孕前体重指数对多囊卵巢综合征患者妊娠结局的影响

目的比较不同体重指数对多囊卵巢综合征（polycystic ovarian syndrome,PCOS）患者妊娠结局和新生儿结局的影响。方法回顾性分析2011年1月至2013年12月于首都医科大学附属北京妇产医院产科就诊的PCOS孕妇328例,按照孕前体重指数（body mass index,BMI）分为体重正常组（BMI 18．5～24．9kg／m^2）和超重及肥胖组（BMI≥25．0kg／m^2）,比较两组PCOS孕妇妊娠结局及新生儿结局等情况。结果超重及肥胖组的既往流产率和辅助生殖技术助孕妊娠比例、妊娠期糖尿病、妊娠期高血压疾病和胎盘早剥的发生率显著高于正常体重组（P〈0．05）;两组问胎膜旱破、胎儿生长受限、前置胎盘和产后出血等并发症无统计学差异（P〉0．05）;在分娩方式上,超重及肥胖PCOS孕妇与对照组相比顺产率低而剖宫产率高,早产和巨大儿的发生率也显著增加,差异具有统计学意义（P〈0．05）。结论孕前超重及肥胖的PCOS患者发生妊娠期并发症的风险增高,新生儿容易出现不良结局,对这类患者应加强健康管理,孕前即注意体重的控制以改善母婴结局。     

145例肥胖妇女妊娠结局分析

目的探讨肥胖对妊娠结局的影响。方法选择本院住院孕检分娩资料齐全的肥胖孕妇145例及同期间正常体重妊娠145例对比分析两组妊娠期糖尿病、妊高症、胎膜早破、剖宫产术、产后出血、产褥感染、早产儿、巨大儿、小于胎龄儿、新生儿窒息、新生儿低血糖的发生率。结果肥胖妇女上述并发症的发生率均高于正常体重妇女。结论肥胖对孕妇及胎儿会产生不良影响,对肥胖妇女应加强围产监护,减少肥胖妇女孕、产期并发症及新生儿并发症。     

孕妇体重状况与妊娠并发症及分娩结局的关系

目的探讨孕妇孕前体重指数（BMI）、孕期BMI增幅与妊娠期高血压疾病子痫前期、妊娠期糖尿病及分娩结局的关系。方法将870例单胎孕妇按孕前BMI分为正常组（18．5≤BMI（23）、超重组（23≤BMI〈25）和肥胖组（BMI〉125）三组。再根据整个孕期BMI的增幅，分为Ⅰ组（BMI的增幅〈4）、Ⅱ组（4≤BMI的增幅≤6）和Ⅲ组（BMI的增幅〉6），并分别对妊娠期高血压疾病子痫前期、妊娠期糖尿病及分娩结局的关系作前瞻性分析。结果肥胖组、超重组孕产妇的妊娠期高血压疾病子痫前期、妊娠期糖尿病；巨大儿、胎儿窘迫、难产发生率明显高于正常组，具有统计学意义（P〈0．01）；Ⅱ组、Ⅲ组孕产妇的妊娠期高血压疾病子痫前期、妊娠期糖尿病；巨大儿、胎儿窘迫、难产发生率明显高于正常组，具有统计学意义（P〈0．01）。产后出血的发生与孕前BMI及孕期BMI增幅无明显关系。结论孕前BMI及孕期BMI增幅与妊娠期高血压疾病子痫前期、妊娠期糖尿病；巨大儿、胎儿窘迫、难产发生率之间有密切关系，控制孕前体重及孕期体重的增加可减少妊娠期高血压疾病子痫前期、妊娠期糖尿病；巨大儿、胎儿窘迫、难产的发生。     

单纯性肥胖妇女妊娠与妊娠结局的临床研究

目的 探讨单纯性肥胖妇女妊娠与妊娠结局的关系.方法 将2010年1月～2010年12月在开平市中心医院分娩的单胎足月产妇资料,根据孕妇孕前体重指数(BMI)分为3组,随机选择孕前BMI≥30(Ⅱ度肥胖)组40例,孕前在25≤BMI＜30之间(Ⅰ度肥胖)组随机选择100例,孕前BMI在18.5～25之间(对照)组随机选择140例,比较各组孕妇在妊娠并发症及剖宫产率的差异.结果 Ⅱ度肥胖、Ⅰ度肥胖孕妇妊娠期高血压疾病、GDM、巨大胎儿的发生率、剖宫产率及腹部伤口延期愈合的发生率明显高于对照组,而且三组的发生率差异有统计学意义(P<0.05).结论 孕前体重指数越高,发生妊娠并发症及剖宫产率的危险性越高;对单纯性肥胖妇女适当地控制孕前体重及孕期体重增加,加强产前检查,可减少不良妊娠结局的发生.     

孕期合理增长体重的研究

目的 探讨正常妊娠孕期体重增长对母儿健康的影响,指导合理控制体重增长范围,加强孕产期保健.方法 筛选孕期体重指数(BMI)正常的孕妇,选取孕期体重增长≥20kg的孕产妇47例作为观察组,孕期体重增长在10～15kg的孕产妇40例作为对照组,分析两组对产程及分娩结局、新生儿并发症的情况.结果 孕前体重指数正常,但孕期体重增长≥20kg的孕产妇的产程时间、剖宫产、阴道助产、产后出血、新生儿窒息、新生儿黄疸、巨大儿的发生率与对照组比较差异有显著性(P＜0.01,P＜0.05).结论 孕前体重指数正常,但孕期体重增长≥20kg的孕妇对母儿健康均产生不利的影响,合理控制孕期体重增长范围,减少手术生产率和新生儿并发症.     

孕期合理增长体重的研究

目的探讨正常妊娠孕期体重增长对母儿健康的影响,指导合理控制体重增长范围,加强孕产期保健。方法筛选孕期体重指数（BMI）正常的孕妇,选取孕期体重增长≥20kg的孕产妇47例作为观察组,孕期体重增长在10～15kg的孕产妇40例作为对照组,分析两组对产程及分娩结局、新生儿并发症的情况。结果孕前体重指数正常,但孕期体重增长≥20kg的孕产妇的产程时间、剖宫产、阴道助产、产后出血、新生儿窒息、新生儿黄疸、巨大儿的发生率与对照组比较差异有显著性（P〈0.01,P〈0.05）。结论孕前体重指数正常,但孕期体重增长≥20kg的孕妇对母儿健康均产生不利的影响,合理控制孕期体重增长范围,减少手术生产率和新生儿并发症。     

妊娠期糖尿病身体质量指数与妊娠结局关系探讨

目的 探讨妊娠期糖尿病身体质量指数与妊娠结局的关系.方法 :对200例孕妇进行体重指数计算,糖筛查试验,空腹血糖测定,引产方式统计.结果 :孕妇体重增加,肥胖妇女和孕期体重增加与血糖值,与巨大儿、难产及子痫前期-子痫成明显正相关(P<0.05).结论 :肥胖是导致血糖增加和发生子痫前期-子痫的因素,肥胖孕妇体重增加10.0～15.0对于妊娠结局和分娩正常体重新生儿最为适宜.     

影响新生儿体重的相关因素研究

目的了解影响新生儿体重的相关因素。方法定时纵向测量413例新生儿体重,并对母亲妊娠前体质指数（BM I）、母亲妊娠期增加BMI、母亲文化程度、母亲年龄与新生儿体重之间的关系进行了分析。结果（1）母亲妊娠前BMI、母亲妊娠期增加BMI与各时段新生儿体重均呈正相关（P〈0.05）;（2）除外12~14d这一时段,在其他时段,母亲不同文化程度组,新生儿体重差异均有统计学意义（P〈0.05）;（3）母亲不同年龄组间,新生儿体重差异无统计学意义（P〉0.05）。结论新生儿体重随母亲妊娠前BMI、妊娠期增加BMI的增大而增大;母亲文化程度程度不但影响新生儿出生体重,而且影响新生儿期体重累积增长值。母亲分娩年龄对新生儿体重影响不大。     

孕前体质量指数和妊娠期体质量增长对新生儿出生体质量及不良结局的研究

目的 探讨孕前体质量指数及妊娠期体质量增长对新生儿出生体质量及不良结局的影响。方法 选取溧水区人民医院1510例孕母及婴儿作为研究对象。采用多重线性回归分析孕前体质量指数及妊娠期体质量增长与新生儿出生体质量的关联关系，采用多因素Logistic回归分析探讨孕前体质量指数及妊娠期体质量增长与新生儿出生不良结果发生风险的关联关系。结果 孕前低体质量、超重、肥胖女性的发生率8.87%、18.08%、8.68%；随着孕前体质量指数的增加，新生儿出生体质量呈增加趋势；超重及肥胖女性，发生巨大儿及大于胎龄儿的风险增加；整体上，妊娠期体质量增长不足时新生儿出生体质量低，体质量增长过多时新生儿出生体质量高、发生巨大儿及大于胎龄儿的风险增加；不同的孕前体质量指数，当妊娠期体质量增长不同时，新生儿的出生体质量及不良结局亦不同。结论 孕前超重及肥胖增加了新生儿发生巨大儿及大于胎龄儿不良结局的风险，不同孕前体质量指数因妊娠期体质量增长不同、新生儿的出生体质量及不良结局不同。根据孕前体质量指数制定个体化的营养方案，有助于减少新生儿不良结局的可能性。     

孕前体重指数、孕期体重增加与新生儿窒息发生率的关系

目的：探讨孕前体重指数、孕期体重增加量与新生儿窒息发生率的关系。方法：对2012年1月至2014年1月在我院参加孕前检查且分娩单胎活产儿的1522例孕产妇,其中新生儿窒息182例(11.96%),按孕前体重指数分为偏瘦组(BMI<18.5)、正常组(18.5≤BMI<24.0)、超重组(24.0≤BMI<28.0)、肥胖组(BMI≥28),按孕期体重增加分为<0.3 kg/周组、0.3~0.5kg/周组、>0.5 kg/周组,回顾性分析新生儿窒息发生率与孕妇孕前体重指数、孕期体重增加的关系。结果：偏瘦组(BMI<18.5)、正常组(18.5≤BMI<24.0)、超重组(24.0≤BMI<28.0)、肥胖组(BMI≥28)的新生儿窒息的发生率分别是10.60%、11.30%、16.10%、26.83%,呈逐渐递增的趋势;孕期增加体重<0.3 kg/周组、0.3~0.5 kg/周组、>0.5 kg/周组的新生儿窒息率分别为17.81%、11.41%、10.36%,随着孕期增重的增加,新生儿窒息率随之下降。结论：孕妇孕前体重指数(BMI)、孕期体重增加是新生儿窒息发生的重要影响因素,临床上应对孕妇孕前体重指数及孕期体重增加量进行监测,充分评估新生儿发生窒息的危险性,并及早行干预措施,降低新生儿窒息发生率,最大程度保障母婴安全。     

Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes

OBJECTIVE: The purpose of this study was to examine if depressive symptomatology in pregnancy is associated with adverse obstetric and neonatal outcomes. METHOD: In a prospective observational study, 959 women were followed up longitudinally from early pregnancy to postpartum. The level of depression was measured at baseline (first antepartum visit) and in late pregnancy using the Beck Depression Inventory (BDI). Adverse obstetric and neonatal outcomes were recorded at delivery. RESULTS: Depression in late pregnancy was associated with increased risk of epidural analgesia (33% vs. 19%, p =.01, adjusted RR = 2.56, 95% CI 1.24-5.30), operative deliveries (caesarean sections and instrumental vaginal deliveries) (39% vs. 27%, p =.02, adjusted RR = 2.28, 95% CI 1.15-4.53), and admission to neonatal care unit (24% vs. 19%, p =.03, adjusted RR = 2.18, 95% CI 1.02-4.66). These effects remained significant even when controlled for potential confounders, such as antepartum complications. CONCLUSION: Previous studies have shown that antepartum anxiety or stress was associated with growth retardation, premature delivery, and epidural analgesia. Our findings add to this body of evidence, which together suggest an adverse impact of antepartum psychological morbidity on maternal and neonatal well-being.     

妊娠前体质指数和胎次对妊娠糖尿病发病的影响

目的：探讨妊娠前体质指数(body mass index,BMI)、胎次与妊娠糖尿病(gestational diabetes mellitus,GDM)发病的关系,并探讨其对妊娠糖尿病(GDM)发病的影响。方法：本研究选择我院2014年2月至2014年12月接受孕产期检查、临床资料完整的且患有妊娠糖尿病的孕妇262名,对其采取葡萄糖耐量实验(OGTT实验),按照WTO标准,对262例足月妊娠初产妇女在孕24~28周常规进行75 g口服糖耐量试验,并完整记录年龄、孕周、文化程度、妊娠前体质指数及胎次等临床资料。根据妊娠前体质指数(BMI)将孕妇分为BMI分为4组,BMI<18.5 kg/m2者为偏瘦组,BMI 18.5~23.0 kg/m2者为正常体质量组,BMI 23.1~25.0 kg/m2者为超重组,BMI>25.0 kg/m2为肥胖组,采用SPSS l8.0统计软件对资料进行描述性分析、两样本t检验、非条件Logistic回归分析两组孕妇妊娠前体质指数(BMI)、胎次与妊娠糖尿病的关系。结果：4组OGTT结果显示妊娠前超重或肥胖的孕妇发生妊娠糖尿病的风险高于正常和偏瘦体质量组;非条件logistic回归分析结果表明,影响GDM的因素依次为：胎次、体质指数、年龄、文化程度,各影响因素回归系数分别为：2.372、     

Low Body Mass Index Is Associated with Increased Risk of Acute GVHD after Umbilical Cord Blood Transplantation in Children and Young Adults with Acute Leukemia: A Study on Behalf of Eurocord and the EBMT Pediatric Disease Working Party

Body mass index (BMI) may influence outcomes after allogeneic hematopoietic stem cell transplantation (HSCT). However, the impact of BMI on survival in children undergoing HSCT is not well defined, with conflicting results being reported on this issue. We analyzed 855 patients age 2 to 20 years with diagnosis of acute leukemia who underwent umbilical cord blood transplantation (UCBT) from 1990 to 2015. Patients were classified according to BMI as normal (fifth to 85th percentile), underweight (less than fifth percentile), overweight (85th to 95th percentile), and obese (>95th percentile) using growth charts for age and sex. All patients received single-unit UCBT after a myeloablative conditioning regimen. Diagnosis was acute lymphoblastic leukemia in 68% of the patients. Sixty-one percent of patients (n?=?523) were in the normal BMI category, 11% (n?=?96) were underweight, 16% (n?=?137) overweight, and 12% (n?=?99) obese. The cumulative incidence of grade II to IV acute graft-versus-host disease (aGVHD) was 35% (32% to 38%). According to pretransplantation BMI, aGVHD was 46% (33% to 59%) for underweight, 34% (31% to 42%) for normal, 36% (18% to 38%) for overweight, and 27% (15% to 37%) for obese (P?=?.04). In multivariate analysis, a BMI less than the fifth percentile was associated with higher incidence of acute grade II to IV GVHD compared with normal-BMI patients (hazard ratio,? 1.61; 95% confidence interval, 1.15 to 2.26; P?=?.006). Our results show that being underweight at the time of transplantation is associated with an increased risk of aGVHD, highlighting the importance of nutritional status before UCBT.     

Obstetrical and neonatal outcomes of cardio-facio-cutaneous syndrome: Prenatal consequences of Ras/MAPK dysregulation

We systematically delineated the prenatal phenotype, and obstetrical and neonatal outcomes of the RASopathy cardio-facio-cutaneous (CFC) syndrome. A comprehensive, retrospective medical history survey was distributed to parents of children with confirmed CFC in collaboration with CFC International, Inc. Data were collected on CFC gene variant, maternal characteristics, pregnancy course, delivery, and neonatal outcomes with the support of medical records. We identified 43 individuals with pathogenic variants in BRAF (81%), MEK1 (14%), or MEK2 (5%) genes. The median age was 8.5 years. Hyperemesis gravidarum, gestational diabetes, gestational hypertension, and preeclampsia occurred in 5/43 (12%), 4/43 (9%), 3/43 (7%), and 3/43 (7%) of pregnancies, respectively. Second and third trimester ultrasound abnormalities included polyhydramnios, macrocephaly, macrosomia, and renal and cardiac abnormalities. Delivery occurred via spontaneous vaginal, operative vaginal, or cesarean delivery in 15/42 (36%), 7/42 (16%), and 20/42 (48%), respectively. Median gestational age at delivery was 37 weeks and median birth weight was 3501 grams. Germline pathogenic vaiants had mutiple congenital consequences including polyhydramnios, renal and cardiac abnormalities, macrosomia, and macrocephaly on second and third trimester ultrasound. Elevated rates of operative delivery and neonatal complications were also noted. Understanding and defining a prenatal phenotype may improve prenatal prognostic counseling and outcomes.     

Alu insertions versus blood group plus protein genetic variability in four Amerindian populations

Background: Various charts based on body mass index (BMI) and per cent body fat (%BF) are used to classify childhood body composition but outcomes may vary.

Aim: The study investigated variation in incidences of childhood obesity as depicted by four classification charts.

Subjects and methods: BMI and DXA-derived %BF were assessed in 741 children. Incidences of overweight and obesity were compared between two BMI charts and two bioelectrical impedance (BIA)-based %BF charts.

Results: The International Obesity Task Force (IOTF)-adopted BMI chart designated 21%, 6% (boys), and 26%, 9% (girls) as overweight and obese, respectively. Corresponding figures using the USA CDC BMI chart were 27%, 11% (boys) and 27%, 12% (girls). Using a USA-derived %BF chart incidences were 17%, 2% (boys) and 21%, 8% (girls) and using a UK-derived %BF chart 51%, 24% (boys) and 53%, 36% (girls). Sensitivity of BMI varied according to the %BF reference chart.

Conclusions: In contrast to the BMI-based charts, there were considerable variations in depicted incidences of obesity between the %BF-based charts. These discordances were considered to result from previously reported variation within and between BIA and DXA %BF assessments underlying the charts. The present study highlights the need for valid, reliable, unchanging BIA and DXA procedures.     

An increased body mass index was not associated with higher rates of 30-day postoperative complications after unicompartmental knee arthroplasty

BackgroundThe association of postoperative complications and obesity after total knee arthroplasty (TKA) has been well described. However, the effect of an increased body-mass index (BMI) on postoperative complications after unicompartmental knee arthroplasty (UKA) is controversial. Therefore, our aim was to assess the influence of BMI on 30-day postoperative complications after UKA when analyzed as both a categorical and continuous variable.MethodsThe American College of Surgeons National Quality Improvement Program (NSQIP) database was used to identify a total of 8029 patients who underwent UKA from January 1, 2008, to December 31, 2016. The database was queried for over 30 unique complications occurring within 30 days. The impact of BMI on short-term outcomes was assessed as a categorical variable using univariate and multivariate regression. Additionally, BMI was assessed as a continuous variable using spline regressions.ResultsUnivariate regression analysis revealed that compared to normal weight patients, overweight patients had a lower risk of major complication (odds ratio [OR], 0.506; 95% confidence interval [CI], 0.279–0.918; p = 0.025), and any complication ([OR] 0.632; 95% CI, 0.423–0.944; p = 0.025) Multivariate regression analysis found no statistically significant relationship between categorical BMI and complications or outcomes, except for morbidly obese patients who had a greater risk of superficial SSI (p = 0.026). Spline regression found no statistically significant non-linear relationships between BMI and any complication (p = 0.4687), major complications (p = 0.1567), or minor complications (p = 0.4071).ConclusionOverweight and obese individuals who undergo UKA may not have an increased risk of 30-day postoperative complications compared to normal weight individuals.     

地屈孕酮联合低分子肝素钙治疗先兆流产患者的效果

目的 探讨地屈孕酮联合低分子肝素钙治疗先兆流产患者的效果。方法 选取2017年4月~2018年12月我院收治的先兆流产患者80例,按照随机数字表法分为对照组和研究组,各40例。对照组采用地屈孕酮进行治疗,研究组在对照组基础上联合低分子肝素钙进行治疗,比较两组妊娠结局及所产出新生儿不良结局。结果 研究组早产、流产、正常足月妊娠占比分别为12.50%、7.50%、80.00%,优于对照组的30.00%、17.50%、52.50,差异有统计学意义（P＜0.05）。研究组新生儿畸形、喘息急促、新生儿偏大、足月体重轻、正常新生儿占比分别为5.00%、10.00%、0、2.50%、82.50%,优于对照组的15.00%、22.50%、5.00%、10.00%、47.50%,差异有统计学意义（P＜0.05）。结论 地屈孕酮联合低分子肝素钙治疗先兆流产患者能够有效地改善患者的妊娠结局,减少新生儿畸形、喘息急促、新生儿偏大、足月体重轻等不良结局。     

Disposition of sperm donors with resultant abnormal pregnancies

We wished to determine how clinicians manage sperm donors whose offspring have chromosomal or structural abnormalities. A directed, multiple-choice survey was given to reproductive endocrinologists and obstetrical geneticists to assess management of sperm donors whose offspring have chromosomal or structural abnormalities. The questionnaire was completed by 66 reproductive endocrinologists and obstetrical geneticists. Abnormalities and the most common inheritance modes included: Trisomy 21 (aneuploidy, maternal origin), Turner syndrome (aneuploidy, paternal origin), cleft lip/palate (multifactorial), VATER sequence (vertebral defects, imperforate anus, tracheo-esophageal fistula, radial and renal dysplasia, sporadic inheritance), and Hurler syndrome (autosomal recessive). Response choices were: (i) remove donor from programme, (ii) inform potential recipients of prior pregnancy outcomes and continue to use donor, or (iii) further study donor to assess karyotype/mutations. Inheritance mode appeared to influence decisions to remove donors from sperm banks; however, no clear consensus was noted. Guidelines exist for screening potential gamete donors, but not for managing donors whose offspring has a chromosomal or structural abnormality. Guidelines must be developed to manage sperm donors with untoward pregnancy outcomes.     

Obstetrical and neonatal outcome following clonazepam use during pregnancy: a case series

BACKGROUND: Given the high prevalence of panic disorder in women, treatment decisions are frequently made regarding the use of anti-panic medications during the childbearing years and during pregnancy. The objective of this case series was to evaluate obstetric and neonatal outcome associated with treatment with clonazepam during pregnancy. METHODS: Subjects were 38 women with histories of panic disorder who used clonazepam during pregnancy. Information regarding the amount and duration of clonazepam use during pregnancy was obtained. Obstetrical records describing pregnancy, labor and delivery and infant Apgar scores were obtained for all subjects. Neonatal nursery records were obtained for 27 subjects. RESULTS: Maternal outcome assessed by obstetrical records and acute neonatal outcome assessed by Apgar scores were positive. Based on neonatal records, there were no cases of orofacial anomalies, neonatal apnea, benzodiazepine withdrawal syndromes, or temperature or other autonomic dysregulation. In 2 infants born to the same mother, use of clonazepam and imipramine at the time of delivery was associated with transient neonatal distress. CONCLUSION: Clonazepam use during pregnancy did not appear to be directly related to any obstetric complications during pregnancy, labor, or delivery. There was no evidence of neonatal toxicity or withdrawal syndromes in babies born to mothers who took clonazepam during pregnancy. Absence of serious maternal or neonatal compromise following clonazepam use during pregnancy in these mothers and infants is somewhat reassuring. One case of hypotonia and 1 case of respiratory distress in babies who were exposed to clonazepam in combination with imipramine at the time of delivery may suggest that coadministration of benzodiazepines with other psychotropic medications may require close neonatal observation.