孕早期妊娠呕吐相关危险因素回顾性队列研究

目的 调查分析武汉市孕早期妊娠剧烈呕吐的相关危险因素,指导孕期妇女的预防保健工作。方法 采用回顾性队列研究的方法,选择孕早期来院产检的孕妇,了解其早孕反应的情况,采用logistic回归分析对资料进行分析。结果 武汉市孕早期妊娠剧烈呕吐的相关危险因素有：孕周、噪音、睡眠不好、新近装修、咖啡和孕后食量减少,而孕后口味嗜酸辣、少吃蔬菜、TORCH至少有一项IGM阳性是HG的保护因素,并且孕前体重越大则HG的发生越少。结论 应重视孕早期剧烈呕吐问题,减少噪音等不良因素的暴露,创造良好妊娠条件,注意均衡饮食,保证睡眠,不提倡瘦身怀孕．以尽量减少HG的发生。     

妊娠早期被动吸烟与不良妊娠结局关系的队列研究

目的:分析城市孕早期妇女被动吸烟状况,探讨被动吸烟与不良妊娠结局的关系。方法:调查孕早期妇女被动吸烟状况,追踪其妊娠结局,采用卡方检验和Logistic回归分析的方法,分析被动吸烟与不良妊娠结局的关系。结果:城市孕早期妇女被动吸烟率为38.2%,被动吸烟与不良妊娠结局有一定的剂量反应关系,每日被动吸烟时间超过3 h对妊娠结局有显著影响。结论:被动吸烟可使不良妊娠结局发生的危险增加,每日被动吸烟时间超过3 h是不良妊娠的高危因素,孕妇应尽量避免暴露于吸烟环境,以减少不良妊娠结局的发生。     

妊娠早期被动吸烟与不良妊娠结局的队列研究

目的分析城市孕早期妇女被动吸烟状况,探讨被动吸烟对不良妊娠结局的影响,减少不良妊娠结局的发生。方法调查孕早期妇女被动吸烟状况,将其分成被动吸烟组与无被动吸烟组,追踪其妊娠结局,采用χ2检验和Logistic回归分析方法,分析被动吸烟与不良妊娠结局的关系。结果城市孕早期妇女被动吸烟率为38·2%,被动吸烟与不良妊娠结局呈一定的剂量-反应关系,每日被动吸烟的时间越长发生不良妊娠结局的可能性就越大,每日被动吸烟的时间超过3h对不良妊娠有显著影响。结论被动吸烟可使不良妊娠发生的危险增加,每日被动吸烟的时间超过3h是不良妊娠的强危险因素。加强孕前对孕妇的宣教和指导,尽量避免暴露于吸烟环境,可减少不良妊娠结局的发生。     

高危妊娠孕妇不良妊娠结局影响因素分析

目的：分析高危妊娠孕产妇不良妊娠结局相关影响因素。方法：回顾性收集2013年1月-2020年12月在本院建立《母子健康手册》的孕产妇1227例临床资料，建立《母子健康手册》时根据北京市孕期高危因素初筛表分为初筛高危组、低危组，统计两组一般临床资料及妊娠结局，分析高危妊娠孕产妇发生不良妊娠结局的危险因素。结果：高危组早产(5.9%)、胎儿不良结局(23.8%)和难产(19.8%)发生率高于低危组(2.5%、18.3%、16.9%);高危组中发生不良妊娠结局者年龄(37.1±0.8岁)、孕前体质指数(25.4±0.4 kg/m²)均高于非不良妊娠结局者(30.2±0.6岁、22.3±0.1kg/m²)(均P<0.05);多因素logistic回归分析，孕妇年龄≥35岁、孕前BMI异常是高危孕妇发生不良妊娠结局的独立性危险因素(P<0.05)。结论：年龄≥35岁、孕前BMI异常是高危妊娠孕妇发生不良妊娠结局的独立危险因素。     

孕早期高危因素与不良妊娠结局关系的追踪研究

目的　研究孕早期高危因素与不良妊娠结局之间的关系 ,为加强孕期保健提供依据。方法　以 2 0 0 0年 1月～ 2 0 0 0年 6月在铜陵市 30个妇幼保健网点进行孕期保健体检的孕早期妇女为研究对象 ,追踪观察至分娩 ,获得有效调查表 12 5 7份。结果　孕妇年龄 30岁以上、孕早期发热 38.5 0以上、孕早期阴道出血、HBe Ag阳性、既往异常妊娠史且生育间隔 2年以内、既往异常妊娠史且孕早期阴道出血等与不良结局的发生有密切统计学关联。结论　孕早期多种高危因素可增加不良妊娠结局的风险 ,孕期保健应从孕早期开始     

不良妊娠结局危险因素的巢式病例对照研究

目的探讨影响不良妊娠结局的危险因素,为预防不良妊娠结局的发生提供科学依据。方法选取2014年9月-2015年3月在该院产科门诊就诊并建档的孕妇310例为研究对象,采用巢式病例对照研究,将孕妇队列中确诊为不良妊娠结局的76例孕妇作为病例组,将妊娠结局正常的234例孕妇作为对照组,分析影响不良妊娠结局发生的相关因素。结果不良妊娠结局的发生率为24.5%。Logistic回归分析显示,流产史(OR=1.828,95%CI:1.051~3.180)、孕早期保胎史(OR=1.773,95%CI:1.021~3.080)是不良妊娠结局的危险因素;剖宫产史(OR=0.219,95%CI:0.073~0.655)是不良妊娠结局的保护因素;与孕前体重指数过低者相比,孕前体重指数正常(OR=0.113,95%CI:0.026~0.501)、超重(OR=0.171,95%CI:0.045~0.654)和肥胖(OR=0.188,95%CI:0.044~0.804)均是不良妊娠结局的保护因素。结论流产史、孕早期保胎史、剖宫产史、孕前体重指数与不良妊娠结局有关,应加强育龄妇女的健康教育,促进其采取有效的避孕措施及养成健康的行为生活方式,预防不良妊娠结局的发生。     

高危妊娠孕妇特征及妊娠结局影响因素研究

目的 探讨高危妊娠孕妇特征及妊娠结局,以期为高危妊娠围产保健工作提供科学依据。方法 对明确诊断为高危妊娠的孕妇建立个人追踪档案,记录年龄、孕产史、民族、诊断时孕周（孕28~42周）、文化程度、产检情况、孕前体重,收集每次产检时进行的各项检查结果至分娩,收集每例高危妊娠孕妇的分娩结局。采用描述流行病学分析方法对结果进行分析,并采用单、多因素分析方法对不良妊娠结局影响因素进行分析。结果 本研究共纳入 982例高危妊娠产妇,年龄35~44岁,以35~39岁（占90.33%）、再孕经产（占68.13 %）、汉族（占92.97 %）、累计产检次数<10次（占69.86 %）、一般高危妊娠（占60.18%）、诊断时孕32~36周（占38.90 %）、有流产史（占79.94%）、有剖宫产史（占56.01%）、妊娠期高血压（占50.20%）、孕前超重（占50.10 %）等特征为主。982例高危妊娠孕妇中不良妊娠结局发生293例,发生率为29.84%。多因素Logistic回归分析结果显示,年龄越大（OR=1.587）、极其严重高危妊娠（OR=8.637）、流产史（OR=1.711）、产前出血（OR=4.884）、前置胎盘（OR=3.780）的高危妊娠孕妇发生不良妊娠结局可能性更高。结论 高危妊娠孕妇呈现高龄、不良妊娠结局发生率高等特征,其中不良妊娠结局受诸多因素影响,建议妇女在合适年龄妊娠,定期产前检查,尽早干预妊娠并发症,以减少出生缺陷,提高出生人口素质。     

影响妊娠合并慢性肝脏疾病妊娠结局的相关因素

目的 对妊娠合并慢性肝脏疾病的相关危险因素进行分析.方法 对87例妊娠合并慢性肝脏疾病者妊娠结局进行调查,并分析导致妊娠合并慢性肝脏疾病患者发生不良妊娠结局的相关因素.结果 妊娠合并肝脏疾病孕妇共38例(43.68％)发生了不良妊娠结局,其中胎膜早破占19.54％,死胎占13.79％；经过多因素非条件Logistic回归模式进一步分析,结果显示:发病孕周(OR=3.353,95％ CI:1.764 ～4.164)、肝硬化(OR=3.452,95％ CI:1.534 ～7.673)、总胆红素峰值(OR=4.235,95％ CI:1.456 ～5.474)是影响妊娠合并慢性肝脏疾病妊娠结局的相关危险因素.结论 妊娠合并慢性肝脏疾病发生不良妊娠结局比例较高,其中发病孕周较早、肝硬化、总胆红素水平较高是导致妊娠合并慢性肝脏疾病发生不良妊娠结局的危险因素.     

贵州省农村育龄妇女不良妊娠结局现状及影响因素分析

目的了解贵州省农村育龄妇女不良妊娠结局发生现状,并分析影响不良妊娠结局的因素,为贵州省预防不良妊娠结局提供科学依据。方法采用巢式病例对照研究,分析男女方因素与不良妊娠结局的相关性。结果不良妊娠结局发生率为10.3%。χ~2检验结果显示,不良妊娠结局与女方的年龄、体重指数、不良妊娠史、吸烟以及男方的年龄、体重指数和饮酒的关联差异有统计学意义;多因素Logistic回归分析结果显示,女方年龄在35岁及以上(OR=1.315,95%CI:1.072~1.614)是不良妊娠结局的危险因素;与孕前体重指数正常妇女相比,孕前体重指数偏胖(OR=1.183,95%CI:1.010~1.384)或肥胖(OR=1.953,95%CI:1.418~2.689)是不良妊娠结局的危险因素;不良妊娠史(OR=1.128,95%CI:1.004~1.267)是不良妊娠结局的危险因素。结论女方的高龄、体重指数偏胖或肥胖、不良妊娠史与不良妊娠结局有关。应鼓励孕龄期妇女优生优育,加强育龄夫妇的健康教育,有针对性地对不同情况的夫妇进行孕前保健和指导,以减少不良妊娠结局的发生。     

输卵管妊娠合并宫内妊娠术后恢复及妊娠成功率影响因素分析

目的:探讨影响输卵管妊娠合并宫内妊娠术后恢复及妊娠成功率的影响因素。方法:回顾性分析43例行输卵管妊娠合并宫内妊娠产妇的临床资料,根据手术时间将产妇分为早期组、中期组及晚期组,对比手术时间对产妇术后恢复及妊娠成功率的影响,并分析影响术后恢复及妊娠成功率危险因素。结果:早期组患者术后出血量、出血时间、HCG改善情况、妊娠周数及妊娠结局均明显优于中期组及晚期组(F=13.5161,P=0.0016;F=16.5243,P=0.0011;F=16.1167,P=0.0000;F=9.7250,P=0.0061;X2=3.4697,P=0.0000)。经直线相关分析显示年龄、孕周、手术时间、术前HCG与术后恢复及妊娠结局均呈直线相关性(P<0.05),经Logistic相关分析显示年龄、孕周、手术时间、术前HCG均是影响术后恢复及妊娠结局的重要危险因素。结论:年龄、孕周、手术时间、术前出血量、术前HCG均是影响术后恢复及妊娠结局的重要危险因素。     

Adverse Maternal and Birth Outcomes in Women Admitted to Hospital for Hyperemesis Gravidarum: a Population‐Based Cohort Study

Background

Evidence for risks of adverse maternal and birth outcomes in women with hyperemesis gravidarum (HG) is predominantly from small studies, unknown, or conflicting.

Methods

A population‐based cohort study using secondary health care records (Hospital Episode Statistics covering all of England from 1997 to 2012) was used to calculate odds ratios (OR) with 99% confidence intervals (CI) for the association between HG hospital admission and adverse outcomes, adjusting for maternal and pregnancy confounders.

Results

Within 8 211 850 pregnancies ending in live births or stillbirths, women with HG had increased odds of anaemia (OR 1.28, 99% CI 1.23, 1.33), preeclampsia (OR 1.16, 99% CI 1.09, 1.22), eclampsia (OR 1.84, 99% CI 1.07, 3.18), venous thromboembolism antenatally (OR 1.94, 99% CI 1.57, 2.39 for deep vein thrombosis, and OR 2.54, 99% CI 1.89, 3.40 for pulmonary embolism) and post‐partum. Odds of stillbirth (OR 0.77, 99% CI 0.66, 0.89) and post‐term (OR 0.86, 99% CI 0.81, 0.92) delivery were decreased. Women were more likely to be induced (OR 1.20, 99% CI 1.16, 1.23), to deliver preterm (OR 1.11, 99% CI 1.05, 1.17), very preterm (OR 1.18, 99% CI 1.05, 1.32), or by caesarean section (OR 1.12, 99% CI 1.08, 1.16), to have low birthweight (OR 1.12, 99% CI 1.08, 1.17) or small for gestational age (OR 1.06, 99% CI 1.01, 1.11) babies and although absolute risks were small, their offspring were more likely to undergo resuscitation or neonatal intensive care.

Conclusion

HG may have important antenatal and postnatal consequences that should be considered in communications between health care professionals and women to best manage HG and prevent progression during pregnancy.     

Hyperemesis Gravidarum and the Sex of the Offspring

Studies have suggested that offspring of women hospitalized for hyperemesis gravidarum have a different sex ratio than those of women without this diagnosis, but little is known of the potential association between fetal gender and variables such as severity of hyperemesis, gestational trimester, and maternal age. Our findings provide evidence that pregnant women with a diagnosis of hyperemesis gravidarum in the first trimester give birth to a higher proportion of female newborns than do all mothers, regardless of whether they are hospitalized.     

Maternal Influences on Nausea and Vomiting in Early Pregnancy

Symptoms of nausea and vomiting in early pregnancy (NVP) are common among pregnant women, but whether some women are more likely than others to experience these symptoms has not been well established. We examined potential risk factors for NVP symptom severity, timing of onset, and duration. We included 2,407 newly pregnant women who participated in a prospective cohort study on early pregnancy health between 2000 and 2004 in three U.S. cities. Data on NVP and other health information were collected through telephone interviews, early gestation ultrasound, and medical record abstractions. Generalized linear models were used to model possible risk factors for each NVP characteristic. Eighty-nine percent of women had NVP; for 99% of these, symptoms started in the first trimester. None of the characteristics examined were associated with having NVP. Among those with NVP, increasing risk of delayed symptoms onset was associated with advancing maternal age; increased risks were also seen among non-Hispanic Black [Risk ratio (RR) = 4.3, 95% confidence interval (CI): 1.6,11.6] and Hispanic women (RR = 2.3, 95% CI:0.4,11.5). NVP symptoms for multigravidae were more likely to last beyond the first trimester with each additional pregnancy. Most pregnant women experienced NVP. Nearly all of them, regardless of characteristics examined, had symptoms beginning in the first trimester. Maternal age, race/ethnicity, and gravidity were associated with delayed onset and symptoms that persisted into the second trimester.     

Polyunsaturated Fatty Acids and Their Metabolites in Hyperemesis Gravidarum

Polyunsaturated fatty acids (PUFAs) have been studied in relation to pregnancy. However, there is limited knowledge on PUFAs and their metabolites in relation to hyperemesis gravidarum (HG), a pregnancy complication associated with nutritional deficiencies and excessive vomiting. In order to survey the field, a systematic review of the literature was performed, which also included nausea and vomiting of pregnancy (NVP) due to its close relationship with HG. In the very few published studies found, the main subjects of the research concerned free fatty acids (four records), lipid profiles (three records), and bioactive lipids (one article about prostaglandin E₂ and one about endocannabinoids). The authors of these studies concluded that, although no cause-and-effect relationship can be established, HG is linked to increased sympathetic responsiveness, thermogenic activity and metabolic rate. In addition, NVP is linked to a metabolic perturbance (which lasts throughout pregnancy). The low number of retrieved records underlines the need for more research in the area of PUFAs and HG, especially with regard to the underlying mechanism for the detected effects, potentially involving growth differentiation factor 15 (GDF15) since evidence for GDF15 regulation of lipid metabolism and the role for GDF15 and its receptor in nausea and vomiting is emerging.     

城市流动与户籍孕产妇产前保健利用状况比较分析

目的:了解流动孕产妇与户籍孕产妇产前保健服务的利用情况,发现两人群的差异,探讨影响因素并为制定干预措施提供依据。方法:采用对比研究,在广州、浙江、福建、北京对379名流动孕产妇和381名户籍孕产妇进行问卷调查,了解其社会人口学因素及产前保健利用情况,包括初检孕周、产检次数及早、中、晚孕期的产检项目等。结果:流动与户籍孕产妇孕早期初检率分别为40.5%和57.1%,产检5次及以上的比率分别为60.4%和80.6%;流动孕产妇孕早、中期各基本项目检查率低于户籍孕产妇,孕晚期差异不大。流动人口、文化程度低、经济收入低、未婚或离异、无保险、经产妇、计划外生育、怀孕后无人通知产检等会影响孕产妇的产检利用情况。结论:城市中流动孕产妇产前保健服务的利用情况与户籍孕产妇相比存在较大差异,孕产妇保健应注重提供普惠性的服务项目及加大服务宣教力度。     

Understanding the Association of Biomedical,Psychosocial and Behavioral Risks with Adverse Pregnancy Outcomes Among African-Americans in Washington,DC

This study investigates the relationship between adverse pregnancy outcomes in high-risk African American women in Washington, DC and sociodemographic risk factors, behavioral risk factors, and the most common and interrelated medical conditions occurring during pregnancy: diabetes, hypertension, preeclampsia, and Body Mass Index (BMI). Data are from a randomized controlled trial conducted in 6 prenatal clinics. Women in their 1st or 2nd trimester were screened for behavioral risks (smoking, environmental tobacco smoke exposure, depression, and intimate partner violence) and demographic eligibility. 1,044 were eligible, interviewed and followed through their pregnancies. Classification and Regression Trees (CART) methodology was used to: (1) explore the relationship between medical and behavioral risks (reported at enrollment), sociodemographic factors and pregnancy outcomes; (2) identify the relative importance of various predictors of adverse pregnancy outcomes; and (3) characterize women at the highest risk of poor pregnancy outcomes. The strongest predictors of poor outcomes were prepregnancy BMI, preconceptional diabetes, employment status, intimate partner violence, and depression. In CART analysis, preeclampsia was the first splitter for low birthweight; preconceptional diabetes was the first splitter for preterm birth (PTB) and neonatal intensive care admission; BMI was the first splitter for very PTB, large for gestational age, Cesarean section and perinatal death; employment was the first splitter for miscarriage. Preconceptional factors strongly influence pregnancy outcomes. For many of these women, the high risks they brought into pregnancy were more likely to impact their pregnancy outcomes than events during pregnancy.     

Understanding the association of biomedical, psychosocial and behavioral risks with adverse pregnancy outcomes among African-Americans in Washington, DC

This study investigates the relationship between adverse pregnancy outcomes in high-risk African American women in Washington, DC and sociodemographic risk factors, behavioral risk factors, and the most common and interrelated medical conditions occurring during pregnancy: diabetes, hypertension, preeclampsia, and Body Mass Index (BMI). Data are from a randomized controlled trial conducted in 6 prenatal clinics. Women in their 1st or 2nd trimester were screened for behavioral risks (smoking, environmental tobacco smoke exposure, depression, and intimate partner violence) and demographic eligibility. 1,044 were eligible, interviewed and followed through their pregnancies. Classification and Regression Trees (CART) methodology was used to: (1) explore the relationship between medical and behavioral risks (reported at enrollment), sociodemographic factors and pregnancy outcomes; (2) identify the relative importance of various predictors of adverse pregnancy outcomes; and (3) characterize women at the highest risk of poor pregnancy outcomes. The strongest predictors of poor outcomes were prepregnancy BMI, preconceptional diabetes, employment status, intimate partner violence, and depression. In CART analysis, preeclampsia was the first splitter for low birthweight; preconceptional diabetes was the first splitter for preterm birth (PTB) and neonatal intensive care admission; BMI was the first splitter for very PTB, large for gestational age, Cesarean section and perinatal death; employment was the first splitter for miscarriage. Preconceptional factors strongly influence pregnancy outcomes. For many of these women, the high risks they brought into pregnancy were more likely to impact their pregnancy outcomes than events during pregnancy.     

223例妊娠晚期孕妇的心理状态现状及影响因素分析

目的 调查妊娠晚期孕妇心理状况及影响因素,为后期采用针对性心理疏导提供参考依据。方法 随机选取本院2020年6—12月产科门诊223例妊娠晚期孕妇（孕周>28周）,收集研究对象基本信息（年龄、教育程度、个人经济收入、工作状态、家族遗传史、初产情况）,使用焦虑自评量表（SAS）和抑郁自评量表（SDS）对妊娠晚期孕妇心理状况进行评估。结果 223例妊娠晚期孕妇焦虑发生率为38.57%,抑郁发生率为29.15%。焦虑多因素logistic回归分析结果显示,初中及以下学历、个人月收入小于5 000元、无业、家族遗传史、不良孕史及初产是妊娠晚期孕妇焦虑发生的独立危险因素（P<0.05）。抑郁多因素logistic回归分析显示,初中及以下学历、个人月收入小于5 000元、无业、家族遗传史、不良孕史是妊娠晚期孕妇抑郁发生的独立危险因素（P<0.05）。结论 妊娠晚期孕妇整体焦虑及抑郁发生率较高,临床应为孕产妇提供心理保健服务,采用针对性心理评估,尽可能提升分娩体验。     

10407名单胎活产儿SGA发生率及其影响因素的队列研究

目的:了解安徽省8地市小于胎龄儿(SGA)发生情况并分析其影响因素。方法:选择安徽省8地市妇幼保健部门首次保健服务的孕妇为研究对象,填写《孕产期母婴健康记录表》,收集母亲的社会人口统计学特征和孕前6个月及孕早期环境暴露因素,同时于孕晚期收集孕期妊娠期高血压等妊娠合并症及并发症的发生情况,记录单胎活产儿出生信息,运用χ2检验和多因素Logistics回归模型分析人口统计学特征与环境暴露对SGA的影响。结果:SGA发生率为3.4%(357/10 407),将SGA按重量指数分型,匀称型SGA占55.2%(197/357),非匀称型SGA占43.4%(155/357);将SGA按身长/头围分型,为匀称型SGA占73.7%(263/357),非匀称型SGA占4.2%(15/357)。多因素Logistic回归模型结果显示,孕妇为城市户口、孕早期发生妊娠呕吐但未做医疗处理、孕期头3个月服用微量元素坚持1个月以上是SGA发生的保护因素,OR值分别为0.71(95%CI:0.57～0.89)、0.79(95%CI:0.63～0.99)、0.30(95%CI:0.11～0.81);胎儿性别为女、孕前BMI<18.5、发生妊娠呕吐并去医院就诊为SGA的危险因素,OR值分别为1.83(95%CI:1.47～2.29)、1.46(95%CI:1.16～1.85)、1.72(95%CI:1.12～2.65)。结论:孕妇孕前BMI较低及妊娠呕吐等会影响SGA的发生,加强孕前和孕期保健,应重视妊娠呕吐的发生,发生时应及时就诊以减少SGA的发生。