Increased Mortality Risk in Children with Fetal Alcohol Spectrum Disorders: A Scoping Review

Objective: Fetal Alcohol Spectrum Disorders (FASDs) are common, often undiagnosed, lifelong developmental disorders that result from prenatal alcohol exposure. FASD is present at birth and typically identified around seven years of age. The most severe outcome in cases of FASD is mortality. The purpose of this scoping review is to 1) use a systematic review to provide an estimated mortality proportion for children with FASD, and 2) update a study published in 2014 by reviewing published reports of mortality in individuals diagnosed with FASD. Method: A search of PubMed, CINAHL, and Google Scholar for reports published between 2013 and 2023 on mortality in individuals with FASD. Results: Three population-based studies have reported on all-cause mortality rates, finding a combined mortality rate of 10.9%, a 2.63 fold (95% CI: 2.61 to 2.65) increase in mortality risk over the general population. Since 2016, this review identified only eight new cases meeting the study inclusion criteria. The reported causes of death were five cases of pneumonia, and one case each of failure to thrive and dehydration, intestinal dilatation and asphyxiation caused by overeating due to pica, and acute gastric volvulus. Discussion: While current research suggests a diagnosis of FASD is associated with a 2.6-fold increase in mortality risk, this is likely an underestimation, as most cases of FASD-related mortality go unreported. Globally, about 1 new case is reported every 15 months. However, in the United States alone, between 1752 to 4400 FASD related deaths occur annually. Our review suggests that FASD is rarely identified as a causal or contributing factor in deaths of children and adolescents, resulting in a substantial undercount of FASD-related deaths. Increased attention to the role of FASD in infant and child mortality case reviews, child death review committee reports, and mortality reviews is needed.

The Combination of the Fetal Fibronectin Bedside Test and Cervical Length in Preterm Labor Is Useful for Prediction of Preterm Birth

Objective: To determine the value of fetal fibronectin (FFN), cervical length (CL) measurement and their combination as binary predictors for preterm birth (PB) in women with preterm labour (PTL) between 24 + 0 and 34 + 0 weeks. Methods: One hundred fifty-nine patients with signs of PTL (singleton pregnancies (SP) = 125, twin pregnancies (TP) = 34) were evaluated in a retrospective study. Inclusion criteria were contractions > 4/20 min, intact membranes, no bleeding. The cut-off was ≥50 ng/ml for FFN and ≤20 mm for CL measured by transvaginal ultrasound. The primary outcome variable was delivery within 7 days from admission. Results: We evaluated 125 SPs and 34 TPs. In SPs, both methods had a sensitivity of 80%;the specificity was 82% for FFN, and 50% for CL. For the combination of both tests sensitivity was 80% and specificity 88%. In TPs, the sensitivity of both tests was lower (FFN 33%, CL 67%) but the combination of both tests represented the highest result for specificity (77% compared to 68% for FFN alone and 32% for CL alone). Conclusion: The combination of FFN and CL in PTL results in a significant higher specificity in SPs. In TPs the performance of the tests is less accurate.

Outcomes of Fetal Macrosomia and Associated Factors: A Case-Control Facility Based Study

Objective: To identify risk factors of perinatal complications among macrosomic babies in a third level health care facility. Method: We conducted a case-control institutional based study. Cases (macrosomic babies and mothers with perinatal complications) and controls (pairs free of perinatal complication) of singleton live births were extracted from the maternity registry from January 2017 to December 2019. Matching was done for sex and gestational age after exclusion of genetic cause of macrosomia. The main primary outcome was the risk factors for complications. Logistic regression was used to estimate the odds ratio and the magnitude of association between the primary endpoint and the different covariates of the study. Results: Out of 362 couples included, we had 186 cases and 176 controls. The main perinatal complications were the delivery by caesarean section (26.5%) and lesions of the genital canal, 20.2%. There were no maternal deaths. Among newborns, metabolic complications (19.6%) were a leading cause of harmful outcomes before respiratory complications (12.4%), dystocic presentations (6.3%) or traumatic injuries (1.7%). The neonatal case fatality rate was 2.8%. Maternal age ≥30 years (p = 0.024);non-screening for gestational diabetes (p = 0.027);history of caesarean section (p = 0.041);weight gain ≥16 kg (p 0.001);maternal HIV (p = 0.047);birth weight ≥4500 g (p = 0.015) and birth height ≥52.7 ± 1.7 cm (p = 0.026) were risk factors for perinatal adverse outcomes. Conclusion: The delivery of a macrosomic baby remains problematic in this setting, and emphasizes the need to improve routine screening of gestational diabetes within a quality of prenatal follow-up through a multidisciplinary perinatal team involving obstetricians, endocrinologists and neonatal pediatricians.

不同孕期血脂水平与胎盘重量和胎盘/出生体重比的相关性

目的:探讨不同孕期母体空腹血脂与胎盘重量(PW)和胎盘/出生体重比(PFR)的相关性。方法:收集规律产检及足月、顺产分娩的1172例单胎孕妇的基本信息、不同孕期空腹血脂及PW、PFR,分析母体不同孕期空腹血脂对PW、PFR的影响及其与PW和RFR的关系。结果:在排除孕前体质指数(BMI)、孕龄、产次、胎儿性别等混杂因素后,妊娠早期低密度脂蛋白C(LDL-C)每升高1个单位,PW增加9.396 g(95%CI:0.510~18.283,P=0.038);妊娠中期总胆固醇(TC)、甘油三脂(TG)每升高1个单位,PW分别增加8.582 g(95%CI:3.464~13.699,P=0.001)和7.565 g(95%CI:1.825~13.305,P=0.010);载脂蛋白a1(APOA1)每升高1个单位,PW减少31.422 g(95%CI:-49.139~-13.705,P=0.001);妊娠晚期TG每增加1个单位,PW增加5.618 g(95%CI:1.149~10.088,P=0.014);HDL-C每增加1个单位,PW减少18.622 g(95%CI:-30.047~-7.196,P=0.001)。PFR与妊娠晚期APOA1负相关(P<0.05),与妊娠晚期载脂蛋白b(APOB)正相关(P<0.05)。结论:妊娠期母体血脂异常可导致PW、PFR异常,影响胎盘功能及新生儿体重,临床需加强监测母体血脂指标变化并及时干预。

孕早期胎儿结构畸形超声筛查的卫生经济学评价

目的通过成本-效用分析,评价孕早期行胎儿结构畸形超声筛查相比于孕中期行胎儿结构畸形超声筛查的经济性,为临床路径优化提供循证依据。方法从全社会角度出发,构建决策树模型,模拟孕妇于孕早期行胎儿结构畸形超声筛查(干预组)与于孕中期行胎儿结构畸形超声筛查(对照组)2种不同产前筛查方案的临床选择及转归路径,评估2组不同路径下的成本-效用情况。模型模拟时长为18周,临床转移概率和成本参数来源于深圳市南山区妇幼保健院数据,效用数据来源于已公开发表的文献。结果指标包括成本、质量调整生命年(qualityadjusted life years,QALYs)和增量成本-效果比(incremental cost-effectiveness ratio,ICER)。通过敏感性分析评估模型结果的稳健性。结果相比对照组,干预组可减少不必要的妊娠发生,以更少的总成本投入获得更多的QALYs,ICER为−161732.68元/QALY,具有绝对成本效果优势。概率敏感性分析表明基础分析结果具有稳健性,干预组具有成本效果的概率为94.60%。结论在全社会角度下,于孕早期进行胎儿结构畸形筛查相比于孕中期具有绝对的经济学优势。

多胎B超在湖羊繁殖体系中的应用

文章结合湖羊繁殖工作中母羊妊娠鉴定重要环节,引进英国BCF生产的Ovi-Scan便携式兽用多胎B超,辅助繁殖人员及时准确快速检查配种母羊怀孕状况,通过对406只成年母羊、223只青年母羊、184只复配母羊进行多胎B超妊娠检查,B超孕检受胎率分别达到80.05%、82.96%和69.56%,准确度平均达到99.34%;母羊怀孕3羔及以上多胎B超妊娠检查准确度达到95.39%;3羔及以上母羊分娩152只,产羔463只,羔羊平均初生重3.27 kg,同比提高4.81%。通过多胎B超使用,显著提高母羊孕检揭发率,并对检出空怀母羊及时配种,同时对检出怀孕3羔及以上母羊分群饲养,有效提高羔羊初生重,提高湖羊母羊繁殖效率。

地屈孕酮联合黄体酮对先兆流产保胎成功情况、激素水平、新生儿出生指标、疗效及安全性的影响研究

目的探究先兆流产患者联合应用地屈孕酮、黄体酮治疗对保胎成功情况、激素水平、新生儿出生指标、疗效及安全性的影响。方法100例先兆流产患者,经随机数字表法分为对照组与观察组,每组50例。对照组实施地屈孕酮治疗,观察组实施地屈孕酮联合黄体酮治疗。比较两组保胎成功情况、激素[雌二醇(E_(2))、孕酮(P)、人绒毛膜促性腺激素(HCG)]水平、新生儿指标(新生儿体重和新生儿畸形率)、治疗效果以及不良反应发生情况。结果观察组保胎成功率为88.00%,高于对照组的70.00%,差异显著(P<0.05)。治疗后,两组E_(2)、P、HCG水平均上升,且观察组E_(2)、P、HCG水平分别为(1078.41±18.26)pg/ml、(31.86±3.66)nmol/L、(8574.21±96.69)U/ml,高于对照组的(905.25±26.69)pg/ml、(25.91±4.13)nmol/L、(7410.33±105.53)U/ml,差异显著(P<0.05)。对照组新生儿体重为(3259.87±84.91)g,新生儿畸形0例;观察组新生儿体重为(3275.46±86.29)g,新生儿畸形1例(2.00%)。两组新生儿体重、新生儿畸形率比较无显著差异(P>0.05)。观察组治疗总有效率96.00%高于对照组的84.00%,差异显著(P<0.05)。两组不良反应发生率比较,无显著差异(P>0.05)。结论先兆流产患者联合应用地屈孕酮、黄体酮治疗可获得突出效果,利于提升先兆流产保胎成功率,改善激素水平,不会对新生儿出生指标产生影响,且安全性较高,建议临床推广应用。

Vaginal Cesarean Section, an Alternative to High-Risk Trigger on Scarred Uterus

The objective is to report a clinical case of vaginal cesarean section performed to expel a dead fetus in scarred uterus. For this indication, vaginal hysterectomy constitutes an alternative to vaginal expulsion with a high risk of uterine rupture and to classic abdominal cesarean section with risk of significant surgical trauma, particularly adhesions. However, this surgical technique, described since the 19th century, remains unknown to many practitioners and few publications exist on the subject throughout the world. Considered obsolete by some practitioners, it retains all its advantages in the practice of modern obstetrics. We report this case of expulsion of fetal death on a tri-scarred uterus performed by vaginal cesarean section at the Health District Reference Health Center (District Hospital) of Commune I in Bamako, Mali in a 37-year-old patient with a pregnancy of 27 weeks of amenorrhea.

Risk factors of intrapartal fetal death in a low-resource setting

Objective: To identify the risk factors of intrapartal fetal death in a tertiary hospital in Yaoundé. Methods: It was a case-control study comparing 53 women who delivered with intrapartal fetal death to 106 women who delivered without intrapartal fetal death, carried out at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon. Results: The risk factors of intrapartal fetal death identified at bivariate analysis were: maternal age <20 years (OR = 3.1;CI = 1.1 - 8.3), absence of regular income (OR = 2.4;CI = 1.2 - 4.7), single motherhood (OR = 2.9;CI = 1.5 - 5.7), illiteracy and primary level of education (OR = 4.7;CI = 1.9 - 11.5), referral (OR = 5.0;CI = 2.5 - 9.9), parity 0 and 1 (OR = 2.3;CI = 1.1 - 4.5), no antenatal care (OR = 9.2;CI = 2.4 - 35.6), number of antenatal visits <4 (OR = 4.2;CI = 2.1 - 8.6), antenatal care in a health center (OR = 3.8;CI = 1.9 - 7.5), antenatal care by a midwife (OR = 2.5;CI = 1.3 - 4.9) or a nurse (OR = 5.2;CI = 1.4 - 18.7), absence of malaria prophylaxis (OR = 10.6;CI = 2.9 - 39.5), absence of obstetrical ultrasound (OR = 4.7;CI = 1.9 - 10.9), prematurity (OR = 3.4;CI = 1.5 - 7.3), abnormal presentation (OR = 2.6;CI = 1.1 - 5.9), ruptured membranes at admission (OR = 2.7;CI = 1.3 - 5.4), ruptured membranes >12 hours at admission (OR = 5.1;CI = 2.5 - 10.3), stained amniotic fluid (OR = 4.8;CI = 2.4 - 9.7), labor lasting more than 12 hours (OR = 18.1;CI = 8.0 - 41.0), presence of maternal complications (OR = 4.7;CI = 2.2 - 10.3), and presence of fetal complications (OR = 48.6;CI = 18.3 - 129), particularly acute fetal distress (OR = 52.3;CI = (14.6 - 186), cord prolapse (OR = 12.1;CI = 3.3 - 43.4), and birth weight <2500 g (OR = 2.8;CI = 1.2 - 6.6). Conclusion: Close attention should be offered to pregnant women, so as to identify these risk factors and promptly provide an appropriate management.

Prenatal Exposure to Polycyclic Aromatic Hydrocarbons and Birth Weight in China

Adverse birth outcomes are a leading cause of mortality in children in China, but the environmental influences of these conditions remain largely unexplained in this population. We aimed to evaluate the levels of polycyclic aromatic hydrocarbons (PAHs) in Chinese pregnant women and their newborns, and to examine the association between levels of PAHs and infant birth weight. We conducted a cross-sectional study including 81 pairs of mothers and newborns from four hospitals in four different cities in China. High Performance Liquid Chromatography was used to measure the concentration of nine PAHs in maternal and cord blood and multiple linear regression analyses were used to evaluate the associations of these PAHs with infant birth weight. Anthracene (ANT) had the highest average concentration and detection rate (geometric mean = 69.54 ng/g and 76.5%, respectively) in maternal serum samples, while fluoranthene (FLT) had the highest concentration and detection rate (geometric mean = 68.4 ng/g and 50.6%, respectively) in the cord blood. Most of the measured PAHs in maternal serum and three PAHs in cord blood were inversely but non-significantly associated with birth weight. The strongest associations were observed for higher concentrations of benzo (a) pyrene (BaP) in maternal serum (230.7 g decrease for levels > median vs. < LOD;p = 0.151) and for ANT in cord blood (153.1 g decrease for levels < median vs. < LOD;p = 0.208). Ant and FLT were the predominant PAHs in the maternal and cord blood serum. Serum concentrations of several measured PAHs were associated with a decreased birth weight, although not significantly, suggesting that further studies with larger sample sizes are needed to validate our findings.

The Fetal Outcome and Fetal Wastage Pattern among Different Types of Obstetric Fistula at the National Obstetric Fistula Centre, Abakaliki, Nigeria

BACKGROUND: Obstetric Fistula is a major public health problem in developing world. It is associated with a high fetal wastage rate. The objective of this study was to evaluate different types of obstetric fistula and their fetal wastage rate. METHOD: A retrospective population study was done at the National Obstetric Fistula Centre, Abakaliki between 1st January-31st December, 2016. The calculated minimum sample size was 3, however, the total number of 203 patients were studied. The case notes of all the women who had obstetric fistula repairs over the period were analyzed. RESULTS: The mean age from this study was 38 ± 12.1 years. The fetal wastage rate from this study was 82.76% while the live birth was 17.24%. Seventy percent of the stillbirth were delivered via SVD, while 11% of stillbirth were delivered through EmCS. Twelve different types of fistula were identified in this study using anatomical classifications. Large extensive fistula, urethral loss and multiple fistula had the highest fetal wastage of 100% respectively. This was followed by mid-vaginal fistula (95.7%), Juxtaurethral fistula 94.4%, Juxtacervical fistula 88.5%, Intracervical fistula 85.71%, Ureteric fistula 85.71%, Vesicouterine 84.21%, Vault fistula 62.5%. Rectovaginal fistula had the least fetal wastage of 15.79% and the highest live birth of 84.2%. CONCLUSION: The findings showed a high fetal wastage rate amongst women with obstetric fistula. There was high fetal wastage across different types of obstetric fistula. Rectovaginal fistula had the best outcome in terms of live births.

Maternal anxiety associated with fetal echocardiography

Background: Women awaiting fetal echocardiography (fECHO) report high anxiety. It is unclear if anxiety decreases after performance of fECHO. Methods: At fECHO, subjects’ current (state) vs baseline (trait) anxiety was assessed using the Spielberger State-Trait Anxiety Inventory. Anxiety scores of the pre- and post-fECHO groups were compared. Results: From January 2007 to January 2009, we recruited 84 subjects: 40 pre-fECHO and 44 post-fECHO. Of the post-fECHO group, 30 had normal fetal cardiac structure and function confirmed, 12 were told of an abnormality, and 2 were told to follow up equivocal results. Anxiety scores were compared between the 40 pre-fECHO subjects and the 30 post-fECHO subjects with normal results. The mean state anxiety score of the pre-fECHO group was higher than that of the post-fECHO group (42.1 ± 15.1 vs 30.8 ± 8.5, p < 0.001);there was no difference in trait scores. Neither state nor trait anxiety was associated with maternal age, parity, history of miscarriage or known fetal anomaly. Compared to those with a normal fECHO (N = 30), subjects with an abnormal fECHO result (N = 12) had higher state anxiety (46.8 ± 15.5 vs 30.8 ± 8.5, p = 0.005). There was no difference in anxiety scores between subjects awaiting fECHO and post-fECHO subjects who had an abnormal result. Conclusion: Immediately following normal fECHO, women report low anxiety compared with women awaiting fECHO. Women awaiting fECHO report anxiety levels that are as high as women who are told there is fetal cardiac anomaly.

Effect of Antenatal Depression on Fetal Growth Outcomes at the Jos University Teaching Hospital Jos, Plateau State, Nigeria

Background: Depression is the most prevalent psychiatric disorder in pregnancy and it is associated with psychosocial and obstetric factors. Studies have shown that pregnancy does not prevent women from becoming depressed;rather, it may be a time when depression occurs for the first time in some women. Antenatal depression has been identified as a risk factor for post natal depression, adverse obstetric outcomes, poorer neonatal outcomes and higher growth retardation in infants. Purpose: This study aimed to determine the fetal growth outcomes among depressed pregnant women in their third trimester attending antenatal clinic at the Jos University Teaching Hospital (JUTH), Jos, Plateau State, Nigeria. Method: A prospective cohort study design was used to assess 514 women who consented to the study (256 cases and 258 controls). A socio-demographic questionnaire was given to the women to fill out the study entry. Edinburgh Post Natal Depression Scale (EPDS) was used to screen for depression and MINI neuropsychiatric interviews were used to diagnose depression in those women found to be at risk of depression using the EPDS. Ultrasonography was used to determine the fetal weight in the third trimester of pregnancy. The birth weight of the babies born to the women was obtained from the birth register in the labor ward and the fetal growth rate was calculated from the estimated fetal weight on ultrasound scan in late pregnancy and the birth weight of babies. Result: The mean fetal weight in the third trimester for non-depressed women was slightly higher than in depressed women though the difference was not statistically significant (P = 0.431). The difference in the mean calculated fetal growth rate for fetuses of non-depressed women in the third trimester was statistically significantly higher than in depressed women (p = 0.000). Depressed women also had babies with lower birth weight than non-depressed women and the difference was statistically significant (p = 0.00).

Mortality in Fetal Alcohol Spectrum Disorders

Objective: Mortality in FASD has not been well studied. In this paper we review published reports of mortality in FASD. Method: We searched using Pub Med for all years in all languages for reports of all-cause mortality associated with any FASD. Results: We located 26 papers reporting on 57 deaths. Cause of death was reported for 49/57 cases (86%). The two most prevalent potential causes of death were malformations of the heart (37 of 49 cases, 75.5%) which varied from atrial septal defect or patent ductus arteriosus to tetralogy of Fallot, hypoplastic left heart, aortic arch interruption, etc. and brain malformations(25 of 49, 51%) including microcephaly, hydrocephalus, porencephaly, agenesis/absence of the corpus callosum and semilobar holoprosencephaly. In several cases potential causal findings overlapped. The three most frequent other causes of death were sepsis (7 cases, 14.3%), kidney malformations (7 cases, 14.3%), and cancer (4 cases, 8.2%). Over half the deaths (30/55, 54.5%) occurred in the first year of life. Discussion: We found that congenital heart disease was the most common cause of death in people with FASD. This may be due to an ascertainment bias since many of the published studies were focused on congenital heart disease in FASD. We conclude that FASD is frequently undetected in mortality events and could be a common finding in infant, child, adolescent and adult mortality.

Prevention of shoulder dystocia related birth injuries: Myths and facts

Traditionally, brachial plexus damage was attributed to excessive traction applied on the fetal head at delivery. Recently, it was proposed that most injuries occur spontaneously in utero. The author has studied the mechanism of neurological birth injuries based on 338 actual cases with special attention to(1) fetal macrosomia;(2) maternal diabetes; and(3) methods of delivery. There was a high coincidence between use of traction and brachial plexus injuries. Instrumental extractions increased the risk exponentially. Erb's palsy following cesarean section was exceedingly rare. These facts imply that spontaneous neurological injury in utero is extremely rare phenomenon. Literary reports show that shoulder dystocia and its associated injuries increased in the United States several-fold since the introduction of active management of delivery in the 1970's. Such a dramatic change in a stable population is unlikely to be caused by incidental spontaneous events unrelated to external factors. The cited investigations indicate that brachial plexus damage typically is traction related. The traditional technique which precludes traction is the optimal method for avoiding arrest of the shoulders and its associated neurological birth injuries. Effective prevention also requires meticulous prenatal care and elective abdominal delivery of macrosomic fetuses in carefully selected cases.

2 872对不同绒毛膜性双胎子代不良结局差异及影响因素分析

目的探讨不同绒毛膜性双胎子代不良结局发生的差异及其影响因素。方法选择2020年1月1日至12月31日,北京市妇幼保健网络信息系统中登记的2872例双胎妊娠孕妇及其子代为研究对象,所有孕妇均进行了早孕期绒毛膜性超声确认,并有明确妊娠结局。根据超声提示的双胎绒毛膜性将孕妇分为单绒毛膜双胎妊娠组(单绒组,n=642)和双绒毛膜双胎妊娠组(双绒组,n=2230)。比较单绒组和双绒组子代不良结局(<28周流产、围产期死亡、双胎均死亡和出生缺陷等)的差异,对影响单绒组和双绒组子代不良结局差异的影响因素进行多因素分析。结果单绒组和双绒组子代发生<28周流产率(分别为15.0%、9.0%,OR=1.85,95%CI:1.50~2.27)、围产期死亡率(分别为1.0%、0.4%,OR=3.22,95%CI:1.45~7.12)和双胎均死亡率(分别为12.0%、4.6%,OR=2.71,95%CI:1.91~3.83)的风险高于双绒组子代;子代不同孕周死亡风险由高到低依次为孕14~27周、孕14周前、孕28~33周和孕≥34周,单绒组子代死亡风险均高于双绒组。单绒组子代出生缺陷发生风险高于双绒组但差异无统计学意义(7.3%比6.7%,OR=1.04,95%CI:0.80~1.35)。结论单绒双胎妊娠在子代流产、围产期死亡和双胎均死亡的风险均高于双绒双胎妊娠,早孕期开始超声筛查确定绒毛膜性、中孕期加强定期检查和胎儿畸形筛查、晚孕期持续加强对每一个胎儿的关注并适时终止妊娠,对于改善双胎子代结局有积极意义。

胎儿先天性畸形的诊治

先天性畸形是导致婴幼儿死亡和先天残疾的主要原因之一,严重影响儿童生存和生活质量。随着医学影像学、临床遗传学和分子生物学等产前诊断技术的快速发展,越来越多的胎儿先天性畸形可在妊娠期得以筛查和诊断。部分胎儿先天性畸形在宫内迅速恶化,且出生后缺乏有效的治疗方法,预后较差。胎儿宫内治疗能有效阻止胎儿疾病恶化所导致的不可逆性胎儿损伤或死亡,为产后治疗创造有利条件。对胎儿先天性畸形做出尽可能精准的诊断和评估,进行有效预防和早期干预,有望降低出生时死亡率,改善患儿预后,提高生命质量。文章从宫内胎儿先天性畸形诊治的发展、宫内胎儿结构畸形的临床诊治概念和常见宫内胎儿结构畸形诊治的临床应用等三方面进行阐述,以期为临床开展相关工作提供参考。

巨大儿发生率及其影响因素研究

[目的]探讨巨大儿发生率及产妇分娩巨大儿的危险因素,为尽早识别出高风险产妇、预防巨大儿发生提供参考。[方法]收集曲靖市妇幼保健院2021年1月1日-12月31日在院分娩的7590例孕产妇,选取与出生体重有关的孕期相关危险因素,采用非条件Logistic回归分析危险因素的聚集情况。[结果]分娩巨大儿的产妇中,62.87%的产妇出现危险因素的聚集,当有2种危险因素聚集时,即年龄≥30岁有妊娠合并肥胖的产妇(OR=9.282,P<0.05)、妊娠糖尿病的经产妇(OR=9.282,P<0.05)分娩巨大儿的风险最高;3种因素聚集时,即身高≥160 cm合并妊娠肥胖的经产妇(OR=22.277,P<0.05)分娩巨大儿的风险最高;4种因素聚集时,即年龄≥30岁合并妊娠肥胖和妊娠糖尿病的经产妇(OR=18.564,P<0.05)分娩巨大儿的风险最高;有5种危险因素的产妇(OR=25.315,P<0.05)分娩巨大儿的风险高于其他所有产妇。[结论]孕期危险因素聚集可升高发生巨大儿的风险,孕期应及早识别并重视有风险特征的产妇,加强健康教育和孕期保健,减少巨大儿的发生。

经阴道超声联合胎儿纤维连接蛋白预测自发性早产的临床价值

目的分析经阴道超声测量子宫宫颈前角(ACA)、宫颈长度(CL)联合胎儿纤维连接蛋白(f FN)预测自发性早产(SPB)的临床价值。方法选取2019年6月~2022年6月我院收治的98例先兆早产孕妇为研究对象,根据是否发生SPB将其分为SPB组(n=33)和足月组(n=65)。采用单因素及Logistic多因素回归分析先兆早产孕妇发生SPB的风险因素。通过绘制ROC曲线评估ACA、CL及f FN对SPB的预测效能。结果经单因素分析,两组孕前BMI、胎膜早破、宫内感染、羊水过多、妊娠期糖尿病情况及ACA、CL、fFN水平的差异有统计学意义(P<0.05)。经Logistic多因素回归分析,胎膜早破、ACA、fFN是先兆早产孕妇发生SPB的风险因素(OR>1,P<0.05),孕前BMI、CL是先兆早产孕妇发生SPB的保护因素(OR<1,P<0.05)。ROC曲线显示,当ACA≥116.500°时,预测先兆早产孕妇发生SPB的AUC为0.630,敏感度为48.5%,特异性为69.2%。当CL≤25.000 mm时,AUC为0.667,敏感度为54.5%,特异性为73.8%。当fFN≥96.155μg/L时,AUC为0.652,敏感度为60.6%,特异性为69.2%。三者联合预测的AUC为0.740,敏感度为72.7%,特异性为75.4%。结论经阴道超声测量ACA、CL及f FN水平均对预测先兆早产孕妇发生SPB具有一定预测价值,且三者联合预测效能更佳。

团体认知行为治疗对妊娠期糖尿病孕妇妊娠结局的影响:一项倾向性评分匹配研究

背景妊娠期糖尿病(GDM)是妊娠期常见的并发症,在GDM孕妇中实施单纯的个体化医学营养治疗依从性较差,团体认知行为治疗(GCBT)对GDM孕妇妊娠结局的影响尚不明确。目的探讨团体认知行为治疗在GDM妊娠结局中的作用,为改善妊娠结局并制定有效的GDM管理方案提供参考依据。方法回顾性选取2020—2021年接受个体化医学营养治疗并在本院分娩的878例GDM孕妇为研究对象,接受GCBT的GDM孕妇为观察组(n=141),未接受GCBT干预的GDM孕妇为对照组(n=737),分析倾向性评分匹配前后两组GDM孕妇妊娠结局差异。结果通过1∶2倾向性评分匹配后观察组GDM孕妇134例,对照组GDM孕妇256例。匹配后,观察组GDM孕妇增重正常比例(50.7%,68/134)高于对照组(37.5%,96/256)(χ^(2)=6.334,P<0.05);观察组GDM孕妇分娩孕周〔(39.0±1.1)周〕长于对照组〔(38.5±1.7)周〕(t=3.080,P<0.05),早产儿(3.7%)、巨大儿(1.5%)、低出生体质量儿(2.2%)比例低于对照组(10.5%,5.9%,9.0%)(P<0.05)。结论GCBT可降低GDM孕妇分娩早产儿、低出生体质量儿及巨大儿的发生可能,为建立GDM多学科管理模式提供参考依据。