Growth Hormone Treatment, Cardiovascular Risk and Autonomic Maturation in Children and Adolescents with Growth Hormone Deficiency or Born Small for Gestational Age

Introduction: The impact of growth hormone therapy in children with short stature on cardiovascular prognosis seems to be unpredictable from big databases. The enhanced cardiovascular risk in this group of patients may be related to adverse autonomic imprinting by early life stress. Autonomic dysfunction and possible effects of growth hormone therapy on the autonomic nervous system can be measured easily by calculating heart rate variability (HRV) from Holter electrocardiogram monitoring. Methods: We performed HRV analysis prior to growth hormone therapy (N = 33), within the first year of growth hormone therapy between 4 and 10 years of age (N = 19), at least a further HRV measurement between 10 and 15 years (N = 30). Additional measurements were performed before and after cessation of growth hormone therapy (N = 14). Data were compared to untreated pediatric patients with short stature and to age matched healthy controls. Results: Untreated patients with short stature due to growth hormone deficiency or intrauterine growth restriction in early childhood have significantly increased heart rates most of all at night and concomitantly reduced global HRV indicated as Standard Deviation of Normal to Normal Intervals (SDNN). Growth hormone treated adolescents and the untreated patients with short stature show significantly elevated mean heart rates and concomitantly reduced vagus activities measured as reduced Route Mean Square Standard Deviation (RMSSD). After cessation of growth hormone treatment SDNN significantly increases and heart rate decreases to normal values in formerly treated patients with catch-up growth. Conclusion: There is a comparable autonomic dysfunction in treated and untreated children with short stature as an indicator for enhanced cardiovascular risk. After cessation of growth hormone therapy, we found a significant improvement of reduced HRV to normal values.

Morden Management of Inflammatory Bowel Disease in Pregnancy: A Practical Review for Obstetricians

Inflammatory bowel disease (IBD) is a chronic, sometimes debilitating condition that affects mainly the young population. The effect of IBD on pregnancy is therefore an important clinical issue. Many Obstetricians are likely to come across the occasional patient with this chronic condition. The following article discusses the salient factors which need to be considered in pregnant women with IBD and serves as a quick, practical but nevertheless comprehensive guide for the practicing Obstetrician.

Peak systolic velocity Doppler of middle cerebral artery in small for gestational age （SGA） fetus

BACKGROUND： Small for gestational age （SGA） has high frequency which increases the risk of long-term adverse outcomes. Thus the aim of this study was to evaluate peak systolic velocity Doppler of middle cerebral artery （MCA） in SGA fetus in order to find appropriate method to diagnosis SGA sooner. MATERIALS and METHODS： This prospective longitudinal study was conducted on 90 pregnant women with a diagnosis of SGA fetus and 90 pregnant women with normal fetus. Then MCA and umbilical artery assessment were performed for all subjects and compared between two groups. RESULTS： Doppler assessment showed that umbilical artery PI was significantly higher in SGA group as compared to normal group （1.114-0.37 vs 0.984-0.18, P = 0.003）, while MCA PI was significantly lower in SGA group （1.77±0.44 vs 1.92±0.47, P = 0.028）. On the other hand, PSV did not differ between the groups （P = 0.592）. Moreover, we found that PSV was more in SGA group by grouping maternal age （〈 27 years） （P = 0.006）, and gestational age （〉 34 weeks） （P 〈 0.001）. CONCLUSION： The results of this study suggest that MCA PI decreased significantly in SGA fetuses, while UA PI increased in this group. Moreover, PSV increased in this group when evaluated in different subgroups （based on maternal age and gestational age）.

妊娠期糖尿病患者妊娠早期TyG指数与分娩小于胎龄儿的相关性

目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)患者妊娠早期甘油三酯葡萄糖指数(the triglyceride-gluscose index,TyG指数)与分娩小于胎龄儿(small for gestational age infant,SGA)之间的关系。方法选取2018年1月至2023年6月复旦大学附属上海市第五人民医院和新疆喀什地区第二人民医院产科孕早期建档并符合纳入标准的孕妇1532例为研究对象,根据孕妇24~28周行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)结果,将其分为GDM组(754例)及非GDM组(778例)。GDM组患者根据新生儿体重,将其分为SGA组、大于胎龄儿(large for gestational age infant,LGA)组和适于胎龄儿(appropriate for gestational age infant,AGA)组。分析GDM患者分娩SGA的独立影响因素,采用Logistic回归模型分析TyG指数与发生SGA的相关性。绘制ROC曲线以分析妊娠早期TyG指数对GDM患者分娩SGA的预测价值。结果GDM患者SGA组TyG指数显著低于LGA组、AGA组及非GDM组(P<0.05);多因素Logistic回归分析结果显示,TyG指数与GDM患者分娩SGA的发生独立相关(P<0.05);ROC曲线结果显示,妊娠早期TyG指数对GDM患者分娩SGA具有较好的预测价值(AUC=0.821,95%CI:0.763~0.879,P<0.001)。结论GDM患者妊娠早期TyG指数与分娩SGA之间存在独立相关,对于GDM患者分娩SGA具有较好的预测价值。

Vγ9Vδ2-T lymphocytes have impaired antiviral function in small-for-gestational-age and preterm neonates

Preterm and small-for-gestational-age （SGA） neonates are vulnerable groups that are susceptible to various microbial infections. Vγ9Vδ2-T cells are critical components of the host immune system and have been demonstrated to play an important role in the defense against viral infection in adults. However, the characteristics of Vγ9Vδ2-T cells in children, especially the preterm and SGA populations, are poorly understood. Here, we examined the frequency and antiviral function of Vγ9Vδ2-T cells in neonates, including preterm, SGA and full-term babies. When compared to adults, neonates had a significantly lower percentage of Vγ9Vδ2-T cells in the blood. Upon influenza virus stimulation, neonatalVγ9Vδ2-T cells, especially from preterm and SGA babies, showed markedly decreased and delayed antiviral cytokine responses than those of adults. In addition, the antiviral responses of neonatal Vγ9Vδ2-T cells were positively correlated with gestational age and birth weight. Finally, a weaker expansion ofVγ9Vδ2-T cells by isopentenyl pyrophosphate （IPP） was shown in neonates than the expansion in adults. Our data suggest that the depressed antiviral activity and decreased frequency of Vγ9Vδ2-T cells may likely account for the high susceptibility to microbial infection in neonates, particularly in preterm and SGA babies. Improving Vγ9Vδ2-T -cell function of neonates may provide a new way to defend against virus infection.

早产SGA在1岁时体格及神经发育追赶状况研究

目的 探讨早产小于胎龄儿（ SGA）1岁时体格发育和神经发育的追赶状况，为早产儿发育提供干预依据。方法 根据早产儿出生体重和胎龄，将早产儿分为早产SGA组（35例）和早产适于胎龄儿（AGA）组（71例），随访至校正年龄12个月，比较两组早产儿身长和体重追赶差异，生长迟缓发生率及精神运动发育指标的差异。结果 校正年龄12个月时，SGA组早产儿体重低于AGA组[（9．70±1．41）kg vs （11．03±3．52）kg]，且差异有统计学意义（t＝－2．148，P＜0．05）；体重增长迟缓的发生率高于AGA组（31．4％vs 12．7％），且差异有统计学意义（χ^25．385，P＜0．05）；两组身长差异无统计学意义（P＞0．05）。 SGA组智能发育指数低于AGA组[（79．4±10．9）分vs （85．3±16．1）分]，且差异有统计学意义（t＝－2．409，P＜0．05）；运动发育指数较AGA组低，但差异无统计学意义（P＞0．05）。结论 1岁时早产SGA体重增长和智能发育指数仍较早产AGA落后，应加强出院后营养监测和早期精神运动功能训练，促进早产儿综合发育。

Multiple Sclerosis in Pregnancy—A Practical Guide for the Obstetrician

Technological advances, a deeper understanding of disease processes and increased sophistication of therapeutic methods have all led to better outcomes in rare diseases which previously had devastating effects on many women’s lives. The inevitable result of this progress is that women, who in the past did not contemplate pregnancy because of significant morbidity, now get to adulthood and are reasonably “disease free” enough to have their own families. The ever expanding, but relatively new specialty of Obstetric medicine seeks to further improve the outcome in pregnant women with intercurrent disease by enhancing the literature base, thereby contributing to the creation of appropriate guidance in the management of these patients. This article is a brief but useful guide for the busy obstetrician who may have limited experience in dealing with multiple sclerosis in pregnant women.

Influential and prognostic factors of small for gestational age infants

Background Small for gestational age （SGA） infants are associated with a high rate of oligohydramnios, stillbirth and cesarean delivery. Among SGA patients there is a higher risk of neonatal complications, such as polycythemia, hyperbilirubinemia, and hypothermia. Additionally, the SGA infant is prone to suffer from major neurologic sequelae, as well as cardiovascular system disease, in later life. Proper monitoring and therapy during pregnancy are, therefore, of utmost importance. The present study aimed to investigate the influential and prognostic factors of SGA infants.Methods From January 2001 to June 2007, a total of 55 SGA neonatal infants were included in a study group. All were born at Peking Union Medical College Hospital, with regular formal antenatal examinations. In addition, a total of 122 cases of appropriate for gestational age （AGA） infants were born at the same time and were registered into a control group. All cases were singleton pregnancies with detailed information of the maternal age, gravidity, parity, maternal height and weight, complications, uterine height and abdominal circumference, results from transabdominal ultrasonography between 32-38 gestational weeks, pregnancy duration, delivery manner, placenta, umbilical cord, and neonatal complications.Results Significant differences were observed in placenta weight and neonatal malformations between the study and control groups. Multivariate analysis revealed increased parity, maternal hyperthyroidism and hyperthyroidism history as risk factors. Fetal abdominal circumferences less than 30 and 32 cm at 32-38 gestational weeks respectively, as determined by ultrasonography, resulted in a Youden index of 0.62. Conclusions SGA infants were associated with a greater risk of smaller placentas and infant malformations. Increased parity, maternal hyperthyroidism, and a hyperthyroid history were risk factors for SGA infants. Fetal abdominal circumference less than 30 cm at 32 gestational weeks and less than 32 cm at 38 weeks, as determined by ultrasonograohy, was considered an effective index for SGA.

Men becoming fathers by injection were more often age intracytoplasmic sperm born small for gestational

Being born with nonoptimal birth characteristics decreases the chance of becoming a father. Urogenital malformations as well as metabolic syndrome are more common in men born small for gestational age （SGA） and could be contributing factors to the reduced fertility rate seen in these men. It could imply that men becoming fathers by assisted reproductive technology （ART） more often are born with low birth weight （LBW）, preterm, and/or SGA than men conceiving without treatment and also that men where intracytoplasmic sperm injection （ICSI） had to be performed more often are born with nonoptimal birth characteristics than men where conventional in vitro fertilization （IVF） successfully could be used. In this retrospective, case-control study using Swedish national registers, we compared the birth characteristics of 1206 men who have become fathers by ART with a control group consisting of age-matched men who became fathers without treatment. The differences in birth characteristics between men becoming fathers by IVF and ICSI were also assessed. For men becoming fathers by ART, OR of being born with LBW was 1.66 （95% CI = 1.17-2.36） compared with fathers who conceived without treatment. OR of being born prematurely was 1.32 （95% CI = 1.00-1.77）. Men becoming fathers via ICSI had a doubled increased likelihood of being born SGA compared with men who became fathers via IVF （OR = 2.12; 95% CI = 1.17-3.83）. In conclusion, we have found that men becoming fathers by ICSI treatments had more often been born SGA than men becoming fathers by conventional IVF.

Neonatal hemorrhage stroke and severe coagulopathy in a late preterm infant after receiving umbilical cord milking:A case report

BACKGROUND Umbilical cord milking(UCM)is an alternative placental transfusion method for delayed umbilical cord clamping in routine obstetric practice,allowing prompt resuscitation of an infant.Thus,UCM has been adopted at some tertiary neonatal centers for preterm infants to enhance placental-to-fetal transfusion.It is not suggested for babies less than 28 wk of gestational age because it is associated with severe brain hemorrhage.For late preterm or term infants who do not require resuscitation,cord management is recommended to increase iron levels and prevent the development of iron deficiency anemia,which is associated with impaired motor development,behavioral problems,and cognitive delays.Concerns remain about whether UCM increases the incidence of intraventricular hemorrhage.However,there are very few reports of late preterm infants presenting with neonatal hemorrhage stroke(NHS)and severe coagulopathy after receiving UCM.Here,we report a case of a late preterm infant born at 34 wk of gestation.She abruptly deteriorated,exhibiting signs and symptoms of NHS and severe coagulopathy after receiving UCM on the first day of life.CASE SUMMARY A female preterm infant born at 34 wk of gestation received UCM after birth.She was small for her gestational age and described as vigorous with Apgar scores of 9 and 10 at one minute and five minutes of life,respectively.After hospitalization in the neonatal intensive care unit,she showed hypoglycemia and metabolic acidosis.The baby was administered glucose and sodium bicarbonate infusions.Intramuscular vitamin K1 was also used to prevent vitamin K deficiency.The baby developed umbilical cord bleeding and gastric bleeding on day 1 of life;a physical examination showed bilateral conjunctival hemorrhage,and a blood test showed thrombocytopenia,prolonged prothrombin time,prolonged activated partial thromboplastin time,low fibrinogen,raised D-dimer levels and anemia.A subsequent cranial ultrasound and computed tomography scan showed a left parenchymal brain hemorrhage with extension into the ventricular and subarachnoid spaces.The patient was diagnosed with NHS in addition to disseminated intravascular coagulation(DIC).Fresh frozen plasma(FFP)and prothrombin complex concentrate were given for coagulopathy.Red blood cell and platelet transfusions were provided for thrombocytopenia and anemia.A bolus of midazolam,intravenous calcium and phenobarbital sodium were administered to control seizures.The baby’s clinical condition improved on day 5 of life,and the baby was hospitalized for 46 d and recovered well without seizure recurrence.Our case report suggests that preterm infants who receive UCM should undergo careful clinical assessment for intracranial hemorrhage,NHS and severe coagulopathy that may develop under certain circumstances.Supportive management,such as intensive care,FFP and blood transfusion,is recommended when the development of massive NHS and associated DIC is suspected.CONCLUSION Our case report suggests that for late preterm infants who are small for gestational age and who receive UCM for alternative placental transfusion,neonatal health care professionals should be cautious in assessing the development of NHS and severe coagulopathy.Neonatal health care professionals should also be more cautious in assessing the complications of late preterm infants after they receive UCM.

Prior Preterm Birth and Birthweight Below the 5 th Percentile are Independent Risk Factors for Recurrence of a Small for Gestational Age Neonate

Objective::This study aimed to determine:(1)whether recurrent deliveries of a small for gestational age(SGA)neonate are associated with increased obstetrical or neonatal complications;(2)whether the risk factors that can predict small for gestational age(SGA)recurrence.Methods::This study was based on Soroka Medical Center's Obstetrics electronic database.The database consisted of 109022 women who had 320932 deliveries between the year 1988-2014.The study cohort included 6.8%(7368/109022)of these patients who gave birth to a singleton SGA neonate on their first delivery and had more than one delivery.The study population was divided into two groups according to the outcome of the subsequent delivery:(1)women with sporadic SGA who delivered a non-SGA neonate(n=5416);(2)women with recurrent SGA(n=1952).SGA defined as birthweight<10 th percentile.Maternal and neonatal complications were compared between the two groups.Logistic regression was used to determine independent risk factors for SGA recurrence.Results::The prevalence of birthweight<5 th percentile was higher among the recurrent SGA group in the first delivery(P<0.001).Bedouin ethnicity was more prevalent in the recurrent SGA group(P<0.001).The rate of preterm delivery was higher in the first delivery of the recurrent SGA group(P=0.015).The sporadic SGA group had a higher rate of perinatal mortality during the first pregnancy(P=0.017).The rate of severe hypertension(P=0.005),polyhydramnios,meconium-stained amniotic fluid,nonreassuring fetal heart rate and total perinatal mortality(P<0.001)were higher in the second delivery of the recurrent SGA group.In a logistic regression model,preterm delivery and birthweight<5 th percentile at the first delivery was found to be independent risk factors for recurrence of an SGA neonate in the subsequent birth(relative risks:1.530,confidence interval:1.249-1.875;relative risks:1.826,confidence interval:1.641-2.030,respectively).Conclusion::Women with recurrent SGA neonates have specific clinical characteristics.Among women who deliver an SGA neonate,preterm delivery,and birthweight<5 th percentile are independent predictors for its recurrence.

匀称型和非匀称型婴儿智能发育观察

目的 根据中华儿科杂志小于胎龄儿 (SGA)的临床分型对 43例 SGA进行临床分型并观察其智能发育情况。方法 应用 Bayley婴儿发育量表对不同临床分型的SGA婴儿的智能发育进行评价。结果 匀称型 SGA其两种临床分型方法的符合率达到72 .0 9% ,而体重、头围和身高均在该胎龄值的第 10百分位以下婴儿仅占 32 .5 6 % ,其精神发育指数 (MDI)和心理运动发育指数 (PDI)均较低。匀称型 SGA的 MDI和 PDI高于非匀称型。结论 对目前

89例早产儿矫正月龄2岁内体格发育纵向研究

目的了解早产儿0~2岁纵向生长发育特点,为早产儿生长发育监测和营养指导提供参考依据。方法选取2012年7月至2013年6月在四川省妇幼保健院出生,在儿保科随访的89例早产儿为研究对象,并按照出生时胎龄和体重将其分为小于胎龄早产儿组(SGA,29例)和适于胎龄早产儿组(AGA,60例)。进行0~24月龄生长发育监测,包括体重、身长、头围测量和喂养咨询指导,共完成12次随访。结果 (1)SGA组早产儿在大部分矫正月龄身长、体重、头围值和年龄别体重Z值(WAZ)、年龄别身长Z值(HAZ)、年龄别头围Z值(HCZ)均低于AGA组早产儿,且差异有统计学意义(体重:t=-5.24^-3.15,均P<0.05;身长:t=-5.23^-2.95,均P<0.05;头围:t=-2.91^-2.01,均P<0.05;WAZ:t=-5.93^-3.07,均P<0.05;HAZ:t=-5.51^-4.01,均P<0.05;HCZ:t=-3.52^-2.36,均P<0.05)。(2)SGA组在绝大多数矫正月龄,WAZ、HAZ和HCZ均为负值。AGA组早产儿WAZ和HCZ在大多数矫正月龄为正值,而HAZ在矫正3月龄前为正值,3月龄后均为负值。(3)比较两组早产儿体格发育的增长速率发现,3~4月龄段,SGA组体重、身长和头围的增长速率值低于AGA组,两组差异有统计学意义(t值分别为-2.57、-4.23、-2.73,均P<0.05),SGA组在5~6月龄身长增长速率值、8~10月龄头围增长速率值、10~12月龄体重和头围增长速率值均低于AGA组,两组差异有统计学意义(t值分别为-3.03、-2.36、-3.42、-2.48,均P<0.05)。18~24月龄段,SGA组体重、身长的增长速率值低于AGA组,两组差异有统计学意义(t值分别为-3.73、-2.91,均P<0.05)。(4)比较两组早产儿体格发育的增速发现,在出生1个月内,SGA组体重的△Z值明显大于AGA组(t=2.63,P<0.05),而SGA组在3~4月龄体重、身长和头围的△Z值,12~18月龄体重和头围的△Z值,18~24月龄体重、身长和头围的△Z值低于AGA组早产儿,两组差异均有统计学意义(t值分别为-2.72、-3.23、-2.63、-2.52、2.26、-2.73、3.61、2.91,均P<0.05)。结论 AGA早产儿追赶生长持续到2岁,SGA早产儿1岁内追赶生长明显,其生长潜能落后于AGA早产儿。在临床工作中应重视早产儿尤其SGA早产儿的追赶生长发育。

小于胎龄儿出生后48—72小时血清脂肪酸成分的改变

本文用气相色谱法测定了29例小于胎龄儿(SGA)和57例适于胎龄儿(AGA)脐血清及出生后48～72小时的静脉血清总脂肪酸(TFA)和游离脂肪酸(FFA)的成分,以了解SGA儿出生后脂肪酸代谢特点,更好地指导喂养。 SGA儿和AGA儿生后48～72小时静脉血清C18∶2 φ6、C20∶4φ6、C18∶3φ和C22∶6φ3百分含量显著低于出生时水平,可能系营养源改变、体内有关去饱和酶活性不足及脑组织对必需脂肪酸(EFA)之需求所致,提示生后一段时间的SGA儿与AGA儿都有可能发生EFA缺乏。生后AGA儿血清EFA浓度显著高于脐血清,而SGA此时浓度与出生时无明显差异,提示SGA儿更易发生EFA缺乏,须强调出生后喂养。

不同孕周新生儿出生体重分析

目的了解不同孕周新生儿出生体重的现况及其变化规律,为妇幼卫生保健工作提供科学依据。方法收集2005年1月至2014年12月湖北省妇幼保健院产科分娩的88 365例新生儿资料进行分析。结果孕41周出生的新生儿平均出生体重最重,达3 512.55±383.03g。孕41周之前,新生儿平均出生体重随孕周增加而增加,其增速在第31周、34周及37周时出现3个高峰,分别增重195.97±25.76g、219.48±15.67g、277.64±8.66g。从42周开始,出生体重逐渐减轻。不同孕周新生儿平均出生体重的差异具有统计学意义(F=4 297.65,P<0.0001)。在早产儿、足月儿及过期产儿三组中,小于胎龄儿(SGA)的发生率分别为11.17%、4.59%、8.75%;大于胎龄儿(LGA)的发生率分别为4.24%、21.21%、10.17%。SGA、适于胎龄儿(AGA)及LGA的构成比在三组中的分布不同,其差异具有统计学意义(χ2=2 185.65,P<0.0001)。结论新生儿平均出生体重随孕周延长而增加有一定的规律。在我国应加强产前教育,避免无必须医学指征的提前分娩,进一步研究胎儿生长规律,积极采取措施增加新生儿的出生体重,可以进一步提高我国出生人口质量。

140例小于胎龄儿高危因素及并发症分析

目的 探讨小于胎龄儿（SGA）的高危因素及围产期并发症。方法应用病例对照方法回顾性分析西安交通大学医学院新生儿科2011年1月至12月间的小于胎龄儿140例和适于胎龄儿140例临床资料，采用SPSS13．0统计软件进行SGA危险因素及并发症分析。结果SGA发病率6．69％，男女发病率无显著性差异（P=0．17〉0．05）。通过对22个单因素分析发现羊水量少、脐带异常、孕母妊娠高血压疾病、既往不良产史、父亲吸烟情况及母亲职业等6个因素有统计学意义（P〈0．05）。通过对以上因素进行Logistic回归分析，发现妊娠期高血压疾病（X2=23．781，P〈0．001）、羊水量少（P=0．003）、脐带异常（P=0．019）和母亲职业（P=0．013）是sGA的独立危险因素。SGA组各种围产期并发症发生率均高于AGA组，在高胆红素血症（P=0．046）、胎粪排出延迟（P=0．002）、新生儿呼吸窘迫综合征（P=0．010）、呼吸暂停（P=0．032）方面有统计学差异。结论妊娠期高血压疾病、羊水量、脐带异常和母亲职业是SGA的高危因素。新生儿高胆红素血症、胎粪排出延迟、新生儿窒息和新生儿呼吸窘迫综合症是SGA常见的并发症。

足月小于胎龄儿Ghrelin及IGF-1水平与生长追赶的关系探讨

目的:探讨足月小于胎龄儿(SGA)Ghrelin、IGF-1水平和生长追赶(CUG)的相关性。方法:选取足月SGA(研究组)与适于胎龄儿(AGA,对照组)各50例,对比两组出生后第3天的Ghrelin、IGF-1水平,并比较有CUG的SGA(研究组1)、无CUG的SGA(研究组2)及对照组在出生1个月与1年的Ghrelin、IGF-1,分析三组出生1年后Ghrelin、IGF-1与身长、体重、头围、BMI的相关性。结果:与对照组比较,研究组出生第3天SGA的Ghrelin更高,IGF-1更低(P<0.05);出生1个月与1年后研究组2的Ghrelin、IGF-1与对照组相比差异有统计学意义(P<0.05);Ghrelin与体重、BMI呈负相关性,IGF-1与体重呈正相关性。结论:对出生1个月后体重偏低的SGA应及时行Ghrelin、IGF-1检测,并及早促进CUG水平,降低SGA生长发育异常率。

西部5县376例足月小于胎龄儿影响因素研究

目的了解西部农村地区足月小于胎龄儿(SGA)的影响因素,以便为今后进一步开展干预研究提供科学依据。方法选择2010年11月至2011年10月在西部地区5个县的15家县级医疗机构和8家乡级医疗机构分娩足月小于胎龄儿的母亲,经知情同意后填写调查问卷了解研究对象的人口学信息、孕前体重、孕期保健情况、孕期并发症/合并症的发生情况以及饮食情况等,对照组按1:1成组配比,收集合格病例共计376对。结果与足月小于胎龄儿有关的影响因素包括:家庭平均月收入低于2 000元、母亲文化程度初中以下、母亲有早产史或低出生体重史、孕前低体重、不良产史、母亲本身是早产儿或低出生体重儿、孕期产检≤4次、孕期发生并发症或合并症(多胎、胎膜早破、子痫前期和羊水过少)、孕期未补充叶酸,饮食中鱼禽肉、牛奶、蛋类以及花生瓜子等坚果摄入相对不足。经多因素分析,羊水过少(OR=34.832,P=0.013)是足月小于胎龄儿的危险因素,而家庭平均月收入高于2 000元(OR=0.147,P=0.025)和孕期饮食中蛋类食物摄入至少每周1次(OR=0.045,P=0.029)是足月小于胎龄儿的保护因素。结论对于高危人群应进一步加强健康教育,提高孕期保健的次数。同时,应加强相关培训,提高基层医务人员孕期保健服务意识和能力,开展规范的孕期保健服务,保证孕期保健的质量。

不同程度小于胎龄儿的母体临床危险因素分析

目的·探讨不同程度小于胎龄儿(small for gestational age infant,SGA)母体的孕前及孕期高危因素。方法·纳入2013年9月—2016年12月在上海交通大学医学院附属新华医院分娩的母体及单胎新生儿,根据子代不同出生体质量所在百分位分为4组:轻度SGA组(SGA5^th^10^th)、中度SGA组(SGA3^rd^5^th)、重度SGA组(<SGA3^rd)、正常对照组。采用多变量Logistic回归分析SGA母体孕期及孕前高危因素与不同程度SGA发生的相关性。结果·母体的年龄、产次、受教育程度、早产发生率、胎儿性别与SGA无相关性。母体体质量指数(body mass index,BMI)、妊娠高血压和接受辅助生殖与SGA显著相关(均P<0.05)。孕前低BMI和妊娠高血压的母体中度SGA的发生率分别为无相关危险因素者的3.6倍和4.0倍。母体接受辅助生殖,其子代重度SGA的发生率是未接受辅助生殖者的6.4倍。轻度SGA与母体BMI、妊娠高血压、接受辅助生殖因素均无相关性。结论·母体低BMI、妊娠高血压是中度SGA的高危因素,接受辅助生殖是重度SGA的高危因素;不同程度SGA的高危因素并不相同。

The relationship between second trimester alpha fetoprotein levels and adverse pregnancy outcome

Design: Retrospective analysis. Setting: East London Hospital. Subjects: 724 women who had maternal serum alphafetoprotein levels measured between 15 to 19 weeks gestation. Main outcome measure: The main outcome measures were defined as any case of preeclampsia, small-for-gestational age (SGA) birth- weight th centile, placental abruption, stillbirth or early neonatal death. Methods: Women with MSAFP > 2.0 Multiples of Median (MoM) were classified as screen positive. Results: 41 (5.7%) women developed preeclampsia. Women with MSAFP > 2.0 Multiples of the Median (MoM) were significantly more likely to develop preeclampsia (p th centile