Folate supplementation and twin pregnancies

BACKGROUND: Women in many countries are advised to increase their folate intake to lower the risk of neural tube defects. For this purpose several countries add folate to the flour. Therefore, it is important to monitor possible adverse effects of this B vitamin. We have assessed the effect of folate on twin pregnancies. METHODS: We conducted a retrospective, population-register based study of 176,042 women who gave birth from December 1998 through the end of 2001. Use of folate and multivitamin supplements was recorded on the mandatory birth notification form of the Medical Birth Registry of Norway. Pregnancies after in vitro fertilization (IVF) were reported separately. RESULTS: With adjustment for maternal age and parity, we observed an increased risk of twin pregnancies associated with preconceptional use of folate (odds ratio = 1.59; 95% confidence interval = 1.41-1.78). This association was largely explained by confounding with IVF pregnancies, which were strongly associated both with twin pregnancies and folate use. After exclusion of known IVF pregnancies, and accounting for underreporting of both IVF pregnancies and folate use, the risk was no longer elevated (1.02; 0.85-1.24). Weak associations with twin pregnancies were observed for use of multivitamins and folate during pregnancy, but could be due to increased use of vitamins after a recognized twin pregnancy. CONCLUSIONS: The association between preconceptional folate use and twin pregnancies was strongly confounded by IVF. After accounting for IVF pregnancies and underreporting, we found no evidence for an association between preconceptional folate supplements and twinning.     

双胎输血综合征与发育不同一性双胎妊娠的妊娠结局对比分析

目的分析比较双胎输血综合征与发育不同一性双胎妊娠的妊娠结局。方法收集1999年1月至2009年8月中山三院分娩的23例双胎输血综合征(A组)和43例发育不同一性双胎妊娠(B组)的临床资料,对比分析2组在一般情况、发生孕周、妊娠并发症、合并症、分娩情况和围产儿预后方面的差异。结果 A组平均发生孕周为25+4周,较B组平均发生孕周31+3周要早,A组分娩孕周平均为29+5周,B组分娩孕周平均为35+3周,2组差异有统计学意义(P<0.05)。A组晚期流产、羊水过多、双胎之一胎死宫内和胎盘早剥的发生率分别为26.1%、47.8%、21.7%和13%,B组为13.9%、20.9%、9.3%和2.3%,2组差异有统计学意义(P<0.05)。A组围产儿死亡率45.7%,新生儿窒息率69.6%;B组围产儿死亡率为30.2%,新生儿窒息率40.7%,2组差异有统计学意义(P<0.05)。A组新生儿平均出生体质量(1732±673)g,B组平均出生体质量为(2321±568)g,2组差异有统计学意义(P<0.05)。结论双胎输血综合征和发育不同一性双胎妊娠都是双胎妊娠特有的并发症,临床表现均以胎儿发育不一致为特征,然而2者在发病机制与妊娠结局上仍有不同,临床上应予重视并鉴别,及时处理,改善围产儿预后。     

IVF-ET受孕双胎与自然受孕双胎的妊娠结局比较

目的:了解体外受精-胚胎移植(IVF-ET)受孕双胎的产科并发症和围生儿发病风险。方法:回顾性分析南方医院1998年1月～2005年5月43例IVF-ET受孕双胎和75例自然受孕双胎的产科并发症和围生儿结局。结果:IVF-ET受孕双胎组的母亲年龄为(30.81±4.36)岁,自然受孕双胎组母亲年龄为(27.26±3.40)岁,两组之间有显著性差异(P<0.001);IVF-ET受孕双胎组孕34～37周间早产率显著高于自然受孕组(46.51%vs20.00%,P<0.01),OR值为3.478,OR值95%的可信区间为1.52～7.93;IVF-ET受孕双胎组剖宫产率显著高于自然受孕双胎组(88.23%vs67.86%,P<0.05),OR值为2.247,OR值95%的可信区间为1.017～4.965;IVF-ET受孕双胎组单卵双胎的发生率显著低于自然受孕组(4.60%vs22.66%);两组其他产前、产时并发症和围生儿并发症无统计学差异。结论:IVF-ET受孕双胎组母亲年龄较大,早产发生率较高,单卵双胎比例较低,分娩方式以剖宫产为主,其他产科并发症与围生儿并发症与自然受孕双胎组相似。     

双胎妊娠的并发症及妊娠结局

目的 探讨双胎妊娠的并发症和妊娠结局情况。 方法 根据围生保健册资料,回顾分析128例双胎妊娠新生儿体重及围生儿死亡率与单胎妊娠的差异。 结果 双胎妊娠的妊娠高血压综合征(妊高征)、贫血、胎膜早破和早产的发生率显著高于单胎妊娠,妊娠时间及新生儿体重均显著短于和低于单胎妊娠。足月双胎新生儿出生体重低于足月单胎妊娠300-500 g。 结论 双胎妊娠的并发症、重度妊高征、贫血、早产及围生儿死亡率显著高于单胎妊娠。双胎妊娠的产前监护及并发症的积极预防和治疗对于改善双胎妊娠的预后和降低双胎妊娠的围生儿死亡率有重要意义。     

1995年苏州地区双胎妊娠结局分析

【目的】分析出生指标。评价双胎妊娠结局。【方法】采用1995年苏州地区围产保健监测资料，比较单、双胎孕周、出生体重、Apgar评分、新生儿死亡率及死亡原因。【结果】双胎妊娠中早产儿占35．0％；低出生体重儿占49．2％；1min和5min Apgar评分窒息者分别占13．9%和5．6％；各指标均显著高于单胎。双胎新生儿死亡率为45．9‰；早期新生儿死亡率42．8‰；新生儿主要死亡原因为早产。【结论】与单胎儿相比，双胎妊娠胎儿宫内发育时间、发育状况、产后适应能力等均明显偏差，新生儿死亡率显著偏高。应采用多种干预措施，改善双胎妊娠不良结局。     

Selective termination of the development of the defective fetus in discordant twin pregnancies

Selective termination of the affected fetus in twin pregnancies was performed in the second trimester of seven pregnancies. The malformations included anencephaly/exencephaly (2 cases), hydrocephalus (1 case), thoracoabdominopagus of "B" and "C" cotwins (1 case), urethral obstruction sequence (1 case) and hygroma colli (2 cases). Intrauterine intervention on the affected fetus was done by transabdominal intracardial injection of 20% NaCl solution in the 15--24 weeks of gestation. All cases had dichorionic placentation. Unaffected co-twin infants were delivered at term with normal weight in 4 cases. In 2 cases the affected fetus was found in the lower gestational sac and both pregnancies, as well as the triplet pregnancy were lost 1--6 weeks and 3 weeks after the intervention, respectively. In the other cases, neither the mother, nor the survived fetus showed any complications. We believe that using hypertonic saline is lethal for the affected fetus but carries little or no risk either the other fetus or the mother, even if small amounts of the solution might inadvertently enter their circulation.     

Fetal sex pairing and adverse perinatal outcomes in twin gestations

PurposeTo assess the association between fetal sex pairing in twin pregnancies and adverse perinatal and infant outcomes.MethodsA retrospective cohort study of 9770 infants from 4885 twin pregnancies delivered in 2007 was conducted with a statewide hospital discharge database for Texas. Log-binomial regression models based on generalized estimating equations were used to calculate relative risks (RR) and 95% confidence intervals (95% CI) for the following dichotomous outcomes: breech presentation, hospital mortality, intrauterine growth restriction (IUGR), low birth weight, prolonged length of stay (>4 days), receipt of mechanical ventilation, and respiratory distress syndrome (RDS).ResultsThe sample was composed of 4918 females and 4852 males. An approximately equal number of infants were from a female–female pregnancy (n = 3270), mixed-sex pregnancy (n = 3296), and a male–male pregnancy (n = 3204). Twins of either sex from mixed-sex pairs were 45% less likely to die in the hospital compared with females from a female–female pregnancy (RR, 0.55, 95% CI, 0.31–0.98). Males from a male–male pair were 33% less likely than females from female–female pairs to experience IUGR (RR, 0.67; 95% CI, 0.53–0.83). The incidence of RDS was significantly increased in males from male–male twin pairs versus females from female–female pairs (RR, 1.21; 95% CI, 1.05–1.41).ConclusionsMale infants from male–male twin pairs were more likely to develop RDS and be placed on a ventilator but less likely to experience IUGR than female infants from female–female pairs.     

不同绒毛膜性质双胎妊娠母婴结局分析

目的 探讨不同绒毛膜性双胎妊娠围产期母儿结局。方法 选取2019年1月至2020年12月在北京市海淀区妇幼保健院产科产检和分娩的双胎妊娠254例孕妇为研究对象。按照胎盘绒毛膜性的不同分为两组,单绒毛膜双羊膜囊双胎组(monochrionic diamniotic twin, MCDA)62例和双绒毛膜双羊膜囊双胎组(dichorionic diamniotic twin, DCDA)192例,比较两组孕产妇围产期并发症及围产儿结局。结果 (1) MCDA组自然受孕率90.3%明显高于DCDA组46.4%,差异有统计学意义(P<0.01)。(2)不同绒毛膜性的双胎妊娠围产期合并症、并发症均无统计学意义,仅MCDA组早产发生率稍高于DCDA组(P=0.07)。MCDA组新生儿畸形发生率明显高于DCDA组(9.7%vs 2.6%),差异有统计学意义(P<0.05)。结论 孕早期需要及时判定双胎的绒毛膜性,除了在孕18～24周行超声双胎结构筛查,孕期应增加超声监测频次,评估胎儿宫内安危,适当干预,减少母婴不良围产结局。     

Importance of twin research in preventive medicine and future perspective

The importance of twin research in the field of preventive medicine is described from the viewpoint of gene-environment interaction. The recent advancements in twin research in Japan and other countries are the major topics in this paper. The historical background of the Japan Society for Twin Studies is described. The Center for Twin Research of Osaka University is also described as the first center of this kind in Japan. The advancement of epigenetic research is described as a new global trend of twin research, particularly in European countries. Other new trends in twin research in Asian countries, such as China, Indonesia, Russia, Iran, and Malaysia, are also described.     

Fetal programming of cardiovascular function through exposure to maternal undernutrition

A substantial and robust body of epidemiological evidence indicates that prenatal dietary experience may be a factor determining cardiovascular disease risk. Retrospective cohort studies indicate that low birth weight and disproportion at birth are powerful predictors of later disease risk. This prenatal influence on non-communicable disease in later life has been termed programming. Maternal nutritional status has been proposed to be the major programming influence on the developing fetus. The evidence from epidemiological studies of nutrition, fetal development and birth outcome is, however, often weak and inconclusive. The validity of the nutritional programming concept is highly dependent on experimental studies in animals. The feeding of low-protein diets in rat pregnancy results in perturbations in fetal growth and dimensions at birth. The offspring of rats fed low-protein diets exhibit a number of metabolic and physiological disturbances, and are consistently found to have high blood pressure from early postnatal life. This experimental model has been used to explore potential mechanisms of programming through which maternal diet may programme the cardiovascular function of the fetus. Indications from this work are that fetal exposure to maternally-derived glucocorticoids plays a key role in the programming mechanism. Secondary to this activity, the fetal hypothalamic-pituitary-adrenal axis may stimulate renin-angiotensin system activity, resulting in increased vascular resistance and hypertension.     

体外受精-胚胎移植术后双胎妊娠之一发育停止后存留胎儿的妊娠结局

目的探讨体外受精～胚胎移植术（IVF-ET）后宫内双胎妊娠之一发育停止后存留胎儿的妊娠结局。方法对2004年1月—之012年6月在本科室行IVF-ET、单精子卵胞浆内注射术（ICSI）后获得妊娠的临床资料进行回顾性分析,比较IVF-ET、ICSI术后双胎妊娠存留胎儿（另一胎儿在孕早期,≤12周或孕中晚期,〉12周发育停止）与同期IVF-ET术后单胎妊娠的妊娠结局。结果宫内双胎妊娠之一〉12周发育停止组分娩孕周和新生儿出生体重[（36．3±1．8）周、（2656．3±664．6）g],双胎妊娠组分娩孕周、新生儿体重、早产和低体重儿发生率[（35．1±2．4）周、（2515．8±493．6）g、50．9％、28．2％],双胎妊娠之一〉12周发育停止组早产、低体重儿发生率和新生儿死亡率（30．9％、21．8％、3．6％）,与单胎妊娠组比较,差异有统计学意义。结论IVF-ET后双胎妊娠之一在孕中晚期（〉12周）发育停止后存留胎儿的妊娠结局较单胎妊娠差。     

Adolescent pregnancy: The perspective of the sisterhood of black single mothers

The Sisterhood of Black Single Mothers Inc. (The Sisterhood) is an organization which exemplifies the considerable potential of community members united for a common good. The Sisterhood began eleven years ago under the leadership of Ms. Daphne Busby. The objective of the Sisterhood is salvation of a generation subject to insensitivity and misunderstanding—through helping families, especially those headed by women and adolescent women—to establish a new and positive mind set.The Sisterhood regards individuals and social phenomenon as parts of a complex and dynamic whole and uses a positive approach to assessment of situations. Therefore, adolescents who come to the Sisterhood already parents, as well as those who may become parents in their formative years, are provided programming appropriate to their overall needs. They are given opportunities for help in such areas as: securing medical care, public assistance, counseling, housing and financial assistance. Outreach to other significant persons in the life of these adolescents includes intervention with the service providers with whom they come in contact (doctors, teachers, social workers etc.).In addition to addressing the practical needs of adolescents who come to the Sisterhood, positive examples of healthy ways of relating to others and presentation of a system of values consonant with self and family development are provided.Examples are: (1) the Youth Awareness Project (YAP) which deals with concerns of young people as a specific group. The program's focus is bringing young people together who are growing in positive ways and encouraging continuation of that growth; (2) the Fatherhood Collective, a fathers' support group initiated at the request of a group of males whose focus is raising consciousness among male and female teens around family issues and personal development; (3) the Big Apple Project (Brooklynites Involved in Getting Adolescent Parents Positive Living Environments), which focuses on helping teen mothers and their families to stay together, and when not possible, helping them to secure healthy alternatives; and (4) KIANGA HOUSE, a long-term residence which permits young mothers with one child to live in apartment-like suites while receiving intensive training in self-sufficiency skills, personal awareness/development, child development, home management and other skills essential to productive, mature functioning.Khadijah Matin is Special Project Coordinator for The Sisterhood of Black Single Mothers, Inc.     

A conceptual framework for context-sensitive prevention programming: A symbolic interactionist perspective

The rate of future progress in the field of prevention is dependent, in part, on the adoption of an overarching conceptual framework which will provide a sound theoretical basis for the development of multilevel, context-sensitive prevention programming. Two broad approaches to the study of culture (cultural adaptationism and symbolic interactionism) are examined and compared regarding their ability to provide such a framework. It is argued that symbolic interactionism provides a resolution to three issues which have proven problematic for cultural adaptationism: the issues of locus, scope, and cultural integrity. The advantages of symbolic interactionism for prevention programming include an emphasis on targeting both the individual and the multiple contexts in which the individual is embedded, a distinction between the contexts of poverty and ethnic heritage, and a focus on understanding, accommodating to, and explicitly teaching the interactional norms, strategies, and styles appropriate to different sociocultural contexts.     

双胎早孕期轻度贫血对妊娠结局的影响

目的探讨早孕期轻度缺铁性贫血对双胎妊娠母儿结局的影响。方法对2016～2017年上海国际和平妇幼保健院分娩的双胎妊娠孕妇临床资料进行回顾性研究,比较孕早期轻度贫血(90 g/L≤血红蛋白110 g/L)与非贫血(血红蛋白≥110 g/L)孕妇的母儿结局。结果共纳入704例双胎孕妇,其中203例(28.8%)早孕期出现轻度贫血。早孕期轻度贫血双胎孕妇妊娠期糖尿病发生率(15/203,7.4%)低于非贫血组(68/501,13.6%)(P0.05);两组其他妊娠期并发症、分娩情况和围产儿结局比较,差异无统计学意义(P0.05)。结论早孕期轻度缺铁性贫血的双胎孕妇妊娠期糖尿病发生率下降,同时并未增加围产儿不良结局风险。因此,双胎妊娠早孕期轻度缺铁性贫血可能为妊娠期糖尿病的保护因素,无须对所有双胎孕妇尤其是非贫血孕妇进行常规补充铁剂治疗。     

Fetal programming of dietary fructose and saturated fat on hepatic quercetin glucuronidation in rats

ObjectivePhase II biotransformation of flavonoids generates bioactive metabolites in vivo. However, data on the effect of environmental and physiologic factors and fetal programming on phase II pathways toward flavonoids are limited. We examined the effect of parental exposure to a diet high in saturated fats and fructose 1 mo before conception through lactation on in vitro hepatic uridine 5′-diphosphate (UDP)-glucuronosyltransferase (UGT) activity toward quercetin in parent and offspring rats and the interaction between diet and sex.MethodsParents were fed a diet containing 9.9% coconut fat, 0.5% cholesterol, 30% fructose, and 30% glucose (SFF) or a control (C) diet containing 11% corn oil and 60% glucose. After weaning, offspring were fed the C diet for an additional 12 wk. The glucuronidation rate of microsomal UGT was determined with quercetin 30 μmol/L and 12.5 μg of protein in a total volume of 100 μL after a 15-min incubation at 37°C. Three quercetin glucuronides (7-O-quercetin glucuronide, 4′-O-quercetin glucuronide, and 3′-O-quercetin glucuronide) were quantified.ResultsIn the parent females, the SFF diet decreased by 29% and 19% the production rate of 3′- and 4′-O-quercetin glucuronide quercetin glucuronides, respectively, compared with the C diet (P ≤ 0.05). The production rate of 7-O-quercetin glucuronide quercetin glucuronide in the female offspring rats born to C dams was 59% larger than in their male counterparts (P < 0.05), but no difference was observed in the offspring of SFF dams.ConclusionHigh dietary fructose and saturated fat decreased UGT capacity toward quercetin in female rats and in utero exposure to the diet decreased the glucuronidation capacity of their pups.