Treatment status of maternal syphilis infection and factors associated with their adverse pregnant outcomes in Shanghai during 2013-2015 / 中华传染病杂志

Objective To analyze the factors associated with syphilis treatment compliance and adverse pregnant outcomes among pregnant women with syphilis in Shanghai.Methods The prospective cohort was established based on maternal syphilis monitoring system of Shanghai,which included all the pregnant women diagnosed with syphilis during Jan 2013 to Dec 2015.A total of 1 717 pregnant women with syphilis were recruited at the baseline,and 1 147 of them were followed up during treatment and their pregnancy,and the delivery outcomes were recorded.The information of testing/treatment of pregnant women with syphilis and health outcomes of infants were collected.Chi-square test was used for univariate analysis and logistic regression model was used to identify the factors associated with syphilis treatment and adverse pregnant outcomes.Results A total of 685 participants received syphilis treatment during pregnancy,with the treatment rate of 59.7％.Among them,397 (34.6％) patients underwent two courses of complete treatment.The poor educated,unemployed/job-waiting or multipara population had poor compliance to treatment.Only 34.9％ (142/407) of cases diagnosed at last trimester received syphilis treatment and 10.1％ (41/407) completed the treatment.The proportion of non-treponemal conversion were higher in subjects who received syphilis treatment during pregnancy than those who did not (39.1％ [268/285] vs 3.7％ [17/462]).Complete syphilis treatment during pregnancy was protective factor to decrease neonatal death adjusted relative risk ([aRR] =0.05,95％ CI:0.01-0.37,P =0.003) and prematurity/low birth weight (aRR =0.44,95％ CI:0.27-0.70,P =0.001).Strong positive non-treponemal result before delivery increased the risks of neonatal death (aRR =12.89,95％ CI:1.70-100.43,P =0.014) and prematurity/low birth weight (aRR =12.78,95％ CI:152-5.06,P =0.001).Conclusions Factors such as educational level,employment status,and maternal history will affect the compliance of syphilis treatment during pregnancy.Early diagnosis and complete treatment course of syphilis could improve the pregnant outcomes and the health status of infants.

Echocardiographic characteristics and pregnant outcome in fetuses with complete closure of the ductus arteriosus / 中华超声影像学杂志

Objective To explore the echocardiographic features and pregnant outcomes in fetuses with complete closure of the ductus arteriosus ( DA) . Methods The echocardiographic data and follow-up materials were retrospectively reviewed in 28605 fetuses . Of all the fetuses ,6 fetuses had complete closure of the DA . The echocardiographic features and pregnant outcomes of the 6 fetuses with complete closure of the DA were summarized . Results Of all the 6 fetuses ,4 cases were found in the third trimester and 2 cases in the second trimester . There was no the lumen of the DA in the three vessel view on the two dimensional echocardiography ,demonstrating the line-like low echogenicity in the DA area . No DA flow signal was found on the color and spectral Doppler imaging . Four cases had dilated right heart .Six cases had thickened wall of the right ventricle ( WRV ) ,and hypokinetic motion of the WRV . Moderate to severe tricuspid regurgitation were found in 5 cases and disappeared or reversal a-wave of the ductus venosus were found in 5 cases . The mild pericardial effusion was found in 2 cases . Of all the 6 cases ,4 cases were delivered by cesarean section and the echocardiographic findings were unremarkable at the follow -up of six months . Conclusions Intrauterine complete closure of the DA can be accurately diagnosed by fetal echocardiograph in the 2-3 trimesters . If indicated ,elective delivery results in good outcome .

Clinical analysis of 350 pregnant women with epilepsy / 中华神经科杂志

Objective To investigate the usage of antiepileptic drugs (AEDs),epileptic seizures,pregnancy outcomes and infant feeding practices among pregnant women with epilepsy,and provide scientific evidence for eugenics.Methods The clinical characteristics of 350 pregnant women with epilepsy from Shaanxi Provincial Epilepsy & Pregnancy Register from October 2012 to July 2016 were analyzed retrospectively.Results A total of 350 patients with 376 pregnancies were included in the final analysis.Among 376 pregnancies,272 pregnancies (72.3％) were under the treatment of AEDs.Of them,246 pregnancies (90.4％) were on monotherapy,26 (9.6％) on polytherapy.Only patients during 179 pregnancies (47.6％) took folic acid in the first trimester.Seizure frequency increased in patients during 123 pregnancies (32.7％),of whom patients during 43 pregnancies (35.0％) did not use AEDs.Although other patients during 80 pregnancies (65.0％) took AEDs,regular pharmacokinetic monitoring was absent.A total of 170 pregnancies (45.2％) attained seizure-free.Seizure frequency decreased in 42 pregnancies (11.2％) and remained unchanged in 24 pregnancies (6.4％).The rates of cesarean section and natural delivery were 43.8％ (158/361) and 56.2％ (203/361),respectively.Totally 4.5％ (17/376) pregnancies had adverse pregnancy outcome,and 1.9％ (7/376) had fetal malformations.The most common congenital malformation was heart malformation,which was observed in two offspring.One offspring developed dysostosis,one developed chromosome abnormality,and another developed cerebellum deformity.In addition,one twin developed conjoined deformities.Breastfeeding rate was 52.6％ (190/361).Conclusions In Shaanxi province,AEDs compliance,pharmacokinetic monitoring and usage rate of folic acid still need to be improved in pregnant women with epilepsy.Clinical trial registration Chinese Clinical Trial Registry,ChiCTR-OOC-16009277

Investigation on Toxoplasma gondii infection and awareness of toxoplasmosis-related knowledge in women with poor pregnant outcomes in Wuxi City / 中国血吸虫病防治杂志

Objective To investigate the prevalence of Toxoplasma gondii infection and awareness of toxoplasmosis?related knowledge among women with poor pregnant outcomes in Wuxi City. Methods A total of 217 women with poor pregnant out?comes from Wuxi City during the period of January 2011 to December 2015 were randomly selected as the study subjects( a study group),while 250 women with normal pregnancy were served as controls(a control group). The sero?prevalence of T. gon?dii infection was detected by using ELISA and compared between the study and control groups. The awareness of toxoplasmosis?related knowledge was investigated by using a self?designed questionnaire and compared between the study and control groups. Results The positive rate of anti?Toxoplasma antibody was 30.88%in the study group,which was significantly higher than that (8.8%)in the control group(χ2 =36.7,P0.05). Conclusions This study demonstrates higher prevalence of T. gondii infection in women with poor pregnant out?comes than in those with normal pregnancy in Wuxi City. Considering the harm of T. gondii infection during pregnancy and the low awareness of toxoplasmosis?related knowledge in pregnant women,the health education of toxoplasmosis?related knowledge should be strengthened,especially for pregnant women,so as to reduce the prevalence of T. gondii infection among pregnant women to improve the better child?bearing and rearing level.

Impact of subclinical hypothyroidism on the outcome of pregnancy / 中华内分泌代谢杂志

Objective To evaluate the impact of subclinical hypothyroidism (SCH) on the outcome of pregnancy and the therapeutic effect of L-T4.Methods A total of 1 786 pregnant women during the first, second, and third trimesters were enrolled for thyroid screening by determining serum free thyroxine (FT4), total thyroxine (TT4), thyrotropin (TSH), and thyroid peroxidase antibody;123 pregnant women with SCH were successfully divided into treated group (n =42) and untreated group (n =81).The treated group was treated by L-T4 based on American Thyroid Association (ATA) 2011 guideline.Collected items include obstetric outcomes and complications.Results (1) Compared to control group, the rate of spontaneous abortion in pregnant women during first trimesters was increased in SCH group (20.99％ vs 8.45％, x2 =12.96, P =0.00), with higher incidence of diabetes during second trimester (24.69％ vs 10.45％, x2 =14.11, P =0.00).The incidences of hypertension during pregnancy, premature delivery, ablatio placentae, placenta praevia, fetus growth restriction, and low birth weight showed no difference between two groups (all P ＞ 0.05).(2) Compared with the untreated group, the incidences of spontaneous abortion and diabetes were decreased in the treated group (7.14％ vs 20.99％, x2 =3.89, P =0.05;9.52％ vs 24.69％, x2 =4.05, P =0.04), while the incidences of hypertension, premature delivery, ablatio placentae, placenta praevia, fetus growth restriction, and low birth weight infant accident rate were not different between two groups (all P ＞ 0.05).Conclusions SCH during the frist trimester is a risk factor of spontaneous abortion;SCH during the middle stage of pregnancy is a risk factor of gestational diabetes mellitus.Treatment of SCH with L-T4 may be beneficial.

Study on the high risk value of TSH in pregestational women / 中华内分泌代谢杂志

Objective To analyze the relationship of the serum concentration of TSH in pregestational women with pregnancy and pregnant outcome,and to investigate the high risk value of TSH in eugenic and healthy examination before pregnancy.Methods The distribution of TSH in fertile woman and the relationship of serum TSH level with sex hormone levels,rate of pregnancy,and adverse pregnant outcomes (no healthy infants were born,abortion,premature delivery,and malformation) were investigated in national-free pregestational eugenic and healthy examination during 2013.The high risk level of TSH in pregestational women was determined.Results The average level of TSH in 5 798 prepregnant women was 2.36 mIU/L with the median of 2.01 mIU/L,and the serum level of TSH showed abnormal distribution with long tail.The pregnant rate of fertile women within one year was 76.1％.The beneficial range of TSH levels for pregnancy was 0.35-3.5 mIU/L,while the pregnant rate in other ranges of TSH level was decreased with statistically significant difference (P＜0.01).When the concentration of TSH was below 0.35 mIU/L or above 5.5 mIU/L,abnormal pregnant outcomes were significantly increased (P＜0.01).Logistic regression analysis indicated that the relative risks of infertility and abnormal pregnant outcomes were significantly increased.Compared with TSH 0.35-2.5 mIU/L group,there were significantly differences in FSH,LH,and estradiol (E2) in TSH＞4.5 mIU/L or＜0.35 mIU/L group (P＜0.01).TSH was related with LH,E2,progesterone,and prolactin (r=0.29,-0.28,-0.37,0.36).Conclusion The high risk value of serum TSH in prepregnant women should be below 0.35 mIU/L or above 5.5 mIU/L.

The effects of elderly pregnancy complicated with hypertensive disorder complicating pregnancy on the pregnant outcome / 中国基层医药

Objective To investigcte the effects of elderly pregnancy complicated by hypeaensive disorder on the pregnant outcome.Methods The analysis on the ultimate outcomes of pregnancy with HDCP and their neo nates is conducted.among which 51 cases with the pregnancy at the age of 35 or above were chosen as the observation group,while 143 cases whose ages are below 35 were chosen as the control group and their 217 neonates.The process of two groups of pregnancy complications:The rate of heart failure,abnormal liver function,kidney damage,HELLP syndrome,premature,placenta abruption,severe preeclampsia and eclampsia.The rate of fetal distress,neonatal as phyxia,perinatal mortality rate,FGR were observed.Results The rate of kidney damage,abnormal liver function, HELLP syndrome or premature in the observation group is remarkably higher than that in the contrl group(P＜ 0.05).There is no significant difference between the two groups on the rate of severe preeclampsia and eclampsia, heart failure,placenta abruption(P＞0.05).The rate of FGR,fetal distress,neonatal asphyxia,perinatal mortality rate is signicartly higher in the observation group than that in the control group(P＜0.05).Conclusion Elderly pregnancy complicated by HDCP is harmful for pregnant women and neonatal.It is necessary to reinforce the prevention measures and clinical treatment.

Avaliação nutricional antropométrica de gestantes brasileiras: uma revisão sistemática: [revisão] / Anthropometric nutritional evaluation in pregnant Brazilian women: a systematic review: [revision]

Trata-se de uma revisão sistemática objetivando a identificação de métodos de avaliação nutricional de gestantes adotados no Brasil e sua associação com desfechos obstétricos. A busca bibliográfica foi feita nas bases Medline, Lilacs e Scielo, no período de 1980 a 2006. Os descritores utilizados em combinação foram pregnant, pregnancy nutritional assessment, anthropometric state, weight gain. Foram identificados 26 estudos, sendo o método proposto por Rosso (1985) o mais adotado. Alguns autores usaram apenas a avaliação do estado nutricional pré-gestacional com base no método proposto pelo Institute of Medicine (1990) ou a avaliação do ganho de peso gestacional segundo a Organização Mundial da Saúde (1995). Os resultados indicam a inexistência de metodologia apropriada para avaliação nutricional de gestantes brasileiras, o que pode estar contribuindo para a desvalorização desse procedimento nos serviços de assistência pré-natal. A maior parte dos estudos considerou o peso ao nascer como o principal desfecho do peso gestacional na validação dos métodos de classificação antropométrica. Os resultados encontrados no estudo demonstram a escassez de informações, em quantidade e qualidade, que possam contribuir para analisar a efetividade dos métodos de avaliação nutricional antropométrica para as gestantes brasileiras. O desenvolvimento de estudos com rigor metodológico neste campo é premente, e deverá contemplar as diferenças etárias e os fatores biológicos, socioeconômicos e ambientais das gestantes.

A systematic review was carried out of national and international literature on the available knowledge regarding nutritional assessment methods for anthropometric evaluation during pregnancy and its association with obstetric outcomes among Brazilian women was confirmed. Tracking resulted in 26 studies, where the most commonly used weight-gain assessment method was that proposed by Rosso (1985). Some of these used only pregestational nutritional status Institute of Medicine (1990) or weight gain during pregnancy assessments of World Health Organization (1995). The results indicate the lack of appropriate methods for assessing nutrition during pregnancy, which reflects the low importance prenatal services give to the standardization of anthropomorphic evaluation during pregnancy. There is an urgent need for well-defined methodological studies involving pregnant women that address age differences and intervening factors. Most researchers consider birth weight to be the main outcome of nutritional assessment during gestation to validate anthropometric methods. Outcomes encountered in this study demonstrate a lack of information, both quantitative and qualitative, to evaluate the effectiveness of nutritional assessment methods among pregnant Brazilian women. The development of studies using a rigorous methodology in this field is essential and these should address differences in terms of age and biological, socioeconomic and environmental factors.

A Clinical Study of Pregnancy and Delivery in The Early Thirties / 대한산부인과학회지

OBJECTIVE: To access the pregnancy and delivery in the early thirties. METHODS: From January 1994 to December 2003, we statistically compared and investigated the 21,744 deliveries in Sung Ae Hospital, considering pregnant women aged 30-34 as study groups, and pregnant women aged 35 or older (elderly gravidas) as control groups. RESULTS: The rate of Cesarean section, preterm delivery, gestational diabetes, pregnancy-induced hypertension, placenta previa, placenta abruptio, low birth weight was low statistically in the study groups. But, the percentage of the pregnant complication in the early thirties were increased than of in pregnant women younger than 30. CONCLUSION: Pregnant women in the early thirties were safer from the maternal complication, and neonatal complication than women aged 35 or older (elderly gravidas), but were exposed to these illnesses more than women aged younger than 30. Therefore, to improve the pregnant outcome of women in the early thirties, it is needed to concern their pregnancy and delivery and to take care of before and after childbirth thorougly.

Effects of thyroid autoimmunity on pregnant outcome / 中国实用内科杂志

In pregnant women,positive rate of thyroid peroxidase antibody(TPOAb) is approximately 3%~10%.It is still controversial whether thyroid antibody positive rate is higher in women undergoing artificial assistant reproductive technologies.TAI might have a negative effect on pregnant outcome,which has been proved in different groups of women.Intravenous immunoglobulin,thyroxin replacement therapy and selenium therapy have been used for TAI intervention.More evidence is needed to demonstrate mechanism and evaluate effect for each therapy.