[Factors relevant to newborn birth weight in pregnancy complicated with abnormal glucose metabolism].

OBJECTIVE: To investigate the influencing factors of neonatal birth body mass in women with abnormal glucose metabolism during pregnancy. METHODS: A study was conducted on 1157 singleton gravidas, who were diagnosed and treated for abnormal glucose metabolism and delivered in the Department of Obstetrics and Gynecology, First Hospital, Peking University from January 2005 to December 2009, by reviewing the medical records. Based on the pre-pregnant body mass index, the selected cases were divided into 4 groups: low body mass group [body mass index (BMI) < 18.5 kg/m(2), n = 53], ideal body mass group (BMI 18.5-23.9 kg/m(2), n = 647), over body mass group (BMI 24.0-27.9 kg/m(2), n = 323), and obese group (BMI ≥ 28.0 kg/m(2), n = 134). 1157 newborns were divided by birth body mass into 3 groups: normal birth body mass group (body mass 2500-4000 g, n = 987), of which 545 cases of birth body mass 3000-3500 g for the appropriate newborns, macrosomia group (body mass ≥ 4000 g, n = 112); low birth body mass group (body mass < 2500 g, n = 58). The following information was collected, including pre-pregnancy body mass, height, gestational age of diagnosis and body mass gain after diagnosis, maternal serum level of cholesterol, history of adverse pregnancy, and family history of diabetes, gestational age, delivering body mass, neonatal birth body mass. The influence of pre-pregnant BMI, body mass gain during pregnancy, gestational age of diagnosis, body mass gain after diagnosis, maternal serum level of cholesterol, family history of diabetes on the newborns' birth body mass was analyzed. The appropriate ranges of gestational body mass gain were calculated in women with abnormal glucose metabolism. RESULTS: (1) The average neonatal birth body mass for each group respectively were (3142 ± 333) g for low body mass group, (3339 ± 476) g for the ideal body mass group, (3381 ± 581) g for over body mass group, and (3368 ± 644) g for obese group. The neonatal birth body mass was increasing with maternal pre-pregnant BMI, and average birth body mass of the newborns in low body mass group was lower than other 3 groups, respectively, the difference was statistically significant (P < 0.05). The difference was not statistically significant (P > 0.05), when it was compared among the obese group, ideal weight group and over body mass group. (2) The body mass gain during pregnancy in women delivered normal birth weight newborn and delivered macrosomia for each group respectively were (13.5 ± 4.5) and (17.1 ± 5.4) kg for the ideal body mass group, (11.6 ± 4.9) and (15.3 ± 6.4) kg for the over body mass group, (10.3 ± 5.0) and (14.7 ± 7.4) kg for the obese group. The difference was statistically significant in 3 groups (P < 0.05). The difference of body mass gain during pregnancy in women delivered normal birth weight newborn and delivered macrosomia for low body mass group could not be compared statistically, because of only 1 case delivered macrosomia. (3) The gestational age of diagnosis in women who delivered normal birth weight newborn and macrosomia for the ideal body mass group respectively were (27.8 ± 5.8) and (29.8 ± 5.3) weeks, the difference was statistically significant (P < 0.05). The gestational age of diagnosis in gravidas who delivered normal birth weight newborn and macrosomia for the over body mass group respectively were (26.7 ± 6.8) and (30.2 ± 4.1) weeks, the difference was statistically significant (P < 0.05). The gestational age of diagnosis in women who delivered normal birth weight newborn for obese group was (26.2 ± 7.5) weeks, less than that of pregnant women who delivered macrosomia [(25.7 ± 9.3) weeks], but the difference was not statistically significant (P > 0.05). The difference of the diagnosed gestational age for low body mass group could not be compared statistically, because of only 1 case delivered macrosomia. (4) The serum triglyceride (TG) levels of pregnant women who delivered macrosomia was (3.1 ± 1.5) mmol/L, higher than that of pregnant women who delivered normal birth weight newborn [(2.7 ± 1.2) mmol/L], and the difference was statistically significant (P < 0.01). The serum high density lipoprotein cholesterol (HDL-C) levels of pregnant women who delivered macrosomia was (1.4 ± 0.3) mmol/L, lower than that of pregnant women who delivered normal birth weight newborn [(1.7 ± 0.9) mmol/L], and the difference was statistically significant (P < 0.01). The serum low-density lipoprotein cholesterol (LDL-C) and cholesterol level of pregnant women who delivered macrosomia respectively was (2.8 ± 0.8) and (5.4 ± 1.1) mmol/L, less than those of pregnant women who delivered normal birth weight newborn [(3.0 ± 0.9) mmol/L and (5.6 ± 1.1) mmol/L], but the difference was not statistically significant (P > 0.05). (5) The final regression model of variables into the top three were pre-pregnant BMI, body mass gain during pregnancy and maternal serum level of HDL-C, when analyzing the related factors of affecting neonatal birth body mass with multiple logistic regression analysis such as age, history of adverse pregnancy, family history of diabetes, pre-pregnancy BMI, body mass gain during pregnancy and after diagnosis of abnormal glucose metabolism, maternal serum level of cholesterol, abnormal glucose metabolism categories, gestational age and other factors (P < 0.01). CONCLUSION: Pre-pregnant BMI, body mass gain during pregnancy and maternal serum level of HDL-C may affect the neonatal birth body mass whose mothers were complicated with abnormal glucose metabolism during pregnancy.

[Postpartum stress urinary incontinence and associated obstetric factors].

OBJECTIVE: To evaluate the effect of cesarean section (CS) and vaginal delivery (VD) on postpartum stress urinary incontinence (SUI) and pelvic floor muscles strength and to find out the correlated obstetric factors and prevention for postpartum SUI. METHODS: Totally, 788 women, who visited the antenatal clinics, delivered and had the follow-up at 6-8 weeks after delivery in Beijing Obstetrics and Gynecology Hospital in the year of 2008, were enrolled in this study and were divided into 3 groups: CS group (n = 212); normal vaginal delivery (NVD) group (n = 534) and forceps delivery (FD) group (n = 42). Women in the NVD and FD group were merged into one VD group and then divided into SUI and non-SUI group. Information of delivery mode and the correlated obstetric factors were obtained through questionnaires and medical records. Femiscan pelvic floor muscle examine system was applied to measure the pelvic floor muscle strength to understand the relationship between postpartum SUI and pelvic floor muscle strength. RESULTS: (1) Incidence of SUI: the overall proportion of women who complained of urinary incontinence (UI) during pregnancy was 15.4% (121/788), and it was 15.9% (85/534), 11.9% (5/42) and 14.6% (31/212) in the NVD, FD and CS group, respectively (P > 0.05). The overall incidence of postpartum SUI was 17.1% (135/788), and it was 19.1% (102/534), 26.2% (11/42) and 10.4% (22/212) in the NVD, FD and CS group, respectively, with significant difference between the NVD and FD group, and between the CS and NVD group (all P < 0.01). (2) The associated obstetric factors of postpartum SUI: among the VD group, 113 women were in the postpartum SUI group and 463 in the non-SUI group. Univariate analysis and logistic multivariate analysis showed that delivery mode, neonatal birth weight and UI during pregnancy were risk factors of postpartum SUI. CS decreased and higher neonatal birth weight and UI during pregnancy increased the risk of postpartum SUI. In the VD group, neonatal birth weight, forceps delivery and UI during pregnancy increased the incidence of postpartum SUI (P < 0.01), but no correlation was found with labor analgesia, duration of labor, episiotomy, breast feeding, volume of postpartum bleeding, gestational weeks at delivery, induction and pre-pregnant BMI, etc (all P > 0.05). (3) Pelvic floor electromyogram: pelvic floor muscles strength in the CS group was significantly higher than that of the VD group [activity value: (19.7 +/- 9.9) microv vs (14.8 +/- 8.4) microv; work value: (84.5 +/- 37.2) microv vs (78.8 +/- 28.2) microv; peak value: (25.5 +/- 12.5) microv vs (19.7 +/- 11.8) microv, all P < 0.01]. Among women in the VD group, the relaxation value and the ratio of relaxation value over activity value (r/a) in the postpartum SUI group were significantly lower than those in the non-SUI group [relaxation value: (1.7 +/- 1.8) microv vs (3.0 +/- 3.9) microv; r/a ratio: 0.2 +/- 0.2 vs 0.3 +/- 0.5, all P < 0.01]. The r/a ratio in the VD group showed no difference compared to that in the CS group (0.2 +/- 3.5 vs 0.2 +/- 0.2, P > 0.05). CONCLUSION: Women experienced vaginal delivery, either NVD or FD, have a higher incidence of postpartum SUI than those delivered through CS. UI during pregnancy, forceps delivery and neonatal birth weight are risk factors of postpartum SUI.

The dynamic changes of plasma neuropeptide y and neurotensin and their role in regulating cerebral hemodynamics in neonatal hypoxic-ischemic encephalopathy.

Hypoxic-ischemic encephalopathy (HIE) is a common cause of neonatal encephalopathy and is one of the most important causes of neonatal death and disabilities, especially those infants with moderate to severe encephalopathy. However, the pathogenesis of HIE still remains unclear. The purpose of this study was to explore the dynamic changes in plasma neuropeptide Y (NPY) and neurotensin (NT) as well as their role in regulating cerebral hemodynamics in HIE patients. The plasma levels of NPY and NT in the umbilical artery and peripheral blood on the first, third, and seventh days after birth in 40 term infants with HIE and 40 healthy controls were measured using radioimmunoassay. On the first day of life, the blood samples were collected immediately when ultrasound examinations were finished. The ultrasound transducer was placed on the temporal fontanelle to detect the hemodynamic parameters of the middle cerebral artery, including peak systolic flow velocity, end-diastolic flow velocity, time-average mean velocity, pulsatility index, and resistance index (RI) in both groups were measured by pulse Doppler ultrasound in the first day after birth. The relationship between RI and NPY or NT was analyzed by linear regression analysis. NPY levels in umbilical blood ([mean +/- standard deviation] 615.5 +/- 130.7 ng/L) and first-day peripheral blood (355.9 +/- 57.4 ng/L) in neonates with HIE were significantly higher than those in normal newborns' blood (199.1 +/- 63.2 and 214.4 +/- 58.0 ng/L, respectively; P < 0.01). NPY levels in HIE neonates then declined to control levels on the third day after birth ( P > 0.05). However, the levels of plasma NT in umbilical blood and peripheral blood were much higher in the HIE group than those in normal newborns during the first week ( P < 0.01). The results of Doppler ultrasound examinations showed that cerebral blood flow velocity significantly decreased, whereas RI increased markedly in HIE patients compared with healthy controls ( P < 0.01). Linear regression analysis revealed that the RI was positively correlated with NPY levels ( R = 0.614; P < 0.01) and negatively correlated with NT levels ( R = -0.579; P < 0.01). The results of this study showed that there was a significant increase in plasma NPY and NT levels in HIE patients and this was strongly related to the severity of HIE, and the hemodynamic parameter RI was significantly correlated with NPY and NT. Therefore, we believe that the dynamic changes in plasma NPY or NT levels participate in the mechanisms of HIE by regulating cerebral hemodynamic changes after neonatal asphyxia occurs.

[Multicentral randomized controlled studies on acupuncture at Shaoze (SI 1) for treatment of postpartum hypolactation].

OBJECTIVE: To explore effect of acupuncture at Shaoze (SI 1) for treatment of postpartum hypolactation. METHODS: Multicentral randomized controlled and single blind clinical trial was adopted, and 276 cases were divided into a treatment group and a control group, 138 cases in each group. The treatment group were treated with electroacupuncture (EA) at Shaoze (SI 1) and the control group with EA at Shangyang (LI 1). After treatment of 2 courses, the therapeutic effects and changes of cumulative score of TCM symptoms, mammary filling degree, lactation amount, prolactin level were evaluated and investigated. RESULTS: The cured and markedly effective rate was 97.8% in the treatment group and 24.3% in the control group with a significant difference between the two groups (P < 0.05). The treatment group in improvement of the cumulative score of TCM symptoms and the mammary filling degree, and increasing the lactation amount and the prolactin level were better than the control group (P < 0.01). CONCLUSION: Acupuncture at Shaoze (SI 1) has obvious therapeutic effect on hypolactation.

[Screening for G1528C mutation in mitochondrial trifunctional protein gene in pregnant women with severe preeclampsia and new born infant].

OBJECTIVE: Severe preeclampsia, and hemolysis, elevated liver enzymes, and low platelet syndrome (HELLP) are serious complications of pregnancy, and evidence suggests a genetic basis for these conditions. A G1528C mutation in the alpha-subunit of the mitochondrial trifunctional protein (MTP) gene has been identified in association with these conditions. The aim of this study is to explore the carrier rate of the G1528C mutation in the MTP gene in pregnant women with severe preeclampsia, HELLP syndrome and in their newborns, as well as in a normal pregnant population, so as to determine its association with maternal liver disease among women in Beijing. METHODS: A multicenter, prospective, case control study was carried out. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to screen the G1528C mutations in the MTP gene. One hundred and forty cord blood samples from cases with severe preeclampsia (n = 130) and HELLP syndrome (n = 10) were collected. Ninety maternal peripheral blood samples among them (84 from severe preeclampsia and 6 from HELLP syndrome) were also collected for screening the common disease-causing mutation in Caucasians. Five hundred and sixty cord blood samples and 90 maternal peripheral blood samples obtained from normal pregnant women served as controls. RESULTS: The G1528C mutations in the MTP gene were not found in samples from women with severe preeclampsia and their newborns, from women with HELLP syndrome and their new borns, as well as in samples from the normal pregnant women and their new borns. CONCLUSIONS: The common disease-causing mutation of G1528C in MTP gene in Caucasians is probably not a common mutation in Chinese Han people in Beijing. Further study is needed to expand the sample size among HELLP syndrome and maternal liver diseases in Chinese population.

[Study on effect of electroacupuncture at Hegu (LI 4) on the uterotonic time in parturients of uterus inertia].

OBJECTIVE: To evaluate the therapeutic effect and applying value of Hegu (LI 4) for inertia of uterus. METHODS: In three centers, 276 cases enrolled were randomly assigned to a western medicine group and an acupuncture and western medicine group. The western medicine group were treated with intravenous drip of oxytocin, and the acupuncture and western medicine group were treated with electroacupuncture at Hego (LI 4) and intravenous drip of oxytocin. Changes of inertia of uterus and duration and interval of uterine contraction were investigated in the two groups. RESULTS: The total effective rate was 97.1% in the acupuncture group, and 70.3% in the western medicine group with a very significant difference between the two groups (P < 0. 01). There was a significant difference in the duration and the interval of uterine contraction between the two groups (P < 0.1, P < 0.05). CONCLUSION: Elecoroacupuncture at Hego (LI 4) can be adopted for treatment of dystocia due to abnormality of force of labor.

[Case-control study on effect of passive smoking during different pregnancy term on small-for-gestational-age infants at term].

OBJECTIVE: To analyze the effect of passive smoking during different pregnancy term to infant birth weight. METHODS: 155 women which infants were singleton term small-for-gestational-age infant (SGA) -cases and 155 with singleton term non-SGA controls matched by infant sex, infant birthday ( +/-10 days) and maternal age ( < 20 years, 20- 35 years and > or = 35 years) were interviewed. Single and multiple analyses were performed by conditional logistic regression. RESULTS: Passive smoking during the second, the third or the whole term of pregnancy was significantly associated with risk of term SGA (P < 0.05). The odds ratios of these risk factors were 3.07, 2.94 and 3.42 respectively. Passive smoking during the first term of the pregnancy was not associated with risk of term SGA ( P > 0.05) . CONCLUSION: Decreasing passive smoking during the second or the third term of pregnancy maybe benefits to lower the risk of term SGA.

[Screening for the G1528C mutation in long chain fatty acid oxidation enzyme in Han nationality in Beijing population].

OBJECTIVE: To explore the carrier rate of G1528C mutation in alpha-subunit gene of MTP in Chinese newborns. METHODS: 1 200 cases of cord blood samples were taken in pregnant women with Han nationality in Chinese. PCR-RFLP analysis was conducted for detection of G1528C mutation. RESULTS: No. G1528C mutations in LCHAD gene were found in these study subjects. CONCLUSION: G1528C is probably not the common prevalent mutation in MTP gene in Chinese. Different prevalent mutation between Chinese and Western white people needs further study.

[Effects of Spasfon on course of labor].

OBJECTIVE: To observe the effects of Spasfon on improving dilatation of cervix and promoting the progression of labor. METHODS: Ninety seven normal primiparae with cervical edema were randomly divided into Spasfon group (group A, n = 46) and atropine group (group B, n = 51) when the cervix dilated 2 - 3 cm. Group A was given 80 mg of Spasfon intravenously, and group B was injected atropine 0.5 mg into the cervix. RESULTS: (1) The mean time period from drug administration to full dilation of the cervix was (3.1 +/- 0.3) h in group A, and (4.4 +/- 0.4) h in group B (P < 0.01). (2) The disappearance ratio of cervical edema 2 h after drug administration in group A was 95.6%, while in group B it was 90.2% (P > 0.05); the mean dilatation of cervix between the 2 hours in group A was (4.3 +/- 0.2) cm, while in group B it was (2.5 +/- 0.3) cm (P < 0.01). (3) There were no obvious side effects in group A. While eight women in group B complained of thirst and 22 women had increased heart rate accompanied with elevated baseline FHR, which all recovered in about 60 minutes. (4) Vaginal delivery rate in group A was 95.7%, and 90.2% in group B (P > 0.05). (5) There was no statistically significant difference in the color of amniotic fluid, suffocation state and weight of the newborns between the two groups (P > 0.05). (6) There was no statistically significant difference in postpartum hemorrhage between the two groups, either (P > 0.05). CONCLUSION: Spasfon can effectively improve cervical dilatation during labor and it is well tolerated by both mother and newborn.

[Study on diagnostic criterion of pregnancy induced hypertension].

OBJECTIVE: To study the rationality of the current diagnostic criterion of pregnancy induced hypertension (PIH) in mainland China. METHODS: To analytically review the 916 cases of PIH in our hospital, reclassify them using both the current domestic diagnostic criteria and the William Obstetrics' criteria, then compare and analyze perinatal and maternal outcomes from the two standards. RESULTS: (1) Maternal outcomes: comparison result of the occurrences among three groups of premature birth, postpartum haemorrhage and placental abruption according to domestic classification had significant difference (P < 0.05). And it's the same result according to foreign classification (P < 0.05). But the occurrences within three groups of premature birth, postpartum haemorrhage and placental abruption between domestic and foreign classifications showed no significant difference (P > 0.05). (2) Perinatal outcomes: Comparison results of the occurrences among three groups of fetal growth restriction, asphyxia neonatorum and perinatal fetal and neonatal death incidence according to domestic classification had significant difference (P < 0.05). And it's the same result according to foreign classification (P < 0.05). But the occurrences within three groups of fetal growth restriction, asphyxia neonatorum and perinatal fetal death and neonatal incidence showed no significant difference (P > 0.05). (3) The constituent ratio of mild, moderate, severe PIH according to domestic classifications was 46.6%, 18.4%, 34.9% respectively. The constituent ratio of gestationgal hypertision, mild preeclampsia and severe preeclampsia according to foreign classifications was 47.6%, 14.3%, 38.1%. There were significant differences between domestic and foreign constituent ratio (P < 0.05). If you compare the results from these two diagnostic classifications, with mild PIH, the accordant rate was 85.0%; with severe PIH, the rate was 93.8%; but it's only 40.2% with moderate PIH. CONCLUSIONS: The diagnostic criteria for PIH being used in our mainland China is rational, but in the current stage, due to the lack of objective index for early diagnosis and overall assessment of patient's condition, it's also limited. More objective index should be adopted to improve the diagnostic standard for PIH.