妊娠期高浓度血红蛋白对妊娠结局的影响

妊娠期母体血液系统发生一系列生理变化以适应胎儿生长发育,血液总容量增加并有一定程度的血液稀释。如果妊娠期血液不能有效稀释,血红蛋白浓度过高,会引起血液黏度增加,全身血液循环不能适应子宫-胎盘血流的需要。其结果可能导致子宫-胎盘血流量减少、减慢,而引起子宫胎盘缺血缺氧、血管痉挛、血压升高等,而发生妊娠期高血压疾病、小于胎龄儿、早产、低出生体质量、妊娠期糖尿病、死产等。综述妊娠期高浓度血红蛋白对不良妊娠结局的影响,以引起对妊娠期高浓度血红蛋白的重视。     

妊娠期母体高浓度血红蛋白对妊娠结局的影响及其与补铁的关系

母体血红蛋白（hemoglobin，Hb）浓度是妊娠期产前检查的重要指标。近来，越来越多的研究注意到妊娠期高浓度Hb或血浆容量的减少和血液稀释的不足对妊娠结局有潜在的不利影响，包括低出生体重（low birth weight，LBW）、早产、小于胎龄儿（small for gestational age，SGA）、死产以及妊娠期糖尿病（gestational diabetes mellitus，GDM）等。然而，由于高浓度Hb常常被错误的认为处于良好的血铁状况而没有得到足够的注意。     

妊娠期低甲状腺素血症对妊娠期并发症及不良结局的影响

目的:探究在联合分析孕早、中期甲状腺功能情况下,低甲状腺素血症(HT)对妊娠期并发症及不良妊娠结局的影响.方法:回顾性分析重庆医科大学附属第三医院1733例孕妇病例资料.根据孕早、中期血清促甲状腺激素(TSH)、游离甲状腺素(FT4)水平将病例分成4组,分别为:A组:孕早期被诊断为HT且孕中期甲状腺功能正常;B组:孕早...     

妊娠期糖尿病患者糖化血红蛋白及血糖指标异常与妊娠结局的相关性

目的:探讨妊娠期糖尿病(GDM)患者孕中期不同糖化血红蛋白(HbA1c)和不同血糖指标异常与妊娠结局的相关性。方法:回顾性选择2014年1月至2016年9月在广州市妇女儿童医疗中心进行产检和分娩的2224例诊断为GDM的孕妇为研究对象。根据HbA1c水平将其分为4组:A组为6.0%(1375例),B组为6.0%～6.5%(619例),C组为6.6%～7.0%(170例),D组为7.0%(60例);对75 g OGTT检测结果中仅其中1项时间点血糖异常为GDMⅠ组(1328例)、两项时间点血糖异常为GDMⅡ组(638例)、3项时间点血糖异常为GDMⅢ组(258例)。采用多因素Logistic回归分析不同HbA1c水平和血糖异常项数对妊娠结局的影响。结果:①C组和D组孕妇孕前体质量指数(BMI)为超重及以上和经产妇的占比明显高于A组,差异有统计学意义(P0.05);GDMⅢ组孕妇年龄在36～40岁和40岁、孕前BMI为超重及以上、经产妇、有不良孕产史、有糖尿病家族史以及HbA1c水平为6.6%～7.0%和7.0%的占比都高于GDMⅠ组,但孕妇孕期体质量增长低于GDMⅠ组,差异均有统计学意义(P0.05)。②HbA1c水平在6.6%～7.0%和7.0%时是导致发生不良妊娠结局的危险因素,OR值分别为1.75(95%CI 1.12～2.75)和3.03(95%CI 1.45～6.32);3项血糖值均异常时是导致发生不良妊娠结局的危险因素,OR值为2.13(95%CI 1.40～3.22)。结论:糖化血红蛋白水平越高,血糖异常项数越多,不良妊娠结局的发生率也越高,临床上应对HbA1c6.6%和(或)OGTT 3项血糖值异常的孕妇给予高度关注,及时采取应对措施,减少不良妊娠结局的发生。     

护理干预对妊娠期糖尿病患者妊娠结局的影响

妊娠期糖尿病是指妊娠期发生或首次发现的糖尿病,常伴有明显的代谢紊乱,发病率为1%～5%[1]。妊娠期糖尿病属高危妊娠,是妊娠期常见的并发症,如得不到及时治疗,可出现一系列并发症及合并症,如孕妇可发生酮症酸中毒、妊娠期高血压疾病（妊高病）、感染和羊水过多等;也可出现巨大儿、死胎、早产、     

新生儿性别对妊娠期糖尿病人群妊娠结局的影响

目的:探讨在妊娠期糖尿病(GDM)人群中,新生儿性别与母婴妊娠结局的关系。方法:选择2014年7月1日至2017年12月31日期间,在昆明医科大学第一附属医院定期产检分娩的13599例单胎且病例资料完整者,应用国际糖尿病与妊娠研究组2010年发布的GDM诊断标准,对确诊的GDM患者按新生儿性别分组,比较分析两组人口统计学特征和母婴妊娠结局及妊娠期合并症情况。结果:GDM共3442例,发生率18.05%。男性新生儿1845例,女性新生儿1597例。2组间人口统计学如母亲年龄、身高、各孕期体质量、体质量指数(BMI)、孕期增重、瘢痕子宫、糖尿病家族史比较,差异无统计学意义(P0.05)。母亲妊娠期合并症与妊娠结局2组间差异无统计学意义。新生儿出生体质量(3181.97±564.65 g vs 3099.17±523.85 g,P0.001)、身长(49.49±3.03 cm vs 49.06±2.63 cm,P0.001)、巨大儿发生率(5.0%vs 2.4%,P0.001)、新生儿需治疗率(15.6%vs 11.5%,P0.001)、需使用抗生素率(16.3%vs 13.4%,P=0.019)、转新生儿重症监护室率(22.0%vs 18.9%,P=0.025)、黄疸需治疗率(13.0%vs 10.6%,P=0.033)男性新生儿组均高于女性新生儿组。结论:即使给予GDM患者良好的孕期保健及生活方式干预,其生育的男性新生儿的结局仍差于女性新生儿,应加强对GDM母亲所生育男性新生儿的干预。     

高龄孕妇合并妊娠期高血压疾病妊娠结局的临床分析

目的分析高龄孕妇合并妊娠期高血压疾病的临床特征,为改善其妊娠结局提供临床依据。 方法采用回顾性研究方法,收集和分析2018年1月至2018年12月在中山大学孙逸仙纪念医院住院分娩妊娠期高血压疾病71例患者的临床资料,其中年龄≥35周岁24例(高龄组),年龄<35周岁47例(对照组),比较两组患者发病孕周、入院孕周、分娩孕周、妊娠合并症或并发症、分娩孕周、新生儿出生体重、新生儿窒息、新生儿呼吸窘迫综合征发生情况;正态分布资料使用t检验,非正态分布资料,使用Mann-Whitney U法进行统计分析,计数资料采用χ²检验。 结果高龄组与对照组相比较,尿素(5.49±2.44)mmol/L vs (4.40±1.46)mmol/L, t＝－2.342)、入院孕周(34.86周vs 37.14周,t＝－2.095)、分娩孕周(36.07周vs 37.43周,t＝－2.564)、剖宫产率(70.83% vs 42.55%, χ²＝5.092)、顺产率(8.33% vs 46.81%, χ²＝10.510)、引产率(16.67% vs 2.13%, χ²＝5.130),差异有统计学意义(P<0.05)。两组新生儿体重(2 680 g vs 2 960 g, Z＝－1.876)、新生儿窒息率(8.33% vs 8.51%, χ²＝0.001)、新生儿呼吸窘迫综合征率(4.17% vs 14.89%, χ²＝0.913),差异无统计学意义(P>0.05)。 结论高龄患者合并妊娠期高血压疾病,与35岁以下孕妇发生妊娠期高血压疾病相比,临床特征为发病更早、肾脏功能损害更严重,终止妊娠孕周较早,早产率、剖宫产率升高,顺产率降低。对于高龄孕妇,应在妊娠过程中给予比普通孕妇更严密的母胎监测。     

不同孕期终止妊娠对妊娠期糖尿病围生儿结局的影响

目的探讨不同孕期终止妊娠对妊娠期糖尿病(GDM)围生儿结局的影响。方法采用回顾性分析方法对2001年3月至2004年3月在中国医科大学附属第二医院确诊、住院分娩资料完整的GDM患者共191例的资料进行分析。结果GDM发生率为2.91%。母体并发症以妊娠期高血压疾病(48例,25.13%)为主。有23例(12.04%)未经治疗即终止妊娠,经过孕期单纯饮食控制或饮食控制加胰岛素治疗168例,其中血糖控制满意者78例(40.84%),血糖控制不满意者90例(47.12%)。剖宫产137例(71.73%),阴道自然分娩37例(19.37%),产钳助产11例(5.76%),穿颅术6例(3.14%)。血糖控制满意组中围生儿的患病率、死亡率和巨大儿的发生率均明显低于血糖控制不满意组及未经治疗组(P<0.01)。从孕36周开始即有巨大儿的发生,孕37～39周末终止妊娠除巨大儿外,新生儿并发症相对减少。结论控制血糖使血糖维持在正常水平是GDM治疗的关键,是降低母体并发症和减少围生儿患病率和死亡率的主要因素。孕37～39周是终止妊娠的适宜时机,但应注意有发生巨大儿的可能。     

妊娠期糖尿病27例妊娠结局分析

目的 探讨妊娠期糖尿病对母婴的影响。方法 对妊娠28～30周的孕妇进行50g糖筛查试验，阳性者再行75g糖耐量试验确诊，并随访妊娠结局。结果 妊娠期糖尿病母婴患病率明显高于正常组。结论 应对妊娠28～30周的孕妇进行50g糖筛查试验，确诊为妊娠期糖尿病者应予治疗与监测。     

妊娠期高血压合并乙肝孕妇肝功能指标变化及对妊娠结局的影响

目的 探讨妊娠期高血压合并乙型肝炎（乙肝）孕妇肝功能指标变化及对妊娠结局的影响。方法 选取50例妊娠期高血压孕妇为研究组,根据是否合并乙肝分为妊娠期高血压组（32例）与妊娠期高血压合并乙肝组（18例）;另选取同期在医院分娩的50例健康孕妇为正常妊娠组。检测三组孕妇丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆红素（TBIL）、总胆汁酸（TBA）,并比较三组妊娠结局情况。结果 妊娠期高血压合并乙肝组ALT、AST、TBIL及TBA指标明显高于妊娠期高血压组,而妊娠期高血压组高于正常妊娠组,差异具有统计学意义（P<0.05）。妊娠期高血压合并乙肝组早产、剖宫产、产褥感染、产后出血发生率均低于妊娠期高血压组与正常妊娠组,差异有统计学意义（P<0.05）,而妊娠期高血压组与正常妊娠组妊娠结局比较,差异无统计学意义（P>0.05）。结论 妊娠期高血压合并乙肝孕妇肝功能损伤明显,会增加不良妊娠结局发生率。     

Maternal polycystic ovary syndrome may be associated with adverse pregnancy outcomes

Objective

To determine whether maternal polycystic ovary syndrome (PCOS) is associated with adverse pregnancy outcomes in a population of Italian parturients.

Study design

Retrospective study carried out in an academic hospital in Bologna, Italy, including 516 consecutive Italian women who delivered between January and April 2006. PCOS women, women with hyperandrogenic features not configuring PCOS (Intermediate group) and non-hyperandrogenic controls were identified by a telephone survey of 229 women. Statistical analysis was performed using ANOVA or chi-square.

Results

PCOS women, accounted for 6.6% of our cohort. Gestational diabetes mellitus (GDM) was significantly more frequent in the PCOS group than in the other groups (20% vs. 3.6% and 4%; P < 0.01). The association of GDM and pregnancy-induced hypertension occurred in one subject in the PCOS group but in none of the other groups (P < 0.001). Preterm birth was more frequent in the PCOS group than in control group (20% vs. 6.9%; P < 0.05), whereas mean length of gestation was not different. The higher occurrence of adverse outcomes may be, at least partly, related to a higher weight gain during pregnancy in PCOS group with respect to the other groups (P < 0.05).

Conclusions

Women affected by PCOS carry an increased risk of adverse pregnancy outcomes.     

The impact of flood on pregnancy outcomes: A review article

Flood is one of the natural disasters with high prevalence in the world. The aim of this research was to investigate the effect of flood on pregnancy outcome and pregnancy complication such as preterm birth, LBW, SGA, stillbirth, spontaneous abortion, preeclampsia and eclampsia. This is a systematic review based on the PRISMA model that examines pregnancy disorder, pregnancy complication, and reproductive outcomes in floods. For fulfilling of the objectives of the research, related keywords were identified using Mesh and Emtree databases. Then the search was done in the electronic database of Medline, Web of Science, Embase, scopus until 2021.2.10. The search strategy in the Medline database. Database searches resulted in 823 non-duplicate records. After reading the abstracts, 808 articles were excluded. 15 abstracts were eligible for the study, which their full texts were provided. Finally based on inclusion and exclusion criteria 7 articles were included in this study. After flood, the rate of LBW birth and gestational hypertension increases. However, there is no significant difference in preterm birth rates. Pregnancy complications can be reduced or prevented by starting prenatal care early and also by controlling risk factors such as reducing smoking and alcohol consumption.     

Low gestational weight gain improves infant and maternal pregnancy outcomes in overweight and obese Korean women with gestational diabetes mellitus

Objective.?The aim of the study was to retrospectively assess what was the optimal gestational weight gain to have better maternal and neonatal outcomes in overweight and obese Korean women with gestational diabetes mellitus (GDM) who maintained normoglycemia throughout pregnancy by dietary modification, exercise, and/or insulin treatment.

Study design.?We performed a hospital-based study of 215 GDM women with prepregnancy BMI?≥?25 kg/m². Body weight, glucose homeostasis, lipid profiles, insulin treatment, and maternal outcomes were collected as predictors of neonatal birth weight. We divided the subjects into three groups according to modified Institute of Medicine (IOM) guidelines for weight gain during pregnancy: inadequate (n?=?42), normal (n?=?96), and excessive (n?=?77) groups.

Results.?Excessive weight gain resulted in increased macrosomia, HbA_1c at delivery, and postprandial blood glucose levels, but fasting blood glucose levels were not significantly different among the groups. The inadequate weight gain group (2.4?kg weight gain during pregnancy) had better neonatal outcomes and better maternal glycemic control with fewer requiring insulin treatment.

Conclusion.?Minimal weight gain, well below IOM recommendations, and tight control of blood glucose levels during pregnancy with proper medical management and dietary modification may eliminate most of the adverse pregnancy outcomes experienced by obese GDM Asian women.     

The role of continuing metformin therapy during pregnancy in the reduction of gestational diabetes and improving pregnancy outcomes in women with polycystic ovary syndrome

Objectives

To evaluate the value of continuing metformin therapy in women with PCOS throughout pregnancy and its role in reducing the development of gestational diabetes and improving pregnancy outcome by reducing spontaneous miscarriage rate.

Study design

Non randomized, controlled clinical trial.

Population

Fifty-seven infertile cases with polycystic ovary syndrome who became pregnant were classified into two groups: group 1 included 31 cases who conceived while taking metformin therapy with or without other ovulation inducing agents and continued metformin during pregnancy in a dose of 1000–1500 mg daily and group 2 included 26 cases who conceived without taking metformin and did not take it during pregnancy.

Outcome measures

Maternal outcome measures including; assessment of insulin resistance, incidence of gestational diabetes mellitus, the need for insulin therapy and incidence of preeclampsia. Fetal outcome measures include incidence of, spontaneous miscarriage, preterm birth, fetal growth abnormalities, suspected fetal asphyxia at birth, fetal anomalies and neonatal mortality.

Results

The incidence of gestational diabetes mellitus was significantly lower in cases who received metformin than those who did not receive metformin during pregnancy (3.2% versus 23.08%, respectively), and spontaneous miscarriage occurred in one case (3.2%) in patients who continued metformin compared to 7 cases (26.9%) in patients who did not take metformin. No significant differences between both groups in other outcome measures.

Conclusion

Continuous metformin therapy throughout pregnancy in women with PCOS improves pregnancy outcomes by decreasing spontaneous miscarriage rates and prevention of gestational diabetes mellitus with its co morbidity and mortality.     

Placental maternal vascular malperfusion and adverse pregnancy outcomes in gestational diabetes mellitus

IntroductionMaternal vascular malperfusion (MVM) lesions represent hypoxic-ischemic damage to the placenta, and they are associated with adverse pregnancy outcomes. Women with gestational diabetes (GDM) are at increased risk for pregnancy complications, so we set out to characterize the prevalence and clinical correlates of MVM lesions in this cohort.MethodsThis was a retrospective cohort study of 1187/1374 (86.4%) women with GDM delivered between 2009 and 2012 who had placental pathology available. Placental lesions of all types were tabulated and grouped into constructs of related entities. MVM lesions specifically included villous infarcts, decidual vasculopathy, increased syncytial knots, perivillous fibrin, and fibrin deposition. We compared maternal characteristics between women with and without MVM lesions, and we also assessed the impact of these lesions on birth weight, preterm birth, and pre-eclampsia using multivariable logistic regression analysis.ResultsMVM lesions were the most common placental lesion type in women with GDM (n = 362, 30.5%). Excess gestational weight gain was independently associated with MVM lesions (aOR 1.42, 95% CI 1.06–1.91, p = 0.02) after adjusting for maternal characteristics. MVM lesions were associated with lower birth weight (−90.3 g, 95% CI -148.0 to −32.7, p = 0.002), as well as a 2-fold increased risk for delivery of a small for gestational age infant (10.8 vs 5.9%, p = 0.01) in overweight and obese women. MVM lesions were also associated with increased risk for preterm birth <34 weeks (adjusted OR 2.36, 95% CI 1.31–4.23, p = 0.004) and hypertensive disorders of pregnancy (HDP; adjusted OR 1.58, 95% CI 1.13–2.22, p = 0.02).DiscussionPlacental maternal vascular malperfusion lesions may be one pathway linking excess gestational weight gain to adverse pregnancy outcomes in women with GDM, and future studies are needed to identify metabolic factors that may explain this association.     

Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis

Abstract

Objective: To estimate the associations between maternal vitamin D status and adverse pregnancy outcomes.

Study design: We searched electronic databases of the human literature in PubMed, EMBASE and the Cochrane Library up to October, 2012 using the following keywords: “vitamin D” and “status” or “deficiency” or “insufficiency” and “pregnancy”. A systematic review and meta-analysis were conducted on observational studies that reported the association between maternal blood vitamin D levels and adverse pregnancy outcomes including preeclampsia, gestational diabetes mellitus (GDM), preterm birth or small-for-gestational age (SGA).

Results: Twenty-four studies met the inclusion criteria. Women with circulating 25-hydroxyvitamin D [25(OH)D] level less than 50?nmol/l in pregnancy experienced an increased risk of preeclampsia [odds ratio (OR) 2.09 (95% confidence intervals 1.50–2.90)], GDM [OR 1.38 (1.12–1.70)], preterm birth [OR 1.58 (1.08–2.31)] and SGA [OR 1.52 (1.08–2.15)].

Conclusion: Low maternal vitamin D levels in pregnancy may be associated with an increased risk of preeclampsia, GDM, preterm birth and SGA.