ABSTRACT
BACKGROUND@#With an increasing proportion of multiparas, proper interpregnancy intervals (IPIs) are urgently needed. However, the association between IPIs and adverse perinatal outcomes has always been debated. This study aimed to explore the association between IPIs and adverse outcomes in different fertility policy periods and for different previous gestational ages.@*METHODS@#We used individual data from China's National Maternal Near Miss Surveillance System between 2014 and 2019. Multivariable Poisson models with restricted cubic splines were used. Each adverse outcome was analyzed separately in the overall model and stratified models. The stratified models included different categories of fertility policy periods (2014-2015, 2016-2017, and 2018-2019) and infant gestational age in previous pregnancy (<28 weeks, 28-36 weeks, and ≥37 weeks).@*RESULTS@#There were 781,731 pregnancies enrolled in this study. A short IPI (≤6 months) was associated with an increased risk of preterm birth (OR [95% CI]: 1.63 [1.55, 1.71] for vaginal delivery [VD] and 1.10 [1.03, 1.19] for cesarean section [CS]), low Apgar scores and small for gestational age (SGA), and a decreased risk of diabetes mellitus in pregnancy, preeclampsia or eclampsia, and gestational hypertension. A long IPI (≥60 months) was associated with an increased risk of preterm birth (OR [95% CI]: 1.18 [1.11, 1.26] for VD and 1.39 [1.32, 1.47] for CS), placenta previa, postpartum hemorrhage, diabetes mellitus in pregnancy, preeclampsia or eclampsia, and gestational hypertension. Fertility policy changes had little effect on the association of IPIs and adverse maternal and neonatal outcomes. The estimated risk of preterm birth, low Apgar scores, SGA, diabetes mellitus in pregnancy, and gestational hypertension was more profound among women with previous term births than among those with preterm births or pregnancy loss.@*CONCLUSION@#For pregnant women with shorter or longer IPIs, more targeted health care measures during pregnancy should be formulated according to infant gestational age in previous pregnancy.
Subject(s)
Infant , Pregnancy , Humans , Female , Infant, Newborn , Pregnancy Outcome/epidemiology , Premature Birth/epidemiology , Gestational Age , Pre-Eclampsia , Hypertension, Pregnancy-Induced , Eclampsia , Cesarean Section/adverse effects , Birth Intervals , Risk Factors , Diabetes MellitusABSTRACT
OBJECTIVE:To evaluate the efficacy and safety of cerebrolysin in adjuvant treatmenut of acute cerebral infarction systematically,and to provide evidence-based reference in clinic.METHODS:Retrieved from SCI,Cochrane Library,EMBase,PubMed,CJFD,VIP and Wanfang Database,RCTs about cerebrolysin combined with routine plan (trial group) vs.routine plan alone or combined with placebo (control group) in adjuvant treatment of acute cerebral infarction were collected.After data extraction and quality evaluation by using Cochrane systematic review manual 5.1.0,Meta-analysis was conducted by using Rev Man 5.2 statistical software.RESULTS:A total of 20 RCTs were included,involving 3 313 patients.Meta-analysis showed that NIHSS score [MD=-1.77,95％CI(-2.33,-1.21),P＜0.001],response rate [OR=2.85,95％CI(1.75,4.63),P＜0.001] and Barthel index (BI) score [MD =7.30,95 ％ CI (3.48,11.13),P＜ 0.001] in trial group were significantly higher than control group,with statistical significance.There was no statistical significance in disability rate [OR=0.46,95％ CI(0.20,1.03),P=0.06],mortality [OR=0.79,95％ CI (0.52,1.19),P=0.25],the incidence of ADR [OR=1.04,95％ CI (0.85,1.27),P=0.72] or the incidence of severe ADR [OR=0.01,95％CI(-0.02,0.04),P=0.51] between 2 groups.CONCLUSIONS:Cerebrolysin is good for adjanctive therapy of acute cerebral infarction,can significantly improve neurologic impairment and life quality and dosen't increase the incidence of ADR.