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).

基于超声血流参数评估晚发型胎儿宫内生长受限的研究

目的分析超声血流参数对晚发型胎儿宫内生长受限(FGR)的预测价值。方法选取2020年6月至2022年6月青海大学附属医院收治的82例晚发型FGR孕产妇作为研究对象。根据新生儿妊娠结局分为结局良好组(51例)与结局不良组(31例)。另选取同期在青海大学附属医院产检且胎儿生长正常的32例孕产妇作为对照组。比较3组基线资料及分娩前最后1次超声的大脑中动脉搏动指数(MCA-PI)、脐动脉搏动指数(UA-PI)、脑-胎盘血流比(CPR)、心血管整体评分(CVPS)、Hadlock胎儿体质量估测(EFW),绘制受试者工作特征(ROC)曲线评估上述超声血流参数对晚发型FGR孕产妇不良妊娠结局的预测价值。结果结局不良组新生儿出生体质量均低于结局良好组及对照组,且结局良好组低于对照组,差异均有统计学意义(P<0.05)。结局不良组分娩孕周短于对照组和结局良好组,差异均有统计学意义(P<0.05)。结局不良组MCA-PI、CPR、CVPS、EFW均低于结局良好组及对照组,且结局良好组低于对照组,差异均有统计学意义(P<0.05)。结局不良组UA-PI高于结局良好组及对照组,且结局良好组高于对照组,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,MCA-PI、UA-PI、CPR、CVPS、EFW单独预测晚发型FGR孕产妇不良妊娠结局的曲线下面积分别为0.667、0.792、0.762、0.820、0.917。结论超声血流参数MCA-PI、UA-PI、CPR、CVPS、EFW均对晚发型FGR孕产妇不良妊娠结局有一定预测价值,其中CVPS及EFW预测价值较高,可为临床治疗及判断分娩时机提供重要依据。

预测胎儿体质量实用进展

产前能否准确预测胎儿体质量,及早发现巨大儿,对选择分娩方式、避免母亲软产道损伤,减少产后出血,减少感染,减少胎儿产程中肩难产、臂丛神经损伤、锁骨骨折、颅内出血、新生儿窒息等具有十分重要的意义。及早发现胎儿生长受限,可以减少围生儿病死率、降低胎儿出生缺陷发生率、可早诊断、早干预减少新生儿后遗症的发生。现对对胎儿体质量估计的众多的测量方法进行综述。

Establishing Chinese Fetal Growth Standards: Why and How

Choosing a fetal growth standard or reference is crucial when defining normal and abnormal fetal growth.We reviewed the recently published standards and compared them with a customized fetal growth chart based on a nationwide population in China.There were substantial discrepancies in the fetal growth pattern,suggesting that these standards may not be applicable to Chinese fetuses.Developing a Chinese-specific standard may better meet our clinical requirements.We also discuss the steps to establish a Chinese fetal growth standard and the potential challenges,including regional disparities and accuracy of sonographic estimated fetal weight.Standardized ultrasound measurement protocol and the introduction of new ultrasonography technology may be helpful in developing a more precise standard than existing ones for the Chinese population.

孕晚期胎儿脐静脉标准化血流率对其体质量增长速度的预测价值分析

目的 超声测量孕晚期胎儿脐静脉参数,探讨标准化血流率(nQuv)对其体质量增长速度(EFWG)的预测价值。方法 采用前瞻性队列研究,对2020年1月—2020年12月在成都市龙泉驿区妇幼保健院超声科的94例孕晚期正常入选胎儿进行两次超声测量(孕周分别为29~32周6 d、36~39周6 d)。通过测量胎儿双顶径、头围、腹围及股骨长,获取胎儿体质量(EFW)和体质量增长速度(EFWG);通过测量脐静脉内径(Duv)、平均流速(Vuv),获取Quv和nQuv。采用Pearson相关性分析法分析胎儿脐血流参数与胎儿体质量的相关系数,为QUV-EFW和nQuv-EFWG的选择最佳拟合曲线,建立回归方程式。结果 (1)成功获得94例孕晚期正常胎儿脐静脉血流参数Duv、Quv及nQuv的均值(0.562±0.09;340.23±128.03;201.75±58.49)以及90%可信区间。(2)胎儿Quv与头围HC明显相关(r=0.55,P<0.01),Quv与腹围AC显著相关(r=0.66,P<0.01),同时,Quv与体质量EFW显著相关(r=0.68,P<0.01),以上3组相关性以Linear线性拟合度最高。(3)胎儿体质量增长速度EFWG与脐血流标准率nQuv显著相关(r=0.61,P<0.01),相关性以Linear线性拟合度最高。结论 孕晚期的胎儿脐静脉标准化血流率对胎儿体质量增长速度有一定的预测价值,可以为孕晚期胎儿生长发育趋势和妊娠结局提供更多的参考。

胎儿生长受限的筛查

胎儿生长受限危害胎儿存活及健康,越来越受到围产工作者的关注,胎儿生长受限的筛查有助于针对筛查高风险孕妇加强监护,降低晚孕期死胎、死产和新生儿死亡。文章就目前胎儿生长受限筛查的意义和常见的筛查方法及进展作一综述。

超声估测胎儿体重和多普勒参数评价晚发型胎儿生长受限的临床价值

目的探讨INTERGROWTH和Hadlock胎儿体重估测（estimated fetal weight，EFW）标准以及多普勒参数预测晚发型胎儿生长受限（fetal growth restriction，FGR）的准确性。方法本研究为前瞻性队列研究。收集2015年3月至2016年3月在复旦大学附属妇产科医院建卡并分娩的32～41周单胎妊娠孕妇。每2周监测超声指标（包括胎儿生长测量、脐动脉和大脑中动脉），采用分娩前7d内最后一次超声测量值，分别按照INTERGR0WTH和Hadlock标准计算胎儿体重，同时采用Logistic回归方程建立EFW、脐动脉、大脑中动脉单参数模型和多参数联合模型预测晚发型FGR。根据新生儿出生体重是否低于同胎龄应有体重第10百分位数（〈10^th％），分为FGR组（晚发型FGR，出生体重〈10^th％）和对照组（非FGR，出生体重≥10^th％）。并对两种标准预测FGR行ROC曲线分析。结果820例孕妇符合人组条件，排除144例失访病例。最终获得有效数据676例，分为FGR组116例，对照组560例。ROC曲线分析显示，Hadlock—EFWc预测晚发型FGR的截断值为22．6^th％，对应的敏感性、特异性和曲线下面积（AUC）分别为87．3％、82．8％和0．930（0．908—0．953），均高于INTERGROWTH—EFWc的预测价值[截断值为27．5^th％，对应的敏感性、特异性和AUC分别为71．4％、83．7％和0．847（0．807—0．888）]。多普勒参数单独预测晚发型FGR的价值较低（均AUC〈0．7），多参数联合模型（combined model—Ⅰ和Ⅱ）预测FGR的价值较高（AUC分别为0．865和0．936），与其对应的胎儿体重预测模型的准确性相似。结论Hadlock和INTERGROWTH的EFW标准预测本地区晚发型FGR的临床价值均较高，但是Hadlock标准的预测准确性更优。多普勒参数（脐动脉、大脑中动脉）预测晚发型FGR的准确性较低，建议高危孕妇选择性监测。