补充叶酸与兰州地区孕妇发生子痫前期风险的研究

目的 调查兰州地区孕妇孕期各阶段补充叶酸与子痫前期发生的相关风险.方法 回顾2010-2012年在甘肃省妇幼保健院建卡并随访到分娩结局的14 591名孕妇为研究对象,以Logistic回归模型分析围孕期补充叶酸与子痫前期的关联性.结果 30％的孕妇在怀孕前补充叶酸,可降低子痫前期的风险(OR值:0.70;95％可信区间...     

补充叶酸及膳食叶酸摄入与早产发生风险的交互效应研究

目的探讨女性围孕期补充叶酸及膳食叶酸摄入与早产发生风险的关系及其对早产发生风险的交互作用。方法 2011年1月至2013年3月在甘肃省妇幼保健院建卡就诊并随访到分娩结局的单胎孕妇为研究对象,调查一般人口学、围孕期叶酸补充情况、围孕期膳食摄入频次、种类及其胎儿分娩时的信息。以logistic回归模型分析围孕期叶酸补充和膳食叶酸摄入与早产的发生风险及其交互效应。结果在控制相关混杂因素后,围孕期补充叶酸12周以及膳食叶酸摄入≥209.94μg/d均可降低早产的发生风险,且存在剂量反应关系(OR=0.83,95%CI:0.72~0.96;OR=0.84,95%CI:0.76~0.94,P趋势0.05)。交互作用分析显示,围孕期补充叶酸与膳食叶酸摄入间存在相乘及相加的交互作用[RERI(95%CI)=0.32(0.12~0.51),AP(95%CI)=0.92(0.24~1.61),S(95%CI)=0.68(0.56~0.82)]。类似的保护作用在早期与极早期早产、自发性早产、自发性早产不伴胎膜早破中均有体现,而在适度早产、干预性早产、自发性早产伴胎膜早破中无相乘及相加的交互作用。结论围孕期补充叶酸与膳食叶酸摄入对早产及部分早产亚型具有协同保护作用,故在补充叶酸的同时增加膳食中叶酸的摄入量能显著降低早产的发生风险。     

双胎妊娠的临床结局分析

目的探讨双胎妊娠的并发症及围生儿结局。方法选取2017年1月1日-2018年12月31日在广东省妇幼保健院住院分娩的双胎孕妇200例,回顾性分析孕妇及新生儿的临床资料,分别比较孕妇的一般情况、妊娠期并发症及围生儿结局。结果双胎妊娠并发症的发生率达67. 0%,尤其是未足月胎膜早破(PPROM),且辅助生殖的双胎发生率明显高于自然妊娠双胎发生率(P<0. 05)。双胎输血综合征(TTTS) 12例,双胎之一胎死宫内6例。出生体质量不同一性双胎22例,其中围生儿死亡6例。结论辅助生殖技术的应用导致双胎妊娠发生率增加,使双胎围生儿结局改善的关键是预防和治疗未足月胎膜早破。单绒毛膜双胎围生结局不良,应加强孕期干预。     

孕妇增补微量营养素状况及其与妊娠结局关联的队列研究

目的:了解安徽地区孕妇增补微量营养素的现况,探讨增补微量营养素与妊娠结局的关系。方法:以2008年10月～2010年10月在安徽省合肥、马鞍山、芜湖3个市的妇幼保健机构首次进行孕期保健体检的孕妇为对象,调查孕早期增补微量营养素的情况,通过孕妇保健手册了解妊娠结局情况。结果:至2011年5月分娩单胎活产儿的孕妇共10 269人。孕早期服用复合维生素、复合微量元素、钙剂、铁剂、叶酸坚持1个月以上的孕妇分别为660人(6.4%)、520人(5.1%)、384人(3.7%)、208人(2.0%)、5 358人(52.2%),孕前半年服用叶酸坚持1个月以上的孕妇2 021人(19.7%)。在控制母亲年龄、文化程度、家庭人均月收入、孕前BMI、自然流产史、人工流产史及胎儿性别后,孕早期持续服用复合微量元素(RR=0.25,95CI%=0.09～0.69)和叶酸(RR=0.72,95CI%=0.55～0.96)都会减少发生小于胎龄儿的风险。多元线性回归模型显示,控制母亲年龄、文化程度、家庭人均月收入、孕前BMI、自然流产史、人工流产及胎儿性别后,孕早期补充复合维生素、复合微量元素、叶酸均能增加胎儿出生体重,孕早期服用叶酸可增加胎儿出生胸围,差异具有统计学意义(P<0.05),而孕前半年增补叶酸与妊娠结局指标无显著关联(P>0.05)。结论:孕妇孕早期补充微量营养素可促进胎儿宫内生长,减少小于胎龄儿的发生。     

沿着苏德隆教授开辟的学术道路深入开展现场流行病学调查

目的探讨围孕期增补叶酸与子代不良出生结局的关联。方法选取马鞍山市4家市级医疗卫生机构2008年10月至2010年10月孕期保健的孕妇建立孕妇队列。随访期间收集孕妇社会人口统计学资料、妊娠间隔、妊娠并发症、围孕期服用叶酸等情况。追踪随访分娩情况,包括新生儿体重、身长、出生头围、胸围等。共获得有效问卷和出生详细信息的活产单胎儿4448人,其中早90人,小于胎龄儿147人,低出生体重104人。数据使用Dunnett-t检验、x²检验和多因素logistic回归模型进行分析结果围孕期规范增补叶酸,或单纯孕早期增补叶酸其子代出生体重、身长、头围等体格指标明显好于未增补者;控制初次建卡孕龄、孕妇年龄、文化程度、户籍、家庭人均月收人、孕前BMI、孕周、孕次、产次、妊娠间隔、既往不良孕育史、妊娠合并症后,多因素logistic回归模型分析结果显示:规范增补叶酸是不良出生结局的保护因素,可降低小于胎龄儿、早产、低出生体重发生的风险,其RR值(95%CI)分别为0.45 ( 0.24~0.86),0.52(0.32~0.87),0.39(0.19~0.80 )。而单纯孕前增补、单纯孕早期增补和其他增补叶酸情况对早产、小于胎龄儿和低出生体重的发生率并无明显影响。结论围孕期增补叶酸是否规范,直接影响子代不良出生结局的发生。     

高龄初产不同分娩方式临床分析

目的探讨单胎高龄初产妇不同分娩方式与妊娠结局及与妊娠合并症/并发症的关系。方法对2012年8月12日至2014年4月30日在湖北省妇幼保健院分娩的单胎高龄初产妇分娩情况及母儿妊娠结局及妊娠合并症/并发症进行回顾性分析,并进行统计学处理。结果单胎高龄初产妇剖宫产组平均出生体重高于阴道分娩组,平均出血量高于阴道分娩组。剖宫产组孕妇患妊娠期糖尿病、妊娠期高血压疾病多于阴道产组,阴道分娩组胎膜早破多于剖宫产组。结论高龄初产是高危妊娠的一种,应加强孕期管理,控制血糖血压,控制胎儿体重,选择合适的分娩方式。     

研究孕期体重管理对孕产妇分娩结局的影响

目的:探讨孕妇在孕期接受体重管理对改善分娩结局的应用效果.方法:选择本人于2018年1月~2018年12月建卡、产检的162例孕妇作为研究对象,按照随机数字表法分为对照组(80例,孕期常规管理)和研究组(82例,在对照组基础上采用孕期体重管理),收集分析两组孕妇管理前后体重增长情况、妊娠并发症情况和分娩结局.结果:两组孕妇管理前体重情况无明显差异(P>0.05),管理后研究组孕妇体重指数明显低于对照组,妊娠并发症发生率明显低于对照组,分娩结局明显优于对照组,差异均有统计学意义(P<0.05).结论:孕妇在孕期进行体重管理,能够降低孕期体重增长量,降低妊娠并发症发生率,改善分娩结局,提高母婴的生命安全,值得临床推广应用.     

孕妇体质对母儿及分娩的影响

目的:探讨孕妇体质对母儿及分娩的影响。方法:对632例单胎、足月妊娠、无内外科合并症的孕妇自妊娠13周前开始至分娩定期测量体重、身高、计算体重指数(BMl),观察不同BMI组的妊娠并发症、分娩方式及新生儿情况。结果:孕前BMI≥28及分娩时BMI≥30者羊水过多发生率显著增加:分娩时BMI≥25以上特别是BMI≥30者及整个孕期体重增长≥20kg、整个孕期BMI增长在7以上者孕妇的剖宫产率、巨大儿发生率均显著增加。结论;孕前体重指数过重和孕期体重增长过多是妊娠并发症、不良妊娠结局的重要因素。根据本资料分析孕期体重增长应控制在20kg以内、孕期体重指数增加应控制在7以内。     

双胎早孕期轻度贫血对妊娠结局的影响

目的探讨早孕期轻度缺铁性贫血对双胎妊娠母儿结局的影响。方法对2016～2017年上海国际和平妇幼保健院分娩的双胎妊娠孕妇临床资料进行回顾性研究,比较孕早期轻度贫血(90 g/L≤血红蛋白110 g/L)与非贫血(血红蛋白≥110 g/L)孕妇的母儿结局。结果共纳入704例双胎孕妇,其中203例(28.8%)早孕期出现轻度贫血。早孕期轻度贫血双胎孕妇妊娠期糖尿病发生率(15/203,7.4%)低于非贫血组(68/501,13.6%)(P0.05);两组其他妊娠期并发症、分娩情况和围产儿结局比较,差异无统计学意义(P0.05)。结论早孕期轻度缺铁性贫血的双胎孕妇妊娠期糖尿病发生率下降,同时并未增加围产儿不良结局风险。因此,双胎妊娠早孕期轻度缺铁性贫血可能为妊娠期糖尿病的保护因素,无须对所有双胎孕妇尤其是非贫血孕妇进行常规补充铁剂治疗。     

围孕期补充叶酸的益处及疑惑

目前叶酸对围孕期的重要作用已得到广泛关注,但对于围孕期补充叶酸的益处、安全性等方面仍存在一些疑惑。本文简要综述了叶酸对先天畸形和妊娠结局的影响,叶酸补充的推荐剂量,体内叶酸状态监测以及补充叶酸时肿瘤、维生素B12缺乏和双胎的影响,为围孕期妇女补充叶酸提供参考。     

Weight loss during pregnancy is associated with adverse pregnancy outcomes among HIV-1 infected women

In a prospective study of 1002 pregnant, HIV-1 infected Tanzanian women, we examined the incidence of fetal death, preterm delivery, low birth weight (LBW), and small for gestational age (SGA) births in relation to maternal anthropometry at the first prenatal visit, weight loss, and low weight gain during pregnancy. Anthropometric measurements were obtained monthly during the 2nd and 3rd trimesters. Low maternal height and weight at the first visit were significantly related to lower mean birth weight and increased risk of SGA, but not to preterm delivery. Maternal stature < 150 cm was significantly related to fetal death. Weight loss during pregnancy, defined as a negative slope of the regression of weight measurements on the week of gestation, occurred in 10% of the women. It was related to increased relative risk (RR) of fetal death (RR = 1.83, 95% CI = 0.93, 3.57), preterm delivery (RR = 1.85, 95% CI = 1.40, 2.44), and LBW (RR = 2.85, 95% CI = 1.69, 4.79) after adjusting for multivitamin supplementation, height, primiparity, baseline weight, malaria, CD4 cell count, HIV disease stage, and intestinal parasitoses. The significant association with fetal death was stronger for weight loss during the 2nd trimester, whereas increased risks of preterm delivery and LBW were higher for weight loss during the 3rd. Similar but weaker associations were found with low weight gain during pregnancy (slope < 25th percentile). We conclude that poor anthropometric status at the first prenatal visit and weight loss during pregnancy among HIV-1 infected women are strong risk factors for adverse pregnancy outcomes.     

Does lack of multinutrient supplementation during early pregnancy increase vulnerability to alcohol-related preterm or small-for-gestational-age births?

The objective of this study was to assess whether women who do not take multinutrient supplements during early pregnancy are more susceptible to the effects of low-to-moderate alcohol consumption on preterm birth and small-for-gestational-age birth (SGA) compared to women who do take multinutrients. This analysis included 800 singleton live births to mothers from a cohort of pregnant women recruited for a population-based cohort study conducted in the Kaiser Permanente Medical Care Program in Northern California. Participants were recruited in their first trimester of pregnancy and information about their alcohol use and supplement intake during pregnancy was collected. Preterm birth (n = 53, 7%) was defined as a delivery prior to 37 completed weeks of gestation and SGA birth (n = 124, 16%) was defined as birth weight less than the 10th percentile for the infant’s gestational age and sex compared to US singleton live births. A twofold increase in the odds of SGA birth attributed to low-to-moderate alcohol intake was found among multinutrient supplement non-users (95% CI: 1.1, 5.3). Yet, among multinutrient supplement users, there was no increased risk of an SGA birth for women who drank low-to-moderately compared to women who abstained (aOR: 0.97, 95% CI: 0.6, 1.6). Similar results emerged for preterm birth. Our findings provide marginal evidence that multinutrient supplementation during early pregnancy may modify the risk of SGA births and preterm birth associated with alcohol consumption during pregnancy and may have important implications for pregnant women and women of child-bearing age. However, future research needs to be conducted.     

新生儿早产、低出生体重及小于胎龄的危险因素

目的 研究早孕期相关暴露因素与新生儿早产、低体重及小于胎龄的关系。方法 选取“中国孕产妇队列研究·协和”项目于2017年7月25日至2018年7月24日入组并于2018年12月31日前分娩且符合纳入标准的3 172例孕妇为研究对象,使用二分类logistic回归分析对早孕期相关暴露因素与新生儿不良分娩结局的关系进行统计分析。结果 新生儿早产、低体重及小于胎龄的发生率分别为4.76%、3.53%、5.74%。在早产方面,北方孕妇和孕期增重是早产的保护因素,而胎膜早破、妊娠期高血压、1～3年内有口腔检查或治疗、家庭人口为3～4人是早产的危险因素。在低出生体重方面,孕期增重和食用奶及奶制品是低出生体重儿的保护因素,而胎膜早破、妊娠期高血压、工作久坐时间>6 h、1～3年内有口腔检查或治疗、被动吸烟等是低出生体重儿的危险因素。在小于胎龄方面,女婴、被动吸烟、食用花生油及口味偏淡是小于胎龄儿的危险因素,而补充叶酸是小于胎龄儿的保护因素。结论 新生儿早产、低体重及小于胎龄的影响因素是多因素的,应针对相关危险因素采取有针对的预防和干预措施以降低新生儿不良出生结局的发生风险。     

Is Maternal Smoking during Early Pregnancy a Risk Factor for All Low Birth Weight Infants?

Background

Low birth weight (LBW) infants do not form a homogeneous group; LBW can be caused by prematurity or poor fetal growth manifesting as small for gestational age (SGA) infants or intrauterine growth retardation. We aimed to clarify the relationship of maternal smoking with both SGA and preterm LBW infants.

Methods

The study population comprised pregnant women who registered at the Koshu City between January 1, 1995, and December 31, 2000, and their children. We performed multivariate analyses using multiple logistic regression models to clarify the relationship of maternal smoking during pregnancy with the SGA outcome and preterm birth in LBW infants.

Results

In this study period, 1,329 pregnant women responded to questionnaires, and infant data were collected from 1,100 mothers (follow-up rate: 82.8%). The number of LBW infants was 81 (7.4%). In this cohort, maternal smoking during early pregnancy was associated with LBW and the SGA outcome. Maternal smoking during early pregnancy was a risk factor for LBW with SGA outcome and for LBW with full-term birth. However, it was not a risk factor for LBW with appropriate weight for gestational age (AGA) and LBW with preterm birth.

Conclusion

These results suggested that LBW with AGA and LBW with preterm birth were associated with other risk factors that were not considered in this study, such as periodontal disease. For the prevention of LBW, not only abstinence from smoking during pregnancy but also other methods such as establishing a clinical setting should be adopted.Key words: Infant, Low Birth Weight; Pregnancy; Risk Factors; Smoking     

The effect of high doses of folic acid and iron supplementation in early-to-mid pregnancy on prematurity and fetal growth retardation: the mother–child cohort study in Crete, Greece (Rhea study)

Purpose

We examined whether high doses of folic acid and iron supplementation in early-to-mid pregnancy affect the risk of preterm birth, low birth weight, and small for gestational age neonates, in the mother–child cohort in Crete, Greece (Rhea study).

Methods

We included 1,279 women with singleton pregnancies with complete data on supplements use in early-to-mid pregnancy and birth outcomes. Anthropometric measurements at birth were obtained from medical records. Red blood cell folate concentrations in cord blood were measured in a subsample of the study population (n = 58).

Results

Sixty-six percent of the study participants reported high doses of supplemental folic acid use (5 mg/day), while 21 % reported excessive doses of folic acid use (>5 mg/day) in early-to-mid pregnancy. Daily intake of 5-mg supplemental folic acid was associated with a 31 % decrease in the risk of preterm birth (RR, 0.69; 95 % CI, 0.44, 0.99), 60 % decrease in the risk of delivering a low birth weight neonate (RR, 0.40; 95 % CI, 0.21, 0.76), and 66 % decrease in the risk of delivering a small for gestational age (SGA) neonate (RR, 0.34; 95 % CI, 0.16, 0.73). Daily doses of iron supplementation more than 100 mg were associated with a twofold increased risk for SGA neonates (RR, 2.14; 95 % CI, 0.99, 5.97).

Conclusion

These findings suggest that high daily doses of supplementary folic acid in early-to-mid pregnancy may be protective for preterm birth, low birth weight, and small for gestational age neonates, while high daily doses of supplementary iron may be harmful for fetal growth.     

预防低出生体重儿的孕期护理探索

目的:探索预防低出生体重儿的孕期护理。方法:183例产妇,在产后24h对其进行问卷调查有关家庭、社会、经济情况及人口学特征,同时摘录相关孕期检查记录卡;对早产儿组低出生体重儿54例、足月小样儿组低出生体重儿26例、对照组103例进行病例对照研究。结果:3组中,早产组出生体重最低,早产是低出生体重的主要原因;早产组在各阶段的胎头双顶径均>足月小样儿组,且在35周前均不<对照组;足月小样儿组在29周以后越来越<对照组,本研究显示其差距呈波动性。各孕周孕妇体重与基础体重之间增加的情况显示,早产组各阶段一直处于最低,SGA组次之,对照组增加最多。结论:从孕期护理预防低出生体重儿,重点是预防早产儿的发生;关注B超预测与胎婴儿实际体重间的密切相关性是孕期护理不可忽视的工作;做好基础体重的测量与记录,把每次孕妇体重增加情况与基础体重比较,发现低于本研究中对照组增加幅度的,可及时给予孕期营养指导。     

Does Maternal Exposure to Secondhand Tobacco Smoke During Pregnancy Increase the Risk for Preterm or Small-for-Gestational Age Birth?

Introduction While associations between active smoking and various adverse birth outcomes (ABOs) have been reported in the literature, less is known about the impact of secondhand smoke (SHS) on many pregnancy outcomes. Methods We examined the relationship between maternal exposure to SHS during pregnancy and preterm (<?37 weeks gestation) and small-for-gestational age (SGA; assessed using sex-, race/ethnic-, and parity-specific growth curves) singleton births using non-smoking controls from the National Birth Defects Prevention Study (1997–2011). Multivariable logistic regression models for household, workplace/school, and combined SHS exposure—controlled for maternal education, race/ethnicity, pre-pregnancy body mass index, and high blood pressure—were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Interaction was assessed for maternal folic acid supplementation, alcohol use, age at delivery, and infant sex. Results Infants of 8855 mothers were examined in the preterm birth analysis with 666 (7.5%) categorized as preterm, 574 moderately preterm (32–36 weeks), and 92 very preterm (<?32 weeks). For the SGA analysis, infants of 8684 mothers were examined with 670 (7.7%) categorized as SGA. The aORs for mothers reporting both household and workplace/school SHS were elevated for preterm (aOR 1.99; 95% CI 1.13–3.50) and moderately preterm birth (32–36 weeks) (aOR 2.17; 95% CI 1.22–3.88). No results for the SGA analysis achieved significance, nor was evidence of interaction evident. Conclusion The findings suggest an association between SHS from multiple exposure sources and preterm birth, but no evidence for association with SGA births. Continued study of SHS and ABOs is needed to best inform public health prevention programs.     

Factors associated with repetition of low birthweight: Missouri longitudinal study

The tendency to repeat low birthweight (LBW < 2500 g) was studied in 182 285 linked first and second birth Missouri livebirths for 1978–90, of which 10 701 had first birth LBW. We examined the likelihood of LBW repetition by first birth birthweight, preterm delivery, and small-for-gestational-age (SGA) status by race, and the odd ratios (ORs) of repeat LBW for risk factors such as smoking, in comparison with ORs of second birth LBW among women with normal-weight first births. We found a strong tendency to repeat LBW (21%), especially following more extreme LBW first births. Adjusted ORs for repeat LBW were 10.1 for births that were preterm and SGA; 7.9 for preterm non-SGA; and 6.3 for SGA term births. Significant ORs of LBW repetition were found for smoking (1.52 and 1.85 for smoking in second pregnancy only and both pregnancies, respectively), short interpregnancy interval (1.33), and advanced maternal age (1.17), but the ORs were generally lower than those for women with normal-weight first births. Low pre-pregnancy weight was a significant risk factor for LBW repetition.     

Impact of maternal asthma on perinatal outcomes: a two-stage sampling cohort study

There are conflicting results concerning the impact of maternal asthma during pregnancy on perinatal outcomes. The present study investigated the associations between maternal asthma during pregnancy and the risk of a small-for-gestational-age (SGA) infant, a low-birth-weight (LBW) infant, and preterm birth. A population-based cohort of 40,788 pregnancies from asthmatic and non-asthmatic women was reconstructed through the linking of three Quebec (Canada) administrative databases between 1990 and 2002. A two-stage sampling cohort design was used to collect additional information by way of a mailed questionnaire. The generalized estimation equation models were used to obtain adjusted odds ratios of SGA, LBW and preterm birth comparing asthmatic and non-asthmatic women. The cohort included 13,007 pregnancies from asthmatic and 27,781 pregnancies from non-asthmatic women. Final estimates showed that the odds of SGA (odds ratio: 1.27, 95% confidence interval: 1.14, 1.41), LBW (1.41: 1.22, 1.63) and preterm delivery (1.64: 1.46, 1.83) were significantly higher among asthmatic than non-asthmatic women. Mothers with asthma during pregnancy are more likely to have SGA, LBW, or preterm birth infants than non-asthmatic women. These results can be more easily generalized to women with lower socio-economic status since the cohort under represents women with high socio-economic status.