Predicting large fetuses at birth: do multiple ultrasound examinations and longitudinal statistical modelling improve prediction?

Zhang J, Kim S, Grewal J, Albert PS. Predicting large fetuses at birth: do multiple ultrasound examinations and longitudinal statistical modelling improve prediction? Paediatric and Perinatal Epidemiology 2012; 26 : 199–207. Predicting large fetuses at birth has long been a challenge in obstetric practice. We examined whether ultrasound examinations at multiple times during pregnancy improve the accuracy of prediction using repeated, longitudinal statistical modelling, and whether adding maternal characteristics improves the accuracy of prediction. We used data from a previous study conducted in Norway and Sweden from 1986 to 1989 in which each pregnant woman had four ultrasound examinations at around 17, 25, 33 and 37 weeks of gestation. At birth, infant size was classified as large‐for‐gestational age (LGA, >90th centile) and macrosomia (>4000 g) or not. We used a longitudinal random effects model with quadratic fixed and random effects to predict term LGA and macrosomia at birth. Receiver–operator curves and mean‐squared error were used to measure accuracy of the prediction. Ultrasound examination around 37 weeks had the best accuracy in predicting LGA and macrosomia at birth. Adding multiple ultrasound examinations at earlier gestations did not improve the accuracy. Adjusting for maternal characteristics had limited impact on the accuracy of prediction. Thus, a single ultrasound examination at late gestation close to birth is the simplest method currently available to predict LGA and macrosomia.     

Supplementation of EPA and DHA in pregnant women with type 1 diabetes mellitus

Background/objectiveLower proportions of n-3 PUFAs have been observed in neonates born to diabetic mothers. We aimed to investigate the association between DHA and EPA supplementation during pregnancy complicated with type 1 diabetes on concentration and proportion of fatty acids in maternal and foetal blood.Subjects and methodsWe conducted a prospective randomized, single-blinded, placebo-controlled trial of 111 eligible pregnant women with type 1 diabetes and presented the results of 84 (intervention arm and control arm comprised 42 participants each) of them who successfully finished the trial in an academic hospital. The initiation of EPA and DHA supplementation or placebo started at randomization visit on gestational week 11–12. Blood samples were taken on the first (screening) visit to the clinic (1st trimester, between 8th and 10th gestational week, GW), then in the second trimester (19–24th GW) and third trimester (30th–33rd GW). On the delivery day, a blood sample was taken on fasting just before birth. The umbilical vein blood sample was taken shortly after the delivery.ResultsWe found a significant increase in the intervention group when compared the first and the third trimester for n-3 PUFAs concentration, 4.3 mg/L (3.3–7.6): 10.0 mg/L (7.1–13.7), p < .001. In the intervention group, the concentration of DHA in maternal vein serum was 11.4 mg/L (7.7–17.5), and in umbilical vein serum, it was 5.1 mg/L (3.0–7.7), which was significantly higher than that in the control group, maternal vein serum: median 9.2 mg/L(6.0–12.3), p = .03 and umbilical vein serum: median 3.4 mg/L (2.1–5.6), p = .009.ConclusionThe increased weight gain in pregnancy and concentration and proportions of DHA, n-3 PUFAs with a decreased proportion of AA, n-6 PUFAs, and AA/DHA ratio in maternal and umbilical vein serum summarize the effect of supplementation with EPA and DHA.     

Fetal pancreatic Langerhans islets size in pregnancies with metabolic disorders

Objective: Metabolic disorders are a pandemic and increasing health problem. Women of childbearing age may also be affected, thus an abnormal metabolism may interfere with pregnancy short- and long-term outcomes, harming both mother and child. In the context of an abnormal maternal and intrauterine metabolic milieu the development of fetal organs, including pancreas, may be affected.

Aim: To investigate the effects of pregnancy metabolic disorders on the morphology of pancreatic Langerhans islets in human late-third trimester stillborn fetuses.

Methods: Samples from fetal pancreas underwent a quantitative histological evaluation to detect differences between pregnancy with (cases, n?=?9) or without (controls, n?=?6) abnormal metabolism.

Results: Results show that the islets size increases in fetuses from dysmetabolic pregnancies and that this increment is related to both beta-cell hyperplasia and hypertrophy. Moreover, according to pregnancy and fetal metabolic disorders, a threshold of abnormal size of the islets has been identified. Above this threshold the size of fetal pancreatic Langerhans islets should be considered excessively increased.

Conclusion: The study suggests that an accurate fetal pancreas analysis supplies an important tool in stillborn fetus, to discover metabolic disturbances that should be kept in mind and managed in future pregnancies.     

孕早期家用化学品使用与妊娠结局关系

  目的  探讨孕期家用化学品暴露与不良妊娠结局的关联。  方法  选取2015年8月 — 2016年12月在重庆医科大学附属第一医院进行首次产前保健的708名孕妇,采用χ²检验和logistic回归分析5种常见家用化学品（空气清新剂、杀虫剂、灭蚊化学品、头发染烫剂和化妆品）暴露与不良妊娠结局的关系。  结果  孕期空气清新剂、杀虫剂、灭蚊化学品、头发染烫剂和化妆品的使用率分别为2.12 %、3.81 %、27.26 %、1.84 % 和2.82 %,χ²检验和Fisher确切检验结果显示,使用空气清新剂的孕妇中妊娠期糖尿病的检出率高于未使用组（P < 0.05）,使用杀虫剂的孕妇中早产的检出率高于未使用组（P < 0.05）。logistic回归分析显示,孕期空气清新剂的使用与妊娠期糖尿病有统计学关联（OR = 3.62,95 % CI = 1.29～10.92）,孕期杀虫剂的使用与早产有统计学关联（OR = 5.47,95 % CI = 1.51～15.82）,进一步调整混杂因素后,关联仍然具有统计学意义。  结论  孕期空气清新剂使用与妊娠期糖尿病风险增加有关,孕期杀虫剂使用与早产风险增加有关。     

Is routine abdominal ultrasonography necessary in macrosomic newborns with difficult delivery?

Adrenal hemorrhage is a relatively uncommon clinical problem of the newborn period. Clinical features of adrenal hemorrhage are variable. An abdominal mass, anemia, unexplained/persistent jaundice, bluish discoloration of the scrotum may be the presenting sign. Here, we presented a macrosomic infant (4150 gr) whose left side adrenal hematoma associated with asphixia and early onset of hyperbilirubinemia. We concluded that the pediatricians should be considered abdominal US screening regard as internal hemorrage in macrosomic newborns who delivered with difficult labor and then seen pathologic jaundice.     

B超测量胎儿腹围预测胎儿体重的价值

目的 研究B超测量胎儿腹围预测巨大胎儿的临床价值。方法 选择184例宫高＋腹围≥140cm的足月单胎孕妇，应用B超测量胎儿双顶径（BPD），头围（HC）腹围（AC），股骨长度（FL）；根据新生儿体重将孕妇分为巨大儿组及非巨大儿组，比较两组间差异；分析腹围与新生儿体重的关系。结果 胎儿腹围与新生儿体重的相关性最好（r=0.84），当胎儿腹围≥35.0cm时，可以预测85.7%的巨大胎儿。结论 超声测量胎儿腹围能准确预测巨大胎儿的体重。     

中原油田巨大儿发生的相关因素分析

目的　通过十年间巨大儿的状况变化 ,分析巨大儿发生的相关因素。方法　回顾性分析我院十年间 12 2 3例巨大儿病例。结果　十年间新生儿体重逐年增高 ,巨大儿发生率亦逐年增加 ,由 1991年的 2 95 %增至 2 0 0 0年的13 73%且超巨大儿发生率亦有逐年增长趋势。巨大儿中孕妇肥胖者占 82 6 % ,巨大儿中男性占 6 0 30 % ,明显高于非巨大儿中男性比率 4 9 4 5 % (P <0 0 1)。巨大儿剖宫产占同期剖宫产比率逐年增加。巨大儿中 ,过期妊娠占2 0 2 8% ,妊娠期糖尿病占 19 91%。巨大儿新生儿病率 12 98% ,显著高于非巨大儿 1 2 6 % (P <0 0 1)。巨大儿产妇产后出血量平均为 (32 0± 15 0 )ml,较同期孕妇产后出血明显增多 (P <0 0 5 )。结论　中原油田巨大儿发生率逐年增加 ,占同期剖宫产率逐年增加。     

巨大儿相关因素的前瞻性初步研究

观测１１０例孕妇孕期增重，５０ｇ葡萄糖筛选试验血糖（５０ｇＧＣＴ），母血及脐血胰岛素（ＩＮＳ），生长激素（ＧＨ）及脐血糖与新生儿体重的关系。结果发现，孕期增重≥１５ｋｇ者巨大儿发生率明显增高；巨大儿组５０ｇＧＣＴ血糖明显高于非巨大儿组。提示孕期增重、５０ｇＧＣＴ可作为预测巨大儿相关参数     

超声测量估计巨大胎儿体重多项公式的临床验证

目的 :探讨超声测量估计巨大胎儿体重的精确性较高的公式。方法 :应用超声对 36 1例胎儿腹围、双顶径、股骨长、肱骨皮下脂肪厚度进行测量 ,并与新生儿出生体重进行多元线性回归推导出一个预测体重的公式 ;然后 ,应用此公式对 75例巨大儿进行临床验证 ,并与其它两个预测巨大胎儿精确性较高的公式进行比较。结果 :新公式巨大儿的检出率为 6 4 % ,均较单参数公式和另一个多参数公式高 (P <0 .0 5 )。结论 :应用腹围、头围、股骨长、肱骨皮下脂肪厚度预测巨大胎儿准确率较高 ,有较好的临床应用价值。