭归县近15年来孕产妇死亡原因及相关因素,对指导今后妇幼保健工作及孕产妇系统管理,提高产科质量,降低孕产妇死亡率是非常必要的。现对秭归县1991~2005年的孕产妇死亡情况