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Objective:To analyze the clinical characteristics of patients with inflammatory bowel disea-ses(IBD)in pre-pregnancy,pregancy and loctation.Methods:The clinical data of pregnancy compli-cated with IBD in Department of Obstetrics and Gynecology of Peking University Third Hospital and deli-very from September 2011 to June 2022 were collected.The clinical characteristics of the patients were analyzed retrospectively.According to the state of diseases during pre-pregnancy,pregnancy and lactation,the patients were divided into active and remission group,and the two groups were compared interms of pre-pregnancy counseling,nutritional status,pregnancy and delivery complications,gestational week,mode of delivery,and neonatal outcome.Results:A total of 33 pregnant women with IBD were included in this study,of which 7 delivered a second child,for a total of 40 deliveries,with 36 natural pregnan-cies(90.0％)and 4 assisted reproductions(10.0％).Among the 40 cases,21 cases(52.5％)were sustained in remission in pre-pregnancy,pregnancy and lactation,and 19 cases(47.5％)in disease ac-tivity,of which 8 cases(42.1％)were due to self-withdrawal of drugs or failure to take medicine regu-larly.Compared with the activity group,the disease remission group had a higher rate of pre-pregnancy counseling(57.1％vs.15.8％,P=0.010),and higher levels of hemoglobin[(112.67±8.53)g/L vs.(102.84±5.23)g/L,P＜0.001],serum total protein[(66.58±6.34)g/L vs.(60.83±6.25)g/L,P=0.006],serum albumin[36.4(35.1,38.3)g/L vs.34.3(31.1,35.6)g/L,P=0.006],se-rum calcium[(2.25±0.10)μmol/L vs.(2.13±0.15)μmol/L,P=0.004],but a lower incidence of gestational hypertensive disorders(0 vs.31.6％,P=0.007).In 40 deliveries,there were 27 cases of vaginal delivery(67.5％),13 cases of cesarean section(32.5％).The analysis of neonatal outcomes showed 38 full-term deliveries and 2 preterm deliveries;1 case of macrosomia,1 case of small-for-gesta-tional-age,1 case of low birth weight and 3 cases of birth defects.There were 10 newborns admitted to neonatal intensive care unit,including 4 cases of neonatal infections and 2 cases of neonatal jaundice.Conclusion:Pre-pregnancy counseling and evaluation of IBD patients are very important,and good preg-nancy outcomes can be obtained through careful management during pregnancy in the most of the pa-tients.
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Objective To explore the relationship among serum vitamin D,calcium ion,blood lipid lev-els and preeclampsia in pregnant women,and analyze the pregnancy outcomes of pregnant women with pre-eclampsia.Methods A total of 166 pregnant women with preeclampsia who underwent pregnancy examina-tion and delivered in Urumqi Municipal Maternal and Child Health Care Hospital from January 1,2021 to Jan-uary 1,2023 were selected as the observation group,and 200 healthy pregnant women during the same period were selected as the control group.The levels of serum vitamin D,calcium ion,phosphorus ion,blood lipid in-dicators,uric acid,and creatinine were detected in the two groups,and the pregnancy complications and preg-nancy outcomes were observed.The influencing factors of preeclampsia were analyzed by using multivariate logistic regression model.Results The levels of serum vitamin D,calcium ion,and high density lipoprotein in the observation group were lower than those in the control group,and the levels of serum uric acid and creati-nine were higher than those in the control group,with statistical significance(P＜0.05).The incidence of fetal growth retardation,placental abruption,oligohydramnios,cesarean section,low birth weight infants,premature delivery,and postpartum hemorrhage in the observation group were significantly higher than those in the con-trol group(P＜0.05).Multivariate logistic regression analysis showed that serum vitamin D(OR=15.141,95％CI:1.831-125.204,P=0.012),calcium ion(OR=4.625,95％CI:2.654-8.059,P＜0.001),high-den-sit y lipoprotein(OR=0.395,95％CI:0.235-0.666,P＜0.001),creatinine(OR=1.034,95％CI:1.005-1.063,P=0.020)and uric acid(OR=1.006,95％CI:1.003-1.010,P＜0.001)were independent factors for the occurrence of preeclampsia in pregnant women.Conclusion The levels of serum vitamin D,calcium ions,blood lipids,uric acid and creatinine may be correlated with the occurrence of preeclampsia.
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Objective:To evaluate the effect of Qishi Tongguan Prescription on pregnancy outcomes after interventional recanalisation in patients with tubal infertility (TFI).Methods:This was a retrospective study based on real-world and propensity score matching. Totally 260 patients with TFI from January 2020 to October 2021 in Shuguang Hospital of Shanghai University of Traditional Chinese Medicine and Maternal and Child Health Hospital of Pudong New Area were selected as observation subjects, and were divided into 123 cases in the TCM combination group and 137 cases in the control group based on whether they were treated with Qishi Tongguan Prescription in combination with interventional revascularization. Propensity score matching (PSM) was used as a covariate to obtain a new sample of inter group covariate equilibrium, and confounding factors that may affect the pregnancy outcome of TFI patients undergoing interventional recanalization surgery were used as covariates. The intrauterine pregnancy rate, ectopic pregnancy rate, biochemical pregnancy rate, early abortion rate and adverse reactions of the two groups of patients within 12 months of follow-up were compared, and the influence of TFI intervention and recanalization combined with Qishi Tongguan Prescription on intrauterine pregnancy rate was evaluated.Results:Age, years of infertility, type of infertility, history of miscarriage, history of ectopic pregnancy, history of biochemical pregnancy, history of uterine surgery, history of pelvic laparotomy, and degree of tubal patency had an effect on whether intrauterine pregnancy was achieved after interventional reversal in patients with TFI ( P<0.05), with age [ OR (95% CI) was 0.843 (0.769, 0.926)], history of pelvic laparotomy [ OR (95% CI) was 0.477 (0.248, 0.920)] and the degree of tubal obstruction [ OR (95% CI) was 0.152 (0.046, 0.500)] were independent factors ( P<0.01 or P<0.05). 81 patients were seen in each of the 2 groups after PSM, of whom the intrauterine pregnancy rates in the combined herbal group at 9 and 12 months after recanalisation were 48.1% (39/81) and 58.0% (47/81) respectively, compared with 32.1% (26/81) and 35.8% (29/81) in the control group, with statistical significance between the 2 groups ( χ2 values of 4.34 and 8.03, respectively, P<0.01); there was no statistical significance in the ectopic pregnancy rate, biochemical pregnancy rate and early abortion rate between the 2 groups ( P>0.05). There were no significant adverse reactions during the treatment. Conclusion:Qishi Tongguan Prescription combined with interventional recanalization can effectively improve the intrauterine pregnancy rate and shorten the waiting time for pregnancy in patients with TFI with higher safety.
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Zinc deficiency during pregnancy is common and has been significantly associated with adverse pregnancy outcomes such as spontaneous preterm birth(PTB),recurrent abortion(RA),low birth weight(LBW),small-for-gestational-age infant(SGA),preeclampsia(PE),and gestational diabetes mellitus(GDM).Unfortunately,there is no specific biomarkers which are sensitive,easy-to-collect and detect available for the clini-cal evaluation of zinc nutritional status.However,recent studies have identified metallothionein and the ratio of oleic acid to dihydroxymethyl gamma-linolenic acid(LA/DGLA)as potentially candidates of biomarkers.This article focuses on summarizing and discussing the progress of domestic and international researches on zinc deficiency dur-ing pregnancy and adverse pregnancy outcomes,potential zinc biomarkers,and zinc deficiency treatments,aiming at providing ideas for perinatal nutritional guidance.
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Objective To investigate the effects of comprehensive nutrition management on glycolipid metabolism and pregnancy outcomes in patients with gestational diabetes mellitus(GDM).Methods A total of 121 pregnant women with GDM at 24-28 weeks gestation who were registered in the obstetrics department of 6 sub-central hospi-tals in China from May 2021 to July 2021 were included in this study and were randomly divided into intervention group(n=74)and control group(n=47).The intervention group received intensive comprehensive nutrition man-agement,including at least 6 outpatient interventions,individualized nutrition management and a half-day standard-ized outpatient education on gestational diabetes mellitus,continuous dynamic blood glucose monitoring and micro-blood glucose monitoring,and routine check of glycated albumin and urine every 4 weeks.Body weight,body com-position and diet and exercise implementation procedures and fetal development as well as complications were recor-ded.The control group received conventional nutritional guidance.The two groups were compared for difference in blood glucose related indicators at 37 weeks of gestation,weight gain before delivery,some lipid metabolism indica-tors,pregnancy outcomes,and oral glucose tolerance test(OGTT)at 42 days postpartum.Results Compared with the control group,the level of prenatal fasting blood glucose(P=0.006),intravenous plasma glucose(P=0.009)and blood ketone(P = 0.044)in the intervention group was significantly reduced.There was no significant difference in weight gain and weight attainment rate between the two groups.The 2-hour postpartum OGTTs of preg-nant women in the intervention group(P=0.006)were significantly lower than those in the control group,and the incidence of preeclampsia and postpartum blood loss were lower than those in the control group but no statistical difference was found.For newborns,the incidence of macrosomia(P=0.042)and planation(P=0.048)in the in-tervention group was slightly lower than that in the control group,and the results were statistically different.Other adverse pregnancy outcomes were not statistically different between the two groups.Conclusions Intensive compre-hensive nutrition management has a positive impact on the control of the blood glucose in pregnant women and im-proves the maternal and neonatal outcomes of women with GDM.
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Objective To investigate the effects of combined assessment of normal morphology sperm rate(MNS)with sperm DNA fragmentation index(DFI)on the outcomes of in vitro fertilization-embryo transfer(IVF-ET).Methods A retrospective analysis was conducted on the clinical data of 641 patients who underwent IVF-ET in our center from June 2020 to February 2023.According to MNS and DFI levels,the patients were divided into group A(MNS＜4％,DFI＜25％,403 cases),group B(MNS ≥4％,DFI ≥25％,9 ca-ses),group C(MNS≥4％,DFI＜25％,125 cases),group D(MNS＜4％,DFI≥25％,104 cases),group A1(MNS＜1％,DFI＜25％,106 cases)and group D1(MNS＜1％,DFI≥25％,60 cases).The general information,semen parameters,embryo develop-ment and pregnancy outcomes were compared among all the 6 groups.Results No statistically significant differences were found be-tween female and male age among these groups(P＞0.05).Significant differences were observed in sperm motility,progressive motili-ty,sperm concentration and fertilization rates(P＜0.05),but no differences of usable embryo rates,good-quality embryo rates,clinical pregnancy rates,early miscarriage rates,or live birth rates(P＞0.05)among the groups A,B,C,D,A1 and D1.Conclusion The decreased MNS and increased DFI in males were associated with reduced sperm motility and concentration,affecting fertilization rates in IVF-ET,but had no significant impact on clinical pregnancy outcomes.The combined assessment of MNS with DFI had limited pre-dictive value for IVF-ET pregnancy outcomes.
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Objective To explore the predictive value of serum proprotein convertase subtilisin/kexin type 9(PCSK9)and proprotein convertase subtilisin/kexin type 9(CTRP6)in pregnant women undergoing threatened abortion and fetal protection treatment for pregnancy outcomes.Methods Eighty pregnant women with threatened abortion who were treated in the Second Affiliated Hospital of Shaanxi University of Chinese Medicine from August 2021 to May 2022 were selected as the study subjects.According to the pregnancy outcome,they were grouped into the good pregnancy outcome group(n=62)and the bad pregnancy outcome group(n=18),while another 60 pregnant women with normal pregnancy tests in the hospital were selected as the control group.The serum levels of PCSK9,CTRP6,progesterone and β-human chorionic gonadotropin(β-HCG)were measured by enzyme-linked immunosorbent assay(ELISA).Pearson method was applied to analyze the correlation between serum PCSK9,CTRP6 levels and progesterone and β-HCG levels.Multivariate Logistic regression analysis was applied to analyze the factors affecting the pregnancy outcomes of pregnant women with threatened abortion.The predictive value of serum PCSK9 and CTRP6 on pregnancy outcome of pregnant women with threatened abortion and pregnancy protection treatment was analyzed by the receiver operating characteristic(ROC)curve.Results The level of progesterone(45.65±3.48,38.29±3.54 and 31.56±4.11 nmol/L),β-HCG(32 056.56±4 244.54,23 642.32±3 897.67 and 11 375.56±3 454.35 mIU/L)and CTRP6(436.53±36.23,328.44±31.06 and 277.86±25.56 ng/ml)in control group,good pregnancy outcome group and bad pregnancy outcome group decreased gradually,while the level of PCSK9(64.22±10.35,82.24±13.33 and 114.56±17.67 ng/ml)in the control group,the good pregnancy outcome group and the bad pregnancy outcome group increased gradually,with statistically significant differences(F=129.231,199.334,244.007,111.297,all P＜0.05).Pearson method showed that serum PCSK9 was negatively correlated with progesterone and β-HCG levels(r=-0.545,-0.514,all P＜0.05),and serum CTRP6 was positively correlated with progesterone and β-HCG levels(r=0.567,0.496,all P＜0.05).Multivariate Logistic regression analysis showed that the high level of PCSK9 was an independent risk factor for pregnancy outcome of threatened abortion and fetal protection treatment,and the high level of CTRP6,progesterone and β-HCG were independent protective factors for pregnancy outcome of threatened abortion and fetal protection treatment(P＜0.05).ROC results showed that the area under the curve(AUC)of serum PCSK9 and CTRP6 levels for patients with adverse pregnancy outcomes in the prediction of threatened abortion and fetal protection treatment was 0.843 and 0.849,respectively.The AUC predicted by the combination of the two was 0.941,which was better than that predicted by each individual(Z=1.725,1.882,P＜0.05),with a specificity and a sensitivity of 85.48%,94.44%,respectively.Conclusion The serum PCSK9 level of pregnant women undergoing threatened abortion and fetal protection treatment was obviously increased,and the level of CTRP6 was obviously reduced.This study indicated both have important value in predicting the pregnancy outcomes of pregnant women undergoing threatened abortion and fetal protection treatment.
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Objective:To optimize the existing protocols for the detection of sperm nuclear DNA integrity and to explore their application value in assisted reproductive technology.Methods:194 couples intending to undergo in vitro fertilization-embryo transfer(IVF-ET)treatment at the Affiliated Reproductive Hospital of Jiangxi University of Traditional Chinese Medicine from January 1,2021,to December 8,2022,were selected as the study subjects.The sperm samples from the male partners were collected as the control group,and the same semen,processed after optimization using a double-layer density gradient centrifugation method,was used as the observation group.According to the DNA fragmentation index(DFI)results,the control group and the observation group were divided into three subgroups,control group A and observation group A:DFI＜15％;control group B and observation group B:DFI 15％～30％;control group C and observation group C:DFI ≥30％.Then the DFI values of the observation group and control group were compared.The conditions of assisted pregnancy and pregnancy were analyzed among the subgroups.Results:①The sperm DNA fragmentation index(DFI)of the observation group was signifi-cantly lower than that of the control group[(13.55±10.17)％vs.(18.56±11.54)％,P＜0.05].②There was no significant difference in fertilization rate,cleavage rate and high-quality embryo rate among the six subgroups(P＞0.05).③There were significant differences in pregnancy rate and implantation rate among the six subgroups(P＜0.05);The clinical pregnancy rate(all above 65.00％)and implantation rate(all above 50.00％)were com-pared among four groups:control group A,control group B,observation group A and observation group B.There was no significant difference among the four groups(P＞0.05),but they were all higher than those of control group C(43.24％,31.67％)and observation group C(13.64％,8.82％)(P＜0.05).The clinical pregnancy rate and implantation rate in the control group were significantly higher than those in the observation group C(P＜0.05).Conclusions:The DNA integrity of sperm nucleus can be improved obviously after the sperm was opti-mized.Both of the two methods have good application value in assisted reproductive technology,but the DFI≥30％of semen after optimal treatment has a better predictive value for adverse pregnancy outcomes in ART.
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Objective:To investigate the effects of basal luteinizing hormone(bLH)and different luteinizing hor-mone/follicle stimulating hormone ratio(LH/FSH)on the pregnancy outcome of in vitro fertilization or intracyto-plasmic sperm injection(IVF/ICSI)in patients with polycystic ovary syndrome(PCOS).Methods:From July 2013 to January 2020,424 PCOS patients who underwent flexible gonadotropin-releasing hormone antagonist protocol for ovulation induction in first IVF/ICSI were collected retrospectively from the department of reproductive medi-cine,The First Affiliated Hospital of Nanjing Medical University.The patients were divided into normal bLH(LH≤10 U/L,316 cases)and high bLH(LH>10 U/L,108 cases)group according to different levels of bLH;At the same time,according to the different levels of LH/FSH ratio,they were divided into low ratio(LH/FSH≤1,227 cases)group,median ratio(1<LH/FSH<2,142 cases)group and high ratio(LH/FSH≥2,55 cases)group.The general condition,ovulation induction and pregnancy outcomes of the groups were analyzed and compared Binary Logistic regression was used to analyze the related factors affecting live birth.Results:①The basal FSH and AMH in high bLH group were higher than those in normal bLH group,and the difference was statistically significant(P<0.05).In terms of ovarian induction,the number of oocytes retrieved and endometrial thickness on HCG injection day in the high bLH group were smaller than those in the normal bLH group,but the total duration of antagonist used was longer and the differences were statistically significant(P<0.05).Furthermore the pregnancy outcomes of the two groups had no statistical difference(P>0.05).②Compared with patients in different LH/FSH ratio groups,the high ratio group had higher AMH and antral follicle count(AFC)than the other two groups,and the differences were statistically significant(P<0.05).In terms of ovulation induction,the high ratio group had lower numbers of retrieved eggs,transferred embryos,and endometrial thickness on HCG day compared to the other two groups,with statistically significant differences(P<0.05).There was no statistically significant difference in pregnancy outcome indicators among the three groups of patients(P>0.05).③Binary Logistic regression analy-sis showed no significant correlation between live birth rate and bLH,LH/FSH ratio(P>0.05),but the live birth rate was related to the number of embryos transferred(P<0.05).Conclusions:Elevated bLH level and LH/FSH ratio may affect the outcomes of ovulation induction in women with PCOS(such as the number of oocytes re-trieved and endometrial thickness on HCG injection day),but there is no significant correlation with live birth rate of assisted reproduction.
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Objective:To evaluate the impact of human papillomavirus(HPV)infection on the clinical outcomes of intrauterine insemination(IUI)in infertile women.Methods:The clinical data of 685 patients(1046 cycles)who underwent IUI treatment were retrospectively analyzed at Tangdu Hospital of Air Force Medical University from January 2019 to July 2021,including 554 cases of artificial insemination with husband sperm(AIH).According to HPV infection,patients were divided into two groups,HPV positive group and HPV negative group,propensity score matching(PSM,1 ∶ 2)was used for IUI(80 cases in HPV-positive group and 158 cases in HPV-negative group)and AIH(65 cases in HPV-positive group and 129 cases in HPV-negative group)treatment patients,and the clinical outcomes of these patients were compared respectively.Results:There was no statistically significant difference in clinical pregnancy rate,live birth rate,ectopic pregnancy rate,abortion rate,macrosomia birth rate,and low body weight birth rate between HPV-positive group and HPV-negative group after matching with IUI treat-ment patients(P>0.05).There was no statistically significant difference in clinical pregnancy rate,live birth rate,ectopic pregnancy rate,miscarriage rate,macrosomia birth rate,and low body weight birth rate between the HPV positive group and the HPV negative group after matching AIH treatment patients(P>0.05).Conclusions:HPV infection in infertile female may not affect the clinical outcomes of IUI patients.
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Treponema pallidum(Tp),a common sexually transmitted pathogen,can infect the fetus via pla-cental vertical transmission,leading to congenital syphilis(CS).This infection results in adverse pregnancy outcomes,such as stillbirth,miscarriage,preterm birth,and fetal growth restriction.However,the exact pathogenesis remains un-clear.Studies indicate that patients with early syphilis primarily exhibit pro-inflammatory immune responses.The Tp has been proven to induce dysfunction in various immune cells and abnormal expression of cytokines,potentially disrupting im-mune tolerance homeostasis and leading to adverse pregnancy outcomes.Grounded in the current understanding of CS and maternal-fetal immunology by scholars both domestically and internationally,this paper provides a comprehensive review of the potential mechanisms of Tp interacting with the cells of the maternal-fetal interface,ultimately leading to adverse pregnancy outcomes.It summarizes the pathogenesis characteristics,clinical manifestations,and maternal-fetal immune responses of CS.
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Objective:To summarize the clinical features, pregnancy outcomes, and treatment strategies of pulmonary thromboembolism (PTE) in pregnant women and puerperae.Methods:Clinical data of 16 pregnant women or puerperae with PTE who were admitted to Beijing Anzhen Hospital from January 2012 to December 2022 were retrospectively collected. Descriptive statistical analysis was used to summarize the clinical features, treatment strategies, and pregnancy outcomes in these cases.Results:The average age of the 16 patients was (29.6±3.5) years (26-35 years) and the median onset time was 12 weeks (7-38 weeks) of gestation in six pregnant women and 4 d (16 h-40 d) after delivery in ten puerperae. There were two cases of high-risk type; nine cases of medium-risk type (six of medium-high risk and three of medium-low risk); and five cases of low-risk type. Definite high-risk factors were detected in four pregnant women (venous thromboembolism risk score ≤2) and nine puerperae (venous thromboembolism risk score of 2-9). None of the six pregnant women had any indications for preventive anticoagulant therapy and nine puerperae had indications but without preventive therapy. All the patients were treated with low molecular weight heparin and sequential administration of warfarin/rivaroxaban, in addition to that, two high-risk patients also received thrombolytic therapy. After therapy, all pregnant women terminated their pregnancies in time and then continued to receive anticoagulation treatment. All 16 patients survived. Among the six pregnant women, five who developed PTE in the first or second trimester underwent iatrogenic termination of pregnancy, and one who developed PTE in the third trimester gave live birth. Among the 10 puerperae, one had PTE after the termination of pregnancy in the second trimester due to intrauterine fetal death; one developed PTE after abortion in the first trimester; the other eight cases developed PTE after cesarean section in the third trimester, with all newborns surviving.Conclusions:Pregnant women and puerperae are at high risk of PTE and most have high-risk factors. Therefore, more attention should be paid to the screening of high-risk factors and the initiation of preventive anticoagulant therapy. Maternal outcomes are good after PTE treatment, but fetal outcomes depend on the time of onset.
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The "Clinical Practice Guidelines for Hypertension in China", released in 2022, has lowered the diagnostic criteria for hypertension. However, no adjustments were made to the diagnostic criteria for hypertension during pregnancy. The impact of adult hypertension diagnostic criteria on the diagnosis of gestational hypertension and pregnancy outcomes remains unclear. Borderline hypertension includes elevated blood pressure and stage 1 hypertension. Compared to pregnant women with normal blood pressure, women with borderline hypertension have an increased risk of adverse pregnancy outcomes. Still, there are no associated guidelines for pregnancy management for now. This article explores the influence of borderline hypertension on pregnancy outcomes and the optimal level for blood pressure control during pregnancy, aiming to improve maternal and fetal outcomes and optimize the management of borderline hypertension during pregnancy.
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[Objective]To explore the clinical efficacy of modified Yupingfeng Powder combined with western medicine in the treatment of pregnant women with mild corona virus disease 2019(COVID-19).[Methods]The pregnant women with mild COVID-19 admitted to Shanghai Public Health Clinical Center from April 2022 to June 2022 were divided into treatment group and control group randomly.The control group(52 cases)was treated with western medicine such as Vitamin C,and the treatment group(48 cases)was treated with modified Yupingfeng Powder on the basis of control group.A comparison was made between the two groups in terms of each symptoms scores,incidence of adverse pregnancy outcomes and total effective rate.Besides,the levels of laboratory indicators involving lymphocyte,C reactive protein(CRP),interleukin-2 receptor(IL-2R)and interleukin-6(IL-6)were also be compared.The negative changes of virus nucleic acid and disease outcome were observed in the two groups.[Results]Compared with control group,after treatment cessation,the total symptom score in treatment group significantly decreased(P＜0.001),and the total effective rate significantly increased(P＜0.01).The levels of inflammatory markers including CRP and IL-6 decreased significantly in treatment group(P＜0.001,P＜0.01),while the count of lymphocyte increased significantly(P＜0.001).Besides,there was no difference in the incidence of adverse pregnancy outcomes between the two groups(P＞0.05).[Conclusion]Modified Yupingfeng Powder combined with western medicine can significantly relieve the clinical symptoms of pregnant women with mild COVID-19,while shortening nucleic acid negative conversion time and does not affect the pregnancy outcome,which has certain clinical value and is worthy of clinical application.
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ObjectiveTo establish the reference intervals of thyroid hormones in pregnant women from Sanming city and compare them with those from other areas in China. MethodsThe study recruited 605 pregnant women and 229 non-pregnant healthy women who visited Sanming First Hospital between March 29 and June 28， 2023. Blood samples were sequentially collected from the participants to determine the serum levels of thyroid stimulating hormone （TSH）， free triiodothyronine （FT3） and free thyroxine （FT4）. The reference intervals of thyroid hormones were established by using a percentile range of P2.5 to P97.5 and their changes in different periods of pregnancy were analyzed and compared with those from other areas in China. ResultsThere were significant differences in levels of TSH， FT4 and FT3 at different periods of pregnancy （all P <0.05）. Compared with non-pregnant women， women in first trimester had significantly decreased levels of TSH and FT4， but similar level of FT3. Since the second trimester， TSH level displayed rising tendency， while FT3 and FT4 levels showed gradual decrease. The reference intervals of thyroid hormones in the first， second and third trimester of pregnancy in Sanming city were TSH （0.068， 2.943） μU/mL， FT3 （4.302， 6.888） pmol/L， FT4 （8.240， 14.719） pmol/L； TSH （0.419， 3.274） μU/mL， FT3 （4.074， 6.629） pmol/L， FT4 （6.726， 11.980） pmol/L； TSH （0.422， 3.570） μU/mL， FT3 （3.741， 5.850） pmol/L， FT4 （6.103， 10.347） pmol/L， respectively. Significant differences were found in the reference intervals of thyroid hormones during pregnancy among different areas in China. ConclusionsThe levels of TSH， FT3， FT4 during pregnancy are different from those during non-pregnancy， and also significantly differ in different periods of pregnancy. Reference intervals of thyroid hormones in pregnant women are affected by various factors such as geographic location， ethnicity and laboratory test method， etc. Therefore， establishing the population-specific reference intervals of thyroid hormones will benefit for the diagnosis and treatment of thyroid disease in pregnant women from Sanming city.
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Objective @#To investigate the factors influencing the pregnancy outcomes during frozen-thawed embryo transfer (FET) cycles in patients with polycystic ovary syndrome (PCOS) . @*Methods @#A retrospective analysis was conducted on patients ’data from 882 FET cycles . According to the pregnancy outcome , the patients were divided into non-implantation group (Group A) , abortion group ( Group B1) and live birth group ( Group B2) . Clinical data and laboratory parameters were compared among the three groups , and ordered Logistic regression analysis was used to study the factors influencing pregnancy outcomes after FET. Patients were also divided into four groups (C1-C4) based on the number of high-quality embryos obtained (0 - 3 , 4 - 6 , 7 - 10 , ≥11) , and their clinical data and laboratory parameters were compared .@*Results @#The clinical pregnancy rate , live birth rate , and miscarriage rate in the 882 treatment cycles were 71 . 09% (627/882) , 61 . 68% (544/882) , and 13 . 24% (83/627) ,respectively. Single-factor analysis showed significant differences in body mass index (BMI) , infertility type , human chorionic gonadotropin (hCG) day estradiol ( E2 ) level , number of retrieved oocytes , and number of high-quality embryos among Groups A , B1 , and B2 (P < 0. 05) . Further multiple Logistic regression analysis revealed that BMI(OR = 1 . 046 , 95% CI:1 . 001 - 1 . 093 , P = 0. 044) and a history of previous pregnancy(OR = 1 . 417 , 95% CI:1 . 030 - 1 . 950 , P = 0. 032) were independent risk factors for successful FET in PCOS patients , while an increased number of high-quality embryos was an independent protective factor for successful pregnancy. Based on the results of Group B2 , compared to Group A , OR = 0. 920 , 95% CI:0. 880 - 0. 962 , P = 0. 000;compared to Group B1 , OR = 0. 923 , 95% CI:0. 862 - 0. 988 , P = 0. 022 . Compared with the other three groups( C1-C3) , the total amount of gonadotropin (Gn) in the C4 group was the lowest and the number of oocytes obtained was the highest (P < 0. 05) . Multiple comparisons showed that Group C4 had lower BMI , follicle-stimulating hormone (FSH) , very low-density lipoprotein ( vLDL) levels , a higher luteinizing hormone and follicle-stimulating hormone ( LH/FSH) ratio compared to Group C1 (P < 0. 05) . Group C4 had lower fasting insulin (FINS) and homeostasis model assessment of insulin resistance ( HOMA-IR) levels compared to Group C3 , and higher high-density lipoprotein-cholesterol (HDL-C) and apolipoprotein A1 (Apo A1) levels compared to Groups C2 and C3 (P < 0. 05) . @*Conclusion@#BMI , the history of previous pregnancy and the number of high-quality embryos were both independent factors for predicting pregnancy outcomes in PCOS patients undergoing FET cycles . Patients with a higher number of high-quality embryos have a higher clinical pregnancy rate during FET cycles .
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Objective:To investigate the effect of intrapartum artificial rupture of the membrane on maternal and infant outcomes among pregnant women infected with group B streptococcus (GBS).Methods:A total of 468 women with a singleton pregnancy who had a GBS infection were included in this case-control study. The enrolled women were divided into an artificial membrane rupture group ( n = 155) and a natural membrane rupture group ( n = 313) according to different methods of membrane rupture. Women in the artificial rupture of membrane group received antibiotic treatment after delivery or before membrane rupture, and the incidence of adverse pregnancy outcomes was compared between the two groups. Results:The incidences of chorioamnionitis, puerperal infection, and postpartum hemorrhage in the artificial membrane rupture group were 1.29% (2/155), 6.45% (10/155), and 4.52% (7/155), respectively, while those in the natural membrane rupture group were 1.92% (6/313), 3.83% (12/313), and 1.92% (6/313), respectively. There were no significant differences between the two groups in terms of incidence of chorioamnionitis, puerperal infection, or postpartum hemorrhage between the two groups ( χ2 = 0.01, 1.58, 1.72, all P > 0.05). The incidences of neonatal sepsis, neonatal asphyxia, neonatal GBS infection, and neonatal pneumonia in the artificial membrane rupture group were 0, 1.29% (2/155), 9.68% (15/155), and 0.65% (1/155), respectively, while those in the natural membrane rupture group were 1.60% (5/313), 0.64% (2/313), 11.82% (37/313), and 1.60% (5/313), respectively. There were no significant differences between the two groups in terms of neonatal sepsis, neonatal asphyxia, neonatal GBS infection, and neonatal pneumonia ( χ2 = 1.22, 0.03, 0.48, 0.18 both P > 0.05). Conclusion:Under the premise of effective antibiotic treatment, artificial rupture of membranes for pregnant women infected with GBS does not increase the incidence of adverse pregnancy outcomes. Artificial rupture of membranes technology can be used as an effective supplement to natural rupture of membranes.
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Objective:To explore the effect of intervention model based on comprehensive nutrition management on glucose and lipid metabolism and pregnancy outcome in patients with gestational diabetes mellitus (GDM).Methods:104 GDM patients admitted to Shanxi Bethune Hospital from February 2022 to March 2023 were randomly divided into control group and experimental group, with 52 cases in each group. The control group implemented routine management measures and nutrition guidance, while the experimental group implemented an intervention model based on comprehensive nutrition management on the basis of routine management. The indexes of glucose and lipid metabolism (glycosylated hemoglobin, fasting blood glucose, 2 h postprandial blood glucose, total cholesterol, triglyceride and low density lipoprotein cholesterol), pregnancy outcome, self-management ability and self-efficacy were compared between the two groups before and after intervention.Results:Before the intervention, there was no significant difference in general situation, glucose and lipid metabolism index, self-management ability and self-efficacy between the two groups ( P>0.05). After the intervention, the level of glucose and lipid metabolism index in the experimental group was significantly lower than that in the control group, with statistical significance ( P<0.05). The incidence of adverse pregnancy outcome in the experimental group was significantly lower than that in the control group, with statistical significance ( P<0.05). The scores of self-management ability and self-efficacy in the experimental group were significantly higher than those in the control group, with statistical significance ( P<0.05). Conclusion:The intervention model based on comprehensive nutrition management can effectively improve the glucose and lipid metabolism index and pregnancy outcome of GDM patients, and significantly improve their self-management ability and self-efficacy related to nutrition management, which has high clinical application and promotion value.
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Objective:To evaluate clinical efficacy and safety of immunotherapy by retrospectively analyzing clinical medica-tion of patients with recurrent pregnancy loss(RPL)complicated with abnormal immune factors.Methods:A retrospective cohort study was conducted on RPL cases in outpatient department of Hebei Reproductive Health Hospital from January 2021 to April 2022.Efficacy and safety of immunotherapy were evaluated from pregnancy outcome,adverse reactions and birth defects of offspring.Results:According to guidelines,192 cases with abnormal autoimmunity and/or immune indicators were included.Early abortion rate was 4.16%in group of two lost pregnancies,which was lower than that in group of three lost pregnancies(16.66%).Twelve week sus-tained pregnancy rate was 89.58%in the former group,and 28 week sustained pregnancy rate was 86.45%,which were significantly higher than those in the latter group(75.00%,71.87%).RPL patients were divided into groups according to their exposure to immuno-modulatory drugs before 12 weeks of pregnancy.There was no significant difference in pregnancy outcome,adverse reaction rate and birth defect rate of their offspring(P>0.05).Conclusion:Immunotherapy can effectively reduce risk of recurrent abortion and increase rate of persistent pregnancy in patients with immune RPL.Personalized immunotherapy can make RPL patients with immune factors achieve expected effect of fetal protection.
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Objective:To explore the predictive value of uterine artery blood flow parameters of Doppler ultrasound combined with coagulation related indicators on the pregnancy outcome of recurrent abortion caused by thrombophilia.Methods:A total of 82 patients with recurrent abortion who admitted to the department of gynecology outpatient of Beijing Haidian Hospital from January 2020 to January 2023 were selected.All patients received relevant treatment,and the follow-up results were calculated as statistic method.Before treatment on the day after admission,uterine artery pulse index(PI),resistance index(RI),the ratio of the maximum blood flow velocity of systolic pressure(S)to the maximum blood flow velocity of end-diastolic(D)(S/D),and activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(FIB),thrombin time(TT)and D-dimer(D-D)of all patients were detected.Pearson correlation analysis was adopted to analyze the correlations between PI,RI,S/D and each of APTT,PT,FIB,TT and D-D.Receiver operating characteristic(ROC)curve was used to analyze the values of single PI,RI,S/D,APTT,PT,FIB,TT and D-D,and the value of the combined detection of them in predicting the pregnancy outcome of recurrent abortion caused by thrombophilia.Results:Follow up results showed that 49 cases of 82 patients with recurrent abortion were successful pregnancy and 33 cases of them occurred pregnancy loss,and the PI,RI and S/D of pregnant women with successful pregnancy were significantly lower than those of pregnant women who occurred pregnancy loss,with statistical significance(t=10.598,6.693,3.059,P<0.05).The levels of APTT,PT,FIB,TT and D-D of pregnant women with successful pregnancy were significantly lower than those of pregnant women who occurred pregnancy loss,and the differences were statistically significant(t=9.552,96.462,22.767,5.100,95.805,P<0.05),respectively.PI appeared respectively positive correlation with APTT,PT,FIB,TT and D-D(r=3.178,P<0.05),and RI appeared respectively positive correlation with APTT,PT,FIB and D-D(r=3.246,P<0.05),and S/D also appeared respectively positive correlation with PT,FIB,TT and D-D(r=3.246,P<0.05).The sensitivities of single PI,RI,S/D,APTT,PT,FIB,TT and D-D detection,and the combined detection of them were respectively 42.40%,48.50%,39.40%,48.50%,63.60%,72.70%,42.40%,39.40%and 84.80%in predicting the pregnancy outcome of recurrent abortion caused by thrombophilia.The specificities of them were respectively 98.00%,71.40%,55.10%,75.50%,59.20%,71.40%,77.60%,85.70%and 98.80%,and the AUC values of them were respectively 0.674,0.685,0.409,0.646,0.784,0.788,0.566,0.563 and 0.941.Conclusion:Both single and combination of PI,RI and S/D of uterine artery blood flow parameters,as well as APTT,PT,FIB,TT and D-D of coagulation related indicators,have a certain value in predicting pregnancy outcome of recurrent abortion caused by thrombophilia,and the combined detection has higher predictive value.