Low Dose Aspirin for Primary Prevention of Adverse Pregnancy Outcome

Background: Pregnancy is associated with various complications such as pre-eclampsia, SGA, preterm birth etc. Low dose aspirin is a possible medication to minimize these adverse outcomes. The aim of this study was to evaluate the use of low dose aspirin for primary prevention of adverse pregnancy outcome. Material & Methods: This cross-sectional study was conducted in department of Gynaecology, North Bengal Medical College Hospital, Mirjapur Bkash Hospital, Mirjapur, Tangail, Bangladesh, during the period from June 2021 to August 2022. Total 200 pregnant women were included in this study. Results: In this study, the mean (±SD) age of the study subjects were 25.12 ± 5.49 years and 25.00 ± 4.83 years in LDA group and control group, respectively. There was no statistically significant (p>0.05) difference in age between the groups. The rate of caesarean section was higher in control group (68%) compared to LDA group (59%) but there was no statistically significant (p>0.05) difference among the groups. In our study, 8% pregnant women in LDA group and 19% pregnant women in control group had gestational hypertension, pre-eclampsia was seen in 6% and 13% pregnant women in LDA group and control group, respectively, preterm birth was seen in 8% and 17% pregnant women in LDA group and control group, respectively, SGA was seen in 19% and 32% pregnant women in LDA group and control group, respectively, and fetal distress was seen in 2% pregnant women in both LDA group and control group. There were statistically significant (p<0.05) differences in complications except fetal distress. Mean (±SD) neonatal birth weight was 2.88±1.03 kg and 2.74±0.85 kg in LDA group and control group, respectively and there was no statistically significant (p>0.05) difference. Conclusion: We found that low dose aspirin could significantly reduce the risk of adverse outcomes, especially for pre-eclampsia, SGA and preterm birth.

Association between stressful life events during pregnancy and adverse pregnancy outcomes: a review / 预防医学

@#Improving the quality of newborns is a health development strategy, which has attracted global attention. Adverse pregnancy outcomes, including preterm birth, low birth weight and small for gestational age, are major causes of perinatal mortality and disability. Based on review of international and national publications pertaining to associations between stressful life events during pregnancy and adverse pregnancy outcomes from 2007 to 2023, this review summarizes the correlation between stressful life events during pregnancy and adverse pregnancy outcomes, including preterm birth, low birth weight and small for gestational age, and describes the underlying biological mechanisms. Previous studies have demonstrated the associations between maternal stressful life events during pregnancy and adverse pregnancy outcomes, and the underlying mechanisms mainly include neuroendocrine regulation, inflammation and microbiota pathways; however, the exact mechanisms remain unclear until now. Further studies to identify the critical window period for the association between stressful life events and adverse pregnancy outcomes, and unravel the pathogenesis of adverse pregnancy outcomes are warranted, so as to provide insights into reduction of adverse pregnancy outcomes.

Analysis of pregnancy outcomes, disease progression, and risk factors in patients with undifferentiated connective tissue disease / 北京大学学报(医学版)

OBJECTIVE@#To investigate the fetal and maternal outcomes, risk factors of disease progression and adverse pregnancy outcomes (APOs) in patients with undifferentiated connective tissue disease (UCTD).@*METHODS@#This retrospective study described the outcomes of 106 pregnancies in patients with UCTD. The patients were divided into APOs group (n=53) and non-APOs group (n=53). The APOs were defined as miscarriage, premature birth, pre-eclampsia, premature rupture of membranes (PROM), intrauterine growth restriction (IUGR), postpartum hemorrhage (PPH), and stillbirth, small for gestational age infant (SGA), low birth weight infant (LBW) and birth defects. The differences in clinical manifestations, laboratory data and pregnancy outcomes between the two groups were compared. Logistic regression analysis was performed to analyze the risk factors for APOs and the progression of UCTD to definitive CTD.@*RESULTS@#There were 99 (93.39%) live births, 4 (3.77%) stillbirths and 3 (2.83%) miscarriage, 20 (18.86%) preterm delivery, 6 (5.66%) SGA, 17 (16.03%) LBW, 11 (10.37%) pre-eclampsia, 7 (6.60%) cases IUGR, 19 (17.92%) cases PROM, 10 (9.43%) cases PPH. Compared with the patients without APOs, the patients with APOs had a higher positive rate of anti-SSA antibodies (73.58% vs. 54.71%, P=0.036), higher rate of leukopenia (15.09% vs. 3.77%, P=0.046), lower haemoglobin level [109.00 (99.50, 118.00) g/L vs. 124.00 (111.50, 132.00) g/L, P < 0.001].Multivariate Logistic regression analysis showed that leucopenia (OR=0.82, 95%CI: 0.688-0.994) was an independent risk factors for APOs in UCTD (P=0.042). Within a mean follow-up time of 5.00 (3.00, 7.00) years, the rate of disease progression to a definite CTD was 14.15%, including 8 (7.54%) Sjögren's syndrome, 4 (3.77%) systemic lupus erythematosus (SLE), 4 (3.77%) rheumatoid arthritis and 1 (0.94%) mixed connective tissue disease. Multivariate Cox proportional risk regression analysis showed that Raynaud phenomenon (HR=40.157, 95%CI: 3.172-508.326) was an independent risk factor for progression to SLE.@*CONCLUSION@#Leukopenia is an independent risk factor for the development of APOs in patients with UCTD. Raynaud's phenmon is a risk factor for the progression of SLE. Tight disease monitoring and regular follow-up are the key measures to prevent adverse pregnancy outcomes and predict disease progression in UCTD patients with pregnancy.

Interaction between adverse pregnancy history and polycyclic aromatic hydrocarbon-DNA adducts on missed abortion / 环境与职业医学

Background The incidence rate of missed abortion is increasing year by year, but the etiology has not been fully elucidated. Adverse pregnancy history and exposure to polycyclic aromatic hydrocarbons (PAHs) may increase the risk of missed abortion. Objective To investigate the interaction between adverse pregnancy history and PAHs exposure on missed abortion in early pregnancy, and to provide evidence for the etiologic research of missed abortion. Methods A total of 114 pregnant women diagnosed with missed abortion in the Department of Obstetrics of the First Hospital of Shanxi Medical University from March to December 2019 were selected as the case group, and 139 pregnant women who visited the same hospital for voluntary induced abortion in the same period as the control group, to collect basic information and medical information of abortion, stillbirth, intrauterine growth retardation, and other adverse pregnancy history. Abortion villus tissues were collected to detect PAH-DNA adducts levels, stratified by pregnancy and adverse pregnancy history and grouped by quartile method: Q1 (< 404.61 ng·L−1), Q2 (404.61−453.75 ng·L−1), Q3 (453.76−506.72 ng·L−1), and Q4 (≥506.73 ng·L−1). SPSS 25.0 statistical software was used for χ2 test and multiple logistic regression, and additive and multiplicative models were used to investigate the interaction between adverse pregnancy history and PAH-DNA adducts level on missed abortion. The PAH-DNA adducts were grouped by tertiles and quartiles, and P33, P50, P67 and P75 were used as data cut points for sensitivity analysis. Results The proportion of adverse pregnancy history in the case group (32.46%) was higher than that in the control group (12.23%) (P < 0.001). Among 160 subjects with≥2 pregnancies, the proportion of adverse pregnancy history in the case group (57.81%) was higher than that in the control group (17.71%) (P < 0.001). The results of χ2 test stratified by pregnancy for different PAH-DNA adducts levels between the two groups showed that the PAH-DNA adducts level was associated with missed abortion in subjects with≥2 pregnancies (χ2=10.14, P=0.017). Being further stratified by adverse pregnancy history, the PAH-DNA adducts level in subjects with no adverse pregnancy history was associated with missed abortion (χ2=9.70, P=0.021). The results of logistic regression analysis showed that adverse pregnancy history (OR=5.88, 95%CI: 2.79−12.39) and PAH-DNA adducts (OR=3.01, 95%CI: 1.22−7.40) increased the risk of missed abortion, but no interaction between them was found. The relative excess risk of interaction (RERI), the attributable percentage of interaction (AP), and the synergy index (SI) and its 95%CI were 0.60 (95%CI: −0.58−1.77), 0.74 (95%CI: −0.83−2.30), and 0.20 (95%CI: 0.01−5.43), respectively. Conclusions Adverse pregnancy history and PAH-DNA adducts in pregnant women may increase the risk of missed abortion. The effect of the interaction between them on the occurrence of missed abortion is not supported by the current study.

Relationship between fetal ultrasonic soft markers and adverse pregnancy outcomes during the first trimester / 中华超声影像学杂志

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.

Periodontal Diseases among Pregnant Women in Kuching, Sarawak

ABSTRACT@#Epidemiological and longitudinal studies have shown that pregnancy is associated with increased gingival inflammation and worsening of periodontal status. Prospective studies suggested that periodontal therapy during pregnancy might reduce the risk of adverse pregnancy outcomes and significant periodontal status improvement. The objectives of this study were to evaluate the prevalence of periodontal disease amongst pregnant women, and to compare periodontal conditions before and after non-surgical periodontal therapy. This study was a cross-sectional and intervention study of pregnant women at the Mother and Child Health Clinic, Jalan P. Ramlee, Kuching, who were referred to the Periodontic Unit, Jalan Masjid Dental Clinic, Kuching for further periodontal examination and treatment. All participants were examined and diagnosed with healthy periodontium or diseased periodontium. Sixty women became the subjects and 85% were diagnosed with periodontal disease, while 15% had healthy periodontium. Plaque score (PS) and bleeding score (BS) were evaluated at baseline and at eight weeks. At baseline, all periodontal parameters (mean ± SD) were higher in the diseased periodontium group compared to the healthy group (BS, 39.6 ± 21.5 vs 6.5 ± 3.9; PS, 46.4 ± 30.1 vs 33.5 ± 31.1). After two months, both groups showed improvement in all periodontal parameters; diseased periodontium (p = 0.001) and healthy periodontium group (p = 0.016). In conclusion, 85% of the participants in this study had periodontal diseases and, the non-surgical periodontal therapy improved the participants’ periodontal status. Furthermore, there was no significant adverse pregnancy outcomes reported in this study.

Research progress on effects of PM2.5 exposure during pregnancy on maternal and infant thyroid function / 环境与职业医学

Ambient air pollution has become a widespread global public health problem. As one of the main components of ambient air pollution, fine particulate matter (PM2.5), with its small diameter and large surface area, can carry a variety of toxic substances and enter the blood circulation directly through the blood-air barrier, damaging various tissues and organs of human body. Studies have shown that PM2.5 exposure during pregnancy can disrupt the mother's and child's thyroid function. Since the fetal thyroid gland does not begin to develop until around the sixth week of pregnancy, the fetal thyroid hormone is almost entirely dependent on the mother during early stages of pregnancy, and maternal thyroid hormone level play a crucial role in the growth and development of fetus. When a mother is exposed to PM2.5 during pregnancy, placenta, the "bridge" between mother and fetus, is also affected to some extent, including changes in placental iodine uptake and oxidative stress, inflammation, and DNA methylation in placental tissue. Exposure to PM2.5 during pregnancy also alters maternal thyroid hormone level and normal placental function, which can have a detrimental effect on pregnancy outcomes, such as preterm birth, low birth weight, and neurological abnormalities. This paper reviewed the effects of PM2.5 exposure during different trimesters on maternal and infant thyroid function, placental function, and pregnancy outcomes, aiming to provide more accurate protection of maternal and fetal health.

Association of glucose metabolism with adverse pregnancy outcomes in pregnant women of Chongming area / 中华内分泌代谢杂志

Objective:To investigate the risk factors of hyperglycemia during pregnancy and its correlation with adverse pregnancy outcomes based on the retrospective analysis of glucose metabolism of pregnant women in Chongming area.Methods:A total of 604 singleton pregnant women who underwent prenatal examination and delivered normally in the Chongming branch of Xinhua Hospital from September 2019 to May 2021 were enrolled in the study. All subjects were divided into normal glucose tolerance gestation (NGTG) group and gestational diabetes mellitus (GDM) group. Pregnant women whose blood glucose exceeded normal but did not meet the diagnostic criteria of GDM were classified into the intermediate state gestational blood glucose (ISGBG) group. Questionnaire, physical examination, and relevant laboratory tests were completed. Data were analyzed using the Statistical Product and Service Solutions 13.0 (SPSS, Chicago, IL).Results:The incidence rate of GDM was 20.86% (126/604), ISGBG was 40.39% (244/604), and NGTG was 38.74% (234/604) in 604 pregnant women. Multivariate logistic regression analysis showed that gestational age ( OR=1.092, P<0.001), serum triglyceride ( OR=1.625, P=0.001) and free T 3 levels ( OR=1.995, P=0.002) were independent risk factors for GDM. The incidence of pregnancy-induced hypertension, cesarean section, macrosomia, the total incidence of adverse pregnancy outcomes and fetal birth weight in ISGBG and GDM were significantly higher than those in NGTG ( P<0.05 or P<0.01). Conclusion:The incidence of GDM in Chongming area is high, especially higher in that of ISGBG. As both GDM and ISGBG lead to increased adverse pregnancy outcomes, early monitoring should be paid more attention to pregnant women in ISGBG in addition to the early intervention of GDM.

Application of real-time three-dimensional speckle tracking echocardiography in the evaluation of early cardiac function damage in patients with pregnancy induced hypertension / 中国基层医药

Objective:To investigate the clinical value of real-time three-dimensional speckle tracking echocardiography in the evaluation of early cardiac function damage in patients with pregnancy induced hypertension.Methods:Sixty-five pregnant women with pregnancy induced hypertension (patient group) and 65 healthy pregnant women (healthy group) who received prenatal examination and delivered between January 2018 and June 2020 in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine were included in this study. The patient and healthy groups were subjected to routine echocardiography and real-time three-dimensional speckle tracking echocardiography at 24-36 and 32-34 weeks of gestation. The imaging parameters of routine echocardiography and real-time three-dimensional speckle tracking echocardiography measured at different periods of gestation were compared between the two groups.Results:At 24-36 weeks of gestation, there were no significant difference in routine echocardiography parameters of the left ventricle between patient and healthy groups ( t = 0.793-1.748; P = 0.129-0.458). Left ventricular diameter (LVD), intra-ventricular septum diastole (IVSD) and left ventricular posterior wall diameter (LVPWD) in the patient group at 32-34 weeks of gestation were (34.97 ± 2.66) mm, (11.96 ± 1.85) mm, (12.07 ± 1.73) mm, respectively, which were significantly greater than those in the healthy group at the same time [(31.56 ± 2.58) mm, (9.17 ± 1.70) mm, (9.23 ± 1.62) mm] and those in the patient group at 24-36 weeks of gestation [(32.36 ± 2.61) mm, (10.15 ± 1.79) mm, (10.19 ± 1.64) mm, t = 5.437, 6.274, 6.319, 3.621, 4.017, 5.241, all P < 0.001]. Left ventricular ejection fraction (LVEF) in the patient group at 32-34 weeks of gestation was (54.36 ± 4.71)%, which was significantly lower than (63.27 ± 5.04)% in the healthy group at the same time and (59.65 ± 4.62) % in the healthy group at 24-36 weeks of gestation ( t = 7.682, 5.483, both P < 0.001). At 24-36 and 32-34 weeks of gestation, the absolute values of real-time three-dimensional speckle tracking echocardiography parameters left ventricular global longitudinal strain, left ventricular global circumferential strain, left ventricular global radial strain and left ventricular global area strain in the patient group were (23.45 ± 2.58)%, (34.09 ± 3.28)%, (22.03 ± 2.31)%, (34.73 ± 3.58)%, (18.63 ± 2.42)%, (30.74 ± 3.07)%, (19.56 ± 2.28)%, (25.85 ± 3.37)%, respectively, which were significantly lower than those in the healthy group [(26.27 ± 2.74)%, (37.62 ± 3.61)%, (24.67 ± 2.59)%, (39.41 ± 3.96)%, (26.10 ± 2.81)%, (37.56 ± 3.64)%, (24.82 ± 2.59)%, (40.16 ± 3.96)%, t = 4.415, 5.013, 4.724, 6.253, 10.736, 8.592, 7.627, 14.319, all P < 0.001]. In patient group, the absolute values of left ventricular global longitudinal strain, left ventricular global circumferential strain, left ventricular global radial strain and left ventricular global area strain at 32-34 weeks of gestation were (18.63 ± 2.42)%, (30.74 ± 3.07)%, (19.56 ± 2.28)%, (25.85 ± 3.37)%], respectively, which were significantly lower than those at 24-36 weeks of gestation [(23.45 ± 2.58)%, (34.09 ± 3.28)%, (22.03 ± 2.31)% (34.73 ± 3.58)%, t = 7.529, 4.785, 5.194, 8.413, all P < 0.001]. Conclusion:Real-time three-dimensional speckle tracking echocardiography is advantageous in identifying the damage to cardiac function over routine echocardiography. Findings from this study provides a great clinical guiding value for protecting the cardiac function of patients with pregnancy induced hypertension.

High-risk factors and adverse outcomes of pregnancy among different occupational populations in a medical college community / 中国职业医学

OBJECTIVE: To explore the characteristics and influencing factors of high-risk factors and adverse outcomes of pregnancy in different occupational populations in a medical college community. METHODS: A total of 719 pregnant women in a medical college community were selected by convenient sampling method and divided into medical staff group(218 women) and non-medical staff group(501 women, including 138 teaching staff subgroup, 129 administrative service staff subgroup and 234 other occupation subgroup). The detection rate of high-risk factors and adverse outcomes of pregnancy were compared among these groups. RESULTS: Among the study subjects with the top five detection rates, high-risk factors of pregnancy were abnormal body mass index, advanced age, diabetes mellitus, scarred uterus and abnormal thyroid function, with the detection rate of 21.4%, 17.5%, 9.7%, 7.5% and 7.5%, respectively. The detection rates of pregnancy high-risk factors≥two, adverse pregnancy outcome, adverse fetal outcome, miscarriage and low birth weight in the medical group were significantly lower than those in the non-medical staff group(all P<0.05). The detection rates of pregnancy risk factors, primary screening risk factors, scarred uterus and pregnancy anemia in the teaching staff subgroup were significantly higher than those in the other occupation subgroups(all P<0.008). The detection rates of pregnancy high-risk factors ≥two and advanced age in the teaching staff subgroup were higher than those in medical staff group(all P<0.008). The detection rates of adverse pregnancy outcome and miscarriage in the administrative service staff subgroup were higher than those in medical staff group(all P<0.008). Multivariate logistic regression analysis results showed that occupation, advanced age, parity and scarred uterus were the main influencing factors of adverse pregnancy outcome(all P<0.05). CONCLUSION: There are differences in pregnancy high-risk factors and adverse pregnancy outcomes among different occupational groups. The teaching staff subgroup has a relatively higher detection rate of pregnancy high-risk factors, and the adverse pregnancy outcomes and miscarriage were relatively higher in the administrative service staff subgroup, compared with the medical staff group.

Thromboelastogram parameters and MTHFR gene polymorphism in the diagnosis of adverse fetal pregnancy outcomes / 中国输血杂志

【Objective】 To retrospectively analyze the situation of patients with adverse fetal outcomes by thromboelastogram (TEG) parameters and, MTHFR gene polymorphism, so as to provide molecular biological diagnosis basis for patients with adverse pregnancy outcomes, and a new scheme for early prevention and treatment of women of childbearing age with MTHFR gene polymorphism. 【Methods】 A total of 100 women with adverse fetal pregnancy outcomes were selected as the adverse pregnancy group, and 100 healthy women of childbearing age with normal pregnancy history were selected as the controls. MTHFR gene C677T and A1298C polymorphisms were detected by polymerase chain reaction (PCR). TEG and blood coagulation were detected in the experimental group. 【Results】 The A1298C gene polymorphism(AA、CC、AC; A、C) was similar in both adverse pregnancy group and the controls. The frequency distribution of C, T allele of MTHFR gene C677T was statistically significant (χ2=4.60, P<0.05, OR =1.645, 95% CI: 1.042~2.595). TT and CT+ CC types showed significant different association with the factors of stillbirth(χ2 =7.49, P<0.05). MA value of TEG in the diagnosis of TT type of C677T genotypes MTHFR in 32 patients with adverse pregnancy outcome was analyzed. The area under the AUC curve of MA value was 0.795. 【Conclusion】 MTHFR C677T polymorphism TT with TEG parameter hypercoagulability is an important risk factor in the occurrence of pregnancy stillbirth in adverse pregnancy outcomes.

Correlation analysis of platelet antibody between adverse pregnancy and the number of pregnancies / 中国输血杂志

【Objective】 To analyze the testing results of platelet antibody in peripheral blood of 266 pregnant women, so as to explore the correlation of platelet antibody between adverse pregnancy and the number of pregnancies. 【Methods】 A total of 266 pregnant women, admitted to Shaanxi Provincial People′s Hospital, were selected for platelet antibody detection. They were divided into two groups according to history of adverse pregnancy, and the positive rate of platelet antibody between two groups was compared. They were divided into group A (1 pregnancy), group B (2 pregnancies) and group C (≥3 pregnancies) in parallel, and the positive rate of platelet antibody among three groups was compared 【Results】 The yield rate of platelet antibody in groups with and without adverse pregnancy was 31.81% vs 14.86%, showing statistical significance(P<0.05). The yield rate of platelet antibody of Group A, B and C was 9.09%, 21.62% and 23.65%, respectively, with The significant differences(P<0.05). The statistical analysis of inter-group χ2 test demonstrated a linear trend between the number of pregnancies and platelet antibodies yielding(χ2=7.056, P<0.05). 【Conclusion】 Platelet antibody was correlated with adverse pregnancy, and the yield rate of platelet antibody in the group with adverse pregnancy was higher than that in the group without adverse pregnancy. There was a linear trend between platelet antibodies yielding and the number of pregnancies. The yield rate of antibodies gets higher as the number of pregnancies increased. Taking platelet antibody test as a routine test during pregnancy is conducive to the early detection of clinical adverse pregnancy, as well as the early prevention, early detection and early intervention of fetal/neonatal homoimmune thrombocytopenic purpura and other diseases.

Role of pregnancy associated plasma protein-A and doppler velocimetry in the assessment of fetomaternal outcome in high risk pregnancy

Background: The study aimed at defining the role of Pregnancy associated plasma protein-A (PAPP-A) and uterine artery doppler (Ut.A.PI) in the development of adverse pregnancy outcome (APO) in high risk pregnancies.Methods: This was an observational study where 100 singleton pregnancies at high risk of development of APO, between 11 to 13 + 6 weeks POG were enrolled. PAPP-A levels were measured at 11 to 13 + 6 weeks POG and uterine artery doppler PI was measured at 20 weeks. Women were followed till delivery. Pregnancy outcome were seen and a cut off at which APO developed was derived.Results: In this study women with lower mean PAPP-A (0.75±0.19 MOM versus 1.23±0.31MOM) (p<0.001) values and higher Ut.A.PI (1.43±0.35MOM versus 0.99±0.25MOM) (p<0.001) developed APO. Cut off value for PAPP-A and Ut.A.PI was determined and was found to be ≤11.65 µg/ml (≤0.79MoM) and   >1.42 (>1.19MoM) respectively which was higher than what is determined in other studies done on low risks populations thereby suggesting for an intervention or more meticulous observations at a higher cut offs.Conclusions: PAPP-A and uterine artery doppler are already being used for the screening of preeclampsia in most of the countries but not for other adverse pregnancy outcomes. PAPP-A levels along with the uterine artery PI in predicting APO in high risk women has high negative predictive value. Hence can be uses as a screening method in high risk population whether they should be used for low risk population also needs further evaluation.

Maternal and fetal outcomes in pregnant women with hyperemesis gravidarum

Background: Hyperemesis gravidarum (HG) is associated with maternal weight loss, nutritional deficiencies, fluid and electrolyte abnormalities, which may lead to adverse fetal and maternal outcomes. The purpose of this study was to evaluate the relationship of hyperemesis gravidarum to maternal and foetal outcomes.Methods: A hospital-based prospective observational study was carried out. All patients with singleton pregnancy diagnosed as / history of hyperemesis gravidarum the current pregnancy was included in the study. The pregnant women with multiple pregnancy, molar pregnancy, presence of pre-gestational diabetes, pre-gestational hypertension, and other causes of nausea such as appendicitis and pyelonephritis were excluded from the study.Results: 36 pregnant women with prevalence rate of 3.28% have been found to be suffering from HG. Almost half (17, 47.22%) of the pregnant women with HG had age less than 25 years. The significant association (p-value: 0.0099) has been found between parity and smoking with HG. HG was significantly associated with low birth weight (p-value: 0.0133); small for gestational age (SGA) (p-value: 0.0316); APGAR score < 7 after 1 minute (p-value: 0.0060); and APGAR score <7 after 5 minutes (p-value: 0.0006). There is no association found between mode of delivery, gestational diabetes, and pregnancy-induced hypertension with HG.Conclusions: HG can adversely affect fetal as well as maternal, though not significant, pregnancy outcomes.

Research progress of effect of carotenoids on maternal and child health / 上海交通大学学报（医学版）

Early life nutrition plays an important role in determining the pregnancy outcomes and offspring lifelong health. Carotenoids deficiency is associated with adverse pregnancy outcomes such as preeclampsia, premature delivery and intrauterine growth restriction. Carotenoids possess antioxidant, inflammation modulating and immune-enhancing properties and promote visual, cognitive and respiratory health in offsprings. Among carotenoids, α-carotene, β-carotene and β-cryptoxanthin can be transformed into vitamin A in vivo, and their conversion rates are affected by the nutritional status of vitamin A. Lutein and zeaxanthin are highly enriched in the brain and retina of infants and young children, which are closely related to the development of visual acuity and cognitive function. Breast milk contains an adequate level of lutein and its absorption rate is significantly higher than that of infant formulas. Consequently lutein supplementation is necessary for artificially fed infants, especially premature infants. In this paper, the functional research progresses of carotenoids related to adverse pregnancy outcomes and offspring development, as well as the present situation of carotenoids supplementation in formula were reviewed.

Association between maternal syphilis treatment and adverse pregnancy outcomes / 中华传染病杂志

Objective To examine the association between maternal syphilis treatmentand the adverse pregnancy outcomes.Methods Syphilis-infected pregnant women retrieved from Information System of Prevention Mother-to-child Transmission of Human Immunodeficiency Virus (HIV),Syphilis,and Hepatitis B Management in Hu'nan Province between January 2012 and December 2017 were retrospectively studied.Information of demographic characteristics,pregnancy history,and syphilis infection/treatment history among these syphilis-infected pregnant women were collected and analyzed.According to the anti-syphilis treatment situation during pregnancy,syphilis-infected pregnant women were divided into three groups:non-treatment group,non-standardized treatment group and standardized treatment group.The incidences of adverse pregnancy outcomes among the three groups were calculated.Multivariate logistic regression was used to control confounding factors and analyze the association between maternal syphilis treatment and the adverse pregnancy outcomes.The adjusted odds ratios (aOR) and 95％ confidence interval (CI) were calculated.Results Among 9 059 syphilis-infected pregnant women,13.9％ (1 262),31.3％ (2 834),and 54.8％ (4 963)were untreated,non-standardized treated and standardized treated patients,respectively.The incidences of total adverse pregnancy outcomes in the non-treatment,non-standardized treatment and standardized treatment groups were 25.5％ (322),20.8％ (589),and 16.2％ (806),respectively.The incidences of stillbirth in the three groups were 2.3％ (29),1.3％ (38),and 0.6％ (28),respectively;those of preterm birth were 12.6％(159),10.5％ (297),and 6.0％ (299),respectively;those of low birth weight were 6.4％ (81),6.2％(175),and 3.3 ％ (162),respectively;those of small for gestational age were 10.9％ (138),8.4％ (237),and 8.0％ (399),respectively;those of neonatal death were 1.3％ (17),1.0％ (28) and 0.3％ (15),respectively;those of neonatal asphyxia were 1.9％ (24),0.9％ (25),and 0.9％ (46),respectively;those of neonatal pneumonia were 0.6％ (8),0.9％ (26),and 0.6％ (32),respectively;those of birth defects were 2.8％(35),1.3％ (37),and 1.1％ (57),respectively;those of neonatal congenital syphilis were 2.5％ (31),2.4％ (69),and 0.8％ (42),respectively.Compared with standardized treatment group,maternal syphilis without treatment was associated with increased risks of total adverse pregnancy outcomes (aOR =1.73),stillbirth (aOR =4.82),preterm birth (aOR =2.52),low birth weight (aOR =1.88),neonatal death (aOR =3.29),neonatal asphyxia (aOR =2.42) and birth defects (aOR =3.26) all P ＜ 0.01;maternal syphilis with non-standardized treatment was associated with increased risks of total adverse pregnancy outcomes (aOR =1.34),stillbirth (aOR =2.54),preterm birth (aOR =1.98),low birth weight (aOR =1.84),neonatal death (aOR =2.49) and neonatal congenital syphilis (aOR =1.70,P ＜ 0.05 or 0.01).Conclusions Maternal syphilis without treatment or with non-standardized treatment would increase the risks of adverse pregnancy outcomes.It is necessary to further strengthen the early screening and early treatment for syphilis-infected pregnant women,and improve the rate of standardized treatment to reduce the occurrence of adverse pregnancy outcomes.

Risk factors of congenital malformations and its impacts on adverse pregnancy outcomes: A prospective cohort study / 中华疾病控制杂志

Objective To explore risk factors of congenital malformations (CMs) and to evaluate its impacts on adverse pregnancy outcomes (APOs). Methods A prospective cohort study was conducted among pregnant women who received the first antenatal care from March 2013 to February 2016 in the reproductive center, obstetrics clinics, infertility clinics and ultrasound department of Hunan Provincial Maternal and Child Health Hospital. Corresponding information from pregnant women and their spouses were collected. Univariate and multivariate Logistic regression were used to screen possible risk factors of CMs and evaluate the impacts of CMs on other APOs. Results The study showed that women had history of non-standard BMI, smoking, hepatitis, pregnancy-related complications, gestational diabetes mellitus, infertility and using assisted reproductive technology before pregnancy; had no folic acid taking, active and passive smoking, drinking, uneven diet, high intensity physical activity during pregnancy increased the risk of CMs in offspring. Furthermore, the history of spouse smoking and eating betel nut also increased the risk of CMs in offspring. CMs might increase the risk of preterm birth, very preterm birth, low birth weight, very low birth weight, and perinatal mortality. Conclusions There are many risk factors of CMs. Knowing these risk factors, and giving them optimal prevention strategies and effective intervention measures are important measures in preventing the occurrence of CMs and other APOs.

Reevaluation of the significance of fetal movement monitoring / 中国实用妇科与产科杂志

Fetal movement counting is one of the common methods for fetal prenatal monitoring. The changes of the normal pattern of fetal movements(FM)indicate abnormal fetal status in uterus.Studies have found that reduced fetal movement is the primary sign of fetal distress,which is associated with adverse pregnancy outcomes such as stillbirth,placental insufficiency,and fetal growth restriction.Increased fetal movement after 32 week's gestation is regular,but a single episode of vigorous FM increases risk of stillbirth.Clinically,fetal safety is preliminarily evaluated by counting numbers of FM to find abnormalities of fetus early and decrease adverse pregnancy outcomes,which is economical,convenient,and simple.However,this method is subjective,due to the different sensitiveness of pregnant women.

Application of Vitamin E in Pregnant Women with Autoimmune Thyroid Disease / 现代医院

Objective To investigate the changes of serum vitamin E in pregnant women with autoimmune thyroid diseases and provide evidence for clinical prevention of adverse pregnancy caused by oxidative stress. Methods Randomly selecting 221 cases of obstetrics and gynecology pregnant women in outpatient clinics in Chancheng District Central Hospital. A double antibody one-step sandwich enzyme-linked immunosorbent assay (ELISA) was used to detect vitamin E concentration. Results The results of 221 subjects were normally distributed. The vitamin E concentration in the disease group was (353. 93 ± 141. 28) mmol/L, and the control group was (310. 49 ± 105. 49) mmol/L. There was a significant difference between the two groups (P＜0. 05). The concentration of vitamin E in different gestational weeks gradually decreased with the increase of pregnancy, and the difference between them was statistically significant (F = 8. 417, P＜0. 05). Conclusion The presence of oxidative stress during pregnancy in women with autoimmune thyroid diseases should be valued by clinicians.

Predictive Value of Fetal Umbilical Artery Doppler on Adverse Pregnancy Outcomes in Women with Systemic Lupus Erythematosus / 中山大学学报(医学科学版)

[Objective]To explore the adverse pregnancy outcomes(APO)and examine the predictive value of umbil-ical artery Doppler in systemic lupus erythematosus(SLE)pregnancies.[Methods]Data of 273 pregnancies from 2010 to 2016 were analyzed retrospectively. Pulsatility index(PI),resistance index(RI),and systolic/diastolic ratio(S/D)of the umbilical artery flow velocity data were monitored by Doppler ultrasound.[Results]One or more APO occurred in 61.9% of patients with SLE,among which pregnancy loss occurred in 60 cases;preterm birth in 56 cases;intrauterine growth retardation occurred in 20 cases;and fetal distress occurred in 21 cases.Twelve of pregnancies resulted in neona-tal Lupus. In total,118 patients underwent fetal umbilical artery Doppler during 28~34 gestational weeks. Doppler PI, RI,and S/D were significantly higher in the APO groups than in the patients without APO.[Conclusion]Pregnancies in lupus still had an increased risk of APO.Umbilical artery Doppler was useful in predicting APO in lupus pregnancies.