妊娠早期剧烈呕吐相关危险因素及其对妊娠结局的影响

目的:探讨妊娠早期剧烈呕吐的相关危险因素,分析妊娠剧烈呕吐与妊娠结局的关系,指导孕期妇女的预防保健工作。方法:采用队列研究的方法,分析孕早期妇女妊娠剧烈呕吐状况,追踪其妊娠结局,主要分析方法为卡方检验和Logistic回归分析。结果:妊娠早期剧烈呕吐的相关危险因素有孕周、噪音、睡眠不好、新近装修、咖啡和孕后食量减少,而孕后口味嗜酸辣、少吃蔬菜是剧烈呕吐的保护因素。孕早期剧烈呕吐不是不良妊娠结局的高危因素,对妊娠结局影响不大。结论:妊娠早期剧烈呕吐与妊娠结局关系不大,但应重视孕早期剧烈呕吐,减少噪音等不良因素的暴露,创造良好妊娠条件,注意均衡饮食,保证睡眠,以尽量减少高危妊娠的发生。     

Population‐Based Study of Risk Factors for Severe Maternal Morbidity

Background: Severe maternal morbidity (SMM) is a serious health condition potentially resulting in death without immediate medical attention, including organ failure, obstetric shock and eclampsia. SMM affects 20 000 US women every year; however, few population‐based studies have examined SMM risk factors. Methods: We conducted a population‐based case–control study linking birth certificate and hospital discharge data from Washington State (1987–2008), identifying 9485 women with an antepartum, intrapartum or postpartum SMM with ≥3‐day hospitalisation or transfer from another facility and 41 112 random controls. Maternal age, race, smoking during pregnancy, parity, pre‐existing medical condition, multiple birth, prior caesarean delivery, and body mass index were assessed as risk factors with logistic regression to estimate odds ratios (OR) and 95% confidence intervals [CI], adjusted for education and delivery payer source. Results: Older women (35–39: OR 1.65 [CI 1.52, 1.79]; 40+: OR 2.48 [CI 2.16, 2.81]), non‐White women (Black: OR 1.82 [CI 1.64, 2.01]; American Indian: OR 1.52 [CI 1.32, 1.73]; Asian/Pacific Islander: OR 1.30 [CI 1.19, 1.41]; Hispanic: OR 1.17 [CI 1.07, 1.27]) and women at parity extremes (nulliparous: OR 1.83 [CI 1.72, 1.95]; parity 3+: OR 1.34 [CI 1.23, 1.45]) were at greater risk of SMM. Women with a pre‐existing medical condition (OR 2.10 [CI 1.88, 2.33]), a multiple birth (OR 2.54 [CI 2.26, 2.82]) and a prior caesarean delivery (OR 2.08 [CI 1.93, 2.23]) were also at increased risk. Conclusion: The risk factors identified are not modifiable at the individual level; therefore, provider and system‐level factors may be the most appropriate target for preventing SMM.     

Effects of Dietary Patterns during Pregnancy on Preterm Birth: A Birth Cohort Study in Shanghai

The objective of this study was to analyse representative dietary patterns during pregnancy in Shanghai and explore the effects of dietary patterns during pregnancy on preterm birth. Data were derived from the ‘Iodine Status in Pregnancy and Offspring Health Cohort’ (ISPOHC) study. Multistage, stratified random sampling was used to select survey participants from 16 districts in Shanghai, which were divided into five sampling areas; 40–70 pregnant women were selected from each area. A total of 4361 pregnant women and their offspring were involved in the study. The male-to-female ratio of the babies was 1.04:1, and the incidence of single preterm birth was 4.2%. Three dietary patterns were extracted by factor analysis: a ‘Vegetarian Pattern’, an ‘Animal Food Pattern’ (AFP), and a ‘Dairy and Egg Pattern’. These patterns explained 40.513% of the variance in dietary intake. Binary logistic regression, which was used to analyse the association between birth outcomes and scores measuring maternal dietary patterns, found only the AFP was a significant risk factor for preterm birth. Higher AFP scores were positively associated with preterm birth (Q2 vs. Q1 OR = 1.487, 95% CI: 1.002–2.207; Q3 vs. Q1 OR = 1.885, 95% CI: 1.291–2.754). After adjusting for other potential contributors, a higher AFP score was still a significant risk factor for preterm birth (Q2 vs. Q1 OR = 1.470, 95% CI: 0.990–2.183; Q3 vs. Q1 OR = 1.899, 95% CI: 1.299–2.776). The incidence of preterm birth was 4.2%. A higher score of AFP was significantly associated with a higher risk of preterm birth. The animal food intake of pregnant women should be reasonably consumed during pregnancy.     

Birth Outcomes of Immigrant Women in the United States,France, and Belgium

Objectives: To compare maternal characteristics and birth outcomes of Mexico-born and native-born mothers in the United States and those of North African mothers living in France and Belgium to French and Belgian nationals. Methods: We examined information from single live birth certificates for 285,371 Mexico-born and 3,131,632 U.S.-born mothers (including 2,537,264 U.S.-born White mothers) in the United States, 4,623 North African and 103,345 Belgian mothers in Belgium, and a French national random sample consisting of 632 North African and 11,185 French mothers. The outcomes were mean birthweight, low birthweight, and preterm births. Differences between native/nationals and foreign-born mothers in each country were assessed in bivariate and multivariate analyses controlling for maternal risk factors. Results: The adjusted odds for low birthweight were lower for immigrants than native/nationals by 32% in the United States, by 32% in Belgium, and by 30% in France. The adjusted odds for preterm births were lower for immigrants compared with native/nationals by 11% in the United States and by 23% in Belgium. In France, the odds for preterm births were comparable for immigrants and naturalized mothers. Infants of immigrant mothers also had higher mean birthweights in all three countries. Conclusion: Despite their disadvantaged status, Mexico-born and North African-born women residing in the United States, France, and Belgium show good birth outcomes. These cannot be explained solely by traditional risk factors. Protective factors and selective migration may offer further clues.     

Adverse Birth Outcomes Among Native-Born and Immigrant Women: Replicating National Evidence Regarding Mexicans at the Local Level

Objectives: For almost two decades, the literature has consistently described an epidemiologic paradox relating to better birth outcomes among high-risk groups, particularly new immigrants from Mexico and Southeast Asia. We hypothesize that regardless of their sociodemographic profile, Mexican immigrants will exhibit lower rates of low birth weight and preterm deliveries than native-(U.S.) born women of Mexican origin, non-Hispanic White and Black women, and Puerto Rican women. Methods: We studied 57,324 live-born singleton infants born to residents in the city of Chicago in a linked data set of 1994 birth–death records. Multivariate logistic regression was used to analyze race/ethnicity differentials in two pregnancy outcome measures, low birth weight and preterm birth. Results: Overall better birth outcome is related to maternal immigrant status regardless of race/ethnic groups. Immigrant Mexican women had a significantly lower risk of both low birth weight [adjusted odds ratio (AOR): 0.78, 95% confidence interval (CI) 0.66–0.91] and preterm births (AOR: 0.75, 95% CI 0.65–0.86) and were at 28% and 33% lower risks of delivering a low birth weight infant or a premature infant, respectively, than non-Hispanic White women.     

Adverse birth outcomes among pregnancies of teen mothers: age‐specific analysis of national data in Taiwan

Background This study was conducted to evaluate the risks of adverse birth outcomes including low birthweight, preterm and small‐for‐gestational age among teen mothers. Methods Data were collected from the Taiwan Birth Registry between 1985 and 1997. Among a total of 1 185 597 live births born to mothers aged 24 years or less, 151 259 (12.8%) were born to teen mothers aged 19 years or less. Crude odds ratios (ORs), adjusted ORs (AORs), their 95% confidence intervals and test for linear trend of maternal age‐specific AOR were estimated using logistic regression analysis. Results After controlling for certain birth characteristics and socio‐economic factors, the age‐specific analysis showed significantly gradient variations in increased risks of adverse birth outcomes among births of teen mothers, where the elevated risk was lessened in older teen mothers. Teen mothers aged 16 years or less were observed to experience particularly high AORs for all adverse birth outcomes of interest. Conclusions Not all teen mothers experienced the same magnitude of increased risk of adverse birth outcomes in Taiwan. Considering all teen mothers as the same group may have overlooked the particularly high risks of adverse birth outcomes among very young teen mothers (16 years or less), who are especially vulnerable to such elevated risks.