云南省农村孕产妇孕前保健知信行调查

目的 了解云南省农村育龄妇女孕前保健知识、态度和行为.方法 采用整群随机抽样抽取甲县5个乡镇.乙县3个乡镇,符合随访条件的共4 367名农村孕产妇进行问卷调查.结果 (1)农村育龄人群对健康生育的要求非常强烈,出生缺陷预防知识点知晓率较为满意.(2)在甲县有51.7%的人在围孕期或孕期补充过叶酸,有31.6%的人能正确服用;乙县该百分比分别为5.4%和1.1%.(3)农村孕前检查率较低.特别是对于一些相对特殊、专业性较强的检查.如梅毒血清学试验、染色体检查等项目则检查率非常低.结论 在出生缺陷干预工作中,计划生育系统应充分发挥系统优势,在搞好宣传教育的同时,进一步加强自身技术建设,为育龄群众提供可及、可得和可接受的孕前保健技术服务.     

Prevention of Obesity and Diabetes in Childbearing Women

Obesity and diabetes have become pandemic in the United States, with more than one‐third of the US population obese and 8.3% of the population affected by diabetes. Efforts to prevent type 2 diabetes focus primarily on healthy eating and physical activity. In particular, women from at‐risk racial and ethnic groups and those who have experienced gestational diabetes are at high risk for developing type 2 diabetes. Achieving a healthy weight prior to conception, staying within weight gain guidelines during pregnancy, and losing accumulated pregnancy weight postpartum are key prevention factors. Maintaining a healthy weight in the long‐term is a challenge. Behavioral psychology and coaching techniques are presented in this article that can be useful in sustaining behaviors that promote a healthy weight.     

Pregnancy and multiple sclerosis

Multiple sclerosis (MS) is often diagnosed among women of childbearing age. This article reviews how MS affects pregnancy and provides information for health care providers who care for women with this disorder. Women with MS need to be informed regarding how the disease will affect their reproductive health. The disease itself does not usually have a negative impact on fertility or pregnancy, although some studies indicate that women with MS have a slightly increased risk for having small-for-gestational-age newborns. Some of the common MS symptoms such as fatigue, urinary frequency, constipation, and mood changes are similar to pregnancy-related symptoms. Mode of birth and anesthesia choices are similar to those for women without MS. Immunomodulatory therapy for MS needs to be discontinued before conception because most of the medications are still under investigation with regard to safety during pregnancy or have adverse effects on pregnancy. Relapse rates are increased for up to 6 months in the postpartum period. Breast feeding does not appear to increase the risk of postpartum relapses. All hormonal contraception can be used by women with MS. Some studies suggest that estrogen may have protective effects against disease progression.     

孕前保健服务的现状调查及建议

目的探讨孕前保健服务对孕产妇及围生儿结局的影响。方法采用问卷调查法,对1 100例在妇产科进行产前检查的孕妇进行调查,并记录产妇分娩结局。结果孕前保健普及率较低,占17.18%;91.64%的孕妇认为孕前保健很重要,5.91%的孕妇认为孕前保健没必要实施,2.45%的孕妇对孕前保健的重要性呈中立态度;孕前检查组孕妇妊娠结局优于非孕前检查组(P<0.01或P<0.05)。结论为适应围孕期人群需要,应加强孕前保健知识的教育,探讨新的孕前保健模式,从而达到优生优育的目的。     

Dietary guideline adherence during preconception and pregnancy: A systematic review

The aim of this study is to determine the level of adherence to dietary guidelines among men and women during preconception, and pregnant women, and factors associated with adherence. Searches were conducted in CINAHL, AMED, EMBASE, and Maternity and Infant Care from inception to March 2018. Observational studies assessing the primary outcome (adherence to dietary guidelines and/or nutritional recommendations) and/or secondary outcome (factors associated with adherence) were eligible. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross‐sectional studies. Men or women (aged ≥18 years) who identified as trying/intending to conceive or were pregnant. Eighteen studies were included. The quality of studies was fair (44%) to good (56%). Most studies indicated preconceptual and pregnant women do not meet recommendations for vegetable, cereal grain, or folate intake. Pregnant women did not meet iron or calcium intake requirements in 91% and 55% of included studies, respectively, and also exceeded fat intake recommendations in 55% of included studies. Higher level education was associated with improved guideline adherence in pregnant women, whereas older age and non‐smoking status were associated with greater guideline adherence in preconceptual and pregnant women. The findings of this review suggest that preconceptual and pregnant women may not be meeting the minimum requirements stipulated in dietary guidelines and/or nutritional recommendations. This could have potential adverse consequences for pregnancy and birth outcomes and the health of the offspring. Major knowledge gaps identified in this review, which warrant further investigation, are the dietary intakes of men during preconception, and the predictors of guideline adherence.     

Cardiac disease in pregnancy

Cardiac disease remains the leading cause of maternal mortality in the UK. Pregnant patients with high-risk cardiac conditions should be managed by a multidisciplinary cardio-obstetrics team comprising a high-risk obstetrician, cardiologist, and an anaesthetist in a tertiary centre. Preconception counselling is necessary to highlight individual maternal, fetal and cardiac risks. Anaesthetists as peripartum physicians need to comprehend the haemodynamic changes occurring during pregnancy, labour and postpartum in pregnant patients with cardiac conditions that may result in haemodynamic compromise. Individualized patient care plans that incorporate risk-stratification, advice on timing, location, mode of delivery, haemodynamic monitoring, use of uterotonics, recommended analgesia/anaesthesia techniques along with postpartum follow-up are recommended to optimize maternal and fetal outcomes.     

高龄女性孕前管理

随着二孩政策的实行,近年来我国高龄孕妇人群明显增多。与非高龄孕妇人群相比,高龄孕妇在孕前及孕期面临更多问题,包括不孕、妊娠期合并症以及出生缺陷发生率高等,因此需要对该群体进行针对性的孕前管理。