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Objective:To analyze the association of pre-pregnancy body mass index (BMI) and gestational weight gain with macrosomia.Methods:In this retrospective cohort study, data of all puerperae and newborns in the Obstetrics Center of Peking Union Medical College Hospital from July 2020 to June 2021 were collected, including basic maternal information, pregnancy complications and neonatal conditions. A total of 2 422 pregnant women with full-term singleton live birth and their newborns were included in the analysis. The incidence of macrosomia (≥4 000 g) was calculated according to the birth weight of the newborns. Logistic regression and heat map were used to analyze the associations of pre-pregnancy BMI and gestational weight gain with macrosomia.Results:The incidence of macrosomia was 4.00% (97/2 422) in full-term singleton live birth newborns. Pre-pregnancy body weight, pre-pregnancy BMI, pre-pregnancy overweight/obesity rate, pre-delivery body weight, total weight gain during pregnancy, mean weekly weight gain during pregnancy, the proportion of excessive weight gain during pregnancy, duration of pregnancy, and the proportion of primiparity and education level of junior college or below were all significantly higher in the puerperae of the macrosomia group than those in the non-macrosomia group [(63.87±8.27) vs (58.14±7.86) kg, (23.33±2.97) vs (21.60±2.72) kg/m2, 35.1% vs 17.3%, (77.48±9.11) vs (70.02±8.79) kg, (13.61±4.56) vs (11.88±4.40) kg, (0.34±0.11) vs (0.30±0.11) kg, 58.8% vs 31.1%, (280.47±7.79) vs (276.14±7.83) d, 34.1% vs 23.7%, 18.6% vs 7.5%] (all P<0.05). Pre-pregnancy BMI ( OR=1.227, 95% CI: 1.145-1.314), mean weekly weight gain during the whole pregnancy ( OR=33.453, 95% CI: 5.172-217.947), duration of pregnancy ( OR=1.083, 95% CI: 1.055-1.112), primiparity ( OR=1.969, 95% CI: 1.232-3.101) and education level of junior college or below ( OR=2.525, 95% CI: 1.325-4.668) were all positively associated with occurrence of macrosomia (all P<0.05). The incidence of macrosomia increased with the pre-pregnancy body mass index and mean weekly weight gain during the whole pregnancy. Conclusions:High pre-pregnancy BMI and mean weekly weight gain during the whole pregnancy are associated with the increased risk of macrosomia. Appropriate weight management during pregnancy may help to reduce the incidence of adverse pregnancy outcomes.
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Objective:To assess the association of appendicular skeletal muscle mass(ASM) to fat mass(FM) ratio in early pregnancy with the risk of gestational diabetes mellitus (GDM).Methods:A total of 468 pregnant women who visited the Nutritional Department of Peking Union Medical College Hospital or Shunyi Maternal and Child Care Service Center in 2018 and 2019 were recruited. Detailed information and clinical data were collected. The body components were measured using the bioelectrical impedance analysis (BIA) method during early pregnancy (< 14 weeks) and the ASM to FM ratio was calculated. The patients were divided into the GDM group and normal glucose tolerance (NGT) group according to the results of the oral glucose tolerance test (OGTT) performed during 24-28 weeks. Binary logistics regression was used to explore the correlation between the ASM/FM ratio and the risk of GDM. The receiver operator characteristic (ROC) curve of subjects was used to evaluate the predictive value of ASM/FM ratio for GDM and the cut-off value was reported.Results:Compared to the NGT group, the ASM and FM in early pregnancy in the GDM group were significantly higher, while the ASM/FM ratio was significantly lower. A lower ASM/FM ratio in early pregnancy was one of the risk factors of developing GDM. The cut-off value of the ASM/FM ratio was 0.809. The area under the ROC curve for predicting GDM increased from 68.1% to 72.3% when ASM/FM ratio was incorporated, with a significant difference by Delong test ( P = 0.006). Conclusion:Inadequate muscle mass would increase the risk of GDM and the ASM/FM ratio could serve as a predictor of GDM.
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Objective:This study aimed to investigate the influence of staple food type on glucose levels in women with gestational diabetes mellitus (GDM).Methods:The drawing lots method was used for randomized grouping. The subject inclusion criteria were being a pregnant woman and diagnosed with GDM at 24-28 weeks gestation. Anyone with severe internal or external disease, previous abnormal glucose metabolism, smoking history, multiple pregnancies, or poor compliance was excluded. Twenty pregnant women were enrolled and were randomized to receive meals and snacks consisting of wholegrain flour products and tuber vegetables (control group) or wholegrain rice (intervention group) for 4 weeks. In the administration of the meals, energy supply, energy distribution, and nutrient level were matched between the two groups. A continuous glucose monitoring system was used for monitoring glucose level, and postprandial glycemia (incremental area under the curve) was measured after lunch and dinner.Results:A total of 17 women with GDM completed the study (8 in group A and 9 in group B). After the dietary intervention, the compliance rate of blood glucose in groups A and B was (89.20±6.06)% and (90.61±5.25)%, and glycated albumin was (12.46±0.84)% and (12.46±0.84)%, respectively ( P>0.05). Moreover, there were no significant differences in cesarean section rate or perinatal complications between the two groups. The incremental area under the curve of glucose within 2 hours after lunch [(137.3±84.4) vs(111.0±78.9)] and dinner [(137.0±87.7) vs (111.0±74.8)] were both significantly lower in the intervention group compared with the control group, which indicates a more stable postprandial glucose response to GDM with wholegrain rice. Conclusion:The intervention diet used in this study showed good glucose control for GDM pregnancies; a diet with wholegrain rice as the staple food led to more stable postprandial glucose response than a diet with wholegrain flour products and tuber vegetables as the staple food.
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Objective:To evaluate the association of maternal nutrition status in the first trimester with gestational diabetes mellitus (GDM) and macrosomia.Methods:378 pregnant women who took prenatal care in Shunyi Women′s and Children′s Hospital of Beijing Children′s Hospital were enrolled in the study. Blood samples were collected at first prenatal visit (<12 gestation weeks) to measure the level of hemoglobin and iron status indexes including serum iron, ferritin, transferrin, total iron binding capacity, iron saturation, transferrin saturation. The incidence of GDM and macrosomia were collected and Logistic regression was used to evaluate the associations of maternal nutrients status in the first trimester with GDM and macrosomia.Results:The incidence rate of GDM was16.9%,the incidence of anemia and iron deficiency in the first trimester were2.4% and 2.5%, respectively. After adjustment for variables such as maternal age, pre-pregnancy BMI, family history of diabetes, and parity, Logistic regression showed that in the first trimester, iron saturation>50% ( OR=0.238, 95% CI 0.068-0.831), transferrin saturation>50% ( OR=0.08, 95% CI 0.010-0.677) were protective factors of GDM; iron saturation 25%-50% ( OR=0.361, 95% CI 0.143-0.908); transferrin saturation 25%-50% ( OR=0.383, 95% CI 0.165-0.891); ferritin>30 ng/ml ( OR=0.418, 95% CI0.186-0.939) were protective factors of macrosomia. Conclusion:Maternal iron status in the first trimester might be associated with GDM and macrosomia. Thus, maternal iron status assessment in the first trimester is necessary.
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Objective To analyze the prevalence of depression in early pregnancy, explore its possible influencing factors, and provide reference for mental health care during pregnancy. Methods A baseline survey of 9 193 early pregnant women recruited by the Chinese Pregnant Women Cohort Study (CPWCS) program was conducted. Edinburgh Postnatal Depression Scale was used to assess the depression symptoms in early pregnancy. The χ2 test and multivariable logistic regression were used to analyze the influencing factors. Results The rate of depression in early pregnant women in CPWCS was 46.50%. Multivariate analysis showed that unplanned pregnancy (OR=1.23, 95%CI: 1.12~1.35, P<0.001), passive smoking (OR=1.28, 95%CI: 1.18~1.39, P<0.001), drinking (OR=1.35, 95%CI: 1.12~1.63, P=0.002) and consumption of carbonated or sugary beverages （OR=0.80, 95%CI: 0.73~0.88, P<0.001） were risk factors for depression during early pregnancy, while enough sleep (OR=0.71, 95%CI: 0.57~0.88, P=0.002), moderate-high level of physical activity (OR=0.87, 95%CI: 0.78~0.98, P=0.023), healthy intake of vegetables and fruits（OR=0.60, 95%CI: 0.51~0.70, P<0.001), animal foods（OR=0.82, 95%CI: 0.74~0.91, P<0.001） and milk and dairy products（OR=0.81, 95%CI: 0.72~0.90, P<0.001）were protective factors. Conclusion The rate of depression was high and it was affected by many factors. It is necessary to pay more attention to depression symptoms during early pregnancy and carry out targeted psychological health care during pregnancy.
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Objective To understand the status of economic burden of maternal health care of pregnant women in China, and to discuss the equity and accessibility of maternal health care during pregnancy among different regions and populations. Methods A total of 9 193 women during early pregnancy were recruited from the Chinese Pregnant Women Cohort Study between July 25, 2017 and November 26, 2018. Information on general condition and economic burden of maternal health care was surveyed. SPSS 25.0 software was used for statistical analysis. Results The median direct medical cost of maternity check-ups for pregnant women was 400 CNY per visit, and the median cost of lost work was 360 CNY per visit. The analysis of the results showed that the median medical expense was highest in pre-pregnant women with BMI 2 (P=0.008). The median medical expense was higher in urban residents than rural residents (Ptrend=0.003). The higher the socioeconomic status was, the higher the direct medical expense was (Ptrend=0.003). The cost of lost work was lower in pregnant women with higher socioeconomic status (P=0.025, Ptrend=0.017). In addition, the medical expense was highest in women living in the eastern part of China (P<0.001). The direct medical expenses (P=0.002) and lost-time expenses of pregnant women in the North were higher than those in the South (P=0.013). Conclusion The problem of equity and accessibility of maternal health care still existed. It is recommended that relevant departments further improve maternal health care services and build a diversified healthcare service system to ensure maternal and child health and promote eugenics.
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Objective@#To study the relationship between exposure factors in early pregnancy and preterm birth (PB), low birth weight (LBW) and small for gestational age (SGA) of neonates.@*Methods@#A total of 3 172 pregnant women who were enrolled in the project of Chinese Pregnant Women Cohort Study-Peking Union Medical College (CPWCS-PUMC) from July 25, 2017 to July 24, 2018 and delivered before December 31, 2018 were selected as subjects in this study. The relationship between exposure factors in early pregnancy and adverse outcomes of neonatal delivery was analyzed by using binary logistic regression analysis.@*Results@#The incidence rates of PB, LBW and SGA were 4.76%, 3.53% and 5.74%, respectively. In terms of PB, the analysis results showed that the gestational weight gain (GWG) and living in northern China were protective factors, while premature rupture of membranes, gestational hypertension, dental examination or treatment within 1-3 years and family with 3-4 members were risk factors. In the respect of LBW, GWG and daily consumption of milk and dairy products were the protective factors, while premature rupture of membranes, gestational hypertension, sedentary working time more than 6 hours, dental examination or treatment within 1-3 years and passive smoking were risk factors. For SGA, baby girl, passive smoking, peanut oil consumption and unsalted taste were risk factors, while folic acid supplementation was protective factor.@*Conclusion@#The risk factors for PB, LBW and SGA were multifactorial, and relevant specific measures should be taken to reduce the occurrence of adverse neonatal outcomes.
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Objective@#To explore oral health care behavior and related factors among women in their 1st trimester.@*Methods@#Our analysis included 7 014 women in their 1st trimester aged 16 years or above from the baseline survey of the Chinese Pregnant Women Cohort Study (CPWCS). Data on socio-demographic characteristics and oral health care behavior were collected using an electronic questionnaire. Multiple-factors Logistic regression was used to analyze factors associated with oral health care behavior.@*Results@#The results revealed that 5 134 (73.20%), 2 482 (35.39%), and 1 046 (14.91%) pregnant women brushed their teeth twice a day or more, never had an oral examination, and used special oral care products for pregnant women, respectively. The frequency of brushing teeth and oral examination was positively associated with age and annual household income. Compared to unemployed pregnant women with rural registered residences and low education levels, highly educated and employed pregnant women with city registered residences had a higher frequency of brushing teeth and undergoing oral examination. Pregnant women with depressive symptoms had a lower frequency of brushing teeth (OR=0.73, 95% CI: 0.65-0.81), while those with medical insurance underwent more frequent oral examination (OR=1.19, 95% CI: 1.02-1.39). Compared to pregnant women who were unaware of the risk of gingivitis, those who believed gingivitis to be harmful to both themselves and their fetus had a higher frequency of brushing teeth and oral examination and were more likely to use special oral care products.@*Conclusion@#Most pregnant women did not pay attention to the need for oral examinations and special oral care products. Their oral health behavior was associated with socioeconomic status, depressive symptoms, and awareness of the importance of oral health. Therefore, oral health care before and during pregnancy was required to help them improve their self-care behavior.
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Objective To access the current status of folic acid supplementation in women at childbearing age in suburban area of Beijing,2016.Methods In this cross-sectional study,a total of 722 women aged 17-41 years from six hospitals in suburban areas of Beijing were selected through cluster sampling.A questionnaire survey was conducted.Results The rates of folic acid intake and regular folic acid intake among women under survey were 63.9％ (456/714) and 83.3％ (380/456).In women who remembered the duration of folic acid supplementation,the overall rate of preconceptional folic acid supplementation was 35.5％ (159/450),in whom 27.3％ (123/450) began to take folic acid 0-3 months before pregnancy;8.0％ (36/450) began to take folic acid 3 months before pregnancy.Multivariate logistic regression analysis indicated that household registering type,preparation for pregnancy or pregnancy,parity,smoking and alcohol use were the influencing factors for folic acid supplementation.Conclusions The rate of folic acid supplementation remained low in childbearing aged women in suburban area of Beijing.It is necessary to further strengthen the health education about the importance of folic acid supplementation to improve the intake rate and the regular intake rate of folic acid in pregnant women and to promote maternal infant health and reduce the related complications.
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Objective To access the current status of folic acid supplementation in women at childbearing age in suburban area of Beijing,2016.Methods In this cross-sectional study,a total of 722 women aged 17-41 years from six hospitals in suburban areas of Beijing were selected through cluster sampling.A questionnaire survey was conducted.Results The rates of folic acid intake and regular folic acid intake among women under survey were 63.9％ (456/714) and 83.3％ (380/456).In women who remembered the duration of folic acid supplementation,the overall rate of preconceptional folic acid supplementation was 35.5％ (159/450),in whom 27.3％ (123/450) began to take folic acid 0-3 months before pregnancy;8.0％ (36/450) began to take folic acid 3 months before pregnancy.Multivariate logistic regression analysis indicated that household registering type,preparation for pregnancy or pregnancy,parity,smoking and alcohol use were the influencing factors for folic acid supplementation.Conclusions The rate of folic acid supplementation remained low in childbearing aged women in suburban area of Beijing.It is necessary to further strengthen the health education about the importance of folic acid supplementation to improve the intake rate and the regular intake rate of folic acid in pregnant women and to promote maternal infant health and reduce the related complications.
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Objective To explore the relationship between SNPs in microRNA binding sites of ABCG5/8 and the glucolipid level during pregnancy.Methods 1 925 pregnant women were recruited at Peking Union Medical College hospital from 2006 to 2011.The clinical data were collected and the total genomic DNA was extracted from whole blood samples.ABCG5/8, which was reported to be related with the glucose and lipid metabolism closely, were selected as the candidate gene and the SNPs in its microRNA binding sites with minor allele frequency >5% in Han Chinese in Beijing were chosen.Then the genotyping was performed and analyzed.Results There was only one SNP matching the criteria, rs2278356, and it is significantly associated with LDL-C and TC level during pregnancy (LDL-C: b=0.104 mmol/L, 95% CI 0.023-0.185 mmol/L, P<0.05;TC: b=0.105 mmol/L, 95% CI 0.080-0.203 mmol/L, P<0.05).Conclusions The association of rs2278356 in 3′UTR of ABCG5/8 with LDL-C and TC level in pregnant Chinese Han women is found, which may provide an individualized treatment strategy for pregnant women with high cholesterol.
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[Summary] A 32 year-old woman in the third trimester of pregnancy was admitted for severe acute pancreatitis due to hypertriglyceridemia . During hospitalization she developed multiorgan dysfunction , infected pancreatic necrosis , abdominal compartment syndrome and intrauterine fetal death . She was successfully treated by multidisciplinary team including department of emergency medicine , ICU, gastroenterology, obstetrics, endocrinology, ultrasonography, radiology, infectious disease, nutrition and surgery.
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Through literature study,this paper summarizes the current status ofreseareh on the relationship between maternal exposure factors and small for gestational age infant both in China and abroad.And at the same time,the relationship between pregnancy outcome of small for gestational age and maternal exposure factors was analyzed.This might contribute to reduce the incidence of small for gestational age infant and provide important guidance and references for perinatal care.
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Through literature study,this paper summarizes the current status ofreseareh on the relationship between maternal exposure factors and small for gestational age infant both in China and abroad.And at the same time,the relationship between pregnancy outcome of small for gestational age and maternal exposure factors was analyzed.This might contribute to reduce the incidence of small for gestational age infant and provide important guidance and references for perinatal care.
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Objective To retrospectively study the serum IgG and IgM antibodies against toxoplasma, rubella virus, cytomegalovirus and herpes simplex virus type 1&2 in various populations, and analyze the clinical values.Methods From 2008 to 2015, 2 661 pregnant women, 324 infertile women, 2 492 women with abnormal pregnancy history, 623 women with recent abnormal pregnancy, 261 infants with intrauterine growth retardation and other diseases, 170 women for preconceptual examination, and 702 women for physical examination in Beijing were included .Commercial EIA kits were used to detect serum IgG and IgM antibodies to toxoplasma, rubella virus, cytomegalovirus and herpes simplex virus type 1&2. Positive reactions of IgM antibodies to any pathogens were re-tested with another kind of commercial EIA kit. PEMS3.1 software was used for statistical analysis.Results The prevalence of serum IgG or IgM antibodies against toxoplasma, rubella virus, cytomegalovirus and herpes simplex virus type 1& 2 were found within 0.7%-1.6%(0-1.2%) , 85.3%-92.0% ( 0.4%-2.7%) , 89.1%-94.9% ( 0.7%-1.7%) , 74.8%-86.0% ( 0 -0.7%) , 8.1% -17.4% ( 0 -4.1%) respectively in the studied population groups.The prevalence of TORCH IgG and IgM antibodies were not found to be higher in both populations with past suspicious exposure ( infertile women and women with abnormal pregnancy history ) and recent suspicious exposure ( women with recent abnormal pregnancy and infants with intrauterine growth retardation and other diseases) than that in pregnant women and women for preconceptual and physical examination. Conclusion No associations between TORCH infections and the suspicious exposure were found in the populations above.
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Objective To evaluate the effect of medical nutritional intervention on clinical outcome of gestational diabetes mellitus.Methods A meta-analysis of randomised controlled trials was conducted.PubMed, EMBASE, OVID, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Chinese WanFang Database were searched for the literatures related to the effect of medical nutritional intervention on clinical outcome of gestational diabetes mellitus from January 2005 to January 2015.At the same time, manual searching and reference review were conducted.Strict screening of the searched literatures was performed based on inclusion and exclusion criteria.All the included trials were divided into two groups based on whether the intervention involved insulin or not.The tool which Cochrane Handbook recommended was used to assess the risk of bias for included literatures.All the studies were graded and extracted by two researchers independently after reading research method in detail.Meta-analysis was conducted using RevMan5.2 software.The effect of medical nutritional intervention was described in terms of fasting blood glucose, birth body mass, and incidences of macrosomia, cesarean section, postpartum glucose intolerance and neonatal long-term chronic disease.Results Totally 27 trials were found, of which 13 met the inclusion and exclusion criteria.1 trial was excluded because the outcomes were using different sample sizes, and finally 12 trials were included in the final meta-analysis, involving 1 392 patients.Among the 12 included trials, 7 only administered nutritional intervention, while the other 5 added insulin with nutritional intervention.The results showed that in the nutritional intervention group, medical nutritional intervention decreased the incidence of macrosomia [risk difference (RD) :-0.35, 95％ CI:-0.55--0.15, P ＜ 0.001, 1 trial], birth body mass [mean difference (MD) :-581.27, 95％ CI:-790.32--372.22, P ＜ 0.001, 2 trials], the rate of cesarean section (RD:-0.40, 95％ CI:-0.58--0.21, P＜0.001, 2 trials), fasting blood glucose (MD:-0.32, 95％ CI:-0.59--0.06, P =0.02, 5 trials), and the incidence of postpartum glucose intolerance (RD:-0.34, 95 ％ CI:-0.44--0.23, P ＜0.001, 1 trial).However, in the multiple intervention group (nutritional intervention plus insulin), no significant differences were shown in the incidence of macrosomia (RD:-0.02, 95％ CI:-0.07-0.03, P=0.39, 3 trials), birth body mass (MD: 86.06, 95％ CI:-104.97-277.09, P=0.38,2 trials) , the rate of cesarean section (RD: 0.02, 95％ CI:-0.05-0.08, P =0.64, 5 trials) , and fasting blood glucose (MD:-0.03, 95％ CI:-0.16-0.11, P =0.71, 3 trials).Conclusion Medical nutritional intervention may be a protective measure against gestational diabetes mellitus, which could help to maintain serum glucose levels within the normal range and improve maternal and neonatal outcomes.
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Objective To explore the pregnancy outcome and obstetric management of pregnancy and delivery after vaginal radical trachelectomy (VRT).Methods Forty-two cases of VRT from December 2003 to May 2012 in Peking Union Medical College Hospital were analyzed retrospectively.Among them ten cases got pregnant successfully.Results The average age of patient at VRT surgery was (30.6 ± 3.7) years old and average follow-up time was 29.5 months.There were 31 patients attempted conception.Ten of them got fourteen conceptions successfully.Overall conception rate was 45％ (14/31).There were four cases of first trimester abortion.Among them,two were miscarriage,two were elective abortion.There was one case of ectopic pregnancy operation and non of second trimester loss.Nine cases reached the third trimester.The total preterm delivery rate was 4/9.There were two cases delivered before 32 gestational weeks (2/9).Cesarean section was performed through a transverse incision in all of nine cases.No uterine rupture and postpartum hemorrhage occurred.All newborns had good outcomes.The average follow-up time after postpartum was 22.9 months.All cases were disease-free.Conclusions The conception rate of patients after VRT in our series is 45％.The preterm birth rate of pregnancy after VRT is higher.Routine cerclage of cervix during VRT procedure and pregnancy is not necessary.Cesarean section shortly after full term pregnancy through a transverse incision should be considered as a suitable and safe procedure.