Iron Deficiency,a Risk Factor for Thyroid Autoimmunity During Second Trimester of Pregnancy in China

ObjectivePrevious studies have reported an association between iron deficiency (ID) and increased thyroid peroxidase antibody (TPO-Ab) during early pregnancy. The objective of this study was to explore the relationship between ID and thyroid dysfunction, as well as thyroid autoantibodies, during the second trimester of pregnancy.MethodsA total of 1,592 pregnant women (13 to 28 weeks gestation) were enrolled in this cross-sectional study. According to serum ferritin (SF) concentrations, they were divided into ID (SF <20 μg/L) or non-ID (SF ≥20 μg/L) groups. Logistic regression analysis was used to evaluate the association between ID and subclinical hypothyroidism (thyroid-stimulating hormone [TSH] >4.0 mIU/L and free thyroxine [FT4] within the reference range) and thyroid autoimmunity.ResultsThe prevalence of ID was 23.43% (373/1,592). Compared with the non-ID group, the ID group had lower FT4 levels (13.94 pmol/L [8.91 to 29.82 pmol/L] versus 14.63 pmol/L [8.22 to 47.24 pmol/L]; P<.001]) and higher TSH levels (1.85 mIU/L [0.01 to 7.84 mIU/L] versus 1.69 mIU/L [0.01 to 10.2 mIU/L]; P<.05). Logistic regression analysis confirmed ID as a risk factor for increased thyroglobulin antibody (TG-Ab) (odds ratio 1.974; 95% confidence interval 1.065, 3.657; P<.05), but not for subclinical hypothyroidism or increased TPO-Ab.ConclusionID is associated with increased TG-Ab during the second trimester of pregnancy.     

Association of Second and Third Trimester Weight Gain in Pregnancy with Maternal and Fetal Outcomes

Objective

To investigate the association between weekly weight gain, during the second and third trimesters, classified according to the 2009 Institute of Medicine (IOM/NRC) recommendations, and maternal and fetal outcomes.

Methods

Gestational weight gain was evaluated in 2,244 pregnant women of the Brazilian Study of Gestational Diabetes (Estudo Brasileiro do Diabetes Gestacional – EBDG). Outcomes were cesarean delivery, preterm birth and small or large for gestational age birth (SGA, LGA). Associations between inadequate weight gain and outcomes were estimated using robust Poisson regression adjusting for pre-pregnancy body mass index, trimester-specific weight gain, age, height, skin color, parity, education, smoking, alcohol consumption, gestational diabetes and hypertensive disorders in pregnancy.

Results

In fully adjusted models, in the second trimester, insufficient weight gain was associated with SGA (relative risk [RR] 1.72, 95% confidence interval [CI] 1.26–2.33), and excessive weight gain with LGA (RR 1.64, 95% CI 1.16–2.31); in third trimester, excessive weight gain with preterm birth (RR 1.70, 95% CI 1.08–2.70) and cesarean delivery (RR 1.21, 95% CI 1.03–1.44). Women with less than recommended gestational weight gain in the 2^nd trimester had a lesser risk of cesarean deliveries (RR 0.82, 95% CI 0.71–0.96) than women with adequate gestational weight gain in this trimester.

Conclusion

Though insufficient weight gain in the 3^rd trimester was not associated with adverse outcomes, other deviations from recommended weight gain during second and third trimester were associated with adverse pregnancy outcomes. These findings support, in part, the 2009 IOM/NRC recommendations for nutritional monitoring during pregnancy.     

正常晚期妊娠妇女血生化指标分析

目的:探讨正常晚期妊娠妇女血生化指标的特点,更好地辅助临床诊断和治疗。方法:测定并比较92例正常晚期妊娠妇女和65例健康非妊娠妇女的15项血生化指标。结果:正常晚期妊娠组与健康非妊娠对照组相比,总蛋白(TP)、白蛋白(ALB)、碱性磷酸酶(ALP)、α-L-岩藻糖苷酶(AFU)、总胆汁酸(TBA)共5项指标均有非常显著性差异(P<0.01),血糖(GLU)、肌酐(CR)等2项指标有显著性差异(P<0.05),而总胆红素(TBIL)、谷丙转氨酶(ALT)、γ-谷氨酰转肽酶(GGT)、谷草转氨酶(AST)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、尿素氮(BUN)、尿酸(UA)共8项指标2组间比较均无统计学意义(P>0.05)。结论:正常晚期妊娠时,孕妇血TP、ALB、ALP、AFU、TBA、GLU及CR等7项指标的改变由妊娠适应性生理反应引起,非机体组织器官疾患所致,该7项指标已不适于以健康未妊娠妇女的正常参考值范围作为衡量标准,提示临床医护人员分析晚期妊娠妇女血生化指标时应结合多项相关指标甚至多种辅助检查结果进行,以便及时制定正确合理的诊疗策略。     

Outpatient Termination of Pregnancy

Termination of pregnancies ranging from 6 to 10 weeks'' gestation is described in 127 women who attended the hospital as outpatients. The technique employed was to aspirate the products of conception through a narrow plastic tube using a high negative pressure. Infiltration of the cervix with local anaesthetic proved so effective that the procedure could be carried out on the fully conscious patient. The short time taken to evacuate the uterus, the small blood loss, and the low incidence of complications in the latter part of the study suggest that the technique is a valuable procedure. Relatively more women can be terminated as outpatients than as inpatients with a corresponding reduction in the demands made on gynaecological beds.     

Rubella Vaccination and Termination of Pregnancy

Six terminations of pregnancy have been carried out in Leicestershire since February 1970 because of rubella vaccine administered inadvertently during early unrecognized pregnancy. Any woman of child bearing age shown by serological tests to be susceptible to rubella should be offered vaccination, preceded and followed by adequate contraception.     

Low Maternal Vitamin D Status during the Second Trimester of Pregnancy: A Cross-Sectional Study in Wuxi,China

BackgroundVitamin D deficiency is common in pregnant women, but an optimal serum vitamin D level during pregnancy has not been determined and remains an area of active research. Vitamin D data from large populations of pregnant Chinese women are still limited.ObjectiveTo evaluate the vitamin D status of women in Eastern China during the second trimester of pregnancy.MethodsA hospital-based, cross-sectional, observational study. Serum 25-hydroxyvitamin D [25(OH)D] concentration was measured in samples from 5823 pregnant women in Wuxi City, China (latitude: 31.5o N), from January 2011 to June 2012.ResultsThe median serum 25(OH)D concentration was 34.0 nmol/L [2.5 nmol/L 25(OH)D = 1 ng/mL 25(OH)D]. Vitamin D deficiency [defined as 25(OH)D < 30 nmol/L according to the Institute of Medicine (National Academy of Sciences, Washington, D.C., USA)] or inadequacy [25(OH)D of 30–49.9 nmol/L] was identified in 40.7% and 38.0% of the women, respectively. Only 0.9% had a 25(OH)D level ≥ 80.0 nmol/L, which is the concentration recommended as adequate by the Endocrine Society (Washington, D.C., USA). Compared with older women, younger women were more likely to be deficient in vitamin D. There were significant differences in the 25(OH)D levels according to season. The 25(OH)D levels reached peak values in September and were correlated with (r = 0.337, P < 0.001), and fluctuated with, average monthly air temperatures.ConclusionsThere is a high prevalence of Vitamin D deficiency among pregnant Chinese women, and 25(OH)D levels varied according to season and air temperature. The results of this study also suggest that currently there is a big gap between the levels of Vitamin D detected in pregnant Chinese women and the levels recommended by the Endocrine Society.