妊娠早期不同一性发育双胎的妊娠结局

目的:评估双胎妊娠早期两胎儿不同一性发育的妊娠结局。方法:回顾性研究在216对双胎妊娠中共有19例(不同一组),41例为对照组。用方差分析和Fisher’sexacttest比较两组胎儿生长受限(IUGR)发生率、新生儿不同一性发生率和早产发生率情况。结果:不同一组IUGR发生率、新生儿不同一性发育发生率以及早产发生率分别为57.2%,35.7%,78.6%,显著高于对照组24.4%,7.5%和30%(P值分别为0.03,0.02和0.01),不同一组先天畸形的发病率高于对照组,当双胎不同一性比率(A-B/A)>25%时,有显著性差异(P=0.039)。所有发现的畸形均为易于识别的严重畸形。结论:双胎不同一性发育可发生于妊娠早期。双胎不同一性程度>25%时,胎儿畸形率增高且为易识别的显著畸形。早期不同一性发育双胎的IUGR发生率、新生儿不同一性发生率和早产发生率均增高。

Birth experience of fathers in the setting of teenage pregnancy:Are they prepared?

AIM To explore the birth experiences of teenage fathers and determine the extent to which they are prepared for childbirth.METHODS A mixed methods observational study was undertaken comparing the birth experience of 50 fathers in the setting of teenage pregnancy(teenage) compared to a group of 50 older fathers. Fathers were recruited in the antenatal period and completed structured questionnaires following the birth of their child. Quantitative and qualitative analysis was undertaken.RESULTS Teenage fathers were younger, less educated and less likely to attend prenatal childbirth education classes(P < 0.0001). During birth, they were less prepared and consulted by attending staff(both P < 0.05). They reported limited roles in intrapartum decision-making(< 20%). In multivariate analysis being a father in the setting of teenage pregnancy remained significantly associated with feeling unprepared for birth. The major themes in qualitative analysis were feeling unprepared,shock, fear, a sense of detachment, happiness, pride, love of the baby and satisfaction with fertility.CONCLUSION Teenage fathers are less prepared for the birth of their child and this results in shock, fear and detachment that may impact on the early father-infant relationship.

Feasibility and metabolic effects of a 5:2 fasting intervention in women with breast cancer during radiotherapy

Purpose Obesity and insulin resistance appear to worsen prognosis of breast cancer patients.We conducted a feasibility study to test a 5:2 fasting regime in breast cancer patients undergoing radiotherapy.The intervention was rated as beneficial if it would be able to reduce fat mass while significantly improving insulin sensitivity.Methods A total of 13 non-metastatic breast cancer patients were recruited and instructed to completely abstain from food on two non-consecutive days(minimum 24 h)per week during radiotherapy.Body composition was measured weekly by bioimpedance analysis.Blood parameters were assessed before and at the end of radiotherapy.The product of triglycerides and glucose was used as a proxy for insulin sensitivity.A control group on an unspecified standard diet was assigned by propensity score matching.Results A total of twelve patients completed the study.Three patients reported side effects during fasting which were mild(grade 1).Two patients reported feeling bad while fasting,whereas five had a generally good or very good feeling.The fasting group experienced an average decrease of approximately 200 g body mass(p<0.0001),200 g(p=0.002)fat mass and 100 g muscle mass(p=0.047)per week,resulting in absolute reductions of 2.45±1.19 kg body mass,1.5±1.6 kg fat mass and 0.7±0.4 kg muscle mass.There was no improvement in insulin sensitivity and other markers of metabolic health except for gamma-glutamyltransferase which decreased by-7±8 U/l.There was also no indication that 5:2 fasting protected against acute skin toxicity.Conclusions 5:2 fasting is safe and feasible for breast cancer patients during radiotherapy and suitable to significantly reduce fat mass,but beneficial metabolic effects could not be confirmed.To improve these results,future studies could combine 5:2 fasting with carbohydrate restriction,increased protein intake and/or exercise.