中国国家出生队列建设背景和设计简介

随着生活行为方式、自然和社会环境的急剧变化,育龄人口生殖健康状况持续下降,快速增加的由辅助生殖技术（ART）孕育的子代的远期健康状况亟待评估。因此,妇幼保健和生殖健康相关研究关注的重点亟需从妊娠期、围产期的死亡和严重疾病表型逐渐向全生命周期和全疾病谱拓展。为了满足这样的研究需求,在我国12个省（自治区、直辖市）启动了中...     

孕前体重指数和孕期增重对不良妊娠结局影响的出生队列研究

目的探讨孕前体重指数(BMI)和孕期增重与早产、低出生体重、小于胎龄儿3种不良妊娠结局的关联。方法选取2014年6月—2015年2月在扬州市妇幼保健院分娩的3 943名孕妇,纳入出生队列,分析不同孕前BMI分组下的孕期增重状况与3种不良妊娠结局的关系。结果多因素logistic回归分析结果显示:孕前体重过低组中,孕期增重不足是发生早产的危险因素(RR=3.043,95%CI=1.104~8.387);孕前体重正常组中,孕期增重不足是发生早产与低出生体重的危险因素(RR=1.987,95%CI=1.146~3.444;RR=3.657,95%CI=1.905~7.021),孕期增重过度是发生小于胎龄儿的保护因素(RR=0.343,95%CI=0.180~0.652)。结论不同孕前BMI分组的孕期增重状况与不良妊娠结局有关联,保持适宜的孕前体重和孕期合理增重对改善出生结局具有重要意义。     

中国国家出生队列孤独症谱系障碍亚队列建设概况

孤独症谱系障碍作为儿童神经发育障碍的代表性疾病,发病率呈现不断上升的趋势,给家庭和社会带来巨大压力和经济负担,探讨其病因及发病机制意义重大。本研究依托中国国家出生队列开展孤独症谱系障碍亚队列建设,并利用该出生队列采用的辅助生殖和自然妊娠同期纳入并随访的平行设计,评价辅助生殖技术对子代神经行为发育的影响,并结合队列采集的...     

上海市双生子出生登记队列建设概况

【目的】建立上海市双生子出生登记队列(STBC),分析遗传因素、共享环境以及非共享环境的相互作用对新生儿出生健康和生长发育的影响。【方法】基于上海市全人群出生队列,筛选2015年1月1日以后出生的户籍双、多胎婴儿家庭进行全面调查,收集双、多胎婴儿的出生健康、生长发育以及家庭环境信息。【结果】截至2021年12月31日,STBC共成功纳入调查的双生子7 195对(14 405例),双生子出生平均身长为47.20 cm,出生平均体重为2 465.30 g,异卵双生子占69.05%,早产儿占57.07%。双生子母亲平均年龄为31.82岁,父亲平均年龄为33.87岁,超过80%的父母文化程度在大专及以上。母亲采用辅助生殖技术的有44.50%,孕期患病的有7.40%,15.90%的母亲孕期存在被动吸烟。调查期间,双胎婴儿的身长平均每月增加2.09 cm,体重平均每月增加0.53 kg。【结论】双生子人群的母亲剖宫产率、新生儿出生早产和低体重等不良结局发生率较高,依托STBC收集双生子人群出生健康以及儿童和青少年期的生长发育信息,为研究儿童慢性非传染性疾病、心理、行为异常等由遗传与环境共同作用的复...     

中国国家出生队列研究调查对象的基线特征分析

目的 探讨生命早期环境因素、遗传因素和遗传与环境交互作用对子代近期和远期健康的影响以及系统评价和比较辅助生殖受孕和自然受孕人群的妊娠结局和子代健康相关结局。方法 中国国家出生队列（CNBC）研究是一项覆盖辅助生殖受孕家庭和自然受孕家庭的多中心前瞻性出生队列研究。2016年,CNBC项目陆续在我国12个省（自治区、直辖市）的24所医院启动,以家庭为单位纳入研究对象,并在辅助生殖治疗前、胚胎移植、孕早期、孕中期、孕晚期及分娩时以及出生后第42天、6个月、12个月、36个月多个时点采集数据信息和生物样本。结果 截至2020年6月,CNBC共纳入27 044个辅助生殖受孕家庭,29 589个自然受孕家庭,CNBC的研究人群中绝大部分为城市居民。在辅助生殖受孕家庭中,男女双方分别有65.5%和63.7%为大学及以上文化程度,年龄为（33.83±5.52）和（32.38±4.67）岁;女方83.2%为初产妇,吸烟率为0.8%,饮酒率为2.1%。在自然受孕家庭中,男女双方分别有81.5%和86.5%为大学及以上文化程度,年龄为（32.06±5.09）和（30.40±4.27）岁,女方67.2%为初产妇,吸烟率为0.1%,饮酒率为2.2%。不同地区的辅助生殖受孕家庭和自然受孕家庭的基线特征均有差异。结论 CNBC的建立将为研究生命早期遗传、环境因素、遗传-环境交互作用以及辅助生殖技术治疗相关因素对出生后子代健康的影响提供了重要资源。     

应用Delphi法确定妇女孕前生殖健康素养的内容

目的确定妇女孕前生殖健康素养评价的内容。方法通过文献查阅确定妇女孕前健康素养评价的方面和能力维度,采用德尔菲(Delphi)专家咨询法对15位妇女保健领域的专家进行3轮函询确立达成共识的妇女孕前生殖健康素养的内容。结果妇女孕前生殖健康素养的内容包括医疗服务、疾病预防和健康促进3个方面和健康素养的获取、理解、评价和应用4种能力。3轮Delphi专家咨询问卷回收率均为93.3%,专家权威系数是0.80。经过3轮Delphi专家咨询,各核心内容均分≥4.0分,变异系数<0.25,专家意见协调系数是0.324。最终确定14条核心内容,主要涉及婚前保健服务、孕前保健服务、叶酸补充、生活方式、生活/职业环境中的危险因素共5个方面。结论本研究建立的妇女孕前生殖健康素养内容可作为后续编制妇女孕前生殖健康素养量表的基础。     

孕前父亲烟草暴露与6岁儿童智力水平的前瞻性队列研究

目的 评估孕前父亲烟草暴露对6岁儿童智力的影响,为指导优生优育服务提供循证依据。方法 本研究纳入2012年建立的上海闵行出生队列的530对母子,在孕妇建大卡时通过结构式问卷获得了孕前3个月父亲烟草暴露情况,在儿童6岁时利用第四版《儿童韦氏智力测试量表》中文版简版考察儿童智力水平。采用多因素线性回归模型分析孕前父亲烟草暴露对6岁儿童智力水平的影响。结果 调整协变量后,孕前父亲烟草暴露使儿童总智商下降2.83分(95%CI:-5.51～-0.16),其中孕前父亲吸烟的效应值(OR=3.15,95%CI:-6.32～0.03)略高于孕前父亲二手烟暴露(OR=2.62,95%CI:-5.54～0.30)。孕前父亲吸烟对儿童总智商和知觉推理的影响呈剂量反应关系(趋势检验P<0.05),父亲每天吸烟5支以上的儿童,总智商下降6.57分(95%CI:-10.88～-2.26),知觉推理下降5.83分(95%CI:-10.61～-1.05)。此外,儿童性别和胎龄与孕前父亲烟草暴露在对儿童智商的影响中表现出显著的交互作用(P<0.05),即父亲烟草暴露对女童、胎龄<39周的儿童的智力影响更强。结论 本研究发现孕前3个月父亲的烟草暴露与6岁儿童智力水平的下降有关,提示孕前健康指导应加强对备孕期间丈夫控烟的宣传,倡导夫妻双方共同承担起优生优育的责任。     

妇女既往孕次及产次对新生儿出生体重影响的队列研究

目的探讨妇女既往孕次及产次对新生儿出生体重的影响。方法基于东莞市免费婚前健康检查和孕前优生健康检查项目,获取受检对象检查结果,追踪随访获取其妊娠结局情况。采用无序多分类logistic回归探讨妇女既往孕次及产次与小于胎龄儿(SGA)、大于胎龄儿(LGA)、低体重出生儿(LBWI)及巨大儿发生率的关系。结果共有17 783名对象参与;调整相关混杂因素后,妇女既往孕次>1次是分娩LGA(RR=1.59,95%CI:1.36～1.85)和巨大儿(RR=1.87,95%CI:1.49～2.35)的危险因素,但可降低分娩SGA(RR=0.70,95%CI:0.60～0.81)和LBWI (RR=0.73,95%CI:0.60～0.89)的风险;妇女既往产次>1次增加分娩LGA(RR=1.74,95%CI:1.40～2.17)和巨大儿(RR=1.98,95%CI:1.45～2.71)的风险,但可降低分娩SGA(RR=0.70,95%CI:0.54～0.90)和LBWI(RR=0.63,95%CI:0.44～0.91)的风险。结论妇女既往孕次、产次对新生儿出生体重有影响,应做好产前保健和...     

孕期甲状腺激素敏感性与出生结局关系的队列研究

目的  研究孕期妇女甲状腺激素敏感性与出生结局的关系。方法  依托武汉市大型出生队列,以符合入选标准的5 411对孕妇-新生儿为研究对象。利用孕期体检的血清三碘甲状腺素(free triiodothyronine, FT3)、游离甲状腺素(free thyroxine, FT4)和甲状腺刺激激素(thyroid stimulating hormone, TSH),计算甲状腺激素中枢敏感性的指标：促甲状腺激素指数(thyroid stimulating hormone index, TSHI)、促甲状腺激素细胞-T4抵抗指数(thyrotroph thyroxine resistance index, TT4RI)和甲状腺反馈分位数指数(thyroid feedback quantile-based index, TFQI)。结局指标包括出生体重、出生孕周、出生体重Z评分,以及低出生体重、早产和小于胎龄儿(small for gestational age, SGA)。分别利用多元线性回归、logistic回归分析模型对甲状腺指标和出生结局中的连续型变量、分类变量进行回归分析,并控制可能混杂因素。结果  FT4、TSHI、TFQI与出生体重和出生体重Z评分呈负相关(均P≤0.01);甲状腺激素敏感性指标TSHI、TT4RI、TFQI与SGA存在统计学意义的正相关(TSHI: OR=1.52, 95% CI: 1.12~2.06, P＜0.01; TT4RI: OR=1.15, 95% CI: 1.03~1.29, P=0.02; TFQI: OR=1.41, 95% CI: 1.10~1.81, P＜0.01);甲状腺功能和甲状腺激素敏感性与低出生体重、早产的差异均无统计学意义。将妊娠合并甲状腺功能减退(甲减)人群排除后进行敏感性分析,研究结果一致。结论  孕期妇女甲状腺激素敏感性受损是不良出生结局SGA的独立风险因素。     

孕前保健对孕妇健康与妊娠结局的影响

目的 研究规范的孕前保健对孕妇健康状况及妊娠结局的影响.方法 按照随机化的原则,选择2012年10月-2014年4月期间在我院孕前门诊采取规范孕前保健的妇女和意外受孕的妇女各120例分别作为观察组和对照组.随访观察两组孕妇的妊娠结局.结果 与对照组相比,观察组孕妇职业稳定性较好,文化程度较高,妊娠并发症如妊娠高血压、妊娠糖尿病及先兆子痫发生率低,两组比较差异有统计学意义（P＜0.05）.此外,早产或过期妊娠及新生儿窒息发生率在两组之间存在显著性差异,观察组显著低于对照组（P＜0.05）,剖腹产率及产后出血量在两组之间差异不明显（P＞0.05）.结论 有效规范的孕前保健对降低妊娠并发症、促进孕妇健康具有重要的意义,并且能有效改善妊娠结局.     

Feasibility of recruiting a birth cohort through the Internet: the experience of the NINFEA cohort

The NINFEA cohort is an Italian birth cohort aiming at recruiting pregnant women through the Internet and following-up their children. To understand whether Internet-based recruitment was feasible we started a pilot in July 2005 targeted to pregnant women visiting the hospitals of the city of Turin (900,000 inhabitants), where we advertised the study. For this purpose we constructed a website (www.progettoninfea.it), with on-line questionnaires to be completed during pregnancy and at 6 and 18 months after delivery. Participants’ characteristics were compared with those of women giving birth in Turin, which are routinely released as individual anonymous records. We also compared complete with partial respondents. We also carried out a survey of 122 women giving birth in the main Turin obstetric hospital to estimate the proportion of pregnant women with access to the Internet and awareness of the NINFEA cohort. By December 2006, we had recruited 670 women. Participation was associated with being older, a university graduate, primiparous and born in Italy. Complete response (n = 633) was associated with being primiparous and participation after the first trimester. In the survey, 66% (95% confidence interval: 56–74%; n = 80) of the women had access to the Internet and 42% (33–51%; n = 51) were aware of the study; 6.5% (2.9–12.5%; n = 8) had participated in the NINFEA cohort. Our study indicates that recruitment of an Internet-based birth cohort is feasible. As with many other types of birth cohort study, the participants are a self-selected sample. To minimise selection bias analyses should therefore be limited to internal comparisons.     

Maternal and cord blood manganese (Mn) levels and birth weight: The MIREC birth cohort study

Epidemiological studies have hypothesized that both insufficient and excess blood manganese (Mn) levels during pregnancy are associated with reduced fetal growth. This literature is characterized by inconsistent results and a limited focus on women with exposures representative of the general North American population. We examined the relationship between maternal and cord blood Mn levels and fetal growth among women enrolled in the Maternal-Infant Research on Environmental Chemicals Study (MIREC). Mothers with singleton, term infants and complete maternal first and third trimester blood Mn data were eligible for inclusion in the present study (n?=?1519). Mean birth weight and odds ratios of small for gestational age (SGA) births according to maternal and cord blood Mn levels (low (<10), referent (10–<90), high (≥90) percentiles) were estimated. We also evaluated the association between the ratio of cord and maternal blood Mn and birth weight. Women with low (<0.82?μg/dL) maternal blood third trimester Mn levels had infants that weighed an average of 64.7?g (95% CI: ?142.3,12.8) less than infants born to women in the referent exposure group. This association was strengthened and became statistically significant when adjusted for toxic metals (lead, mercury, arsenic, and cadmium) [?83.3?g (95% CI: ?162.4, ?4.1)]. No statistically significant associations were observed in models of maternal first trimester or cord blood Mn. A one unit increase in the cord/maternal blood Mn ratio was associated with a 29.4?g (95% CI: ?50.2, ?8.7), when adjusted for maternal and neonatal characteristics. Our findings motivate additional research regarding the relation between Mn exposure and fetal growth. Further inquiry is necessary to determine whether an exposure threshold exists, how growth related effects of maternal and fetal Mn may differ, and how concurrent exposure to other toxic metals may impact the association between Mn and growth.     

妇女生殖生育状况的出生队列分析

目的:了解不同出生队列妇女生殖生育状况的变化趋势。方法:采用多阶段分层整群抽样的方法,由经过统一培训的调查员对泸州地区年龄在30~70岁的妇女进行问卷调查。结果:随着出生年代渐晚,妇女月经初潮年龄提前,绝经年龄在全部绝经队列中无明显变化,平均初产年龄延迟,平均怀孕及分娩次数减少,流产及剖宫产次数增多,平均哺乳时间缩短,选择避孕套和避孕药的比例增加。结论:该研究为指导有关部门开展妇女保健工作,促进妇女养成良好的行为、生活方式提供了客观依据;应进一步开展多次的横断面调查探讨近年妇女的绝经年龄是否有提前趋势。     

Marital dissolution and self-rated health: age trajectories and birth cohort variations

A life course perspective is used to explore the effects of divorce and widowhood on self-rated health across age and birth cohorts. Growth curve analysis of a fifteen-year longitudinal survey--Americans' Changing Lives (ACL), conducted by the Institute for Social Research in the United States between 1986 and 2001 (House, 2002) suggests that although the continuously divorced and widowed exhibit similar health trajectories as the continuously married across age and birth cohorts, there are significant age and birth cohort differences in the effects of transitions to divorce and widowhood on self-rated health. Specifically, the health penalty of the transition to divorce is more apparent for the 1950s than the 1940s birth cohort; and it is stronger at younger than older adulthood especially in the more recent birth cohort. The health penalty of the transition to widowhood is more apparent for the 1910s than the 1920s birth cohort; and it is stronger at older than younger adulthood especially for the earlier birth cohort. These results reflect birth cohort differences in the process of aging and/or in the experience of marital dissolution.     

出生队列效应对体质指数遗传度的影响

目的 探索不同出生队列BMI遗传度的变化情况。方法 基于中国双生子登记系统丽水和青岛两个时点的双生子,按照出生年份分为1958年及以前出生、1959-1961年出生、1962-1970年出生和1971年及以后出生的4个出生队列,在各个时点分别拟合结构方程,计算不同出生队列在不同年龄的遗传度。结果 每个出生队列中,2012年时的体重、BMI高于2001年;出生于1971年及以后的双生子无论体重和BMI均低于其余出生队列。遗传因素能解释BMI的表型变异为54%~76%;出生于1959-1961年的双生子,BMI的遗传度随年龄上升,其余出生队列遗传度较为稳定。结论 BMI受遗传因素影响较大,出生于1959-1961年的双生子,随着年龄增长,遗传因素对BMI的影响增加。     

孕前保健与出生缺陷一级预防策略

了解妇女再生育孕前保健服务利用意愿的影响因素,为促进再生育意向人群的孕前保健服务利用意愿提供建议。

于2020年11月—2021年2月对上海市嘉定区8家孕产保健机构就诊的有再生育意向的妇女进行电子问卷调查。

再生育孕前保健服务利用意愿与既往优生行为有关联,既往优生行为得分较高的妇女相对于得分较低者,其将来有再生育计划时利用孕前保健服务的意愿更强（OR=1.980,95%CI为1.061~3.694,P=0.032）;既往优生行为与孕前优生知识有关联,孕前优生知识得分较高的妇女相对于知识得分较低者,其优生行为得分更高（OR=1.362,95%CI为1.004~1.846,P=0.047）。

为提高再生育意向人群的孕前保健意愿,需进一步加强健康教育和社会动员,提高人群孕前优生知识水平,提高计划妊娠率和优生行为。

     

The effects of preconception interventions on improving reproductive health and pregnancy outcomes in primary care: A systematic review

Background: Reproductive health and pregnancy outcomes may be improved if the reproductive risk assessment is moved from the antenatal to the preconception period. Primary care has been highlighted as an ideal setting to offer preconception assessment, yet the effectiveness in this setting is still unclear.

Objectives: To evaluate the effectiveness of preconception interventions on improving reproductive health and pregnancy outcomes in primary care.

Methods: MEDLINE, CINAHL, EMBASE and PsycINFO databases were searched from July 1999 to the end of July 2015. Only interventional studies with a comparator were included, analysed and appraised systematically, taking into consideration the similarities and differences of the participants, the nature of interventions and settings.

Results: Eight randomized controlled trials were eligible. Preconception interventions involved multifactorial or single reproductive health risk assessment, education and counselling and the intensity ranged from brief, involving a single session within a day to intensive, involving more than one session over several weeks. Five studies recruited women planning a pregnancy. Four studies involved multifactorial risks interventions; two were brief and the others were intensive. Four studies involved single risk intervention, addressing folate or alcohol. There was some evidence that both multifactorial and single risk interventions improved maternal knowledge; self-efficacy and health locus of control; and risk behaviour, irrespective of whether brief or intensive. There was no evidence to support reduced adverse pregnancy outcomes. One study reported no undue anxiety. The quality of the studies was moderate to poor.

Conclusion: The evidence from eligible studies is limited to inform future practice in primary care. Nevertheless, this review has highlighted that women who received preconception education and counselling were more likely to have improved knowledge, self-efficacy and health locus of control and risk behaviour. More studies are needed to evaluate the effects on adverse pregnancy outcomes.     

Indicators of fetal growth and infectious disease in childhood--a birth cohort with hospitalization as outcome

We evaluated the association between indicators of fetal growth and hospitalization with infectious disease during childhood in a cohort of 10,400 newborns. The cohort was based on children born to mothers who at about 36 weeks of gestation attended the midwife centres in Odense and Aalborg, Denmark for a routine examination. Women were recruited to the study from April 1984 to April 1987. After linkage with the National Hospital Registry, the first hospitalization with infectious disease from 6 months up to 12 years of age was identified. The cumulative incidence of hospitalization with infectious disease during follow-up was 18.9%. Preterm birth was associated with an increased risk of being hospitalized with infections during childhood (incidence rate ratio: 1.67,95% CI: 1.33–2.10); low birth weight had a similar association, but only in preterm birth. Reduced birth length related to the head was correlated with an increased risk of hospitalization with infections. The effect of gestational age was mainly seen in the period close to the time of birth, but the children who were short at birth appeared to remain at increased risk throughout the age interval under analysis. In conclusion, the study suggests that preterm birth was the main factor underlying the association between low birth weight and the increased risk of hospitalization with infectious disease during childhood. However, it could not explain the increased risk in children who were short at birth.