Development of a dietary screening questionnaire to predict excessive weight gain in pregnancy

Excessive gestational weight gain (GWG) is a risk factor for several adverse pregnancy outcomes, including macrosomia. Diet is one of the few modifiable risk factors identified. However, most dietary assessment methods are impractical for use in maternal care. This study evaluated whether a short dietary screening questionnaire could be used as a predictor of excessive GWG in a cohort of Icelandic women. The dietary data were collected in gestational weeks 11–14, using a 40‐item food frequency screening questionnaire. The dietary data were transformed into 13 predefined dietary risk factors for an inadequate diet. Stepwise backward elimination was used to identify a reduced set of factors that best predicted excessive GWG. This set of variables was then used to calculate a combined dietary risk score (range 0–5). Information regarding outcomes, GWG (n = 1,326) and birth weight (n = 1,651), was extracted from maternal hospital records. In total, 36% had excessive GWG (Icelandic criteria), and 5% of infants were macrosomic (≥4,500 g). A high dietary risk score (characterized by a nonvaried diet, nonadequate frequency of consumption of fruits/vegetables, dairy, and whole grain intake, and excessive intake of sugar/artificially sweetened beverages and dairy) was associated with a higher risk of excessive GWG. Women with a high (≥4) versus low (≤2) risk score had higher risk of excessive GWG (relative risk = 1.23, 95% confidence interval, CI [1.002, 1.50]) and higher odds of delivering a macrosomic offspring (odds ratio = 2.20, 95% CI [1.14, 4.25]). The results indicate that asking simple questions about women's dietary intake early in pregnancy could identify women who should be prioritized for further dietary counselling and support.     

Tei指数评估妊娠期糖尿病胎儿及其出生后整体心功能的价值

【】目的 探讨Tei指数评估妊娠期糖尿病(GDM)胎儿及其出生后整体心功能的价值。 方法 选取2015年1月-2016年6月我院收治的47例GDM血糖控制不良孕妇(A组)、55例GDM血糖控制良好孕妇(B组)、70例正常妊娠产妇(C组)作为研究对象,所有孕妇均为单胎妊娠。在入组时、分娩后1-7d、分娩后2-3月,采用多普勒超声心动图检测胎儿的左心室及右心室Tei指数。 结果 入组时、分娩后1-7d、分娩后2-3月,3组胎儿左心室Tei指数、右心室Tei指数相比差异均有统计学意义(P＜0.05)。同一个时间点组间进行比较：A组胎儿左心室Tei指数、右心室Tei指数均显著高于B组、C组胎儿(P＜0.05),B组、C组胎儿之间左心室Tei指数、右心室Tei指数相比差异无统计学意义(P＜0.05)。 结论 积极有效控制血糖可以避免GDM胎儿的心功能受损。血糖控制不良可以损害GDM胎儿心功能,即使胎儿分娩后2-3个月内其心功能仍然处于异常水平。     

大连地区冬春季孕早期维生素D水平与妊娠期糖尿病的关系研究

目的 探讨大连地区冬春季孕早期维生素D(vitamin D,VD)水平对妊娠期糖尿病发病率的影响.方法 选择2016年10月至2017年5月于大连市妇幼保健院产检的初产、单胎孕妇470例,测定其体内维生素D、空腹静脉血糖水平,根据其体内维生素D水平,分为正常组53例、不足组241例和缺乏组176例.对于不足组及缺乏组随机分为试验组和对照组,试验组(分别记为不足试验组,缺乏试验组)每日给予VD滴剂胶囊1200IU(3粒),口服.对照组(分别记为不足对照组,缺乏对照组)及正常组给予每日VD滴剂胶囊400 IU(1粒),口服.随访各组至孕24 ～ 28周妊娠期糖尿病的发生及维生素D缺乏的改善情况.结果 正常组GDM发生率低于不足及缺乏组(P＜0.05),试验组孕妇GDM的发生率较对照组有所降低,但差异不具有统计学意义(P＞0.05).试验组维生素D水平较治疗前显著升高,差异具有统计学意义(P＜0.01).正常组和对照组治疗后维生素D水平有所提高,但与治疗前比较,差异不具有统计学意义(P＞0.05).结论 孕早期VD水平缺乏、不足孕妇妊娠期糖尿病发生率较高;每日补充维生素D 1200 IU,可提高体内维生素D水平,但未降低妊娠期糖尿病发病率.     

Usefulness of tissue transglutaminase type 2 antibodies in early pregnancy

Celiac disease (CD), an autoimmune disease triggered by dietary gluten, is a multi-systemic disorder that primarily results in mucosal damage of the small intestine. Reproductive disorders and pregnancy complications have been associated with CD. Conflicting results have been published concerning CD and the risk of impaired fetal growth with reduced birthweight. The aim of our multicentric, perspective, case–control study was to determine the prevalence of undiagnosed CD in mothers of small for gestational age (SGA) newborns in two regions of Italy. The study included 480 mothers: group A consisted of 284 SGA newborns’ mothers and group B consisted of 196 appropriate for gestational age (AGA) newborns’ mothers. Tissue transglutaminase type 2 antibodies (TG2) IgA and IgG were measured in blood samples. We diagnosed two new cases of CD in asymptomatic mothers. It may be appropriate to include the TG2 to the panel of prenatal blood test.     

Impact of gestational age at delivery on the economics of triplet pregnancy

Objective: To establish the charges associated with triplet pregnancies managed at a single tertiary center, over a 5-year time period, and to evaluate the impact of prematurity on these charges.

Methods: All triplet pregnancies that reached at least 20 weeks gestation and received prenatal and neonatal care at our center from 1992 to 1996 were included. Charges for these mothers and neonates were extracted from two separate hospital billing computer systems, encompassing all inpatient, outpatient, technical, and professional charges. Linear regression was used to evaluate the relationship between gestational age at delivery and total charges.

Results: Fifty-five triplet pregnancies were included, resulting in the admission of 149 liveborn neonates. The median gestational age at delivery was 32.1 weeks. The mean charges per triplet mother were: $6,899 (professional), $3,959 (hospital outpatient), and $32,686 (hospital inpatient). The mean charges per neonatal sibling set were: $20,107 (professional) and $124,163 (hospital inpatient). The mean charges per complete triplet pregnancy was $187,814 (maternal plus neonatal). There was a significant inverse relationship between gestational age at delivery and total charges per triplet family, with a decrease of $16,584 for each additional gestational week reached (P = 0.006).

Conclusions: Triplet pregnancy charges averaged almost $190,000 each, which does not include charges associated with assisted reproductive technologies. These charges are almost all related to the expense of prolonged neonatal intensive care, and are significantly related to the gestational age at delivery. Efforts at containing these costs should focus on reducing the incidence of multiple gestation and preventing prematurity.     

HbA1c及CRP在妊娠期糖尿病治疗中的意义

目的评估糖化血红蛋白(HbA1c)及C反应蛋白(CRP)测定在妊娠期糖尿病血糖控制及治疗中的指导意义。方法选取2016年7月—2017年2月于本院妇产科行产前检查的孕24~28周孕妇行空腹血糖(FBG)、75 g口服糖耐量试验(OGTT)、HbA1c及CRP检查,分为正常妊娠者(对照组),妊娠期糖耐量受损者(GIGT组),妊娠期糖尿病者(GDM组)各40例。对受试对象孕36~38周再次进行FBG、HbA1c及CRP复查,比较各项指标及转归。结果孕24~28周GIGT组及GDM组FBG、HbA1c及CRP指标均高于对照组(P<0.05);进行饮食控制及(或)胰岛素治疗后GIGT组及GDM组各指标均有不同程度下降,P<0.05,GIGT组部分孕妇可恢复至正常值。结论HbA1c检测快速简便,联合CRP有助于妊娠期糖尿病的临床检测及诊断,可用于孕期血糖控制的跟踪观察。