Analysis of Cardiac Functional Status and Factors Influencing Adverse Pregnancy Outcomes in Pregnant Women with Combined Heart Disease

Objective:To investigate the cardiac function of pregnant women with complicated heart disease during pregnancy and the factors influencing the adverse pregnancy outcome.Methods:A total of 162 cases of pregnant women with complicated heart disease admitted to the Beijing Anzhen Hospital from October 2021 to December 2023 were selected to compare the occurrence of adverse pregnancy outcomes in pregnant women with complicated heart disease at different levels of cardiac function and to analyze the single and multi factors leading to adverse pregnancy outcomes in pregnant women with complicated heart disease.Results:Among 162 pregnant women with combined heart disease in pregnancy,the highest percentage of heart disease type was congenital heart disease(80/49.38%),and the lowest percentage was other(9/5.56%);the overall incidence of adverse pregnancy outcomes in pregnant women with combined heart disease in pregnancy with cardiac function grades of 3–4 cardiac function(30/68.18%)was higher than that in pregnant women with combined heart disease in cardiac function grades of 1–2(40/33.90%)(P=0.000);age,marital status,hypertension,and past history of all pregnant women were not statistically significant(P>0.05);gestational age,type of heart disease,and cardiac function grading were statistically significant(P<0.05),and these factors were all independent risk factors for adverse pregnancy resolution in pregnant women with combined heart disease(P<0.05).Conclusion:The overall incidence of adverse pregnancy outcomes was higher in pregnant women with heart disease than in those with heart disease grades 1–2,and the number of pregnancies,the type of heart disease,and heart function grades were all independent risk factors for adverse pregnancy outcomes in pregnant women with heart disease.

Missed Opportunities for Intermittent Preventive Treatment among Pregnant Women, in a Secondary Health Facility, Cross River State, Nigeria

The study determined the magnitude and contributory factors for missed opportunities for the administration of IPTp （intermittent preventive treatment for malaria prevention）, during pregnancy among pregnant women attending a secondary health facility in Calabar. This study was a descriptive survey. Exit interviews were carried out on all pregnant and post natal women who attended the antenatal clinic of a secondary health facility for two weeks in November 2008. Data were analyzed using descriptive and inferential statistics. The mean age of respondents was 27.0 ± 5.4, mean parity was 2.4 ± 1.5, mean clinic attendance 4.9 ± 4.0 while mean gestational age at booking was 18.6± 7.7. The prevalence of missed opportunity among the pregnant women was 59.1% for IPTpl ＆ 56.0% for IPTp2; among pregnant PLWHA （people living with HIV/AIDS）, it was 100% for IPTp3, 70% for IPTp2 ＆ 80.0% for IPTpl. Factors accountable for missed opportunity include non-availability of SP （sulfadoxine-pyrimethamine）, lack of supervision, failure to prescribe medication, late booking and lack of knowledge. More women significantly received IPTp2 compared to IPTpl （P = 0.001）. Discussion： The findings establish the need for making SP available in the ANC （antenatal clinic）, educating health workers about current schedule and procedures for administration and early mobilization of pregnant mothers for ANC.

Survey on Pre-pregnancy Health Knowledge and Service Demands among Un-pregnant Married Women

Objective To understand the pre-pregnancy health knowledge and service needs among un-pregnant married women in Shanghai. Methods A total of 968 newly-married un-pregnant women in Changqiao, Lingyun sub-districts and Huajing town of Xuhui district, Shanghai, were recruited and interviewed by structured questionnaire to collect the information on pre-pregnancy health knowledge and service demands. Results 1） Newly-married women thought the contraceptive methods suitable for them was male condom（84.4%）, followed by oral contraceptives（54%）, emergent contraceptive（52.5%） and contraceptive suppository （48.3%）. 2） The score of pre-pregnancy health knowledge was 54.7±14.5 among the subjects. The participants with junior college or a bachelor had more knowledge than those with junior or senior high school, and those who were engaged in medicine /education/science field had higher score. 3） They had higher knowing rate on the common knowledge, and the rate was above 80%. But the knowing rate on the knowledge of birth defect was low, and all below 50%. 4）A proportion of 52. 7% of the respondents knew that there was a station for reproductive health service in their communities, but only 45.5% received the service from the station, 87.0% thought they had insufficient or scarce knowledge, 73.6% planned to consult before pregnancy training courses on preparing pregnancy. and 63.6% were willing to attend the Conclusion The participants had certain pre-pregnancy health knowledge, but still need being improved,＂ in addition, they had higher needs on knowledge and service of birth defect prevention, at the same time they can＇t make full use of the existing reproductive health institution.

Liver injury associated with drug intake during pregnancy

Drug use during pregnancy is not common.Drug-induced liver injury(DILI)is a potential complication that is rare but can adversely affect both the mother and the fetus.Although many drugs can directly cause hepatotoxicity,idiosyncratic liver injury is common in pregnancy.Underreporting of adverse drug reactions,lack of adequate literature regarding drug safety in pregnancy,and the inherent difficulty in diagnosing DILI during pregnancy make the management of this condition challenging.This review attempts to describe the existing literature regarding DILI in pregnancy,which is mainly in the form of case reports;several studies have looked at the safety of antithyroid drugs,antiretroviral drugs,and paracetamol,which have an indication for use in pregnancy;the relevant data from these studies with regard to DILI has been presented.In addition,the review describes the diagnosis of DILI,grading the disease severity,assessment of causality linking the drug to the adverse event,regulatory guidelines for evaluating the potential of drugs to cause liver injury,efforts to ensure better participation of women in clinical trials and studies in pregnant women population in particular,and the challenges involved in generating adequate research evidence.The establishment of DILI registries in various countries is an encouraging development;however,there is a need for promoting active,spontaneous reporting of adverse events during pregnancy to ensure rapid generation of evidence regarding the safety of a drug in pregnant women.

Placental pathologies and fetal outcome in pregnant women with COVID-19: A retrospective study

Objective:To describe histopathologic findings in the placentas in women with coronavirus disease 2019(COVID-19)during pregnancy.Methods:In a cross-sectional study,38 pregnant women with COVID-19 and undergoing delivery between March 2020 and January 2022,were included.The patients had positive polymerase chain reaction(PCR)test for SARS-CoV-2 infection and the placentas after delivery were sent for histopathologic evaluation based on the Amsterdam Placental Workshop Group Consensus Statement and assessed by two pathologists.Results:Our results showed that maternal vascular malperfusion was the most common and was present in 17 cases(44.7%).These features included accelerated villous maturation(36.8%)distal villous hypoplasia(5.3%),placental infarction(5.3%)and intervillous fibrin deposition(10.5%).Other pathologic findings included focal calcification(10.5%),intravillous congestion and hemorrhage(10.5%),sub-chorionic hemorrhage(5.3%),acute villitis,chronic histiocytic intervillositis and delayed villous maturation each in one case(2.6%).Twelve out of 38 cases showed no significant pathologic changes.Fetal outcomes included neonatal intensive care unit admission rate of 13.2%,dyspnea 31.6%,newborn’s anosmia 7.9%,intrauterine fetal demise 2.6%,asphyxia 2.6%and neonate COVID infection 5.3%.Conclusions:Microvasculopathy,as a sign of maternal vascular malperfusion,is a common finding in placentas from SARS-CoV-2 positive pregnant women in the present study.Further studies with larger sample sizes and comparative studies between COVID-19 positive and negative,as well as information from patient follow-up are suggested.

Birth outcomes and pregnancy complications of women with uterine leiomyoma—a population-based case-control study

Objective Uterine leiomyoma is not a rare pathological condition in pregnant women;thus the aim of the study was to evaluate the recent progress in the treatment of these pregnant women on the basis of the association of leiomyoma in pregnancy (LP) with pregnancy complications and birth outcomes including structural birth defects, i.e. congenital abnormalities (CA) in the offspring. Design Cases with CA and matched controls without CA in the population-based Hungarian Case-Control Surveillan- ce System of Congenital Abnormalities (HCC SCA) were evaluated. Only women with prospectively and medically recorded LP in prenatal maternity logbook and medically recorded birth outcomes (gestational age, birth weight, CA) were included to the study. Setting the HCCSCA, 1980-1996 contained 22,843 cases with CA and 38,151 matched controls without CA. Population Hungarian pregnant women and their informative offspring: live births, stillbirths and prenatally diagnosed malformed fetuses. Methods Comparison of birth outcomes of ca- ses with matched controls and pregnancy com- plications of pregnant women with or without LP. Main outcome measures Pregnancy complications, mean gestational age at delivery and birth weight, rate of preterm birth, low birthweight, CA. Results A total of 34 (0.15%) cases had mothers with LP compared to 71 (0.19%) controls. There was a higher incidence of threatened abortion, placental disorders, mainly abruption placentae and anaemia in mothers with LP. There was no significantly higher rate of preterm birth in the newborns of women with LP but their mean birth weight was higher and it associated with a higher rate of large birthweight newborns. A higher risk of total CA was not found in cases born to mothers with LP (adjusted OR with 95% CI = 0.7, 0.5-1.1), the spe- cified groups of CAs were also assessed versus controls, but a higher occurrence of women with LP was not revealed in any CA group. Con- clusions Women with LP have a higher risk of threatened abortion, placental disorders and anaemia, but a higher rate of adverse birth outcomes including CAs was not found in their offspring.

Corona Virus Disease among Pregnant Women: A Systematic Scoping Review

Corona Virus Disease 2019 (COVID-19) is a deadly respiratory viral disease that started in China in the year 2019 before spreading to the world. It affects everybody regardless of race, religion, social economic status or age. However, literature indicates that people with compromised immune status are at a higher risk of contracting viral infections. During pregnancy, the immune status of the woman is suppressed because it acts to protect both the mother and her unborn baby. The purpose of this study was to provide an overview of available evidence on the risk of contracting COVID-19 and COVID-19 infection prevention among pregnant women. Relevant and recent articles were identified from various databases. Article selection was aligned to the study questions. Articles that were related to study objectives were included and those not related to study objectives were excluded. A narrative report was produced and results were described according to study objectives. Approximately 8 data sources were included and most of the reviewed articles indicated that pregnant women are at a higher risk of getting COVID-19. The reviews further indicated that pregnant women can be prevented from this deadly virus by providing community antenatal services instead of visiting the health facilities. If a pregnant woman develops symptoms of respiratory infection, it is advisable to seek immediate diagnosis to rule out COVID-19 and get appropriate management to avoid complications. The selected studies’ quality was appraised through Mixed Methods Appraisal Tool (MMAT) version 2018. Knowledge on the risk of COVID-19 infection among pregnant women will help health workers especially midwives who take care of pregnant women to design confidently and put into action preventive programs to address health needs of pregnant women who are at a higher risk of contracting COVI-19 as compared to other people in the general population. This also will assist health workers to provide appropriate care to pregnant women on the basis of their COVID-19 infection risk status at health facility and community levels. This study review is also creating more awareness on the risk of COVID-19 to pregnant women even in communities. It serves as evidence to guide health policymakers to put emphasis on addressing the preventive measure of this greatly vulnerable group of population. To prevent COVID-19 infection during pregnancy, pregnant women should strictly follow the laid down measures of prevention by World Health Organisation (WHO) and their local health authorities.

Prevalence and factors associated with non-adherence to therapy among partners of pregnant women with syphilis in a city of northeastern Brazil

BACKGROUND One of the main difficulties faced in the prevention of the vertical transmission of syphilis is the inadequate treatment of pregnant women and their partners.The disease causes serious repercussions in infected newborns.AIM To evaluate the prevalence and factors associated with the therapeutic adhesion among partners of pregnant women with syphilis in a county in Northeastern Brazil.METHODS This is a descriptive,analytic,quantitative,cross-sectional study that was carried out through interviews with 46 pregnant women diagnosed with syphilis between 2017 and 2018 as well as with their partners.The interviews aimed at collecting data regarding sociodemographic characteristics,obstetric variables and information about syphilis,and partners’related variables.RESULTS Our results showed that 73.91%of the partners did not undergo appropriate treatments,and obtaining negative results in syphilis tests was the main reason for the absence of therapies.The following factors were significantly associated with the lack of treatment among partners:Being a partner that is not the current mate of the pregnant woman,having a level of schooling inferior to 8 years[oddsratio(OR)=10.28],and the pregnant woman undergoing up to two syphilis tests during the prenatal care(OR=8.6).The study found a higher odds of absent treatment among partners if the pregnant woman is not white(OR=13.88)or if the partner has less than 8 years of schooling(OR=21.00)or has a monthly income of less than half the minimum wage(OR=13.93).CONCLUSION The findings of this study show a high prevalence of partners that are not adequately treated for syphilis,a phenomenon that is strongly associated with socioeconomic factors.

血清IL-6、PCT、TNF-α与GBS感染孕妇不良妊娠结局的关系

目的分析血清白介素-6(IL-6)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)与B族链球菌(GBS)感染孕妇不良妊娠结局的关系。方法选取2020年5月至2022年3月于首都医科大学附属北京天坛医院进行产检以及生产的125例GBS感染孕妇为研究对象(GBS组),另选取同期收治的健康产妇100名为对照组。对比GBS组、对照组血清IL-6、PCT、TNF-α水平;比较两组妊娠结局;分析影响GBS感染孕妇不良妊娠结局的单因素;采用多元Logistic回归分析影响GBS感染孕妇不良妊娠结局的危险因素。结果对照组IL-6、PCT、TNF-α水平均低于GBS组,差异有统计学意义(P<0.05);对照组早产、胎膜早破、胎儿窘迫、新生儿GBS感染以及新生儿病理性黄疸的发生率均低于GBS组,差异有统计学意义(P<0.05);经检查、追踪发现,GBS组有37例产妇有不良妊娠结局,88例产妇为正常妊娠结局;不良妊娠结局组与正常妊娠结局组孕周、是否为初产妇等指标比较,差异无统计学意义(P>0.05);两组年龄、GBS感染分级、血清IL-6、PCT、TNF-α水平比较,差异有统计学意义(P<0.05);经多元Logistic回归分析显示:年龄≥35岁、GBS感染分级为GBS带菌或GBS性绒毛膜羊膜炎、IL-6>0.463 ng/L、PCT≥0.5 ng/mL、TNF-α≥30 fmol/mL均是影响GBS感染孕妇不良妊娠结局的危险因素(P<0.05)。结论血清IL-6、PCT、TNF-α水平在GBS感染产妇不良妊娠结局患者中呈升高状态,三指标可作为监测、预防GBS感染产妇不良妊娠结局的重要指标。

胎儿侧脑室增宽孕妇妊娠结局的影响因素分析

目的探讨胎儿侧脑室增宽(ventriculomegaly,VM)孕妇妊娠结局的影响因素。方法选取2016年4月至2021年4月首都医科大学附属北京妇产医院胎儿VM孕妇179例,根据妊娠结局分为继续妊娠组(152例)和引产组(27例),采用多因素logistic回归分析胎儿VM孕妇妊娠结局的影响因素。结果179例孕妇年龄18~45岁,平均(31.8±4.0)岁,诊断孕周11~40周,平均(27.2±5.9)周。76例孕妇行遗传学检查,其中正常61例(80.3%),异常15例(19.7%),其中染色体数目异常1例,染色体结构异常3例,染色体微缺失微重复11例。多因素logistic回归分析结果显示,诊断孕周≤28周(OR=10.742,95%CI:1.329~86.840,P=0.026)、重度VM(OR=76.674,95%CI:11.266~521.805,P<0.010)及非孤立性VM(OR=10.109,95%CI:1.027~84.439,P=0.020)的孕妇容易发生不良妊娠结局。结论诊断孕周≤28周、重度VM及非孤立性VM是导致胎儿VM孕妇不良妊娠结局的危险因素。

妊娠期妇女抑郁情绪影响因素及其与人格特征的相关性

目的探讨妊娠期妇女抑郁情绪影响因素,分析抑郁情绪与人格特征的相关性。方法应用一般资料调查表、爱丁堡产后抑郁量表(EPDS)、艾森克人格问卷简式量表中国版(EPQ-RSC)、妊娠压力量表(PPS)对246名妊娠期妇女进行调查,采取Pearson相关分析评估抑郁情绪与人格特征和妊娠压力的相关性,采取Logistic回归分析评估妊娠期妇女抑郁情绪的影响因素。结果完成调查的242名妊娠期妇女中,共有36名孕妇EPDS评分≥13分(抑郁情绪组),206名孕妇EPDS评分<13分(正常组),抑郁情绪检出率为14.88%。抑郁情绪组妊娠期妇女精神质、神经质人格评分,PPS总分及各维度压力源评分均高于正常组,外倾性人格评分低于正常组(P<0.01)。妊娠期妇女抑郁情绪与精神质、神经质人格评分,PPS总分及各维度压力源评分均呈显著正相关,与外倾性人格评分呈显著负相关(P<0.01)。外倾性、精神质、神经质人格评分,PPS总分及文化程度、家庭人均月收入、妊娠意愿、睡眠情况、夫妻关系均是妊娠期妇女抑郁情绪的影响因素(P<0.05或0.01)。结论妊娠期妇女易产生抑郁情绪,且与人格特征、妊娠压力密切相关,医护人员应重视妊娠期妇女抑郁情绪相关影响因素评估,制定科学干预措施,改善抑郁情绪。

多元化授课模式下的孕妇学校对促进自然分娩的作用

目的:探讨多元化的孕妇学校授课模式对促进自然分娩的效果。方法:回顾性选取于2023年6—8月在天津市中心妇产科医院产科门诊建档产检并住院分娩的初产妇。根据是否参加过孕妇学校课程,分为研究组(309例)和对照组(300例)。入院待产时进行问卷调查,比较2组产妇对促进自然分娩相关知识的知晓率和自然分娩意愿,对2组产妇的剖宫产率、社会因素剖宫产率、妊娠期合并症发生率、分娩镇痛应用率、巨大儿发生率及产后出血率进行分析比较;对研究组不同授课模式进行满意度调查,统计并比较孕妇学校不同授课模式的学习人次。结果:研究组各项自然分娩知识正确率和顺产意愿高于对照组,差异均有统计学意义(均P<0.05)。2组产妇剖宫产率比较差异无统计学意义(P=0.051),但研究组社会因素剖宫产率、妊娠期合并症比例、巨大儿发生率和产后出血率均低于对照组,分娩镇痛应用率高于对照组,差异均有统计学意义(均P<0.05)。研究组5种不同授课模式的平均学习人次比较,差异有统计学意义(χ^(2)=83.455,P<0.0001),录播课学习人次最高,平均每节课约596人次,其次为微信视频号直播体验课,平均每节课约280人次。参加过孕妇学校课程的产妇对不同授课模式的满意度比较差异有统计学意义(χ^(2)=104.708,P<0.0001),其中微信视频号直播体验课满意度达100%。结论:多元化授课模式的孕妇学校能吸引孕产妇的关注,提升其孕产期保健意识,起到降低妊娠期合并症、促进自然分娩的作用,微信视频号直播体验课具备满意度高、受众广的特点,值得推广。

妊娠合并感染性疾病孕妇的心理状态影响因素及心理干预效果研究

目的研究妊娠合并感染性疾病孕妇的心理状态及心理干预效果。方法200例产科门诊定期产检的孕妇,其中慢性乙型肝炎病毒感染孕妇103例,梅毒感染孕妇70例,正常孕妇27例。对慢性乙型肝炎病毒感染孕妇和梅毒感染孕妇予以心理干预,正常孕妇予以常规产检。收集比较慢性乙型肝炎病毒、梅毒感染孕妇及正常孕妇的临床特征(年龄、文化程度、孕周、产妇类型);比较慢性乙型肝炎病毒、梅毒感染孕妇及正常孕妇心理状态;比较慢性乙型肝炎病毒感染孕妇及梅毒感染孕妇干预后不同孕期的心理状态;分析妊娠合并感染性疾病孕妇焦虑、抑郁心理状态的影响因素。结果慢性乙型肝炎病毒、梅毒感染孕妇及正常孕妇年龄、文化程度、孕周、产妇类型比较,均无差异(P>0.05)。慢性乙型肝炎病毒感染孕妇、梅毒感染孕妇与正常孕妇的焦虑自评量表(SAS)、抑郁自评量表(SDS)标准分比较有差异(P<0.05);经LSD两两比较,梅毒感染孕妇SAS、SDS标准分分别为(48.56±9.42)、(49.35±9.79)分,均高于慢性乙型肝炎病毒感染孕妇的(44.74±9.98)、(45.19±9.86)分和正常孕妇的(31.48±3.86)、(31.74±3.02)分,有差异(P<0.05);慢性乙型肝炎病毒感染孕妇SAS、SDS标准分高于正常组,有差异(P<0.05)。干预后,慢性乙型肝炎病毒感染孕妇早期、中期、晚期SAS、SDS标准分有差异(P<0.05);经LSD两两比较,早期和中期孕妇SAS、SDS标准分均高于晚期,有差异(P<0.05);早期孕妇SAS、SDS标准分与中期无差异(P>0.05)。干预后,梅毒感染孕妇早期、中期、晚期SAS、SDS标准分有差异(P<0.05);经LSD两两比较,早期和中期SAS、SDS标准分均高于晚期,有差异(P<0.05);早期和中期孕妇SAS、SDS标准分无差异(P>0.05)。Logistic回归分析结果显示,年龄、文化程度、孕周、产妇类型、诊断均为妊娠合并感染性疾病孕妇焦虑、抑郁的独立影响因素(P<0.05)。结论年龄、文化程度、孕周、产妇类型、诊断均为妊娠合并感染性疾病孕妇焦虑、抑郁的独立影响因素,对孕妇实施心理干预有助于改善其不良心理状态,降低焦虑及抑郁评分。

孕妇脂血对生化检验的影响及其与不良妊娠结局关系

目的:探究高脂血症孕妇脂血标本生化检验时的影响及处理效果,分析高脂血症与不良妊娠结局关系。方法:回顾性收集2018年12月-2023年12月本院接受产前检查并分娩的高脂血症孕妇102例纳入高脂血症组,同期产前检查并分娩的正常孕妇102例纳入健康组。将观察组血液标本采取低温高速离心法处理,对比标本处理前后生化检验指标血肌酐(Cr)、血清碱性磷酸酶(ALP)、肌酸激酶同工酶(CK-MB)、空腹血糖(FBG)、天门冬氨酸氨基转移酶(AST)和丙氨酸氨基转移酶(ALT)变化;对比两组不良母婴结局;采用受试者工作特征(ROC)曲线分析高脂血对不良妊娠结局的评估价值;采用Spearman相关性分析脂血与不良妊娠结局相关性。结果:高脂血症组血标本处理后Cr、ALP、CK-MB、FBG、AST和ALT水平均较处理前降低,且血TC、TG、HDL-C和LDL-C水平均高于健康组(均P<0.05)。不良妊娠结局高脂血症组(23.5%)高于健康组(6.9%)(P<0.05),但不同孕期诊断高血脂症孕妇其不良妊娠结局发生率未见差异(P>0.05);脂血检测评估不良妊娠结局的ROC曲线下面积为0.720、特异性57.2%、敏感度90.3%,孕妇血脂水平与母体、胎儿不良结局均存在正相关性(均P<0.001)。结论:孕妇脂血对其他生化检验项目均有影响,采用低温离心再处理有一定效果。存在脂血孕妇不良妊娠结局发生率更高。

玉屏风散加减联合西药治疗促进轻型新冠病毒感染孕妇核酸转阴的疗效观察

[目的]探讨玉屏风散加减联合西药治疗轻型新冠病毒感染孕妇的临床疗效。[方法]以上海市公共卫生临床中心2022年4月至6月收治的轻型新冠病毒感染孕妇作为研究对象,随机分成治疗组(48例)及对照组(52例)。对照组给予退热、止咳对症及维生素C等西药治疗,治疗组在对照组基础上给予玉屏风散加减治疗。对比两组患者治疗前后的各症状积分、不良妊娠结局发生率、总有效率和淋巴细胞、C反应蛋白、白细胞介素-2受体、白细胞介素-6等实验室指标变化,并观察两组患者病毒核酸转阴和疾病转归情况。[结果]与对照组比较,治疗组症状总积分显著下降(P<0.001),总有效率显著升高(P<0.01),炎症指标C反应蛋白、白细胞介素-6水平较前显著下降(P<0.001,P<0.01),而淋巴细胞计数较前显著升高(P<0.001),不良妊娠结局发生率两组间差异无统计学意义(P>0.05)。[结论]玉屏风散加减联合西药治疗可显著改善轻型新冠病毒感染孕妇的临床症状,缩短核酸转阴时间,且不会增加不良妊娠结局,具有一定的临床价值,值得临床推广应用。

营养体质量管理在孕妇中的应用效果

目的:探讨营养体质量管理在孕妇中的应用效果。方法:选取2020年2月—2023年1月于湖南省妇幼保健院进行孕期检查的520名孕妇作为研究对象,以投掷硬币法分为对照组与研究组,各260名。对照组实施常规孕期管理,研究组在对照组基础上实施营养体质量管理。比较两组干预效果。结果:研究组产后出血、剖宫产发生率低于对照组,差异有统计学意义(P<0.05)。研究组妊娠糖尿病、妊娠高血压发生率低于对照组,差异有统计学意义(P<0.05)。研究组孕期体质量增长量、新生儿出生体质量低于对照组,差异有统计学意义(P<0.05);两组分娩孕周比较,差异无统计学意义(P>0.05)。研究组巨大儿、胎膜早破发生率低于对照组,差异有统计学意义(P<0.05);两组新生儿窒息、畸形儿、新生儿死亡、早产儿、胎儿宫内受限、前置胎盘发生率比较,差异无统计学意义(P>0.05)。结论:营养体质量管理在孕妇中的应用效果较好,能够控制孕妇体质量,降低产妇产后出血、剖宫产、妊娠并发症发生率以及新生儿不良结局发生率。

BMI变化对妊娠期糖尿病母婴结局的影响

目的探讨妊娠期糖尿病(GDM)孕妇孕期不同体重指数(BMI)变化与母婴结局的相关性。方法选取百色市人民医院2019至2021年进行产检、分娩并确诊为GDM的孕妇200例作为研究对象,根据体重(BMI)增长幅度(ΔBMI)变化量将其分成ΔBMI<4 kg/m^(2)组(BMI增长不足组,n=51)、4 kg/m^(2)≤ΔBMI≤6 kg/m^(2)组(BMI增长正常组;n=87)和ΔBMI>6 kg/m^(2)组(BMI增长过多组,n=62)。利用调查问卷发放的方式获取所有受试者的基线资料与实验数据,利用Logistic回归模型分析评估不同BMI变化与母婴结局的相关性。结果BMI增长过多组妊高症、先兆子痫、产后出血各占29.03%、18.03%、41.94%,BMI增长正常组各占19.54%、14.94%、12.64%,BMI增长不足组各占25.49%、7.84%、13.73%。②BMI增长过多组胎儿窘迫、巨大儿各占29.03%、40.32%,BMI增长正常组各占13.79%、14.94%,BMI增长不足组各占9.80%、7.84%。BMI增长过多组产后并发症发生率、新生儿结局不良率较BMI增长正常组、BMI增长不足组更高(P<0.05)。将BMI增长正常作为参照进行Logistic回归分析发现,BMI增长不足会增加妊高症、先兆子痫、产后出血、胎儿窘迫、巨大儿的发生风险(OR=3.376、2.658、1.354、1.713、2.165,P<0.05);BMI增长过多会增加妊高症、先兆子痫、产后出血、胎儿窘迫、巨大儿、低体重儿和GDM的发生风险(OR=2.647、1.659、3.675、4.132、2.876、3.151、3.325)。结论GDM产妇的BMI增长不足、BMI增长过多均会增加母婴结局的不良发生率,故在孕期内控制可监测孕妇的体重增长,不仅有利于母婴的健康,对降低GDM及相关并发症发生率也有积极的影响。

25-羟维生素D水平与产后抑郁的相关性分析及其对不良妊娠结局的预测价值

目的分析25-羟维生素D[25(OH)D]水平与产后抑郁的相关性及其对不良妊娠结局的预测价值。方法选择2021年1月至2023年1月于潍坊市妇幼保健院进行孕检的115例妊娠晚期(28~40周)孕妇,根据孕妇血清25(OH)D水平分为缺乏组(n=37,<50nmol/L)、不足组(n=46,50~75nmol/L)、正常组(n=32,>75nmol/L),比较不同25(OH)D水平孕妇产后抑郁程度(EPDS)、不良妊娠结局发生情况,分析25(OH)D水平与EPDS不良妊娠结局的相关性,并采用受试者工作特征(ROC)曲线分析25(OH)D对不良妊娠结局的预测价值。结果三组EPDS评分比较,差异有统计学意义(P<0.001);25(OH)D水平与EPDS评分呈负相关性(P<0.05);ROC曲线分析结果显示,25(OH)D预测不良妊娠结局的曲线下面积为0.855,敏感度为0.875,特异度为0.768。结论妊娠晚期孕妇血清25(OH)D水平与产后抑郁具有相关性,缺乏25(OH)D会增加产后抑郁发生的可能性,且25(OH)D可以预测不良妊娠结局,建议临床重视并加强对孕妇维生素D的监测及补充。

孕早期孕妇负性情绪水平、社会支持水平对睡眠质量的影响

目的探讨孕早期孕妇负性情绪水平、社会支持水平对睡眠质量的影响。方法选取269名正常产检的孕早期孕妇为研究对象,采用匹兹堡睡眠质量指数量表、抑郁自评量表、社会支持评估量表对研究对象进行线上问卷调查,采用Pearson相关分析法分析孕早期孕妇睡眠质量、抑郁情绪、社会支持水平之间的相关性,采用多元线性回归模型探讨孕早期孕妇睡眠质量的影响因素。结果孕早期孕妇睡眠质量与社会支持呈负相关、与抑郁情绪呈正相关;多元线性回归分析显示:社会支持(β=0241;95%CI0.027,0.146)和负性情绪(β=-0.285;95%CI-0.153,-0.040)是孕早期孕妇睡眠质量的影响因素。结论孕早期孕妇负性情绪、社会支持水平对睡眠质量有影响,提高孕妇的社会支持水平和情绪管理能力是改善孕早期睡眠质量的重要因素。

孕晚期血清尿酸及血清尿酸/肌酐水平与不良妊娠结局的关系研究

背景孕期血清尿酸代谢紊乱与不良妊娠结局相关,但目前分析并比较血清尿酸及血清尿酸/肌酐水平在孕期不良妊娠结局中的关系研究较少。目的分析孕妇孕晚期血清尿酸及血清尿酸/肌酐水平与不良妊娠结局的关系。方法选取2015—2022年于南京大学医学院附属鼓楼医院常规产检及生产的单胎活产孕妇743例为研究对象。根据是否发生不良妊娠结局,将孕妇分为正常组344例和不良结局组399例。分别以四分位数将血清尿酸及血清尿酸/肌酐分为3个水平:Q1(血清尿酸<257μmol/L)、Q2(血清尿酸257~359μmol/L)、Q3(血清尿酸>359μmol/L)和q1(血清尿酸/肌酐<5.88)、q2(血清尿酸/肌酐5.88~7.94)、q3(血清尿酸/肌酐>7.94)。根据孕妇中位年龄,将孕妇分为年龄<30岁亚组(341例)及年龄≥30岁亚组(402例)。根据既往孕产次情况,将孕妇分为初产妇亚组(539例)及经产妇亚组(194例)。采用多因素Logistic回归分析探讨血清尿酸及血清尿酸/肌酐水平与不良妊娠结局的关系。结果不良结局组孕妇年龄、BMI、血清尿酸、血清尿酸/肌酐、三酰甘油高于正常组(P<0.05)。校正混杂因素后,血清尿酸、血清尿酸/肌酐对不良妊娠结局影响的多因素Logistic回归分析结果显示,与Q1水平血清尿酸相比,Q3水平时子痫前期(AOR=4.41,95%CI=2.16~8.99)、宫内生长受限(AOR=3.59,95%CI=1.08~11.96)的发生风险增加(P<0.05);与q1水平血清尿酸/肌酐相比,q2、q3水平时子痫前期(AOR=2.33,95%CI=1.13~4.79;AOR=3.56,95%CI=1.68~7.56)的发生风险增加,q3水平时早产(AOR=2.76,95%CI=1.33~5.71)、宫内生长受限(AOR=5.15,95%CI=1.39~19.14)的发生风险增加,而q3水平时巨大儿(AOR=0.43,95%CI=0.19~0.98)、大于胎龄儿(AOR=0.38,95%CI=0.15~0.96)的发生风险降低(P<0.05)。血清尿酸、血清尿酸/肌酐在不同年龄亚组对子痫前期、早产的影响结果显示,与Q1水平血清尿酸相比,Q3水平在两个年龄亚组中子痫前期的发生风险均增加(P<0.05);与q1水平血清尿酸/肌酐相比,q2、q3水平在年龄≥30岁孕妇中子痫前期的发生风险增加(P<0.05)。血清尿酸、血清尿酸/肌酐在不同孕产次亚组对子痫前期、早产的影响结果显示,与Q1水平血清尿酸相比,Q3水平在初产妇中子痫前期的发生风险增加(P<0.05);与q1水平血清尿酸/肌酐相比,q2、q3水平在初产妇中子痫前期的发生风险增加,q3水平在初产妇中早产的发生风险增加(P<0.05)。结论高水平血清尿酸、血清尿酸/肌酐时子痫前期、宫内生长受限的发生风险均增加,其中子痫前期主要发生在年龄≥30岁的孕妇或初产妇中。高水平血清尿酸/肌酐时早产的发生风险增加,主要发生在初产妇中。血清尿酸/肌酐较血清尿酸预测的不良妊娠结局更多。