足月胎儿生长受限的妊娠结局

目的:探讨胎儿生长受限(FGR)的主要相关因素,终止妊娠的方法和时机,改善FGR围生儿预后。方法收集近5年的足月FGR病例108例,分析FGR孕妇有关病史、妊娠经过、分娩方式、妊娠结局和相关因素。结果:①与FGR相关因素方面,以妊娠并发症为首要因素,其中又以妊娠期高血压疾病占首位(13·9%),其次为胎盘、胎儿因素,而病因不明者达20·4%。②阴道分娩组与选择性剖宫产组比较,胎儿窘迫率和新生儿窒息率均有显著性差异(P<0·01)。③108例足月FGR新生儿体重为(2250±225)g。结论:妊娠并发症是FGR主要危险因素,选择恰当的分娩时机和分娩方式,有利于减少FGR胎儿窘迫和新生儿窒息的发生。     

孕期被动吸烟对胎儿生长和婴儿神经发育的影响

目的 研究孕期被动吸烟对胎儿生长和婴儿发育的影响。方法 运用前瞻性队列研究的方法，对１０２名孕期有和无被动吸烟史个体所生新生儿的出生体重进行比较，并在３月，６月和１２月龄时应用Ｂａｙｌｅｙ婴儿发育量表对婴儿进行为期一年的神经发育纵向随访研究。结果 孕期被动吸烟组新生儿出生的离均差值明显低于对照组。     

Maternal Diet Influences Fetal Growth but Not Fetal Kidney Volume in an Australian Indigenous Pregnancy Cohort

Suboptimal nutrition during pregnancy is recognised as a significant modifiable determinant in the development of chronic disease in offspring in later life. The current study aimed: (i) to assess the dietary intakes of pregnant Indigenous Australian women against national recommendations and (ii) to investigate the associations between maternal nutrition during pregnancy and the growth of the offspring, including kidney development in late gestation in the Gomeroi gaaynggal cohort (n = 103). Maternal dietary intake in the third trimester was assessed using the Australian Eating Survey Food Frequency Questionnaire. Estimated fetal weight (EFW) and kidney size were obtained by ultrasound. Birth weight was retrieved from hospital birth records. Of the five key nutrients for optimal reproductive health (folate, iron, calcium, zinc and fibre), the nutrients with the highest percentage of pregnant women achieving the nutrient reference values (NRVs) were zinc (75.7%) and folate (57.3%), whereas iron was the lowest. Only four people achieved all NRVs (folate, iron, calcium, zinc and fibre) important in pregnancy. Sodium and saturated fat intake exceeded recommended levels and diet quality was low, with a median score of 28 out of 73 points. After adjusting for smoking and pre-pregnancy body mass index, only maternal intake of retinol equivalents and the proportion of energy from nutrient-dense or energy-dense, nutrient-poor (EDNP) foods were associated with fetal growth. EFW decreased by 0.13 g and birth weight decreased by 0.24 g for every µg increase in maternal dietary retinol intake. Interestingly, EFW, but not actual birth weight, was positively associated with percentage energy from nutrient dense foods and negatively associated with percentage energy from EDNP foods. Dietary supplement usage was associated with increased birthweight, most significantly iron and folate supplementation. Current dietary intakes of pregnant Australian women from this cohort do not align with national guidelines. Furthermore, current findings show that maternal retinol intake and diet composition during pregnancy can influence fetal growth, but not fetal kidney growth in late gestation. Strategies that aim to support and optimise nutrient intakes of Indigenous pregnant women are urgently needed. Future studies with long-term follow-up of the children in the current cohort to assess renal damage and blood pressure are imperative.     

Maternal Concentrations of Polyfluoroalkyl Compounds during Pregnancy and Fetal and Postnatal Growth in British Girls

Background: Prenatal exposures to polyfluoroalkyl compounds (PFCs) may be associated with adverse changes in fetal and postnatal growth.Objective: We explored associations of prenatal serum concentrations of perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), and perfluorohexane sulfonate (PFHxS) with fetal and postnatal growth in girls.Methods: We studied a sample of 447 singleton girls and their mothers participating in the Avon Longitudinal Study of Parents and Children (ALSPAC). Data on weight and length were obtained at birth and at 2, 9, and 20 months. Serum samples were obtained in 1991–1992, from mothers during pregnancy. We explored associations between prenatal PFC concentrations and weight at birth as well as longitudinal changes in weight-for-age SD scores between birth and 20 months.Results: PFOS (median, 19.6 ng/mL), PFOA (median, 3.7 ng/mL), and PFHxS (median, 1.6 ng/mL) were detected in 100% of samples. On average, girls born to mothers with prenatal concentrations of PFOS in the upper tertile weighed 140 g less [95% confidence interval (CI): –238, –42] at birth than girls born to mothers with concentrations in the lower tertile in adjusted models. Similar patterns were seen for PFOA (–133 g; 95% CI: –237, –30) and PFHxS (–108 g; 95% CI: –206, –10). At 20 months, however, girls born to mothers with prenatal concentrations of PFOS in the upper tertile weighed 580 g more (95% CI: 301, 858) when compared with those in the lower tertile. No differences in weight were found for PFOA and PFHxS.Conclusions: Girls with higher prenatal exposure to each of the PFCs examined were smaller at birth than those with lower exposure. In addition, those with higher exposure to PFOS were larger at 20 months.     

Fetal Growth And Maternal Nutrition

Studies of the body composition and liver rescrves of nutrients in fetuses from mothers of a low socioeconomic group in India showed significant effects of maternal malnutrition on fctal growth and composition.     

Maternal Low-Level Lead Exposure and Fetal Growth

Background

Limited epidemiologic studies have examined the association between maternal low-level lead exposure [blood lead (PbB) < 10 μg/dL] and fetal growth.

Objective

We examined whether maternal low-level lead exposure is associated with decreased fetal growth.

Methods

We linked New York State Heavy Metals Registry records of women who had PbB measurements with birth certificates to identify 43,288 mother–infant pairs in upstate New York in a retrospective cohort study from 2003 through 2005. We used multiple linear regression with fractional polynomials and logistic regression to relate birth weight, preterm delivery, and small for gestational age to PbB levels, adjusting for potential confounders. We used a closed-test procedure to identify the best fractional polynomials for PbB among 44 combinations.

Results

We found a statistically significant association between PbB (square root transformed) and birth weight. Relative to 0 μg/dL, PbBs of 5 and 10 μg/dL were associated with an average of 61-g and 87-g decrease in birth weight, respectively. The adjusted odds ratio for PbBs between 3.1 and 9.9 μg/dL (highest quartile) was 1.04 [95% confidence interval (CI), 0.89–1.22] for preterm delivery and 1.07 (95% CI, 0.93–1.23) for small for gestational age, relative to PbBs ≤ 1 μg/dL (lowest quartile). No clear dose–response trends were evident when all of the quartiles were assessed.

Conclusions

Low-level PbB was associated with a small risk of decreased birth weight with a supralinear dose–response relationship, but was not related to preterm birth or small for gestational age. The results have important implications regarding maternal PbB.     

巨大儿相关因素及妊娠结局分析

目的探讨巨大儿发生的相关因素、分娩方式及并发症,提高产前诊断率,选择恰当的分娩方式。方法回顾性分析我院2011年1月至2012年12月分娩的267例巨大儿的情况,并随机选择同期分娩的267例体重2 500³ 999 g的新生儿作为对照组进行比较。结果研究组孕妇身高、体重、产次、孕龄、宫高、腹围及胎儿双顶径、股骨长、腹围明显高于对照组(P<0.01);研究组剖宫产率明显增高,剖宫产组分娩并发症明显低于阴道分娩组。结论巨大儿增加母婴并发症,应正确产前诊断,巨大儿分娩方式以剖宫产相对安全。     

巨大儿相关因素及妊娠结局分析

目的 探讨巨大儿发生的相关因素、分娩方式及并发症,提高产前诊断率,选择恰当的分娩方式.方法 回顾性分析我院2011年1月至2012年12月分娩的267例巨大儿的情况,并随机选择同期分娩的267例体重2 500～3 999 g的新生儿作为对照组进行比较.结果 研究组孕妇身高、体重、产次、孕龄、宫高、腹围及胎儿双顶径、股骨长、腹围明显高于对照组（P＜0.01）;研究组剖宫产率明显增高,剖宫产组分娩并发症明显低于阴道分娩组.结论 巨大儿增加母婴并发症,应正确产前诊断,巨大儿分娩方式以剖宫产相对安全.     

Maternal Diet,C-Reactive Protein,and the Outcome of Pregnancy

Objective: To examine the association of high-sensitivity C-reactive protein (hsCRP), a systemic biomarker for the inflammatory process at entry to care, with pregnancy-induced hypertension/preeclampsia, adverse outcomes of pregnancy, and the maternal diet.

Design: Random sample (N = 520) with normal glucose tolerance from a large prospective cohort study of urban, low income, minority gravidae.

Results: During pregnancy, the highest tertile of hsCRP (range, 7.06–137.41 mg/L) was associated with significantly increased risks for early preterm delivery (<34 weeks). However, after stratification by maternal pregravid body mass index (BMI), risk for early preterm delivery <34 weeks (adjusted odds ratios [AOR] = 3.58, 95% confidence interval [CI] = 1.05–12.27), and pregnancy-induced hypertension (AOR = 2.66, 95% CI = 1.03–6.86) including preeclampsia (AOR = 2.72, 95% CI = 1.08–6.85) was shown to be specific to lean women (BMI <25) with high hsCRP. Increased hsCRP was unrelated to risk among overweight and obese gravidae. We found high hsCRP to be associated with diet. After stratification by BMI, dietary differences (higher intakes of protein and cholesterol with a lower intake of carbohydrate and a higher entry dietary glycemic index) were associated with increased hsCRP only among lean gravidae and not among those who were overweight or obese.

Conclusions: High hsCRP is a diet-related biomarker for serious complications and poor outcome in lean women with normal glucose tolerance.     

Maternal Obesity in Twin Pregnancy: The Role of Nutrition to Reduce Maternal and Fetal Complications

There are more and more obese mothers with twin gestations. For a long time before, the responses of lymphocytes and platelets in obese women can cause a low-grade inflammation. In addition, a proper control of gestational weight gain would improve the outcomes in mothers with high pre-gestational body mass index (BMI). In women with high pre-gestational BMI and twin pregnancy, our aims were to explore the biochemical and hematological parameters and to study the rate of obstetric adverse outcomes. This was an observational and retrospective study conducted in the Hospital Universitario La Paz (Madrid, Spain). We included 20 twin pregnancies as the lean group (BMI = 18.5–24.9 kg/m²), homogeneous in the maternal age and ethnicity, and having parity with other 20 twin pregnancies as the obese group (BMI ≥ 30 kg/m²). The maternal data and maternal, fetal, obstetric, and neonatal complications were collected from the medical records. In the first and third trimester of pregnancy, the biochemical and hematological parameters of the blood were assayed. In this cohort, gestational weight gain was significantly lower in the obese than lean group. In the first trimester, the hemoglobin levels in obese women (12.1 ± 0.8 g/dL) were lower than lean women (12.6 ± 0.7 g/dL; p-Value = 0.048). In addition, the tendency of glucose levels, TSH levels and platelets was to increase in obese compared to lean women. In the third trimester, the TSH levels were higher in obese (3.30 ± 1.60 mUI/L) than lean women (1.70 ± 1.00 mUI/L; p-Value = 0.009). Furthermore, there was a tendency for levels of platelets and lymphocytes to increase in obese compared to lean women. No significant differences were detected in the rate of maternal, fetal, obstetrical, and neonatal complications between the groups. The hemoglobin, platelets, lymphocytes and TSH levels need further investigation to understand potential subclinical inflammation in obese women. Furthermore, obese women with twin pregnancies should follow-up with a specialist nutritionist, to help them control their gestational weight gain with appropriate dietary measures.     

The Effect of Caffeine on Pregnancy Outcome Variables

The American public consumes a wide array of caffeinated products as coffee, tea, chocolate, cola beverages, and caffeine-containing medication. Therefore, it seems of value to inform both the scientific community and the consumer about the potential effects of excessive caffeine consumption, particularly by pregnant women. The results of this literature review suggest that heavy caffeine use (≥ 300 mg per day) during pregnancy is associated with small reductions in infant birth weight that may be especially detrimental to premature or low-birth-weight infants. Some researchers also document an increased risk of spontaneous abortion associated with caffeine consumption prior to and during pregnancy. However, overwhelming evidence indicates that caffeine is not a human teratogen, and that caffeine appears to have no effect on preterm labor and delivery. More research is needed before unambiguous statements about the effects of caffeine on pregnancy outcome variables can be made.     

B超引导下行人工授精对妊娠结局的影响

目的探讨在实施人工授精(AIH)手术时使用B超引导对妊娠结局的影响。方法回顾性分析2014年至2016年在我中心接受AIH治疗的1 056个周期。根据是否使用B超引导分为两组,分析比较两组的临床资料和妊娠结局。结果 B超引导组的人授管血染率为4.91%,显著低于非B超引导组的13.17%,差异有统计学意义(P<0.05)。B超引导组的精液反流发生率为6.84%,显著低于非B超引导组的18.31%,差异有统计学意义(P<0.05)。B超引导组的临床妊娠率为12.28%,非B超引导组的临床妊娠率为10.49%,两组差异无统计学意义(P>0.05)。结论 B超引导下行人工授精术可以显著降低人授管的血染率和精液反流的发生率,在一定程度上可提高临床妊娠率。     

妊娠期高血压疾病伴发胎儿生长受限的研究

目的研究妊娠期高血压疾病发病时间、严重程度与胎儿生长受限(FGR)的关系,为早期干预治疗降低FGR发病率提供依据。方法选取2017年11月至2018年4月在陕西省人民医院分娩的妊高病孕妇110例为研究组,选取同期分娩的健康孕妇110例为对照组,分别比较妊高病组(妊娠期高血压、子痫前期)与正常孕妇组FGR、死胎的发生率。结果妊娠期高血压疾病组FGR发生率为21.80%(χ^2=6.03,P <0.05)。其中子痫前期重度FGR发病率(34.50%),显著高于子痫前期轻度(13.30%)及妊娠期高血压(8.00%)的发病率(χ^2值分别为5.94、9.31,均P <0.05);发病孕周<28周者FGR发病率最高(38.00%),显著高于对照组FGR的2.70%(χ^2=4.23,P<0.05)。子痫前期重度死胎发生率最高(7.30%),正常妊娠组死胎发生率为0.00%(χ^2=3.35,P <0.05)。结论妊娠期高血压疾病发病孕周以及严重程度与FGR的发生呈正相关,发病孕周越早,病情越重,FGR的发生率越高。故建议尽早干预,预防子痫前期的发生,减少并发症,延长孕周,降低FGR的发生率,减少围产儿不良结局。     

Association of Maternal Blood Lead Level During Pregnancy with Child Blood Lead Level and Pregnancy Outcome in Kuwait

High blood lead levels (BLL) in pregnancy are associated with poor pregnancy outcome and neuro-behavioral deficits in infants. We investigated the prevalence of high BLL in pregnant women and its impact on pregnancy outcome in Kuwait. Blood from 194 mother–infant pairs were analyzed for lead by Atomic Absorption Spectrophotometry. Data were collected on birth weight, crown–heel length, head circumference, APGAR score, gestational age, and placental weight. Results revealed that 28% of pregnant women and 58% of infants had BLL >10 g/dL. Cord BLL was significantly higher than maternal BLL (10.92 vs. 5.77 g/dL, p < .001). Maternal BLL was not significantly associated with any of the outcome variables tested, whereas, cord BLL was a significant negative predictor of APGAR score only in boys. A significant proportion of pregnant women and their children in Kuwait have lead levels well above the safety limit, which is a matter of public health concern.     

母婴俱乐部在孕期管理中的作用

目的 探讨全程追踪式母婴俱乐部在孕妇孕期管理的应用效果.方法 选取 2011 年5 月-2012 年5 月在我院产前检查并分娩的产妇350 例,随机分为观察组和对照组,观察组参加母婴俱乐部,接受全程追踪式健康教育和其它服务;对照组给予一般孕期管理方法,孕妇于产检中给予健康教育,定期参加孕期知识讲座.比较两组孕妇孕期保健前后焦虑状态、孕期知识了解程度、产检次数、妊娠期并发症、入院时机掌握及剖宫产的发生例数.并调查孕妇对整个孕期保健工作的满意度.结果 观察组孕妇孕期保健前后焦虑状态缓解更明显,对孕期知识的了解更多,孕期产检次数增加,妊娠期并发症发生较少,能准确掌握入院时机,剖宫产率降低,对医院工作满意度提高,与对照组相比,差异有统计学意义(P<0.01).结论 全程追踪式母婴俱乐部在孕妇孕期管理具有较好的效果,能持续跟踪整个孕期保健,及时满足孕妇的需求,增加管理师职业成就感,取得了良好的社会效益和经济效益.     

早产胎膜早破的潜伏期、终止妊娠时机及分娩方式对母儿预后的影响研究

目的探讨早产胎膜早破(PPROM)的潜伏期、终止妊娠时机及分娩方式对母儿预后的影响。方法收集PPROM产妇108例,以潜伏期48 h为分界点,将患者分为A组(≥48 h,50例)和B组(<48 h,58例);再以孕周为依据,将A组分为甲组(34~36+6w,26例)、乙组(28~33+6 w,24例),B组分为丙组(34~36+6 w,30例)、丁组(28~33+6 w,28例)。结果甲组的新生儿高胆红素血症、缺血缺氧性脑病、肺炎、呼吸窘迫综合征发生率显著低于乙组(P<0.05),丙组各项并发症发生率均显著低于丁组(P<0.05),丁组各项并发症发生率均显著高于乙组(P<0.05),甲组和丙组各项并发症发生率无统计学差异(P>0.05)。A组的产妇产褥感染和产后出血发生率与B组比较无统计学差异(P>0.05)。阴道分娩者的各项新生儿并发症发生率与剖宫产比较无统计学差异(P>0.05)。结论临床上针对孕周满34 w的PPROM孕妇应及时采取妊娠终止措施,而对于孕周低于34 w的孕妇则需立即给予有效的治疗措施,并依照常规方式进行分娩。     

The Effect of Pregnancy on Adolescent Growth and Development

Adolescent pregnancy represents a triple developmental crisis to young women, that of adolescence, pregnancy, and establishing a relationship with a member of the opposite sex. Physiologically the adjustments of pregnancy are superimposed on those of pubescence. Psychologically and intellectually the pregnant adolescent is still developing, and it is thus difficult for her to meet the physiological demands of pregnancy. Society has responded by developing comprehensive programs for intensive care which have reduced considerably the risks of pregnancy. Contraceptive knowledge has not totally prevented the problems of teenage pregnancy, in pan because the adolescents who become pregnant are not sufficiently developed intellectually to perceive that today's actions may prevent future consequences. This paper reviews the literature and synthesizes the published studies with personal experience gained in over five years of professional work with teenage women.     

Fetal Growth is Associated Positively With Maternal Intake of Riboflavin and Negatively With Maternal Intake of Linoleic Acid

Objective To examine whether dietary factors in pregnancy are related to fetal growth.Design Prospective longitudinal study during pregnancy; midway through gestation a dietary history was obtained.Subjects/setting Subjects (n=372) were participants in a study on maternal essential fatty acid status during pregnancy who did not have hypertension or any metabolic, cardiovascular, neurological, or renal disorder. Only pregnant white women with the intention to give birth in one of the three hospitals involved in the study were included. All three hospitals were located in the southern part of the Netherlands.Statistical analyses performed The relation between maternal nutrition and fetal growth was evaluated using multiple regression analyses.Results Maternal intake of n-3 fatty acids plus arachidonic acid and of riboflavin were associated positively with fetal growth. A negative relation was observed between linoleic acid intake and fetal growth.Applications/conclusions Our data suggest that the maternal diet during pregnancy is associated with fetal growth. Although this relationship ought to be more closely investigated, our results imply that much more attention should be paid to an adequate maternal diet during pregnancy, especially with respect to riboflavin and fatty acid intake. J Am Diet Assoc. 1997; 97: 867-870.     

Nutrition and Pregnancy Outcome

Nutrition in pregnancy has been recognized for millennia as being important, but the current nutritional practices of pregnant women often do not conform to what we already know to be optimum. Pregnant women are increasingly entering pregnancy overweight as the dietary habits of young women deteriorate in many societies. This increase in overweight was accompanied by a 5-fold increase in gestational diabetes within 15 years in Norway, together with an unprecedented increase in the prevalence of large babies. This is accompanied by increasing risks of fetal malformations, damage to mother and child during parturition, and an increased risk of both obesity and type 2 diabetes in mother and the adolescent child. The prevalence of overweight girls is therefore a public health challenge with intergenerational implications