'J-SHAPED' RELATIONSHIP BETWEEN DRINKING DURING PREGNANCY AND BIRTH WEIGHT: REANALYSIS OF PROSPECTIVE EPIDEMIOLOGICAL DATA

Worldwide epidemiological studies on the effects of drinkingduring pregnancy on birth weight and prematurity were surveyed.Far more studies have reported no significant effects on birthweight than have reported significant decreases. Statisticalanalyses of the means from the prospective studies in this areaindicated that both maternal smoking and alcohol consumptionduring gestation are associated with a significant decreasein birth weight. The effect of smoking is three times greaterthan the effect of alcohol. When the data were stratified bysmoking status, maternal alcohol consumption did not have asignificant effect on birth weight for non-smokers, but amongsmokers there was a significant linear trend with a thresholdfor decreased birth weight at about an average of two drinksper day. There was also a significant pattern of increased birthweight associated with low levels of alcohol consumption. suggestingan inverted ‘J-shaped’ function between drinkingduring pregnancy and birth weight.     

ALCOHOL AND OTHER DRUGS: THE PREVENTION PARADOXES

This paper asks what prevents the prevention of alcohol and drug use problems. Five prevention paradoxes can be identified, all of which may well be interfering with our attempts to reduce the problems associated with drug use. Drug problem preventers should be aware of these paradoxes and, thus, be able to avoid becoming ensnared by them.     

DRINKING AMONGST PREGNANT WOMEN: SOME INITIAL RESULTS FROM A PROSPECTIVE STUDY

A review is presented of the characteristics of the foetal alcoholsyndrome (FAS). It is noted that in its most extreme form theFAS encompasses both physical and mental abnormalities. Someof the initial results are briefly presented from the firsttwo phases of a Scottish prospective study. This relates tothe patterns of alcohol use and misuse of 1008 pregnant women.These data indicate that self-reported alcohol consumption wasslightly but significantly correlated with previous obstetricproblems. In addition, a minority of the study group, due totheir levels of alcohol consumption, may run an increased riskof giving birth to abnormal offspring. It is concluded thaton the basis of current evidence those planning or experiencingpregnancy should be advised not to drink.     

欣母沛等三种药物减少腹腔镜下肌壁间子宫肌瘤剔除术中出血的研究

目的对比研究腹腔镜下肌壁间子宫肌瘤剔除术应用欣母沛(卡前列素氨丁三醇)、垂体后叶素和缩宫素促子宫收缩减少术中子宫出血的优缺点。方法 2009年1月²012年5月行腹腔镜下肌壁间子宫肌瘤剔除术97例,分成3组,欣母沛组(A组)31例,垂体后叶素组(B组)34例,缩宫素组(C组)32例。比较三组之间的手术时间、术中出血量、术后恢复时间和血压的变化。结果 3组手术均顺利完成,无中转开腹。C组手术时间较长和术中出血量较多,与A、B组比较,差异有统计学意义(p<0.05),A、B组差异无统计学意义(p>0.05)。用药15 min后术中血压B组升高明显,A组轻微升高,C组无明显变化,3组比较差异有统计学意义(p<0.05)。用药30 min后3组血压比较变化不明显,差异无统计学意义(p>0.05)。结论 3组药物应用后均可减少术中出血量,缩短手术时间,且术中应用均较安全,副反应较轻,欣母沛和垂体后叶素应用效果要明显好于缩宫素,但欣母沛价格较高,术者可根据患者实际情况综合考虑,灵活应用。     

THE PREDICTION OF HABITUAL ALCOHOL USE FROM ALCOHOL RELATED EXPECTANCIES AND PERSONALITY

Two studies testing social learning theory predictions of habitualalcohol use in college students are reported. Study 1 (N = 96)investigated alcohol related expectancies and social desirabilityas predictors of habitual alcohol use. Higher habitual alcoholuse was correlated with higher expected dominance, but thiscorrelation was not modified by social desirability or subjectsex. Study 2(N = 88) tested effects of personality traits onhabitual alcohol use. Habitual alcohol use was positively correlatedwith EPI extraversion. Examination of extraversion sub-factorssuggests that impulsivity and sociability independently predictdrinking. The data indicate the strengths and limitations ofalcohol related expectancy as an explanatory construct.     

AN NMR STUDY OF CEREBRAL OEDEMA AND ITS BIOLOGICAL CORRELATES DURING WITHDRAWAL FROM ALCOHOL

Five chronic alcoholic patients admitted for detoxificationwere studied. During the first 24–48 hr of abstinenceraised levels of cerebral water (as measured by NMR), vasopressin,renin and supine aldosterone were recorded. Initial vasopressinconcentration was correlated (r=0.88, P<0.05) with alcoholconsumption in the week prior to admission and was over threetimes higher in the patients measured after 24–48 hr ascompared to less than 24 hr. After one week only supine aldosteronewas still raised (P<0.05). The results suggest that cerebraloedema occurs during the early stages of abstinence. The roleof these changes in the aetiology of withdrawal symptoms, deliriumtremens and brain damage remains to be elucidated.     

EFFECT OF ALCOHOL INTOXICATION DURING PREGNANCY ON FOETAL AND PLACENTAL WEIGHT: EXPERIMENTAL STUDIES

Recent animal studies have shown that alcohol intoxication inutero leads to a decrease in foetal weight and an increase inthat of placenta. These findings are not, however, satisfactorilyexplained. The object of this study was to investigate thesetwo effects, using inhalation of various concentrations of ethanolvapour as a method of intoxication. Three groups of 12 gravid female rats (treated groups) wereintoxicated by permanent exposure to an alcohol atmosphere (19,20or 21 mg/l.). Three control groups of 12 gravid females werenot intoxicated but had their diet reduced to the same energyintake as the treated groups. On day 21 of pregnancy, foetusesand placentas were surgically removed and individually weighed.The body-weight of foetuses was found to be lower in the treatedgroups than in the respective controls. Additionally the reduction of foetal weight was directly relatedto the severity of intoxication. Increases in placental weightwere observed in the three intoxicated groups. The differencesobserved between foetal and placental weights may be interpretedas a foeto-protective phenomenon.     

EFFECTS OF ALCOHOL USE AND OTHER HEALTH PRACTICES ON BLOOD CHEMISTRIES AND BLOOD PRESSURE

Assessment of alcohol consumption, physical activity, nicotineuse, diet patterns, blood pressure, height, and weight was donefor 179 males. Subjects from four different populations weresampled to assure that the entire range of alcohol consumptionfrom abstainers to alcoholics was represented. A blood chemistryprofile of 33 tests, which included hematological parameters,lipids, electrolytes and minerals, renal function tests, andindicators of liver function was done for each subject. Testsof liver function and mean corpuscular volume were most stronglyrelated to alcohol consumption. In contrast, there were otherblood tests which were significantly related to nicotine use,age, body fatness or physical activity, but not to alcohol intake.Blood pressure, red blood cell count, and triglycerides weresignificantly related to several factors including alcohol consumption.The effect of alcohol on the blood chemistry profile was distinguishedfrom the effects of nicotine, diet, body fatness, age and physicalactivity.     

PRELIMINARY STUDY OF HOW ALCOHOL CONSUMPTION DURING PREGNANCY AFFECTS IMMUNE COMPONENTS IN BREAST MILK AND BLOOD OF POSTPARTUM WOMEN

Human milk has been shown to contain numerous immune componentsthat can potentially protect the infant during the period beforeits own immune system is completely developed. Alcohol consumptionin both experimental animals and humans has been associatedwith alterations to a number of immune parameters. We have investigatedthe possibility that alcohol consumption during pregnancy alterscertain immune components in day 3 postpartum breast milk andperipheral blood of women. Our study group consisted of 10 alcoholicbeverage drinkers (moderate to heavy, most of whom smoked a1/2-1 pack of cigarettes per day), 15 non-drinking/non-smokingcontrols, and 10 non-drinking/smokers (1/2-1 pack per day) controls.The immune parameters measured in these otherwise healthy womenwere: (1) percentage and absolute number of the various subsetsof leukocytes; (2) percentage of T cells, B cells, T helperand cytotoxic/suppressors subsets, and natural killer cells;(3) levels of the cytokines IL-6, IL-8 and TNF-; (4) levelsof IgA in milk and IgG in serum. Milk from the alcohol groupcontained an elevated amount of IL-8 as compared with milk fromnon-smoker controls; however, it did not differ statisticallyfrom that of the smoker controls. Blood from the alcohol groupshowed an increased level of IL-8 when compared with that fromboth smoker and non-smoker controls. The total number of leukocytesin milk was elevated in milk from the alcohol group as comparedto both the smoker and non-smoker control groups. In the leukocytecomponent of milk, neutrophils predominate and are responsiblefor the elevation in total number of cells, as both lymphocyteand macrophage populations did not differ from those of thecontrols. For lymphocytes, B cells were also increased in bloodof the smokers as compared with the alcohol and non-smoker controls.There were no statistical differences in any of the other immuneparameters tested among the three groups. The present studyfound that alcohol consumption during pregnancy could modulatethe production of IL-8 and infiltration of certain leukocytesin milk and blood of postpartum women. Some of these alterationswere also evident in the smoker controls and thus could notbe attributed to alcohol consumption alone.     

BIOCHEMICAL MARKERS OF ALCOHOL USE AND ABUSE: EXPERIENCES FROM THE PILOT STUDY OF THE WHO/ISBRA COLLABORATIVE PROJECT ON STATE AND TRAIT MARKERS OF ALCOHOL

The development of reliable diagnostic tools for assessing alcoholismand harmful alcohol consumption is an utmost necessity for thesuccess of efforts to prevent and treat alcohol-induced damageto both individuals and to society. A multinational study isunderway to aid in the development of biological screening tools(state markers) which can, with good sensitivity and specificity,identify problem drinkers. To attain this goal information needsto be available on an individual's drinking history and habitsand related factors. A detailed instrument has been developedto obtain this information. The second goal of the study wasto begin to develop diagnostic ‘trait markers’ whichprovide biological information on genetically determined predisposingand protective factors in the development of alcoholism. Thedeveloped questionnaire also provides background informationon subject characteristics necessary for the development oftrait markers. Centres will assay the obtained biological samplesfor ‘traditional’ and newly identified state markersof excessive alcohol consumption. These will include methanolmeasurements, gamma-glutamyltransferase, aspartate aminotransferase,carbohydrate-deficient transferrin, serotonin metabolite ratios,and erythrocyte aldehyde dehydrogenase. DNA obtained from thelymphocytes of subjects will be assayed for polymorphisms ofalcohol- and aldehyde-metabolizing enzymes and dopaminc receptorpolymorphisms which can provide insights into protective andpredisposing factors in alcoholism. The platelet enzymes, monoamineoxidase and adenylyl cyclase, will be assayed to assess therelationships between these putative trait markers and the geneticand environmental factors contributing to the aetiology of alcoholism.The current report is meant to introduce the study design andpresent a portion of the preliminary data gathered in the processof establishing this research programme.     

孕前体质指数及孕期增重与妊高征和新生儿出生体重的关系

目的：探讨孕妇孕前体质指数及孕期增重情况对妊高征及新生儿出生体重的影响。方法：监测2412例足月单胎初产妇孕前的身高、体重和孕期体重增加情况，并随访妊高征、巨大儿和低出生体重儿的发生情况。结果：孕前高体重组孕妇妊高征和巨大儿的发生率明显高于低体重组和理想体重组（P〈0．001）；低体重组孕妇低出生体重儿的发生率明显高于理想体重组和高体重组（P〈0．001）；无论孕前体质指数如何，当孕期体重增加≥18kg时妊高征和巨大儿的发生率明显增高（P〈0．001）；当孕期体重增加〈9kg时低出生体重儿的发生率明显增高（P〈0．001）。结论：孕前体质指数和孕期增重是妊高征及新生儿出生体重的重要影响因素，提倡定期产前检查及重视母亲孕期体重变化。     

孕期合理营养对胎儿出生体重及剖宫产率的影响

目的探讨孕期合理营养对胎儿出生体重及剖宫产率的影响,为孕期合理膳食提供指导,尽量降低剖宫产率。方法将2010年2月～2011年3月在我院产科门诊孕3个月建产检卡并确定在我院分娩孕妇243例,将自愿或者有能力参加孕期膳食营养指导152例孕妇设为观察组,给予饮食结构分析指导;不愿或者无能力参加孕期膳食营养指导正常饮食孕妇91例设为对照组,孕期常规饮食。结果观察组新生儿的出生体重平均3 158.2 g,对照组3 458.7 g,两组比较有显著性差异(p<0.05),两组之间出生胎龄比较无显著性差异(p>0.05);观察组孕妇正常阴道分娩者121例(79.61%),剖宫产者31例(20.39%),巨大儿12例(7.89%),对照组正常阴道分娩者54例(59.34%),剖宫产37例(40.66%),巨大儿15例(16.48%),两组间在阴道分娩、剖宫产率、巨大儿发生率方面比较均存在显著性差异(p<0.05)。结论孕期对孕妇进行合理饮食指导,有利于合理膳食的摄入,有效的控制胎儿体重增长,减少巨大儿发生和降低剖宫产率,达到理想的分娩结局,保障母婴健康。     

孕早期精神刺激与先天性心脏病关系探索

目的：探索孕早期精神刺激与先天性心脏病发生的关系。方法：采用1：2配比的病例对照研究设计，用统一的调查表对病例和对照的亲生父和(或)母亲孕前、后相关暴露因素进行现场询问，对研究因素用单因素Logistic回归进行初筛、数据结构分析和适当的变量函数转换，然后对初选的可疑危险因素进行共线性诊断，改进变量间的共线性关系后用多因素条件Logistic逐步回归作进一步筛选。结果：母亲孕早期精神刺激为该病危险因素之一，且在各危险因素中作用最强。结论：加强孕早期母亲心理保健，提供必要的政策保护。     

孕期和哺乳期高蛋白饮食对仔鼠生长及代谢相关指标的影响

目的探讨孕期和哺乳期高蛋白饮食对仔代生长及代谢相关指标的影响。方法雌性小鼠受孕后随机分成对照组(C)和高蛋白饮食组(H)。母鼠分娩后,每组再随机分成两组(C)组、(H)组,即CC、CH、HC和HH。孕18d(GD18)剖杀孕鼠,测量仔鼠和胎盘重量以及胎盘组织中养分转运相关基因的mRNA和蛋白表达水平;从仔鼠出生后1d(PND1)至PND21,每3d测量体质量,于PND21处死,测量血清总胆固醇(TC)、甘油三酯(TG)水平。结果 GD18时点,H组胎体比低于C组(P0.01);H组胎盘脂肪酸转运体CD36(P0.001)、胎盘葡萄糖转运体GLUT2(P=0.004)基因和GLUT2蛋白(P0.05)表达水平显著上调。哺乳期仔鼠体重HC组高于其他三组,但差异没有统计学意义(P0.05)。PND14时点,CC组仔鼠血清TC水平显著高于HC组和HH组(P0.05);CC组仔鼠血清TG水平显著高于其他三组(P0.05)。PND21时点,CC组仔鼠血清TC水平显著高于HC组和CH组(P0.05);CC组和HC组仔鼠血清TG水平显著高于CH组(P0.05)。结论孕期和哺乳期高蛋白饮食引起仔代TG、TC等血清学指标的改变;通过影响胎盘转运率,上调胎盘养分转运体的表达水平,从而影响仔代生长、代谢。[营养学报,2019,41(2):139-144]     

SEX HORMONES DURING ALCOHOL WITHDRAWAL: A LONGITUDINAL STUDY OF 29 MALE ALCOHOLICS DURING DETOXIFICATION

It is a well-known fact that alcohol affects sex hormone levelsin males. Even in the absence of liver dysfunction, there isstill a direct toxic effect of ethanol on testosterone synthesisresulting in acutely decreased values. This study is based on29 male alcoholics without severe signs of liver disease treatedon the alcohol detoxification ward at Huddinge hospital in Stockholm,Sweden during 1995. The aim was to study levels of sex hormonesin male alcoholics during detoxification with benzodiazepinesand after 3 weeks of sobriety. Blood samples were taken threetimes: one day after admission (day 2) when the patient wassober, at discharge (day 5) and after 3 weeks of sobriety (day21). Levels of testosterone and sex hormone-binding globulin(SHBG) showed the same pattern during detoxification and follow-up.They were both low, but generally within normal limits, on days2 and 5, but raised after 3 weeks of sobriety. Follicle stimulatinghormone (FSH) and luteinizing hormone (LH) were initially high,but were substantially depressed during detoxification. Levelsof FSH recovered after 3 weeks, whereas LH remained at the samelevel. Most patients exhibited generally low levels of bothFSH and LH, however. Levels of oestrone decreased steadily.There were no correlations between levels of sex hormones andthe number of milligrams of oxazepam administered to the patientsduring detoxification either at admission, at discharge or atfollow-up. In summary, the endocrinological response to alcoholintake is complex. This study suggests that the duration ofendocrinological recovery after drinking is a quite long-lastingprocess, that different hormones need different times to recoverand that the normal glandular-pituitary feed-back processesmay be partly put out of order.     

吸烟、饮酒与胃癌死亡关系的前瞻性队列研究

目的：对吸晒烟、饮酒与胃癌死亡关系的研究。方法：选择晒烟产区四川什邡市某农村社区35岁以上的所有农民30525人进行了10年的前瞻性队列研究,结果：累计吸晒烟量为360kg-,540kg-以上时,其RR分别为3．3429,3．1387;调整后的RR为3．100,2．7431。累计饮白酒量为150kg,300kg以上时,其RR为3．4581,2．6015;调整后的RR为4756,1．7281,吸烟史或饮酒史达30年以上时,其RR分别为1．7624,1．6490。结论：吸晒烟,饮酒是该农村社区人群胃癌发生的两个重要危险因素,建议对该人群应加强戒烟,节制饮酒的宣传,指导他们建立良好的卫生习惯和合理饮食习惯,以降低胃癌的发病率和死亡率。     

护士孕期职业接触抗癌药对胚胎及胎儿生长发育影响的研究

对京津地区5个医院590名护士的715次妊娠进行了分析,其中抗癌药接触组377次妊娠,对照组338次妊娠。结果表明,抗癌药接触组护士足月产率明显低于对照组(79.8%,89.6%),而早产率(5.3%.2.4%)、自然流产率(13.3%,7.7%)以及子代出生缺陷率(31.0‰,9.7‰)明显高于对照组。表明护士职业接触抗癌药对胚胎及胎儿发育有不良影响,应加强防护措施。