Maternal and paternal age at delivery, birth order, and risk of childhood onset type 1 diabetes: population based cohort study

ObjectiveTo estimate the associations of maternal and paternal age at delivery and of birth order with the risk of childhood onset type 1 diabetes.DesignCohort study by record linkage of the medical birth registry and the national childhood diabetes registry in Norway.SettingNorway.SubjectsAll live births in Norway between 1974 and 1998 (1.4 million people) were followed for a maximum of 15 years, contributing 8.2 million person years of observation during 1989-98. 1824 cases of type 1 diabetes diagnosed between 1989 and 1998 were identified.ResultsThere was no association between maternal age at delivery and type 1 diabetes among firstborn children, but among fourthborn children there was a 43.2% increase in incidence of diabetes for each five year increase in maternal age (95% confidence interval 6.4% to 92.6%). Each increase in birth order was associated with a 17.9% reduction in incidence (3.2% to 30.4%) when maternal age was 20-24 years, but the association was weaker when maternal age was 30 years or more. Paternal age was not associated with type 1 diabetes after maternal age was adjusted for.ConclusionsIntrauterine factors and early life environment may influence the risk of type 1 diabetes. The relation of maternal age and birth order to risk of type 1 diabetes is complex.

What is already known on this topic

Maternal age at birth is positively associated with risk of childhood onset type 1 diabetesStudies of the effect of birth order on risk of type 1 diabetes have given inconsistent results

What does this study add?

In a national cohort, risk of diabetes in firstborn children was not associated with maternal ageIncreasing maternal age was a risk factor in children born second or laterThe strength of the association increased with increasing birth order     

200例先天性尿道下裂患儿的临床特征及其危险因素分析

目的:研究200例先天性尿道下裂患儿的临床特征及其危险因素.方法:选择2016年1月?2019年12月我院收治的先天性尿道下裂患儿200例进行研究,记作观察组,另取同期于我院接受体检的健康儿童200例作为对照组,分析观察组患儿的临床分型情况,比较两组儿童父母的一般情况、儿童出生情况,并采用多因素Logistic回归分析...     

Associations of demographic and perinatal factors with childhood neuroblastoma in Texas, 1995–2011

BackgroundNeuroblastoma, the most common extracranial solid tumor in children, contributes disproportionately to childhood cancer mortality and few risk factors have been identified. Our objective was to evaluate associations between parental and infant characteristics and neuroblastoma incidence.MethodsChildren born in Texas between January 1995 and December 2011 were eligible for the present study. Cases (N = 637) were diagnosed with neuroblastoma in Texas during the same period; controls (N = 6370) matched on year of birth were randomly selected from birth certificates that did not link to a record in the Texas Cancer Registry. We obtained data on birth and parental demographic/reproductive characteristics from birth certificates, and estimated odds ratios (OR) and 95% confidence intervals (CIs) for neuroblastoma using logistic regression.ResultsGestational age 34–36 weeks at birth was associated with neuroblastoma (OR 1.45, CI 1.09–1.90), whereas female sex was inversely associated (OR 0.68, CI 0.58–0.81). Relative to children of non-Hispanic White women, children of Hispanic (OR 0.53, CI 0.43–0.64) or non-Hispanic Black (OR 0.52, CI 0.38–0.71) women were at reduced odds of neuroblastoma. When maternal and paternal race/ethnicity were evaluated jointly, similar patterns were observed (two non-Hispanic Black parents: OR 0.55, 95%CI 0.36–0.79; two Hispanic parents: OR 0.53, 95%CI 0.41–0.67). Older maternal age was also positively associated with neuroblastoma (OR 1.41, CI 1.04–1.90 for 35–39 years; OR 1.62, CI 0.87–2.81 for ≥40 years, relative to 25–29 years).ConclusionsFindings provide further evidence of racial/ethnic disparities in neuroblastoma incidence, determinants of which are unknown. In contrast to most published studies, we observed an association between maternal age and neuroblastoma. Further studies with more robust control for confounding are warranted.     

Observation of the effect of the pregnancy complicated with the hepatitis B infection on the lying-in women and neonates

ObjectiveTo investigate the effect of pregnancy complicated with the hepatitis B infection on the pregnancy outcome, immunological factors and the subgroup of lymphocytes in neonates.MethodsSubjects admitting to this hospital between January 1, 2016 and January 1, 2018 in this study were divided into two groups according to the hepatitis B infection, i.e. the observation group (infection) and the control group (healthy), with 60 subjects in each group. Pregnancy complications and the neonatal complications were all recorded, and furthermore, the subgroups of lymphocytes and the levels of immunoglobin in the umbilical cord blood were measured.ResultsThe incidence rates of the premature rupture of fetal membranes, premature delivery, postpartum hemorrhage and pregnancy-induced hypertension syndrome in the observation group were all higher than those in the control group, and the differences had statistical significance. In the observation group, the incidence rates of the neonatal distress and asphyxia, and the levels of neonatal CD3^＋, CD4^＋, CD19^＋, IgA and IgM varied significantly from those in the control group, and the differences showed statistical significance. However, no significant differences were identified in comparison of the incidence rate of the cesarean delivery, neonatal deformity, neonatal death, or levels of neonatal CD8⁺ and IgG.ConclusionDuring pregnancy, complications of hepatitis B infection results in the increases in the incidence rates of the premature rupture of fetal membranes and neonatal asphyxia, with influences on the levels of immunological factors and lymphocyte subgroups in the umbilical cord blood.     

Soil-transmitted helminth infection in pregnancy and long-term child neurocognitive and behavioral development: A prospective mother-child cohort in Benin

BackgroundAn estimated 30% of women in Sub-Saharan Africa suffer from soil-transmitted helminth infection during pregnancy (SHIP), which has been shown to increase risk of pre-term birth, low birth weight, and maternal anemia. A previous study in Benin found that SHIP was associated with impaired cognitive and gross motor development scores in 635 one-year-old children. The objective of the present study was to follow children prospectively to investigate whether the association between SHIP and child neurocognitive and behavioral development persisted at age six.Principal findingsOur prospective child cohort included 487 live-born singletons of pregnant women enrolled in the Malaria in Pregnancy Preventive Alternative Drugs clinical trial in Allada, Benin. SHIP was assessed at three antenatal visits (ANVs) through collection and testing of stool samples. Neurocognitive and behavioral development was assessed in six-year-old children by trained investigators using the Kaufman Assessment Battery for Children 2^nd edition and the parent-reported Strengths and Difficulties Questionnaire (SDQ). Multiple linear regression models generated coefficients and 95% confidence intervals and potential mediating factors were tested. Prevalence of SHIP was 13% at the 1^st ANV, 9% at the 2^nd ANV, and 1% at delivery. SHIP was not associated with low neurocognitive scores in children at six years. Higher SDQ internalizing scores, indicating increased emotional impairments in children, were associated with helminth infection at the 2^nd ANV/delivery 1.07 (95% CI 0.15, 2.00) and at least once during pregnancy 0.79 (95% CI 0.12, 1.46) in adjusted models. Mediation analysis did not reveal significant indirect effects of several mediators on this association.ConclusionsOur study shows that while SHIP is not associated with impaired long-term neurocognitive development, infections may have significant negative impacts on emotional development in six-year-old children. SHIP remains a critical public health issue, and adequate prevention and treatment protocols should be enforced in low- and middle-income countries.     

Performance IQ in children is associated with blood cadmium concentration in early pregnancy

ObjectiveTo investigate whether performance IQ in children is associated with maternal blood cadmium concentration in early pregnancy.MethodThe present study is a component of the Mothers’ and Children's Environmental Health (MOCEH) study, a multi-center birth cohort project in Korea that began in 2006. The study cohort consisted of 119 children whose mothers underwent testing of blood cadmium during early pregnancy. All children were evaluated using the Korean version of the Wechsler Preschool and Primary Scale of Intelligence, revised edition (WPPSI-R), at 60 months of age. Multivariate linear regression analysis was performed to analyze the correlation between IQ in children and maternal blood cadmium concentration in early pregnancy, after adjustment for covariates.ResultsMaternal blood cadmium concentration during early pregnancy was inversely associated with performance IQ, after adjustment for covariates such as sex, educational levels of both parents, family income, and maternal BMI. Maternal blood cadmium concentration, however, was not associated with cognitive IQ.ConclusionPerformance IQ in children is associated with maternal blood cadmium concentration in early pregnancy.     

孤独症儿童生存质量、睡眠质量现状调查及睡眠障碍的影响因素分析

摘要 目的：分析孤独症儿童生存质量、睡眠质量现状,探讨其睡眠障碍的影响因素。方法：选择2017年1月至2019年12月期间我院收治的孤独症儿童100例作为研究组,另选同期于我院进行体检的健康儿童100例作为对照组,分别应用生存质量简易量表、社会支持评定量表、儿童睡眠质量调查问卷调查两组生存质量、社会支持情况、睡眠质量。应用单因素及多因素Logistic回归分析孤独症儿童睡眠障碍的影响因素。结果：研究组儿童生存质量简易量表的主观标准评分、客观标准评分及社会支持评定量表的主观支持评分、客观支持评分、对社会支持的利用度评分、总分均显著低于对照组（P＜0.05）。研究组入睡困难、睡眠不安、间断睡眠、夜惊、夜间尿床、打鼾、梦呓、梦游、张口呼吸、夜间磨牙、睡眠出汗发生率均显著高于对照组（P＜0.05）,两组梦魇发生率比较无统计学差异（P>0.05）。研究组患儿中存在睡眠障碍的46例,无睡眠障碍的54例。单因素分析显示,睡眠障碍组父母关系差、家族精神病史、新生儿窒息史、出生体重<2500 g比例显著高于无睡眠障碍组（P＜0.05）。多因素Logistic回归分析显示,父母关系差、有家族精神疾病史、有新生儿期窒息史、出生体重<2500 g是孤独症儿童睡眠障碍的危险因素（P＜0.05）。结论：与健康儿童相比,孤独症儿童生存质量、社会支持情况较差,睡眠障碍发生率也较高,父母关系差、有家族精神疾病史、有新生儿期窒息史、出生体重<2500 g是孤独症儿童睡眠障碍的危险因素。     

慢性乙型肝炎病毒感染对妊娠期糖尿病及妊娠结局的影响

目的:探讨慢性乙型肝炎病毒(HBV)感染对妊娠期糖尿病(GDM)及妊娠结局的影响,为妊娠期产妇慢性HBV感染预防提供参考。方法:回顾性分析2015年2月-2017年2月在我院住院分娩的2615例慢性HBV感染产妇的临床病历资料,根据《慢性乙型肝炎防治指南》(2015年版)诊断标准,将所有产妇分为4组:慢性HBV携带者(A组)1128例、乙型肝炎e抗原(HBe Ag)阳性慢性乙型肝炎(B组)406例、HBe Ag阴性慢性乙型肝炎(C组)307例、非活动性乙型肝炎表面抗原(HBs Ag)携带者(D组)774例,并收集同期入院的823例HBV阴性产妇为对照组(E组)。比较各组的GDM发生率及不良妊娠结局发生率。结果:2615例慢性HBV感染产妇中,共发生GDM 866例,发生率为33.12%。B组与C组GDM发生率分别为38.92%、37.46%,均大于E组的30.74%(P0.05)。A组、B组、C组的妊娠期高血压疾病(PIH)发生率分别为7.98%、8.87%、9.77%,均高于E组的3.52%(P0.05);A组、B组、C组及早产发生率分别为3.10%、3.94%、4.56%,均高于E组的0.49%(P0.05)。C组的新生儿窒息发生率为1.63%,高于E组的0.36%(P0.05)。结论:产妇慢性HBV感染若合并肝功能受损或肝组织学病变,可能增加GDM的发生率,若HBV病毒复制活跃,可能导致PIH及早产发生风险增加。     

Prenatal Parental Separation and Body Weight,Including Development of Overweight and Obesity Later in Childhood

Background

Early parental separation may be a stress factor causing a long-term alteration in the hypothalamic-pituitary-adrenal-axis activity possibly impacting on the susceptibility to develop overweight and obesity in offspring. We aimed to examine the body mass index (BMI) and the risk of overweight and obesity in children whose parents lived separately before the child was born.

Methods

A follow-up study was conducted using data from the Aarhus Birth Cohort in Denmark and included 2876 children with measurements of height and weight at 9-11-years-of-age, and self-reported information on parental cohabitation status at child birth and at 9-11-years-of-age. Quantile regression was used to estimate the difference in median BMI between children whose parents lived separately (n = 124) or together (n = 2752) before the birth. We used multiple logistic regression to calculate odds ratio (OR) for overweight and obesity, adjusted for gender, parity, breast feeding status, and maternal pre-pregnancy BMI, weight gain during pregnancy, age and educational level at child birth; with and without possible intermediate factors birth weight and maternal smoking during pregnancy. Due to a limited number of obese children, OR for obesity was adjusted for the a priori confounder maternal pre-pregnancy BMI only.

Results

The difference in median BMI was 0.54 kg/m² (95% confidence intervals (CI): 0.10; 0.98) between children whose parents lived separately before birth and children whose parents lived together. The risk of overweight and obesity was statistically significantly increased in children whose parents lived separately before the birth of the child; OR 2.29 (95% CI: 1.18; 4.45) and OR 2.81 (95% CI: 1.05; 7.51), respectively. Additional, adjustment for possible intermediate factors did not substantially change the estimates.

Conclusion

Parental separation before child birth was associated with higher BMI, and increased risk of overweight and obesity in 9-11-year-old children; this may suggest a fetal programming effect or unmeasured difference in psychosocial factors between separated and non-separated parents.     

高龄孕妇分娩新生儿出生体重及出院转归的影响因素分析

摘要 目的：探讨高龄孕妇分娩新生儿出生体重及出院转归的影响因素。方法：选择2021年01月到2022年01月与我院就诊的198例产妇作为研究对象,根据孕妇分娩时的年龄分为观察组和对照组,分娩时年龄满35周岁为高龄产妇组（98例）,分娩时年龄为20~34周岁为适龄组（100例）。比较适龄孕妇和高龄孕妇新生儿出生体重情况和新生儿住院时间,对高龄孕妇新生儿体重和新生儿出院转归影响因素进行Logistic单因素分析和多因素分析。结果：与适龄孕妇相比,高龄孕妇新生儿低出生体重儿、巨大儿发生率更高（P<0.05）,新生儿住院时间明显更长（P<0.05）。对高龄孕妇新生儿体重进行单因素分析结果显示,妊娠糖尿病、产检检查、分娩方式、是否使用催产素、分娩时麻醉方式和脐带情况与高龄孕妇新生儿体重无关（P>0.05）,孕妇年龄、孕前BMI、孕期体重增加情况、妊娠高血压、合并其他疾病状况、孕次、产次、羊水情况与高龄孕妇新生儿体重相关（P<0.05）。进行Logistic多因素回归分析结果显示,孕妇年龄、孕前BMI、孕期体重增加情况、孕次、产次、羊水情况是影响高龄孕妇新生儿出生体重的独立危险因素（P<0.05）。对新生儿出院转归情况进行单因素分析结果显示,胎次、开奶时间、喂养方式和有无接受治疗与新生儿出院转归无相关性（P>0.05）,胎龄、出生体重、Apgar评分、出生窒息史、有无伴发疾病与新生儿转归相关（P<0.05）。进行Logistic多因素分析结果显示,胎龄、出生体重、Apgar评分、出生窒息史、有无伴发病是影响新生儿出院转归的独立危险因素（P<0.05）。结论：孕妇年龄、孕前BMI、孕期体重增加情况、孕次、产次、羊水情况是影响高龄孕妇新生儿出生体重的独立危险因素。新生儿出院转归受到胎龄、出生体重、Apgar评分、出生窒息史、有无伴发病影响。     

住院儿童肺炎发病情况及病毒病原学分析

目的:统计我院1-7岁住院儿童肺炎发病情况并进行病毒病原学分析。方法:收集2015年1月到2017年12月河北省人民医院1-7岁住院儿童8532例的临床资料,统计不同年龄段的肺炎患儿、重症肺炎患儿的发病情况及不同季节肺炎分布特点,统计不同病毒病原体住院肺炎儿童入院时的症状或体征情况,记录住院肺炎儿童并发症发生情况。结果:8532例住院儿童中,肺炎患儿2476例。1岁患儿肺炎、重症肺炎的发病率均最高,分别为54.67%(703/1286)、1.14%(8/703);7岁患儿肺炎发病率最低,为12.52%(126/1006);6岁和7岁重症肺炎发病率均为0.00%。冬季肺炎发病率最高,为33.38%(724/2169),春季、夏季、秋季发病率相当。病毒病原学显示,至少1种病毒检测阳性的有2061例,阳性率为83.24%。腺病毒和偏肺病毒阳性患儿出现发热、呼吸急促和呼吸困难的比例高于其他病毒感染;各种病毒阳性病例中,咳嗽、咳痰、流涕等呼吸道症状出现的频率相当。住院肺炎患儿中出现并发症以呼吸衰竭为主,占比为21.16%,其次是心力衰竭,占比为14.82%,脓毒血症的发生率为8.72%,其他并发症发生率均较低。结论:2015-2017年我院1-7岁住院儿童肺炎和重症肺炎的发生率以1岁最高,且随着年龄的增长发病率呈下降趋势,冬季最多见,病毒病原体中以腺病毒和偏肺病毒感染导致的发热、呼吸急促和呼吸困难症状较多,并发症以呼吸衰竭为主。     

孕妇不良情绪、生活事件与妊娠结局以及分娩方式的关系研究

目的:探讨孕妇不良情绪、生活事件对妊娠结局以及分娩方式的影响。方法:选择2017年3月至2018年7月在海南省三亚市人民医院进行分娩的孕妇232例,搜集孕妇的基本资料,调查孕妇的生活事件及抑郁、焦虑状态,并记录孕妇的妊娠结局以及分娩方式,分析孕妇不良情绪、生活事件与妊娠结局以及分娩方式之间的关系。结果:在232例孕妇中,焦虑情绪孕妇有24例,占10.34%;抑郁孕妇有86例,占37.07%;发生生活事件的孕妇有69例,占29.74%。受到生活事件刺激、存在抑郁及焦虑的孕妇出现不良妊娠结局的概率均高于正常孕妇(P0.05)。剖宫产孕妇负性生活事件发生次数高于自然分娩的孕妇,而正性生活事件发生次数低于自然分娩的孕妇(P0.05)。剖宫产孕妇焦虑、抑郁的发生率均高于自然分娩的孕妇(P0.05)。结论:孕妇的不良情绪及生活事件普遍存在,可导致不良妊娠结局的发生并且对分娩方式产生一定的影响,应引起家庭及社会的重视。     

Low-level Plasmodium vivax exposure,maternal antibodies,and anemia in early childhood: Population-based birth cohort study in Amazonian Brazil

BackgroundMalaria causes significant morbidity and mortality in children under 5 years of age in sub-Saharan Africa and the Asia-Pacific region. Neonates and young infants remain relatively protected from clinical disease and the transplacental transfer of maternal antibodies is hypothesized as one of the protective factors. The adverse health effects of Plasmodium vivax malaria in early childhood–traditionally viewed as a benign infection–remain largely neglected in relatively low-endemicity settings across the Amazon.Methodology/Principal findingsOverall, 1,539 children participating in a birth cohort study in the main transmission hotspot of Amazonian Brazil had a questionnaire administered, and blood sampled at the two-year follow-up visit. Only 7.1% of them experienced malaria confirmed by microscopy during their first 2 years of life– 89.1% of the infections were caused by P. vivax. Young infants appear to be little exposed to, or largely protected from infection, but children >12 months of age become as vulnerable to vivax malaria as their mothers. Few (1.4%) children experienced ≥4 infections during the 2-year follow-up, accounting for 43.4% of the overall malaria burden among study participants. Antenatal malaria diagnosed by microscopy during pregnancy or by PCR at delivery emerged as a significant correlate of subsequent risk of P. vivax infection in the offspring (incidence rate ratio, 2.58; P = 0.002), after adjusting for local transmission intensity. Anti-P. vivax antibodies measured at delivery do not protect mothers from subsequent malaria; whether maternal antibodies transferred to the fetus reduce early malaria risk in children remains undetermined. Finally, recent and repeated vivax malaria episodes in early childhood are associated with increased risk of anemia at the age of 2 years in this relatively low-endemicity setting.Conclusions/SignificanceAntenatal infection increases the risk of vivax malaria in the offspring and repeated childhood P. vivax infections are associated with anemia at the age of 2 years.     

Association between postnatal catch-up growth and obesity in childhood: prospective cohort study

ObjectiveTo identify predictors of postnatal catch-up growth from birth to two years and its relation to size and obesity at five years.DesignRegional prospective cohort study.SettingAvon longitudinal study of pregnancy and childhood, United Kingdom.Subjects848 full term singletons from a 10% random sample of the Avon longitudinal study of pregnancy and childhood.ResultsSize at birth was representative of the national reference. Overall, 30.7% (260 of 848) of infants showed a gain in SD score for weight greater than 0.67 SD scores between zero and two years, indicating clinically significant catch-up growth. These children had lower weight, length, and ponderal index at birth than other children, and were more often from primiparous pregnancies. They also had taller fathers than other children, and their mothers had lower birth weights and were more likely to smoke during pregnancy. Children who showed catch-up growth between zero and two years were heavier, taller, and fatter (body mass index, percentage body fat, and waist circumference) at five years than other children.ConclusionsIn this contemporary well nourished cohort, catch-up growth was predicted by factors relating to intrauterine restraint of fetal growth. Children who showed catch-up growth between zero and two years were fatter and had more central fat distribution at five years than other children. Mechanisms that signal and regulate early catch-up growth in the postnatal period may influence associations between small size at birth and risks for disease in adulthood.     

妊娠晚期合并急性胰腺炎患者的手术时机对妊娠结局的影响分析

目的:研究妊娠晚期合并急性胰腺炎(APIP)患者的手术时机对妊娠结局的影响。方法:回顾性分析我院2016年7月到2018年6月诊治的35例APIP患者的临床资料,依照不同手术时机分成急诊手术组19例及延期手术组16例。观察和比较两组患者的手术时间、住院时间、下床时间、妊娠结局及并发症的发生情况。结果:急诊手术组的手术时间、住院时间及下床时间均明显短于延期手术组(P0.05),产妇出现早产、剖宫产、死胎引产的不良结局发生率(15.79%)明显低于延期手术组(50.00%,P0.05),围产儿发生窒息、畸形、死亡的不良结局发生率(21.05%)显著低于延期手术组(62.50%,P0.05),产妇的术后并发症发生率(5.26%)明显低于延期手术组(31.25%,P0.05)。结论:对已确诊的妊娠晚期合并急性胰腺炎患者实施急诊手术能够显著降低妊娠晚期合并急性胰腺炎产妇及其围产儿发生不良结局的可能性,同时有效促进产妇的术后恢复并降低并发症发生率。     

Stillbirth as risk factor for depression and anxiety in the subsequent pregnancy: cohort study

ObjectiveTo assess women’s symptoms of depression and anxiety during pregnancy and the postpartum year in the pregnancy after stillbirth; to assess relevance of time since loss.DesignCohort study with four assessments: in third trimester and 6 weeks, 6 months, and 12 months after birth.SettingOutpatient departments of three district general hospitals; subjects’ homes.Subjects60 women whose previous pregnancy ended in stillbirth after 18 weeks’ gestation; 60 matched controls.ResultsIn the third trimester women whose previous pregnancy had ended in stillbirth were significantly more depressed than control women (10.8 v 8.2; P=0.004) and had greater state anxiety (39.8 v 32.8, P=0.003) The difference was accounted for by those women who conceived less than 12 months after the stillbirth, who were also more depressed at 1 year. Results in those who conceived 12 months or more after stillbirth were similar to those in their controls at all points and showed lower trait anxiety 1 year post partum. One year after the birth 8% of control women and 19% of subjects scored high for depression (P=0.39), with most of the depression among the more recently bereaved (28% v 11%; P=0.18). In the women who had experienced stillbirth, depression in the third trimester was highly predictive of depression 1 year after subsequent birth (P⩽0.0005).ConclusionVulnerability to depression and anxiety in the next pregnancy and puerperium is related to time since stillbirth, with more recently bereaved women at significantly greater risk than controls. As there are problems for mother and infant associated with high anxiety and depression during and after pregnancy, there may be advantage in waiting 12 months before the next conception.

Key messages

• Women whose previous pregnancy ended in stillbirth had significantly higher levels of depression and state anxiety during their subsequent pregnancy than matched controls
• Those who had conceived over 12 months after stillbirth were, however, similar to controls at all points and had lower trait anxiety a year after the next birth
• Women who had conceived within 12 months after loss had a significantly higher risk of high state anxiety during the next pregnancy and of depression and both state and trait anxiety 12 months post partum than women with longer time since loss
• Women may need a year to mourn the lost child before beginning another pregnancy or women who chose to conceive sooner may be intrinsically more vulnerable to depression and anxiety
• Parents have various and individual reasons for timing the next pregnancy, but there may be advantage in waiting 12 months before conception

     

先天性心脏病患儿术前营养不良的危险因素分析及其对术后临床结局、免疫功能和生存质量的影响

摘要 目的：分析先天性心脏病（CHD）患儿术前营养不良的危险因素,并观察术前营养不良对患儿术后临床结局、免疫功能和生存质量的影响。方法：选取2020年1月-2022年6月期间江苏省人民医院收治的65例CHD患儿,采用世界卫生组织（WHO）推荐的美国国家卫生统计中心制订的相关营养诊断标准评估CHD患儿的营养情况,统计CHD患儿术前营养不良发生率,采用单因素和多因素Logistic回归分析CHD患儿术前营养不良的危险因素,并观察术前营养不良对患儿术后临床结局、免疫功能和生存质量的影响。结果：本次研究入选的患儿中,有31例出现术前营养不良,34例无营养不良。根据患儿的营养状况将患儿分为营养不良组（n=31）和非营养不良组（n=34）。多因素Logistic回归分析结果显示：出生时体质量偏低、母亲有焦虑情况、母亲有抑郁情况是CHD患儿术前营养不良的危险因素,母亲主动获取疾病知识则是其保护因素（P<0.05）。两组并发症发生率组间对比无统计学差异（P>0.05）,营养不良组的住院时间长于非营养不良组,住院费高于非营养不良组（P<0.05）。两组术后3个月CD3⁺、CD4⁺、CD4⁺/CD8⁺升高,CD8⁺下降,且非营养不良组的改善效果优于营养不良组（P<0.05）。两组术后3个月术前沟通问题、心脏问题和症状、治疗焦虑、感知身体外貌、认知心理问题评分均升高,且非营养不良组的改善效果均优于营养不良组（P<0.05）。结论：出生时体质量偏低、母亲有焦虑情况、母亲有抑郁情况是CHD患儿术前营养不良的危险因素,而母亲主动获取疾病知识是CHD患儿术前营养不良的保护因素。术前营养不良会导致CHD患儿术后免疫功能下降,生存质量降低,临床结局相对偏差。     

The role of oral glucose intolerance test in reducing pregnancy complications

The influence of glucose monitoring during pregnancy on newborn body weight, and complications during pregnancy and labor was assessed. We performed a retrospective analysis of macrosomal children, fetal growth, caesarean sections, malformations, still-births and the number of oral glucose tolerance test (OGTT) carried out in a five-year period. The proportion of women participating in OGTT tests increased from 20% to 40% (p<0.05) between 2000 and 2004. Gestation diabetes mellitus (GDM) proportions among pregnant women seen at the Department of Obstetrics and Gynecology at Slavonski Brod General Hospital, Croatia increased from 1% to 6.7% (p < 0. 05) during the observed period. Proportion of births identified as macrosomal decreased from 13.3% to 12.2% (p<0.05). Additionally, infant mortality and still-births along with other fetal and maternal complications declined during the same period. These results suggest that regular measurements of glucose tolerance during pregnancy may prevent preterm birth, decrease the proportion of macrosomal newborns, lower mortality and decrease fetal and maternal complication incidence during pregnancy and delivery.     

置管溶栓与药物机械溶栓对急性下肢深静脉血栓的临床疗效对比

摘要 目的：对比分析置管溶栓（CDT）与药物机械溶栓（PMT）对急性下肢深静脉血栓（DVT）的安全性与有效性。方法：回顾性分析2018年1月至2021年12月在重庆医科大学附属巴南医院的98例单侧DVT患者临床资料,依据不同的治疗方式分为药物机械溶栓组（PMT组）48例和置管溶栓组（CDT组）50例,对比分析两组患者的围手术期指标、治疗后患侧大腿消肿率和小腿消肿率、血栓溶解率、并发症发生率及术后1年的PTS发生率。结果：PMT组患者的尿激酶使用量及住院时间较CDT组显著缩短,差异具有统计学意义（P<0.05）,但术中出血较CDT组显著增加,差异具有统计学意义（P<0.05）,PMT组患者的患肢消肿率和血栓溶解率显著高于CDT组,差异具有统计学意义（P<0.05）,两组患者的并发症发生率及术后1年的深静脉血栓形成后遗症发生（PTS）率无显著统计学差异（P>0.05）。结论：PMT比CDT具有更好的患肢消肿率及血栓溶解率,且PMT治疗能显著缩短住院时间及减少尿激酶用量,但两者的围手术期并发症发生率及术后1年PTS发生率无显著差异。