Birth defects monitoring

Population monitoring of birth defects provides a means for detecting relative changes in their frequency. Many varied systems have been developed throughout the world since the thalidomide tragedy of the early 1960s. Although it is difficult to pinpoint specific teratogenic agents based on rises in rates of a particular defect or a constellation of defects, monitoring systems can provide clues for hypothesis testing in epidemiological investigations. International coordination of efforts in this area resulted in the founding of the International Clearinghouse for Birth Defects Monitoring Systems (ICBDMS) in 1974. In this paper we will describe the functions and basic requirements of monitoring systems in general, and look at the development and activities of the ICBDMS. A review of known and suspected environmental teratogenic agents (eg, chemical, habitual, biological, physical, and nutritional) is also presented.     

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.     

The Association Between Major Birth Defects and Preterm Birth

Objective To evaluate the association between preterm birth and major birth defects by maternal and infant characteristics and specific types of birth defects. Study Design We pooled data for 1995–2000 from 13 states with population-based birth defects surveillance systems, representing about 30% of all U.S. births. Analyses were limited to singleton, live births from 24–44 weeks gestational age. Results Overall, birth defects were more than twice as common among preterm births (24–36 weeks) compared with term births (37–41 weeks gestation) (prevalence ratio [PR] = 2.65, 95% confidence interval [CI] 2.62–2.68), and approximately 8% of preterm births had a birth defect. Birth defects were over five times more likely among very preterm births (24–31 weeks gestation) compared with term births (PR = 5.25, 95% CI 5.15–5.35), with about 16% of very preterm births having a birth defect. Defects most strongly associated with very preterm birth included central nervous system defects (PR = 16.23, 95% CI 15.49–17.00) and cardiovascular defects (PR = 9.29, 95% CI 9.03–9.56). Conclusions Birth defects contribute to the occurrence of preterm birth. Research to identify shared causal pathways and risk factors could suggest appropriate interventions to reduce both preterm birth and birth defects.     

极低与超低出生体质量儿的临床分析

目的 探讨极低出生体质量（VLBW）儿和超低出生体质量（ELBW）儿的临床表现.方法 选择2012年8月至2013年8月于四川大学华西第二医院收治的103例VLBW儿和ELBW儿为研究对象.采用回顾性分析法,对母亲孕期致VLBW儿及ELBW儿的高危因素、患儿生后并发症治疗及转归进行总结和分析（本研究遵循的程序符合四川大学华西第二医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象监护人的知情同意,并与之签署临床研究知情同意书）.结果 103例VLBW儿和ELBW儿的并发症前10位分别为：新生儿肺炎为85例（82.5％）、颅内出血（ICH）为79例（76.6％）、高胆红素血症为60例（58.2％）、呼吸暂停为59例（57.2％）、呼吸衰竭为54例（52.4％）、电解质紊乱为53例（51.4％）、酸碱平衡紊乱为47例（45.6％）、低血糖为40例（38.8％）、贫血为38例（36.9％）、新生儿呼吸窘迫综合征（NRDS）为28例（27.2％）.103例患儿中,存活为84例（81.6％）,死亡为8例（7.8％,放弃治疗后死亡为3例）,家属放弃治疗自动出院为11例（10.7％）.结论 及时、恰当地对VLBW儿和ELBW儿给予保暖、营养支持、积极预防并治疗各种早产儿相关并发症等,可降低其死亡率.     

出生体重与儿童期肥胖

目的：研究出生体重与儿童期肥胖之间的关系。方法：采用随机整群抽样方法，取北京市四个城区35所小学1－2年级学生10221名，进行身高，体重测量。其中9712名学生家长填写了包含出生体重、2岁前喂养情况、家庭经济状况、父母文化和职业等内容的调查问卷。结果：随着出生体重的增加，肥胖超重的发生率呈直线上升。低出生体重组（BW＜2500g)肥胖的发生率为12．8％，正常出生体重组（BW＝2500－3999g)为14．7％，而高出生体重组（BW≥4000g）则高达23．3％，并且以中重度肥胖为主。早产低体重儿的肥胖发生率为18％，明显高于足月小样儿（8．8％）。结论：高出生体重是儿童期肥胖的重要危险因素，早产低体重儿较宫内生长迟缓儿易发生儿童期肥胖。预防肥胖应该从胎儿期抓起。     

Analysis of Birth Weights of a Rural Hospital

Background:

Low birth weight remains a major reason behind childhood malnutrition. The NFHS findings show no dent in this problem.

Objective:

This study was undertaken to explore change in birth weights in a period from 1989 to 2007 and any associations thereof.

Materials and Methods:

All birth records of a private rural hospital spanning two decades (1989-2007) were analyzed for birth weight, age of mother, gender, birth order of the baby, proportion of pre-term babies and low birth weight babies.

Results:

No change was observed in the average birth weights (average 2.71 kg) over the period. Although the birth weight shows some expected variance with the age of mother, it was found to have no relation with the baby’s birth order and gender. The low birth weight proportion is about 24% and shows little difference before and after the series midpoint of year 1998.

Conclusion:

The birth weights have hardly changed in this population in the two decades.     

中国活产出生体重的影响因素

【目的】　根据 1998年中国活产儿出生体重调查数据 ,分析影响出生体重的各种因素。　【方法】　采用分层抽样方法 ,对 1998年 7～ 10月期间在抽样地区出生的孕周≥ 2 8周的活产儿进行出生体重测查。同时调查抽样地区育龄妇女贫血率 ,收集海拔高度、1998年人均国民生产总值等数据。　【结果】　不同胎龄活产儿出生体重一般是男性高于女性 ,但在孕 2 9周和 31周时女性出生体重略高于男性。不论男女 ,在孕 4 2周以后胎儿体重已经停止增长并出现下降趋势。孕 32周后男女活产儿出生体重随胎龄增长的趋势一致 ,并分别于孕 34周和孕 37周出现 2次增重高峰。出生体重受产次影响 ,第 4产或更高产次活产儿的出生体重明显下降。出生体重随海拔高度升高而明显下降 ,海拔高度每升高 10 0m ,出生体重下降 6 .1g。随海拔高度的升高 ,宫内发育迟缓儿的发生率和占低出生体重儿的比例均显著升高。低出生体重发生率随同地区育龄妇女贫血率增加而显著升高 (χ2 =81.4 ,P <0 .0 0 1)。年人均国民生产总值 2 0 0 0元以下地区活产儿的出生体重显著低于 2 0 0 0元以上地区 ,相差达 12 0g。　【结论】　本次调查发现 ,男女胎儿体重增长有 2个高峰 ,分别出现在孕 34和 37周。平均出生体重与同一地区的海拔高度、育龄妇女贫血率和     

Associations Between Preterm Birth,Low Birth Weight,and Postpartum Health in a Predominantly Hispanic WIC Population

ObjectiveTo describe the postpartum health of predominantly Hispanic participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and identify how health characteristics differ between mothers who delivered preterm or low birth weight infants and those who did not.DesignCross-sectional survey among postpartum WIC mothers.SettingLos Angeles and Orange Counties, CA.ParticipantsWIC participants within 1 year of delivery (n = 1,420).Main Outcome MeasuresPostpartum health behaviors, health characteristics, and birth spacing intentions and behaviors.AnalysisFrequencies of health characteristics were estimated using analyses with sample weights. Differences were assessed with chi-square and Fisher exact tests with Bonferroni correction for pairs of tests.ResultsMany women exhibited postpartum risk factors for future adverse health events, including overweight or obesity (62.3%), depressive symptoms (27.5%), and no folic acid supplementation (65.5%). Most characteristics did not differ significantly (P > .025) between mothers of preterm infants and full-term infants or between mothers of low birth weight and normal birth weight infants.Conclusions and ImplicationsDespite few differences between postpartum characteristics of mothers who delivered preterm or low birth weight infants and those who did not, a high percentage of mothers had risk factors that need to be addressed. Current postpartum educational activities of WIC programs should be evaluated and shared.     

Effect of Interpregnancy Interval on Infant Low Birth Weight: A Retrospective Cohort Study Using the Michigan Maternally Linked Birth Database

Objective: To examine the relationship between interpregnancy interval and low birth weight (LBW), using the retrospective cohort design. Methods: We used the maternally linked Michigan livebirth data documented between 1989 and 2000 to evaluate LBW in relation to interpregnancy (i.e., delivery-to-conception) interval, overall and at levels of other reproductive risk factors. We fit separate logistic regression models for pairs of first-second, second-third, third-fourth, and fourth-fifth births to control for confounding. Results: Of the 565,911 infants identified, 5.5% had LBW. Univariate and stratified analyses showed that the risk for LBW was lowest when the interpregnancy interval was 18–23 months, and increased with shorter or longer intervals. This J-shaped relationship persisted after controlling for all risk factors simultaneously. For example, among the first-second birth pairs, the adjusted odds ratios (AORs) for LBW associated with interpregnancy intervals <6, 24–59, 60–95, and 96–136 months were 1.4 (95% confidence interval [CI] = 1.3–1.5), 1.5 (95% CI = 1.3–1.6), 1.1 (95% CI = 1.0–1.1) and 1.5 (95% CI = 1.3–1.8), respectively, compared with an interval of 18–23 months. Among the second-third birth pairs, the AORs were 1.5 (95% CI = 1.3–1.6), 1.3 (95% CI = 1.2–1.4), 1.1 (95% CI = 1.0–1.1), and 1.6 (95% CI = 1.3–2.0), respectively. Among the third-fourth birth pairs, the AORs were 1.2 (95% CI = 1.1–1.4), 1.3 (95% CI = 1.1–1.5), 1.0 (95% CI = 0.9–1.1), and 1.4 (95% CI = 1.0–2.0), respectively. Among the fourth-fifth birth pairs, the AORs were 1.3 (95% CI = 1.1–1.6), 1.2 (95% CI = 0.9–1.5), 1.1 (95% CI = 1.0–1.4), and 1.3 (95% CI = 0.8–2.3), respectively. The population attributable risk associated with interpregnancy intervals shorter than 18 months or longer than 23 months was 9.4%. Conclusion: These data suggest that spacing pregnancies appropriately could be used as a strategy for preventing LBW.     

出生季节、身高、性别与体重4个变量关系的同质分析试用结果

研究正常分娩新生儿４个变量（身高、体重、性别、季节）不同类别间的同质关系,并以２维或３维几何图形表达。「方法」从福州地区一家大型综合性医院１４年的出生登记１２７５５例资料中,选择正常分娩者８４６３例数据,以ＳＰＳＳ８．０ｆｒｏＷｉｎｄｏｗｓ进行同质分析（ｈｏｍｏｇｅｎｅｉｔｙａｎａｌｙｓｉｓ,ＨＯＭＡＬＳ）与绘图。「结果」①一般２维列联表常难以表达上述变量间的本质关系;②奏出生者倾向于偏高,偏重,     

664例低出生体重儿分析

本文分析１２６２５围产儿中６６４例低出生体重儿（ＬｏｗＢｉｒｔｈＷｅｉｇｈｔＩｎｆａｎｔ，ＬＢＷＩ）的出生体重及产妇情况。     

Impact Of Maternal Alcohol Intake On Birth Weight

Alcohol abuse during pregnancy is associated with low birth weight and congenital malformations. Alcoholism prior to conception, even with abstinence during pregnancy, decreases birth weight.     

梅县地区已婚育龄妇女二胎后避孕节育状况调查研究

目的探讨梅县地区已婚育龄妇女二胎后避孕节育状况。方法选取2017年10月至2018年10月625名梅县地区二胎后已婚育龄妇女,根据是否接受过避孕节育健康知识宣教分为对照组(312例,未接受过避孕节育健康知识宣教)与观察组(313例,接受过避孕节育健康知识宣教)。对受访者二胎后避孕节育保健知识掌握情况和避孕节育方式选择进行调查。结果两组避孕节育保健知识掌握情况方面,观察组显著优于对照组(P<0.05);两组避孕节育方法的选择情况,观察组显著优于对照组(P<0.05);观察组经避孕后非意愿妊娠发生率显著低于对照组(P<0.05)。结论梅县地区二胎后已婚育龄妇女避孕节育总体情况良好,进行避孕节育健康知识宣教能提高已婚育龄妇女的避孕知识水平,避免意外怀孕,保护妇女身心健康,提高生活质量。     

Birth weight for gestational age as a health indicator: Birth weight and mortality measures at the local area level

Foetal growth is of interest not only as a predictor of pregnancyoutcome and of infant and child health, but also of subsequentadult disease. Birth weight (BW) standardized for gestationalage and sex (BWSDS) is a measure of foetal growth. The aim ofthis paper was to study the BWSDS as a health indicator in comparisonwith other pregnancy outcome measures such as crude BW, thelow birth weight (LBW) rate and the pre-term birth rate by correlationto mortality rates and to a socioeconomic area index, at localarea level in the city of Göteborg, Sweden 1973–1986.The results showed that BWSDS had a statistically significantcorrelation to mortality rates in the adult population (–0.58to 7minus;0.70) and to a socioeconomic area index (0.89) anda general pattern of closer relationship to these measures comparedto the other pregnancy outcome measures at the local area level.This indicates that BWSDS, in comparison with the BW, LBW rateand the pre-term birth rate, has at least as good (or better)properties as a health indicator. The BWSDS, representing themain perinatal population, has a broader representativity thanmerely being an indicator of foetal health in a restricted sense.Birth weight for gestational age is found to be suitable asa health indicator at the local area level.     

Birth prevalence of congenital hypothyroidism in Mexico

The Mexican Institute of Social Security (IMSS) provides care for more than 40% of the Mexican population. This report constitutes the first study of the incidence of congenital hypothyroidism (CH) in Mexican children. We performed a prospective study with a population base. CH screening began in 1997 with blood samples from the heel taken 72 h after birth; from 2000, the detection strategy was changed nationwide and blood samples were taken from the umbilical cord in all newborns for determination of thyroid-stimulating hormone (TSH) concentration. We evaluated the annual coverage. TSH concentration was measured by chemoluminescence; TSH values ≥30 µIU/mL in umbilical cord blood and 15 µIU/mL in capillary blood were considered positive cases and were confirmed through hormonal studies. The incidence and 95% confidence intervals [95% CI] were calculated.
We found that coverage within the IMSS population was 53% from 1997 to 2000 and had increased to 95% by 2001. A total of 2 777 292 children from 2 975 157 births (93%) were studied between 2000 and 2004. Of these, 4050 had a high TSH concentration leading to suspicion of CH; CH was confirmed in 1286 (32%). The resulting incidence was 4.3/10 000 livebirths [95% CI 3.6, 5.1]. With the results obtained, we conclude that the IMSS strategy of CH screening at birth ensured 95% coverage of children in the system. The birth prevalence of CH reported is among the highest in the world.     

分娩球减轻分娩疼痛的临床观察

目的观察产妇应用分娩球减轻分娩疼痛的临床效果。方法随机选择2008年1月～2008年6月在南岭医院妇产科住院分娩的初产妇200例,按入院单双顺序随机分为观察组和对照组各100例。观察组在临产后,由助产士指导孕妇在宫缩间歇期骑坐在分娩球上,或者通过滚、靠、抱等方式来减轻疼痛;对照组临产后采用常规体位,即卧位(平卧位、交替左右侧卧位)。结果观察组产妇疼痛缓解的效果比对照组好,两组比较有统计学意义(P<0.01)。结论应用分娩球可以减轻分娩疼痛。     

围产保健对降低低出生体重的影响

目的探讨低出生体重与母亲孕产期等因素的关系。方法对１９９３～１９９６年嘉兴市秀城区９３３７例活产儿（２６９例低出生体重儿）的围产保健资料进行收集、整理、统计、分析。结果４年中低出生体重儿（＜２５００ｇ）的平均发生率为２．８８％，有逐年下降趋势。低出生体重儿与母亲的文化、身高、妊娠胎数、产前检查次数、分娩孕周以及胎儿性别有关。结论做好围产保健、孕产妇系统管理，有利于降低低出生体重儿的发生率、围产儿死亡率和婴儿死亡率     

蚌埠市出生缺陷监测

本文报告蚌埠市1983年5月~1984年5月出生缺陷监测结果。在6,395例新生儿中,出生缺陷102例,发生率15.95‰;围产儿死亡185例,死亡率28.93‰;死胎(产)159例,发生率24.86‰。三组间性别差异均无显著性(P>0.05)。出生缺陷以神经系统比例较大(26.67%)。围产儿死亡主要原因为出生缺陷(27.37%)。应用逐步回归技术对28种因素进行了分析,还讨论了新生儿出生缺陷监测意义和重要性。