妊娠期体重增长与新生儿出生体重相关性的回顾性分析

目的探讨妊娠期体重增长(GWG)与新生儿出生体重的关系。方法回顾性分析2014年4~10月在北京协和医院普通产科规律产检并分娩的709例单胎妊娠孕妇的临床资料,根据孕前体重指数(BMI)及不同GWG进行分组,采用χ2检验和Logistic多因素回归分析检验GWG与新生儿出生体重及妊娠结局的关系。结果 (1)709例孕妇妊娠期平均增重(13.92±4.56)kg,新生儿平均出生体重(3 306±456)g;孕前低体重孕妇与正常体重孕妇比较,巨大儿发生率(0vs.6.6%)显著减少(P0.05),小于胎龄儿(SGA)发生率(16.7%vs.8.6%)则显著增多(P0.05)。(2)GWG过少(IGWG)组、体重适宜组和GWG过多(EGWG)组3组间比较,巨大儿发生率(1.8%vs.6.1%vs.10.5%)有显著性差异(P0.05);IGWG组的SGA发生率(13.8%)显著高于其他两组(8.9%、4.8%)(P0.05)。(3)EGWG(OR=1.91,95%CI:1.01-3.61)、妊娠期糖尿病(GDM)(OR=2.74,95%CI:1.38-5.45)是巨大儿发生的危险因素,而高龄(OR=2.36,95%CI:1.24-4.51)、孕前低体重(OR=2.15,95%CI:1.04-4.46)是SGA发生的危险因素。结论 GWG与新生儿出生体重存在密切关系,EGWG与GDM是巨大儿发生的危险因数,高龄和孕前低体重则是SGA发生的危险因素。     

血管内皮生长因子在妊娠期高血压疾病患者中的变化及意义

目的:检测健康妇女、孕妇及妊娠期高血压疾病患者外周血中血管内皮生长因子(VEGF)的水平,并探讨其与妊娠期高血压疾病发病的关系.方法:应用双抗体酶联免疫吸附法(ELISA)检测未妊娠妇女(正常组)90例、正常妊娠妇女(妊娠组)92例以及妊娠期高血压疾病患者95例外周血中VEGF的水平.结果:①妊娠组(143.53±25.77)ng/L与正常组(13.21±4.12)ng/L相比VEGF水平明显增高(P＜0.001)；妊娠组孕中期VEGF水平达高峰(186.71±52.37)ng/L,孕晚期下降(120.20±34.07)ng/L.②妊娠期高血压疾病组VEGF水平(58.28±20.43)ng/L,明显低于妊娠组孕晚期水平(P＜0.01),并随病情的加重,VEGF水平呈逐渐下降趋势(P＜0.05).结论:妊娠后VEGF水平显著下降可能是妊娠期高血压疾病发病机理中的一个重要因素.     

妊娠期代谢综合征危险因素探析

目的探讨妊娠期代谢综合征（GMS）发生的相关危险因素。方法收集在我院检查并住院的56例子痫前期孕妇、80例妊娠期糖尿病孕妇和健康孕妇108例,检测其空腹血糖、空腹胰岛素、甘油三酯、高密度脂蛋白等水平,依据GSM诊断标准计算各组孕妇的GMS发生率并分析其危险因素。结果子痫组和GDM组在FPG、TC、LDL—C等糖、脂代谢指标上较对照组比较差异有统计学意义（P〈0．01）;子痫组和GDM组GMS发生率均明显高于对照组（P〈0．01）,孕前BMI和TG构成两组GMS发生高危因素,其中TG则构成独立危险因素。结论体质量超重或肥胖、糖和脂代谢异常等多重代谢异常集中出现在子痫前期和妊娠期糖尿病孕妇中,孕期BMI、TG等构成妊娠合并代谢综合征危险因素。     

孕早期膳食结构与妊娠期糖尿病关系的临床研究

目的了解妊娠早期孕妇的膳食结构特点,并探讨其与妊娠期糖尿病(GDM)的关系。方法选取孕早期产检妇女1 500例进行孕早期膳食调查,并于孕中期对所有孕妇进行GDM筛查。选取确诊为GDM的孕妇130例作为GDM组,随机抽取与之匹配的健康孕妇130例为对照组,对两组孕妇孕早期三大营养素摄入比进行对照研究,用Logistic回归分析法探讨三大营养素与GDM发病的关系。结果 GDM组孕妇平均每天蛋白质供能百分比[(12.47±5.51)%]低于对照组,总碳水化合物供能百分比[(58.56±10.40)%]高于对照组(均P0.05);低蛋白膳食是GDM的独立危险因素(P0.05)。结论孕早期低蛋白和高碳水化合物摄入与GDM的发病有关;对孕早期孕妇进行膳食摄入的教育和指导可以有效降低孕中期GDM的发生。     

孕妇生殖道B族链球菌的带菌状况分析

目的通过对孕妇生殖道B族链球菌(GBS)的带菌状况分析,为制定有效预防和治疗措施提供依据。方法 2013年1月至2015年1月,对1 590例孕妇生殖道分泌物进行GBS培养与鉴定,结果进行统计学分析。据孕龄及年龄分组,分为孕中期组与孕晚期组,30岁组与≥30岁组。结果 1 590例孕妇中共检出GBS携带者512例,带菌率为32.2%。孕中期组(30.9%)与孕晚期组(33.1%)的带菌率差异无统计学意义(χ2=0.756,P0.05);30岁组(29.0%)与≥30岁组(42.1%)的带菌率差异具有统计学意义(χ2=18.772,P0.01)。GBS阳性者与GBS阴性者的临床症状发生率(18.95%vs7.88%)差异具有统计学意义(χ2=42.427,P0.01)。结论孕妇GBS带菌率较高,与孕妇的孕龄无关,高龄者易于感染。对于GBS携带者,应采取积极有效的预防和治疗措施。     

狼疮肾炎患者妊娠的母婴不良结局的相关因素分析

目的分析妊娠妇女中狼疮肾炎(LN)导致的母婴不良结局及其相关危险因素。方法选取我院2000年12月10日至2013年12月31日13年中收治的111例LN患者共117例次妊娠进行回顾性分析。按照LN的病情分为妊娠前疾病稳定组(n=78)、活动组(n=39)两组。分析妇女妊娠期病情加重、妊娠期或产后尿中蛋白含量增加和肾功能损害加重、子痫前期、低血小板血症、低补体血症等孕产妇不良结局情况,以及治疗需求的终止妊娠、胎儿丢失、早产、低出生体重儿、新生儿窒息、新生儿死亡及胎儿或新生儿的不良结局等情况。结果妊娠前LN稳定组与活动组比较,两组孕产妇的不良结局无显著性差异(P0.05)。活动组胎儿丢失或新生儿不良结局发生率高于稳定组(χ2=20.22,P0.001),其中早产发生率高于稳定组(χ2=5.14,P=0.023),因治疗需求终止妊娠率高于稳定组(χ2=16.71,P0.001),死胎/新生儿死亡率高于稳定组(χ2=9.54,P=0.002);经Logistic回归分析,结果显示LN孕产妇病情加重的相关因素为低血小板血症(OR=0.303,95%CI0.125~0.736)和低补体血症(OR=0.056,95%CI 0.006~0.507),发生子痫前期的相关因素为低血小板血症(OR=0.170,95%CI0.051~0.56)及LN复发(OR=0.144,95%CI0.025~0.841)(P均0.05);胎儿或新生儿不良结局发生的相关因素为孕妇发生子痫前期(OR=0.122,95%CI0.029~0.513)和孕妇LN疾病活动期(OR=0.028,95%CI 0.006~0.135)(P均0.05)。结论 LN孕妇在妊娠前期或妊娠期疾病处于活动期会增加母婴不良结局的发生,故临床上应建议LN的年轻妇女选择病情稳定期妊娠,并在妊娠期间严密监测孕妇的尿蛋白、血小板、补体及肾功能等指标,及时发现LN活动并尽早治疗。     

单胎妊娠妇女下腔静脉塌陷指数分布及其变化的初步观察

目的探讨正常妊娠期下腔静脉塌陷指数在不同孕周的变化。方法选择2018年6~9月我院建档规律产检、单胎妊娠、无循环系统及产科合并症的孕妇共121例,其中妊娠<14周30例,20~28周31例,28~34周30例,>37周30例,超声测量下腔静脉宽度,计算下腔静脉塌陷指数。结果下腔静脉塌陷指数随着孕周增加而减小[妊娠<14周为(40.8±15.2)%,20~28周(32.6±19.9)%,28~34周(26.5±11.8)%],至孕足月(>37周)有所回升[(32.2±19.9)%],差异有显著性(F=3.557,P=0.017),其中妊娠<14周明显高于28~34周(P=0.009)。结论正常孕妇下腔静脉塌陷指数随孕周增加而下降。     

高危妊娠孕妇集体心理干预效果评价

目的评价高危妊娠孕妇孕期集体心理干预的效果。方法将334例高危妊娠孕妇随机分为干预组和对照组各167例。对照组进行常规的产检和随访;干预组在对照组基础上接受6次集体心理干预课程,其中5次为高危妊娠孕妇心理课程,1次为配偶课程。在孕早中期、孕晚期、产后3 d和42 d采用产后抑郁筛查量表(PDSS)对两组进行评估。结果干预组孕晚期、产后3 d和42 d的PDSS评分显著低于对照组(均P0.01)。参加不同频次干预课程的高危妊娠孕妇孕晚期、产后3 d和42 d的PDSS评分差异无统计学意义(均P0.05),丈夫是否参加干预课程的高危妊娠孕妇PDSS评分差异无统计学意义(P0.05)。结论孕期集体心理干预有利于降低高危妊娠孕妇围生期抑郁发生率,但其治疗的依从性和家庭支持系统有待进一步加强。     

子痫前期妇女超声骨密度及血钙分析

目的研究子痫前期妇女骨密度情况及血钙水平与正常孕妇有无差异。方法回顾性病例分析,入组单胎孕妇270人,其中诊断子痫前期者150人,为子痫前期组,包括轻度子痫前期与重度子痫前期,无子痫前期及妊娠期高血压诊断者120人,为对照组。查询所有孕妇早孕期超声骨密度结果,早孕及晚孕生化检查,包括血钙、铁的检测。结果子痫前期组骨密度超声波传导速度(speed of sound,SOS)值明显低于对照组(t=-2.052,P=0.043),骨密度T值明显低于对照组(t=-2.041,P=0.044),子痫前期组早孕期血钙与对照组无差异,晚孕期血钙低于对照组(t=-2.247,P=0.016)。早孕期及晚孕期血铁水平无统计学差异。结论孕早期的超声骨密度检查及孕期的血钙等生化指标测定,对于子痫前期有一定的预测意义。     

妊娠期甲状腺功能亢进症和抗甲状腺药物治疗对新生儿低出生体重的影响

目的探讨妊娠期间甲状腺功能亢进症(甲亢)和抗甲状腺药物(ATDS)治疗对新生儿低出生体重(LBW)的影响。方法对1983年1月1日至2003年12月31日住院分娩的妊娠合并甲亢的100例及其新生儿101例进行回顾性分析。根据母亲孕期甲状腺功能(甲功)、开始服用ATDs时间进行分组,对LBW的发生率、特点及其相关的危险因素进行分析,着重于妊娠甲亢和ATDs对LBW的交互作用。结果母亲孕晚期甲亢时,新生儿平均出生体重显著低于甲功正常和甲功恢复正常组(P<0.05);孕晚期开始服用ATDs,新生儿平均出生体重显著低于孕早中期开始用药组(P<0.001)。孕晚期甲亢、孕晚期开始服用ATDs早产儿和早产LBW率均显著增加,且二者对早产儿、早产儿LBW存在正交互作用(L.R Chisq为19.328和7.486,P=0.0001和0.0237)。孕晚期甲亢和孕晚期开始服用ATDs,发生LBW、早产儿和早产LBW的危险性显著增加。结论妊娠期间甲亢,特别是孕晚期甲亢和孕晚期才开始ATDs治疗,可导致LBW,尤其是早产LBW率增加。     

Differential risk of hypertensive disorders of pregnancy among Hispanic women

Preeclampsia and gestational hypertension are leading complications of pregnancy that also portend increased risk of future chronic hypertension. Although rates of chronic hypertension differ between non-Hispanic Caucasian and Hispanic women, few studies examined their relative rates of hypertensive disorders of pregnancy. The purpose of this study was to compare the risk of preeclampsia and gestational hypertension in a prospective cohort of normotensive, nulliparous Hispanic (n = 863) and non-Hispanic Caucasian women (n = 2,381). Compared with non-Hispanic Caucasian women, Hispanic women demonstrated a significantly decreased incidence of gestational hypertension (1.6% versus 8.5%; P < 0.01), but a similar incidence of preeclampsia (3.8% versus 3.7%; P = 0.9). Adjusting for age, smoking, diabetes, BP, body mass index (BMI), and multiple gestation uncovered an increased relative risk (RR) for preeclampsia among Hispanic women (RR 1.9; 95% CI, 1.1 to 3.3; P = 0.01), while their relative risk for gestational hypertension remained significantly decreased (RR 0.39; 95% CI, 0.22 to 0.72; P < 0.01). Among women who initially presented with hypertension during pregnancy, Hispanic women were over threefold (hazard ratio 3.3; 95% CI, 1.9 to 6.0; P < 0.01) more likely to develop preeclampsia than non-Hispanic Caucasian women. Besides Hispanic ethnicity, baseline BP, BMI, diabetes, and multiple gestation were independent risk factors for preeclampsia, whereas only baseline BP and BMI were associated with gestational hypertension. Socioeconomic status and access to prenatal care were not associated with either disorder. Hispanic ethnicity is independently associated with increased risk for preeclampsia and decreased risk for gestational hypertension. The initial presentation of hypertension during pregnancy in Hispanic women most likely represents early preeclampsia.     

Maternal and fetal outcomes of Asian pregnancies after bariatric surgery

IntroductionObesity is a risk factor for pregnancy-induced hypertension, preeclampsia, gestational diabetes, and large gestational age pregnancy. Bariatric surgery is widely accepted to treat obesity but associated with small for gestational age fetuses.ObjectiveTo report maternal and fetal outcomes after bariatric surgery in morbidly obese Asian females.SettingUniversity Hospital, Singapore.MethodsWe maintain a prospective cohort of patients who underwent bariatric surgery in our institution. Maternal and fetal outcomes are compared with a control group of 31 pregnancies matched for age, parity, presurgery weight, and year of delivery.ResultsTwenty-four pregnancies occurred in 16 patients in our postoperative cohort. Morbidly obese women in the control group were more likely to develop gestational diabetes (19.3% versus 5.0%, P = .150) and pregnancy-induced hypertension/preeclampsia (32.2% versus 0%, P = .003) compared with the postoperative group. Of fetuses, 37.5% in the bariatric group had low birth weight compared with only 9.4% fetuses in the control group (P = .016). Preoperative body mass index, short interval between conception and surgery, and poor weight gain during pregnancy did not predict for small for gestational age fetuses. Subsequent weights were available for 37.5% of the children in the surgical cohort and none of these children exhibited growth retardation.ConclusionBariatric surgery lowers the risk of maternal co-morbidities and large gestational age fetus during pregnancy. Asians are at high risk of small for gestational age pregnancies after bariatric surgery and should undergo close monitoring for fetal growth throughout their pregnancy.     

Familial risk of preeclampsia in Newfoundland: a population-based study

This study sought to quantify the familial risk of preeclampsia (proteinuric hypertension) in Newfoundland and to identify characteristics in probands that predict increased familial risk. Reviewed were 5173 obstetric charts from 10 hospitals, representing 99% of deliveries on the island of Newfoundland for a 1-yr period from April 1996 to March 1997; pregnancy-induced hypertension was diagnosed according to strict criteria. Family obstetric histories were obtained from identified probands with preeclampsia, and sisters and mothers of probands were interviewed. In addition, the obstetric charts from sisters and mothers were reviewed to identify preeclampsia. The incidence of preeclampsia in the population was 5.6% (n = 292), and in primiparous women it was 7.9%. Factors independently associated with increased risk of preeclampsia included primiparous delivery, multiple gestation, pregestational and gestational diabetes, maternal age of more than 35 yr, and region of the province. Of 330 sisters identified, 217 had 445 pregnancies, with 331 charts located for review. The incidence of preeclampsia (based on chart review) in 163 primiparous sisters was 20.2%. The relative risk of preeclampsia in primiparous sisters of probands with preeclampsia compared with primiparous women in the population was 2.6 (95% confidence interval, 1.8 to 3.6). Factors in probands independently associated with a higher risk of preeclampsia in sisters included at least 2+ proteinuria and region of the province. This population-based study, which used unbiased ascertainment and strict diagnostic criteria, demonstrated a significantly higher risk of preeclampsia in sisters of probands with preeclampsia, particularly when probands were defined by severity of preeclampsia and by geographic region.     

Pregnancy in patients with IgA nephropathy: a retrospective study for 20 years

Objective To analyze prognosis of pregnancy and kidney disease, and evaluate effects of renal pathology on pregnant outcomes and clinical risk factors of adverse outcomes of pregnancy in IgA nephropathy (IgAN) patients. Methods IgAN patients with more than 20 weeks of pregnancy were included, by retrieving the medical database in Peking Union Medical College Hospital from January 1996 to December 2015. Their detailed information during hospitalization and follow-up was recorded, and outcomes of pregnancy and kidney diseases in IgAN patients were assessed. According to Lee's renal pathological grade system, patients were divided into gradeⅣ&Ⅴ group and below grade Ⅳ group to compare their pregnant prognosis. IgAN patients were divied into fetus survival group and fetus death group according to their pregnancy outcomes. The fetal survival factors were analyzed by single factor and multivariate regression. Results A total of 64 pregnancies in 62 patients were included with a mean age of (30.31±4.05) years. The fetus survival rate was 87.5% and the average gestational periods was (35.41±5.10) weeks (ranging from 20-40 weeks). The incidence of pregnancy-induced hypertension syndrome is 17.2% (11 cases). The preterm birth rate was 24.1% (14 cases) among the live births. Serum creatinine increased in 18 cases (28.1%) during pregnancy with median increment of 38.5 μmol/L, and 72.2% patients completely recovered to the level before pregnancy in the postpartum period of 6 months. The incidence of fetus death (38.1% vs 0.0%, P＜0.01), low birth weight infant (46.2% vs 11.1%, P＜0.05) and pregnancy-induced hypertension syndrome (33.3% vs 11.1%, P＜0.05) in Lee's grade Ⅳ&Ⅴ group was higher than those in below grade Ⅳ group. The serum creatinine, urine protein excretion, renal hypertension before pregnancy and renal segmental glomerular sclerosis were significantly increased in fetus death group as compared with those in fetus survival group (all P＜0.05). Logistic regression showed that in all patients an estimated glomerular filtration rate (eGFR)＜60 ml?min-1?(1.73 m2)-1 (OR=76.978, 95%CI 3.327-1780.939, P=0.007) and renal hypertension (OR=14.464,95%CI 1.245-168.053, P=0.033) before pregnancy were the independent risk factors for fetus death, while multipara was a protective factor (OR=0.063, 95%CI 0.005-0.876, P=0.040). Conclusions The fetus survival and kidney prognosis in IgAN patients are closely related to the severity of clinical and pathological changes before pregnancy. Reduced eGFR and complication of renal hypertension are the independent risk factors for adverse prognosis of pregnancy.     

Un bilan biologique est-il nécessaire pour réaliser une ALR obstétricale chez une patiente dont l'interrogatoire et l'examen clinique sont strictement normaux ?

In France, coagulation blood tests are usually ordered before performing an epidural anaesthesia. This French habit obeys to the fear of triggering an epidural haematoma induced by neuraxial anaesthesia. This analysis of literature shows that these practices do not protect anaesthesiologists against this clinical risk or its medico-legal consequences. As shown by epidemiological studies, epidural haematoma in pregnancy is associated to the occurrence of HELLP syndrome. On the opposite, gestational thrombocytopenia is not associated to any bleeding risk. According to the recommendations of the French Society of Anaesthesia (Sfar), only a clinical examination and an interrogatory must be done to diagnose coagulation defects before general or loco regional anaesthesia. Normal pregnancy is not an exception to this rule except for the platelet number which must be evaluated during the 3rd trimester of pregnancy. This platelet numeration might detect a rare idiopathic thrombopenic purpura. This recommendation is valid only for normal pregnancy. The clinician must ensure that pregnancy is still normal by seeking for symptoms of pregnancy-induced pathology such as preeclampsia or HELLP syndrome before setting an epidural anaesthesia. The possibly late occurrence of these complications during the per- or post-partum explain why a coagulation test performed even a few days before anaesthesia may not allow to detect any coagulation defect favouring the risk of epidural haematoma.     

Clinical features and influence factors of pregnancy-induced hypertension with renal impairment at high altitude

Objective To investigate the incidence and clinical features of women with hypertension disorders of pregnancy complicated with renal impairment at high altitude, and explore the impact of proteinuria, renal insufficiency and preexisting chronic kidney disease (CKD) on these patients. Methods A pool of 1790 pregnant women admitted to Yunnan Diqing Tibetan Autonomous Prefecture People's Hospital from September 2017 to September 2018. Data of 123 patients who met the criteria of hypertension disorders in pregnancy were collected and retrospectively studied. Their clinical characteristics and pregnancy outcomes were analyzed. Patients with hypertension and renal impairment, simple hypertension patients as well as normal pregnant women were compared. Hypertensive patients with proteinuria, renal insufficiency (Scr＞70 μmol/L) and preexisting CKD were also compared with simple hypertension patients. The impact of proteinuria, renal insufficiency and preexisting CKD on patients with hypertension disorders of pregnancy was assessed by multivariate logistic analysis. Results Of these 123 patients, 61 cases (49.6%) had renal impairment, 57 cases (46.3%) had proteinuria, 15 cases (12.2%) had renal insufficiency and 6 cases (4.9%) had preexisting CKD. Compared with normal pregnant women and simple hypertension patients, patients with hypertension and renal impairment had higher blood pressure, Scr, primipara rate and caesarean section rate (all P＜0.05), lower gestational age, neonatal Apgar scores and plasma albumin level (all P＜0.05), as well as adverse pregnancy outcomes, including premature birth, stillbirth/neonatal death, intrauterine growth restriction, infants of low-birth weight and admission to the neonatal intensive care unit (NICU) (all P＜0.05). The clinical features and pregnancy outcomes of 57 patients with proteinuria correlated with the proteinuria. Compared with non-nephrotic syndrome patients and patients without proteinuria, patients with nephrotic syndrome (NS) had lower plasma albumin level and higher rates of premature birth, infants of low-birth weight and admission to NICU (all P＜0.05). Among 15 patients with renal insufficiency, there were 13 mild abnormal cases (70 μmol/L＜Scr≤123 μmol/L, 86.7%). Compared with those with normal renal function, patients with renal insufficiency had higher Scr, uric acid and rates of preeclampsia/eclampsia, intrauterine growth restriction, infants of low-birth weight and admission to NICU, while lower plasma albumin level (all P＜0.05). Among 6 patients with preexisting CKD, 4 had NS, 2 had renal insufficiency, 5 delivered before 37 weeks, and 2 infants died. Logistic regression analysis showed that NS (OR=4.863, P=0.032), renal insufficiency (OR=7.550, P=0.017) and systolic pressure (OR=1.061, P=0.002) were independent risk factors for adverse pregnancy outcomes among patients with hypertension disorders in pregnancy. Conclusions Renal impairment is common among patients with hypertension disorders in pregnancy at high altitude and has adverse effects on pregnancy outcomes. Massive proteinuria, renal insufficiency and systolic pressure are risk factors for these patients.     

Effect ofpreeclampsia and varying degrees proteinuria on perinatal outcome

Objective To explore the impacts of preeclampsia and the different extent of proteinuria on maternal and perinatal outcomes. Methods The retrospective analysis was conducted according to the perinatal clinical data of preelacmpsia, pregnancy-induced hypertension in pregnant women and normal pregnant women from the Fifth People's Hospital of Shanghai, excluding twins, diabetic mellitus and patients with chronic kidney disease previously. Patients were divided into three groups on the basis of their conditions: ① preeclampsia patients (A group, 220 cases); ② patients with gestational hypertension (B group, 189 cases); ③ normal pregnant (C group, 220 cases). Patients with pre-eclampsia according to the degree of proteinuria were further divided into three subgroups: A1: patients with mild proteinuria (n＝109); A2: patients with moderate proteinuria (n＝72); A3: patients with severe proteinuria (n＝39). Results Compared with the other two groups, the patients in A group had higher blood pressure, serum creatinine, uric acid, cesarean section rate, perinatal prematurity, stillbirth, fetal distress and neonatal asphyxia in preeclampsia group. However, the serum albumin level, eGFR, neonatal birth weight, length and Apgar scores were lower in A group compared with B and C group (P＜0.05). In three subgroups, serum creatinine level, uric acid level, cesarean section rate, perinatal prematurity and fetal distress were significantly increased in A3 group compared with A1 group, while the serum albumin level, eGFR, gestational age and neonatal birth weight were obviously lower in A3 group than in A1 group (P＜0.05). In patients with preeclampsia, 24 h urinary protein wasnegatively related with the levels of serum albumin and eGFR (P＜0.05), and positivly related with the blood pressure, serum creatinine and caesarean production rate (P＜0.05). Large amounts of proteinuria was a risk factor of adverse outcome for pregnant patients with preeclampsia (OR＝2.899，P＜0.05) . Conclusions Preeclampsia patients with large amount of proteinuria have poor maternal and perinatal outcomes. Massive proteinuria is a risk factor of adverse outcome for patients with pre-eclampsia.     

Acid-base state of cerebrospinal fluid during pregnancy and its effect on spread of spinal anaesthesia

To assess the possible relationship between changes in acid-base state of cerebrospinal fluid (CSF) and enhanced spread of spinal anaesthesia during pregnancy, we have measured CSF pH, carbon dioxide tension (PCO2) and HCO3- values in 73 women undergoing spinal anaesthesia with hyperbaric amethocaine 8 mg. Patients were allocated to one of four groups according to gestational period: non-pregnant group (n = 13), first trimester group (8-13 weeks, n = 19), second trimester group (14- 26 weeks, n = 11) and third trimester group (27-39 weeks, n = 30). The pH of the CSF was greater in the second and third trimester groups than in the non-pregnant group. CSF PCO2 decreased by 0.53-0.8 kPa throughout pregnancy. CSF HCO3- was decreased throughout pregnancy. Overall, no clinically significant correlation was found between maximum cephalad spread of analgesia and CSF pH, PCO2 or HCO3-. We conclude that pregnancy-induced changes in acid-base state of CSF have little effect on the spread of spinal anaesthesia, although there is a clinically different spread of spinal anaesthesia between non-pregnant and pregnant states.      

Maternal weight and birth outcomes among women on antiretroviral treatment from conception in a birth surveillance study in Botswana

IntroductionAntiretrovirals such as dolutegravir (DTG) and tenofovir alafenamide (TAF) have been associated with excessive weight gain. The objective of this study was to understand the potential impact of ART‐associated weight gain on pregnancy outcomes among women living with HIV.MethodsUsing data from the Tsepamo birth outcomes surveillance study in Botswana, we evaluated the relationship between maternal weight (and weight gain) and severe birth outcomes (very preterm delivery <32 weeks, very small for gestational age (SGA) <3rd percentile, perinatal death), macrosomia (birthweight > 4000 g) and maternal hypertension. We estimated the relative risk of each outcome by baseline weight (first weight in pregnancy <24 weeks) and second trimester average weekly weight gain (kg/week from 12 ± 2 to 24 ± 2 weeks) using log binomial regression and evaluated effect modification by ART regimen (DTG vs. Efavirenz (EFV)).ResultsOf 22,828 women on ART at conception with singleton deliveries between August 2014 and April 2020, 16,300 (71.4%) had a weight measured <24 weeks’ gestation (baseline weight) and 4437 (19.2%) had weight measured both at 12 (±2) weeks and 24 (±2) weeks, allowing second trimester weight gain calculation. Compared to women with baseline weight 60 to 70 kg, low baseline weight (<50 kg) was associated with increased risk of very preterm delivery (aRR 1.30, 95% CI 1.03, 1.65) and very SGA (aRR1.96, 95% CI 1.69, 2.28). High baseline weight (>90 kg) was associated with increased risk of macrosomia (aRR 3.24, 95% CI 2.36, 4.44) and maternal hypertension (aRR 1.79, 95% CI 1.62, 1.97). Baseline weight was not associated with stillbirth or early neonatal death. For all outcomes, second trimester weight gain showed weaker associations than did baseline weight. Duration of pre‐pregnancy ART (years) was associated with higher baseline weight for DTG but not for EFV, and the risk of maternal hypertension by baseline weight category was higher for DTG than EFV for all strata.ConclusionsART regimens associated with weight gain may reduce the number of women at risk for certain severe adverse pregnancy outcomes associated with low weight but increase the number at risk of macrosomia and maternal hypertension. Further research could determine whether weight‐based ART treatment strategies improve maternal and child health.     

Beta2-microglobulin and hypertensive complications in pregnant women at risk

BACKGROUND AND AIM: Beta2-microglobulin (beta2-m) is a polypeptide, which is freely filtered through the glomerular basement membrane and absorbed almost entirely by the proximal tubular cells. Preeclampsia, a common complication of pregnancy, is characterized by pathological renal changes, mainly glomerular lesions. The aim of the present study was to investigate whether serum beta2-m measured in the early stages of pregnancy could be used as a marker to predict hypertensive complications in women at increased risk. PATIENTS AND METHODS: Serum beta2-m concentrations were prospectively measured in 75 pregnant women with history of chronic hypertension, chronic renal disease, chronic vascular disease or preeclampsia and compared with those in 16 healthy pregnant women. RESULTS: Of the 75 women in the study group, 10 (13%) developed preeclampsia and 20 (26%) had other complications, such as intrauterine growth restriction (n = 8), fetal or neonatal loss (n = 9) and delivery before 30 weeks of gestation (n = 8). Gestational age at delivery, birth weight and cesarean section rate were significantly worse in the patients with complications than in those without and in the healthy controls. No significant difference was detected in early serum beta2-m concentrations between the women who later developed preeclampsia or other complications and those who did not. There was a significant positive correlation of beta2-m concentrations with serum creatinine level (R2 = 0.394, p < 0.001), but not with gestational week at blood collection. CONCLUSION: Serum beta2-m concentrations are not predictive of the development of preeclampsia or other complications in woman at risk.