Maternal Arsenic Exposure and Impaired Glucose Tolerance during Pregnancy

Background

Accumulating evidence has shown an increased risk of type 2 diabetes in general populations exposed to arsenic, but little is known about exposures during pregnancy and the association with gestational diabetes (GD).

Objectives

We studied 532 women living proximate to the Tar Creek Superfund Site to investigate whether arsenic exposure is associated with impaired glucose tolerance during pregnancy.

Methods

Blood glucose was measured between 24 and 28 weeks gestation after a 1-hr oral glucose tolerance test (GTT) as part of routine prenatal care. Blood and hair were collected at delivery and analyzed for arsenic using inductively coupled plasma mass spectrometry with dynamic reaction cell.

Results

Arsenic concentrations ranged from 0.2 to 24.1 μg/L (ppb) (mean ± SD, 1.7 ±1.5) and 1.1 to 724.4 ng/g (ppb) (mean ± SD, 27.4 ± 61.6) in blood and hair, respectively. One-hour glucose levels ranged from 40 to 284 mg/dL (mean ± SD, 108.7 ± 29.5); impaired glucose tolerance was observed in 11.9% of women when using standard screening criterion (> 140 mg/dL). Adjusting for age, Native-American race, prepregnancy body mass index, Medicaid use, and marital status, women in the highest quartile of blood arsenic exposure had 2.8 higher odds of impaired GTT than women in the lowest quartile of exposure (95% confidence interval, 1.1–6.9) (p-trend = 0.008).

Conclusions

Among this population of pregnant women, arsenic exposure was associated with increased risk of impaired GTT at 24–28 weeks gestation and therefore may be associated with increased risk of GD.     

初次妊娠孕妇妊娠期缺铁性贫血及贫血程度的影响因素分析

目的 探讨初次妊娠孕妇妊娠期缺铁性贫血及贫血程度的影响因素.方法 回顾性分析2016年1月至2019年12月我院收治的980例初次妊娠孕妇的临床资料,依据是否出现缺铁性贫血分为对照组(未出现缺铁性贫血,800例)和观察组(出现缺铁性贫血,180例).根据病情严重程度将观察组分为轻度组(血红蛋白100～ 109 g/L,...     

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.     

孕妇贫血对妊娠的结局影响调查

目的 探讨孕妇贫血对妊娠结局的影响.方法 对福清市1022位孕妇的血红蛋白含量及其妊娠结局进行调查分析.结果 孕妇贫血对剖腹产新生儿窒息发生率、流产有显著性影响,而与新生儿体重、孕周及顺产式新生儿窒息发生率则无相关性.结论 孕妇贫血是造成某些不良妊娠结局的重要病因之一,要注意预防和控制孕妇贫血的发生.     

缺铁性贫血对妊娠及其结局的影响

目的　了解孕妇缺铁性贫血 (IDA)的程度和主要相关因素 ,探讨其对妊娠结局的不良影响和补铁后的效果。方法　膳食调查、血液铁水平测定及补铁效果、妊娠结局观察的临床对照研究。结果　育龄妇女在妊娠前、后血红素铁摄入量较低 ;孕中、晚期IDA发生率分别为 14 3%,2 8 3%,其中Hb >10 0 g/L者占 94 3%;IDA孕妇组子痫前期发生率及分娩时宫缩乏力率、宫内发育迟缓和低出生体重发生率均显著高于正常孕妇组 ,IDA孕妇经补铁后 ,其血液铁水平和妊娠结局均有所改善。结论　孕期轻度IDA对母儿均有影响 ,妇女孕前应进行营养教育和指导 ,对孕期IDA应及时防治。     

妊娠晚期贫血影响因素的Logistic回归分析

目的 探讨妊娠晚期贫血的影响因素.方法 数据来自104例孕妇的资料,以她们妊娠中期的血清铁蛋白(SF)、游离红细胞原卟啉(FEP)、红细胞容积分布宽度(RDW)和平均红细胞容积(MCV)四项指标作为自变量,以妊娠晚期游离红细胞原卟啉(FEP)作为因变量,作Logistic回归分析.结果 只有妊娠中期游离红细胞原卟啉(FEP)对妊娠晚期贫血的影响有显着意义(P<0.001),其偏回归系数为12.048,妊娠晚期贫血Logistic回归分析的理论分类与实际分类的总符合率为894%,结果较好,而妊娠中期血清铁蛋白(SF)、红细胞容积分布宽度(RDW)和平均红细胞容积(MCV)对妊娠晚期贫血的影响均无显着性意义(P>0.05).结论 妊娠中期游离红细胞原卟啉对妊娠晚期贫血有重要作用.     

Hemoglobin Concentration during Early Pregnancy as an Accurate Predictor of Anemia during Late Pregnancy

It is undetermined which blood variables related to iron storage during the first trimester of pregnancy could efficiently predict anemia occurring during the third trimester. Red blood cell count (RBC), hemoglobin concentration, hematocrit, ferritin, iron, and total iron binding capacity (TIBC) were assessed longitudinally during the first, second, and third trimesters of 231 healthy Japanese women. None of the patients had anemia in the first trimester and none used iron supplementation before the second trimester blood test. Anemia was defined as hemoglobin (Hb) < 11 g/dL for the first trimester and Hb < 10.0 g/dL for the third trimester. Forty-seven (20%) women developed anemia in the third trimester. The first trimester RBC, Hb, hematocrit, and ferritin levels were significantly lower in women with third-trimester anemia than those without anemia. The first trimester hemoglobin level exhibited a greater area under the curve of the receiver operating characteristic curve for prediction of the third trimester anemia than other blood variables; the optimal cut-off (12.6 g/dL) of hemoglobin yielded a sensitivity of 83% (39/47). First trimester hemoglobin levels were significantly better predictors of anemia during the third trimester than the indices of iron storage, including serum iron, ferritin, and TIBC levels.     

Iron Sucrose Versus Oral Iron Therapy in Pregnancy Anemia

Background:

Iron deficiency anemia (IDA) is the most common medical problem in pregnancy. Parenteral iron is a useful treatment, although iron dextran use decreased due to anaphylaxis. Iron sucrose is a newer agent that has overcome the shortcomings of iron dextran.

Objective:

The aim of this study was to compare the efficacy and tolerance of intravenous iron sucrose (IVIS) therapy with oral iron (OI) therapy in pregnant women with IDA and to study the factors influencing treatment.

Materials and Methods:

This prospective, randomized clinical trial included pregnant women between 14 and 36 weeks with established IDA who were treated with IVIS or OI (ferrous fumarate). All patients were monitored for laboratory response and adverse effects. Independent sample-t test, Chi square test and ANOVA were used for statistical analysis. P < 0.05 was considered significant.

Results:

Although hemoglobin increased in both the groups, increase in the reticulocyte count and percentage increase in hemoglobin was significantly higher in the IVIS group than in the OI group (23.62% vs. 14.11%). Serum ferritin was significantly higher in the IVIS group than in the OI group (P = 0.000). The IVIS group had no major side-effects. Compliance was good with OI, although 23% had gastrointestinal side-effects. Patient weight, gestation at diagnosis, initial hemoglobin and ferritin levels did not influence the response to treatment.

Conclusion:

IVIS is safe and effective in the treatment of IDA during pregnancy. Iron stores increased better with IVIS compared with OI.     

孕期/哺乳期砷暴露对子鼠心、肝、脾、肾发育的影响

[目的]探讨孕期/哺乳期砷暴露对子鼠心、肝、脾、肾发育影响。[方法]昆明种孕小鼠48只,随机分成4组,每组12只。全孕期和哺乳期以自由饮水方式连续染毒。按饮水砷浓度分别设空白对照组,1、4、16 mg/L染砷组。子鼠生后追踪体重和身长发育情况。哺乳喂养,3周断乳。测量断乳子鼠心、肝、脾、肾脏器系数,观察子鼠心、肝、脾和肾组织形态。[结果]体格发育:出生第3、10、15和21天,各组子鼠平均体重和身长均随母鼠饮水砷浓度升高而降低(P<0.05)。脏器系数:生后3周,各组子鼠心、肝、脾、肾脏器系数均随母鼠饮水砷浓度升高而升高(P<0.05)。病理形态:染砷组断乳子鼠心肌纤维厚薄不均,排列紊乱,心肌细胞核密集;肝细胞以及肾皮质区近曲小管内皮细胞出现水变性,高剂量染砷组子鼠肾远曲小管出现蛋白管型;脾脏出现特征性结构边界不清,白髓面积逐渐变小,红髓面积逐渐增大等表现;上述病理损伤随染砷浓度增加而逐渐加重。[结论]孕期/哺乳期砷暴露导致断乳期子鼠多器官组织形态异常,此可能是砷致生后远期慢性疾病发生的解剖学基础和发育源性病因。     

Association of Preconception Blood Pressure with the Risk of Anemia in Children under Five Years of Age: A Large Longitudinal Chinese Birth Cohort

Hypertension during pregnancy may increase the risk of anemia in the offspring. However, few studies have investigated the effects of elevated blood pressure during the preconception period on childhood anemia. This large population-based birth cohort study was performed to determine whether abnormal preconception blood pressure has long-term consequences for childhood health. Data were obtained from the China–US Collaborative Project for Neural Tube Defect Prevention. The study consisted of 40,638 women with singleton live births who were registered in a monitoring system before pregnancy in southern China during the period 1993–1996. Children were assessed by hemoglobin measurement at approximately 53 months of age. The incidences of childhood anemia were 19.80% in the hypertension group and 16.07% in the non-hypertension group. Compared with the non-hypertension group, the hypertension group had an increased risk of childhood anemia (adjusted risk ratio (RR): 1.25; 95% confidence interval (CI): 1.11–1.41). After categorization according to blood pressure, combined systolic and diastolic hypertension was associated with a significantly increased risk of childhood anemia, compared with normotension (adjusted RR: 1.37; 95% CI: 1.16–1.63). Compared with women who had normal blood pressure, the adjusted RRs for childhood anemia were 1.20 (95% CI: 1.13–1.28), 1.26 (95% CI: 1.08–1.47), and 1.38 (95% CI: 1.14–1.67) among women with prehypertension, stage-1 hypertension, and stage-2 hypertension, respectively. Our results suggest a linear association between prepregnancy hypertension and the risk of childhood anemia in the Chinese population. Interventions targeting preconception blood pressure may have a positive effect on childhood health.     

Maternal Anemia during the First Trimester and Its Association with Psychological Health

Anemia during pregnancy is known to be associated with an increased risk of antenatal and/or postnatal depression, as well as adverse pregnancy outcomes. However, there are few studies evaluating psychological health throughout the antepartum and postpartum periods in women with anemia in early pregnancy. This study analyzed data collected by the Korean Pregnancy Outcome Study, a multicenter prospective cohort study conducted in South Korea, to determine the impact of anemia during the first trimester on birth outcomes and maternal mental health during pregnancy and postpartum. Hemoglobin levels were measured during the first trimester, and psychological health was evaluated at 12, 24, and 36 gestational weeks and 4–6 weeks postpartum. Anxiety and depression were defined using the Hospital Anxiety and Depression Scale and the Edinburgh Postnatal Depression Scale, respectively. Among 4067 Korean participants, 119 (2.9%) were diagnosed with anemia during the first trimester. Incidences of anxiety and depression did not differ over the pregnancy period between those with and without anemia during the first trimester. However, postpartum anxiety and depression were significantly more common in participants with anemia than in those without (p < 0.05, both). Hence, obstetricians should pay attention to postpartum mental health in women with anemia during the first trimester.     

Blood Lead Concentrations and Pregnancy Outcomes

In this study, the authors related blood lead concentrations to Apgar scores, birth weight, gestational age, small-for-gestational age, and hypertension in pregnancy (HIP)/toxemia. Data and blood were collected 4 times during pregnancy from 705 women, aged 12–34 yr. Blood lead concentrations, measured by atomic absorption spectrophotometry, were related to reproductive outcomes, abstracted from medical records. Average blood lead concentrations were 1.2 μg/dl (standard error = ± 0.03). Maternal blood lead concentrations were related significantly to HIP/toxemia—before and after adjusting for age, calcium intake, and race/ethnicity (p < .03). Longitudinal regression analyses revealed that blood lead concentrations in women with HIP/toxemia changed by 0.02 μg/dl for every 0.01 μg/dl change in women without HIP/toxemia. Maternal blood lead concentration and its change were not significantly associated with other reproductive outcomes. Low levels of maternal blood lead concentrations were significantly associated with HIP/toxemia.     

贫血患者血液检验中生化仪的临床应用价值分析

目的:分析在为贫血患者实施血液诊断的过程中生化仪的临床应用效果.方法:纳入2018年2月~2019年2月在本院接受贫血治疗的患者78例为本次实验研究的对象,所有患者均经过病理证实,运用生化仪为患者进行血液检验,将检验结果与病理结果进行对比,分析生化仪在贫血患者血液检验中的应用价值.结果:本次实验研究中共有78例患者,生化仪血液检验结果为贫血的有74例,其检验准确率为94.9%;其中溶血性贫血、再生障碍性贫血以及缺铁性贫血患者分别有15例、17例、42例,其与病理结果相比无明显差异(P>0.05).结论:在为贫血患者实施血液检验的过程中生化仪的运用具有着相对较高的检出率,其对溶血性贫血、再生障碍性贫血以及缺铁性贫血均有着相对较高的诊断准确率,可以将其作为贫血患者的理想血液检验方法.     

Anemia among Women of Reproductive Age: An Overview of Global Burden,Trends, Determinants,and Drivers of Progress in Low- and Middle-Income Countries

Relatively little progress has been made in reducing anemia prevalence among women of reproductive age (WRA anemia). Interventions, policies and programs aimed at reducing WRA anemia have the potential to improve overall not only women’s, but also children’s health and nutrition outcomes. To our knowledge, this is the first review that aimed to compile evidence on the determinants and drivers of WRA anemia reduction in low- and middle-income countries (LMICs). We synthesized the available evidence on the determinants and drivers, including government policies and programs, of WRA anemia and their mitigation strategies across a wide range of countries and geographies, thus contributing to the complex and multifactorial etiology of anemia. We carried out a systematic review of published peer-reviewed and grey literature assessing national or subnational decline in WRA anemia prevalence and the associated drivers in LMICs. Among the 21 studies meeting our inclusion criteria, proximal determinants of healthcare utilization, especially during pregnancy and with the use of contraceptives, were strong drivers of WRA anemia reduction. Changes in other maternal characteristics, such as an increase in age at first pregnancy, BMI, birth spacing, and reduction in parity, were associated with modest improvements in anemia prevalence. Access to fortified foods, especially iron-fortified flour, was also a predictor of a decrease in WRA anemia. Of the intermediate determinants, an increase in household wealth, educational attainment and access to improved sanitation contributed significantly to WRA anemia reduction. Although several common determinants emerged at the proximal and intermediate levels, the set of anemia determinants and the strength of the association between each driver and WRA anemia reduction were unique in each setting included in this review. Further research is needed to provide targeted recommendations for each country and region where WRA anemia prevalence remains high.     

血液检验仪在诊断和鉴别诊断贫血中的应用价值

目的:探讨血液检验仪在诊断和鉴别诊断贫血中的价值.方法:选择2018年8月～2019年10月来本院治疗的100例贫血患者作为观察组,并挑选同期90例健康体检者作为对照组,所有人员接受血液检测,对比检测结果.结果:对比再生障碍性贫血组,与对照组的MCV、MCH、RDW水平比较,无统计学意义(P>0.05),而RBC、Hb...     

正常中晚期孕妇的凝血四项和D-二聚体结果分析及其临床意义

目的检测正常中晚期孕妇的凝血四项及D-二聚体指标,了解正常中晚期孕妇的凝血与纤溶功能状态及临床意义。方法凝血四项测定均为凝固法,D-二聚体为免疫比浊法。在Sysmex CA7000全自动血凝仪上进行检测。结果正常妊娠中晚期孕妇与正常非孕妇女对照组比较,PT、APTT时间明显缩短(P<0.05);FIB显著增高(P<0.01);TT差异不明显(P>0.05);D-二聚体水平差异有统计学意义(P<0.05)。结论妊娠中晚期由于凝血功能增强,抗凝及纤溶功能减弱,出现妊娠期高凝状态,有利于产后快速有效止血。产前凝血功能的检测,对预防产科并发症(如DIC及羊水栓塞等)有重要的临床意义。     

Drops of Capillary Blood Are Not Appropriate for Hemoglobin Measurement with Point-of-Care Devices: A Comparative Study Using Drop Capillary,Pooled Capillary,and Venous Blood Samples

Population-based surveys matched by time but using different methodologies for determining hemoglobin (Hb) concentration have shown inconsistencies in estimating anemia prevalence. This study aimed to estimate measurement errors in Hb quantification in HemoCue 201+ using venous blood (VB) and capillary blood both drops (DCB) and pools (PCB), and compare the results against those of a reference method (VB analyzed in hematology analyzers based on the cyanmethemoglobin method). Children (n = 49), adult females (n = 50), and older adults (n = 50) were randomly allocated to donate VB (4 mL) and either DCB (three drops) or PCB (350 µL). Results in HemoCue were analyzed through Bland Altman and Lyn’s concordance against Hb concentration by the reference method. A positive average bias (systematic error) was found for the HemoCue (0.31 g/dL) using the same VB samples. This value was then subtracted from all readings carried out in the device. After this adjustment, DCB still produced a positive bias (0.42 ± 0.81 g/dL), and the variation of single results was ±1.6 g/dL (95% CI). PCB and VB performed similarly; the average bias was negligible (−0.02 ± 0.36 and 0.00 ± 0.33 g/dL, respectively) and the variation of the results (95% CI) was ±0.7 g/dL or lower. Lyn’s concordance values were 0.86, 0.96, and 0.98 for DCB, PCB, and VB, respectively. Random variation using DCB is too large to approximate the true Hb values, and therefore DCB should be discontinued for diagnosing anemia both in individuals and in populations.     

孕晚期缺铁与婴儿缺铁性贫血相关性分析

目的探讨母亲孕晚期铁元素（Fe）缺乏与婴儿缺铁性贫血的的关系。方法对2007年1月1日-2008年1月1日在秦皇岛市妇幼保健院出生的4个月婴儿进行静脉血常规检查及微量元素检查;孕晚期母亲进行微量元素检查及问卷调查,了解贫血的发生情况。结果母亲孕晚期Fe缺乏101例,4个月婴儿缺铁性贫血93例;母亲孕晚期Fe正常363例,4个月婴儿缺铁性贫血85例,差异有统计学意义（P〈0．05）。结论孕晚期母亲Fe缺乏与婴儿缺铁性贫血有明显的相关性,重视孕晚期母亲Fe的补充可以预防婴儿缺铁性贫血。     

Use Of Iron-Fortified Salt To Combat Anemia: The Indian Experience

The incidence of anemia in rural and urban communities of India was reduced by the introduction of salt fortified with iron.     

原子吸收法同时测定人血中砷 硒 汞元素

采用 (3∶1)硝酸—高氯酸混合酸消化液 ,在加回流管的测砷瓶内分步消化血样 ,用流动注射氢化物发生原子吸收法测定人血中砷硒汞。相对标准偏差小于 9.6 % ,样品加标回收率在 95 1%～ 99 6 %之间 ,方法的检出限在 0 39～ 0 78ng/ml;采用流动注射氢化物发生原子吸收法测定人血中砷硒汞 ,其方法灵敏度高、稳定性好 ,精密度和准确度均符合微量分析要求。