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Objective:To explore the relationship between soft markers found in the first trimester (11-13 + 6 gestational weeks) ultrasound screening and fetal adverse pregnancy outcomes. Methods:Single pregnancy fetuses were selected from the Multicenter Clinical Study of First Trimester Screening in China during August 2017 to August 2020. The types and detection rate of soft markers during the first trimester were compared. The correlation between positive soft markers and adverse pregnancy outcomes was analyzed by binary Logistics regression.Results:A total of 16 625 fetuses with complete follow-up outcomes were included in the group. Six hundred and seven ultrasonic soft markers were detected in 556 fetuses with positive soft markers during the first trimester, and the first four most frequently occurred were increased nuchal translucency (NT) (2.08%, 345/16 625), echogenic intracardiac focus (EIF) (0.94%, 156/16 625), hypoplasia of fetal nasal bone (0.20%, 34/16 625), single umbilical artery (SUA) (0.19%, 31/16 625). Among 556 fetuses, the incidence of adverse pregnancy outcome in fetuses with two or more positive soft markers was 32.50% (13/40), which was significantly higher than fetuses with single positive soft marker (11.05%, 57/516), and the difference was statistically significant (χ 2=5.055, P<0.001). The incidence of adverse pregnancy outcome in positive soft markers fetus associated with structural abnormalities was 80.77% (21/26), which was significantly higher than fetuses with isolated positive soft marker (12.08%, 64/530), and the difference was statistically significant (χ 2=90.310, P<0.001). Binary logistic regression analysis showed choroid plexus cyst (CPC), SUA, echogenic bowel (EB), absent/reversed a-wave of ductus venosus, hypoplasia of fetal nasal bone, increased NT, and EIF were closely related to the adverse pregnancy outcomes (all P<0.05). However, there were no significant correlations between tricuspid regurgitation (TR), pyelectasis (PYE) and fetal adverse pregnancy outcomes (all P>0.05). Conclusions:The ultrasonic soft markers during the first trimester are of great significance in predicting fetal adverse pregnancy outcomes. For multiple positive soft markers or positive soft markers combined with structural abnormalities, more attention should be paid to them and comprehensive evaluation is required to be carried out.
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Objective To explore the predictive accuracy of two estimated fetal weight ( EFW ) standards ( INTERGROWT H and Hadlock) and Doppler parameters for late-onset fetal growth restriction ( FGR) . Methods A prospective cohort of women with singleton pregnancies who attended research scans and had a livebirth at the obstetrics and gynecology hospital of Fudan University during 32 - 41 weeks of gestation was involved . The markers of ultrasound examinations (including growth measurements ,umbilical artery and middle cerebral artery parameters) were obtained every two weeks . The INTERGROWT H -EFWc and Hadlock-EFWc data were obtained from the last ultrasonography ( within 7 days before delivery) and were used to predict later-onset FGR in a single model or in combined models with other Doppler parameters by logistic regression analyses ,respectively . According to delivery gestation of age and Chinese birth weight (BW) standards ,all cases were divided into a control group ( non-FGR ,BW ≥ 10th ％ ) and a FGR group ( Late-onset FGR ,BW < 10th ％ ) . ROC curve analyses were performed to compare the predictive accuracy for the late-onset FGR between the Hadlock-EFWc and INTERGROWT H-EFWc . Results A total of 820 eligible women were identified and 676 had finished the follow-up and were enrolled in this prospective cohort study . Among them ,116 neonates were assigned to the late-onset FGR group ,and 560 as control group ( non-FGR) . The cut-off value of the INTERGROWT H-EFWc was percentile 27 .5 ,at which had a sensitivity and specificity of 71 .4％ and 83 .7％ . The corresponding sensitivity and specificity were 87 .3％ and 82 .8％ at a cut-off value of percentile 22 .6 of the Hadlock-EFWc . The Hadlock-EFWc had a higher predictive accuracy for the late-onset FGR than the INTERGROWT H-EFWc ,their AUC were 0 .930 ( 0 .908 - 0 .953 ) and 0 .847 ( 0 .807 - 0 .888 ) ,respectively . The accuracy of Doppler single-parameter ( umbilical artery and middle cerebral artery) for late-onset FGR were low ( AUC < 0 .7) ,but the accuracy of combined model- Ⅰ and Ⅱ were high ( AUC 0 .865 and 0 .936 ,respectively) ,similar to their corresponding EFWc models ,respectively . Conclusions The INTERGROWT H-EFWc could predict effectively for late-onset FGR ,however ,its predictive accuracy is lower than that of the Hadlock-EFWc . The predictive accuracy of Doppler parameters for late-onset FGR are poor ,routine monitoring of non-selected populations is not recommended .
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Objective To investigate the influence of preoperative anxiety-depression status on the postoperative pain in patients undergoing gynecologic laparoscope surgery.Methods Ninety pa-tients,aged 18-65 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ,undergoing gynecologic laparoscope surgery were included in this single-center observational study.All the patients were in-terviewed by anesthetists the afternoon before surgery and completed a Hospital Anxiety and Depres-sion Scale (HADS)to evaluate the anxiety-depression status.Then the patients were divided into two groups,low HADS group (group L)(HADS score≤9)and high HADS group (group H)(HADS score>9).Patients'visual analogue scores (VAS)were recorded at the time 30 min,60 min,6 h, 12 h,24 h after operation.The correlation analysis between HADS before operation and VAS scores at different time point was performed.The use of analgesia medicine,exhausting time and complica-tions such as nausea, vomiting, dizzy, pain of shoulder and back were also recorded. Results Compared to group H,VAS score was lower in group L at 6 hour after surgery but no sig-nificant different was found at 30 min,60 min,12 h,24 h after surgery.There was a significant asso-ciation between preoperative HADS scores and VAS at 6 hour after surgery (r=0.634,P=0.01);but no significant association was found between preoperative HADS scores and VAS at the other time point after surgery.The exhausting time was significantly longer in group H than group L (P<0.05).There was no significant difference in the incidence of nausea,vomiting,dizzy or pain of shoulder and back between the two groups.Conclusion Preoperative anxiety-depression status has a positive influence on postoperative pain at 6 hour after gynecologic laparoscope surgery,and also can delay the recovery of gastrointestinal function.
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Objective To explore the application value of INTERGROWTH-21st standard evaluate intrauterine growth restriction (IUGR).We aimed at predicting IUGR with ultrasonic fetal growth measurements.Methods A prospective cohort of singleton pregnancy scanned after 28 gestational weeks was constructed.The Z-score values of growth measurements were calculated using the INTERGROWTH-21st standard.Logistic regression equation was used to establish the prediction formula.Finally,the new formula was compared with the traditional Hadlock method to predict the accuracy of IUGR.We assessed outcomes for consenting participants who attended research scans and delivered at the Obstetrics and Gynecology Hospital of Fudan University.Results A total of 834 patients fulfilling the inclusion criteria were included.After the exclusion of 143 lost cases,565 of control cases and 126 of IUGR cases were obtained.The sensitivity,specificity,positive predictivevalue,negative predictive value,false positive rate and false negative rate of prediction model wererespectively:88.9 ％,85.4 ％,57.7 ％,97.2 ％,14.6 ％,11.1 ％.In contrast,the values of Hadlock wererespectively:81.7％,82.7％,51.2％,95.3％,17.3％,18.3％.Conclusions This study shows aprediction model of IUGR.INTERGROWTH-21st standard improved the diagnostic accuracy of IUGR,especially enhanced the positive predictive value.
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<p><b>OBJECTIVE</b>To study the impacts of pre-pregnancy maternal BMI and gestational weight gain(GWG) on pregnancy outcomes.</p><p><b>METHODS</b>We adopted a prospective cohort study with cluster sampling in single pregnant women, who were not with hypertension, diabetes, hyperlipidemia or other diseases in the previous history, neither did they have diseases of heart, liver, kidney, thyroid etc. related to current pregnancy. Those pregnant women who visited the prenatal nutrition clinic under 'informed consent' were surveyed with questionnaire to track their peri-natal complications, delivery mode and neonate birth outcomes etc. Pearson and partial correlations, chi-square test and binary logistic regression were used to study the association between pre-pregnancy maternal BMI, GWG and pregnancy outcomes.</p><p><b>RESULTS</b>A total of 623 pregnant women were recruited in the cohort, with 592 (95%) of them eligible for analysis. Results from the Multivariate Logistic Regression analysis indicated that, after controlling the potential confounding factors, when compared to women with pre-pregnancy BMI between 18.5 and 24.0, the odds ratios (ORs) for low birth ponderal index (PI) were 2.34 [95% confidence interval (CI), 1.24-4.42)]among those with BMI<18.5, respectively, while 2.73 (1.12-6.68) for high birth PI among those with BMI > 24.0. Similarly, when compared to pregnant women with normal GWG(defined as weight gain range from P15 to P85 by stratification of pre-pregnancy BMI), low GWG (<P15) seemed to be the risk factor for preterm birth, low birth weight, gestational diabetes mellitus, with low birth PI [ORs as 4.85(1.35-17.51), 10.30 (2.29-46.35), 2.29 (1.07-4.93) and 2.65(1.24-5.68), respectively. High GWG (>P 85)appeared the risk factor for high birth weight, high birth PI, and gestational diabetes mellitus, with ORs as 3.83(1.74-8.44), 2.39(1.14-5.01)and 2.21(1.07-4.55), respectively.</p><p><b>CONCLUSION</b>Low or high pre-pregnancy maternal BMI and GWG were associated with adverse pregnancy outcomes.</p>
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Adolescent , Adult , Female , Humans , Infant, Newborn , Pregnancy , Young Adult , Birth Weight , Body Weight , Follow-Up Studies , Pregnancy Outcome , Prospective Studies , Risk Factors , Weight GainABSTRACT
Objective To study the impacts of pre-pregnancy maternal BMI and gestational weight gain(GWG)on pregnancy outcomes. Methods We adopted a prospective cohort study with cluster sampling in single pregnant women,who were not with hypertension,diabetes,hyperlipidemia or other diseases in the previous history,neither did they have diseases of heart,liver,kidney,thyroid etc. related to current pregnancy. Those pregnant women who visited the prenatal nutrition clinic under‘informed consent’were surveyed with questionnaire to track their peri-natal complications,delivery mode and neonate birth outcomes etc. Pearson and partial correlations,chi-square test and binary logistic regression were used to study the association between pre-pregnancy maternal BMI,GWG and pregnancy outcomes. Results A total of 623 pregnant women were recruited in the cohort,with 592(95%)of them eligible for analysis. Results from the Multivariate Logistic Regression analysis indicated that,after controlling the potential confounding factors,when compared to women with pre-pregnancy BMI between 18.5 and 24.0,the odds ratios(ORs)for low birth ponderal index(PI) were 2.34[95%confidence interval(CI),1.24-4.42)]among those with BMI<18.5,respectively,while 2.73(1.12-6.68)for high birth PI among those with BMI>24.0. Similarly,when compared to pregnant women with normal GWG(defined as weight gain range from P15 to P85 by stratification of pre-pregnancy BMI),low GWG(<P15)seemed to be the risk factor for preterm birth,low birth weight,gestational diabetes mellitus,with low birth PI [ORs as 4.85(1.35-17.51),10.30 (2.29-46.35),2.29(1.07-4.93) and 2.65(1.24-5.68),respectively. High GWG(>P85)appeared the risk factor for high birth weight,high birth PI,and gestational diabetes mellitus,with ORs as 3.83(1.74-8.44),2.39(1.14-5.01) and 2.21(1.07-4.55),respectively. Conclusion Low or high pre-pregnancy maternal BMI and GWG were associated with adverse pregnancy outcomes.
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Objective To study the impacts of pre-pregnancy maternal BMI and gestational weight gain(GWG)on pregnancy outcomes. Methods We adopted a prospective cohort study with cluster sampling in single pregnant women,who were not with hypertension,diabetes,hyperlipidemia or other diseases in the previous history,neither did they have diseases of heart,liver,kidney,thyroid etc. related to current pregnancy. Those pregnant women who visited the prenatal nutrition clinic under‘informed consent’were surveyed with questionnaire to track their peri-natal complications,delivery mode and neonate birth outcomes etc. Pearson and partial correlations,chi-square test and binary logistic regression were used to study the association between pre-pregnancy maternal BMI,GWG and pregnancy outcomes. Results A total of 623 pregnant women were recruited in the cohort,with 592(95%)of them eligible for analysis. Results from the Multivariate Logistic Regression analysis indicated that,after controlling the potential confounding factors,when compared to women with pre-pregnancy BMI between 18.5 and 24.0,the odds ratios(ORs)for low birth ponderal index(PI) were 2.34[95%confidence interval(CI),1.24-4.42)]among those with BMI<18.5,respectively,while 2.73(1.12-6.68)for high birth PI among those with BMI>24.0. Similarly,when compared to pregnant women with normal GWG(defined as weight gain range from P15 to P85 by stratification of pre-pregnancy BMI),low GWG(<P15)seemed to be the risk factor for preterm birth,low birth weight,gestational diabetes mellitus,with low birth PI [ORs as 4.85(1.35-17.51),10.30 (2.29-46.35),2.29(1.07-4.93) and 2.65(1.24-5.68),respectively. High GWG(>P85)appeared the risk factor for high birth weight,high birth PI,and gestational diabetes mellitus,with ORs as 3.83(1.74-8.44),2.39(1.14-5.01) and 2.21(1.07-4.55),respectively. Conclusion Low or high pre-pregnancy maternal BMI and GWG were associated with adverse pregnancy outcomes.
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Objective To evaluate the effects of soy isoflavones on bone density (BMD) in women in randomized clinical trials by meta-analysis. Method We searched the databases the Medline, Pubmed, and CNKI from January 1990 to October 2007 using the keywords, phytoestrogen, isoflavone, soy, genistein in combination with bone. We only included the studies of randomized clinical trial, in which the data of BMDs at lumbar spine, total hip or femoral neck prior to and post isoflavone intervention or their relevant changes and their standard deviation or 95% CI in women were provided. Results Sixteen papers (1304 women, 91% postmenopausal) were included and a mean daily dose of 73 mg supplemental soy isoflavones resulted in weighted mean (%)(95%CI) difference in yearly BMD changes of 18.3 (2.0%,CI 6.0~30.6) and 3.3(0.40%,CI 0.5~6.1) mg/cm2 at the lumber spine and total hip, respectively. Subgroup analyses showed that the effects were more pronounced in those with the isoflavone dose ≥80 mg/d than those of