Lifespan influences on mid- to late-life cognitive function in a Chinese birth cohort.

OBJECTIVE: To explore factors throughout the lifespan that influence cognition in midlife to late life. METHODS: We conducted a retrospective birth cohort study of 2,062 individuals born during 1921-1954 in Beijing, China. In 2003-2005, birth records were abstracted, and participants then 50-82 years old received standardized examinations for health, cognition, and socio-environmental measures. Using cumulative logit models, we assessed adjusted relative effects of prenatal, early life, and adult factors on mid- to late-life cognition. RESULTS: Most prenatal factors were associated with mid- to late-life cognition in the unadjusted models. However, when childhood and adult factors were sequentially added to the models, the impact of prenatal factors showed successive attenuation in effect size, and became insignificant. In contrast, early life factors remained significantly associated with mid- to late-life cognition even after full life-course adjustments. Specifically, those whose fathers had laborer vs professional occupations (odds ratio [OR](Laborer) 1.74; 95% confidence interval [CI]: 1.25-2.42) had poorer cognitive outcomes, while individuals who drank milk daily in childhood (OR 0.65; 95% CI: 0.54-0.80), had more years of education (OR(10-12 years) 0.60; 95% CI: 0.45-0.81; OR(13+ yrs) 0.29; 95% CI: 0.23-0.38), and were taller adults (OR(height > or = SD) 0.65; 95% CI: 0.49-0.86) had better cognition. The high prenatal risk infants had similar patterns with a trend toward a stronger association between cognition and socioenvironmental factors. CONCLUSION: Mid- to late-life cognition is influenced by factors over the entire lifespan with the greatest impact coming from early life exposures. Nutrition, education, social, and family environment in early life may have a long-term impact on cognition in developing countries.

[Evaluation of fetal well-being by vibro-acoustic stimulation test].

For monitoring of fetal well-being, non-stress test (NST) and vibro-acoustic stimulation test (VAS-T) were tested simultaneously in 295 normal pregnant women with gestational age over 36 weeks. In 130 women who delivered babies within 1 week after testing, the monitoring results were compared with the newborn's condition immediately after birth. The results showed that VAS-T improved the accuracy rate diagnosed by NST and shorten the time period required for examination. The clinical significance of 5 different wave forms of VAS-T were studied. Type I and Ib were typical reactive pattern which represented a good fetal condition. Type II, III and IV suggested that the fetus were in various degree of hypoxia. Specifically, Type III reflected the cord around the neck, and type IV was a sign of severe fetal distress and nervous system defect.

[The clinical use of MOM nutrient powder in pregnant women].

Fifty women with normal pregnancy were given MOM nutrient powder (30 g/day) from 16 weeks of gestation to the beginning of labor and another 40 cases of normal pregnancy were given iron, folic acid, calcium, vitA+D at the same time were observed and compared for the nutritional status at 16, 28, 37 weeks of gestation, the serum total protein, albumin, fasting blood sugar, cholesterol, triglyceride serum iron calcium, folic acid vitA and blood glutathione reductase activation coefficient (GRAC), Hb, hematocrit were measured in the two groups. The results showed that all the above mentioned measurements were in normal range, and there was no statistically significant difference between the 2 groups. The maternal body weight at various stages of gestation; maternal weight gain; neonatal birth weight, and the production of breast milk showed also no significant difference between the 2 groups. We conclude that the action supplementation of various nutrients by drug can be replaced by food MOM nutrient powder for the pregnant women.

[Breast-feeding in reducing regular insulin requirement in postpartum for insulin dependent diabetes mellitus and gestational diabetes mellitus].

From Jan. 1987-Jun. 1993, 37 cases of insulin dependent diabetes mellitus (IDDM) pregnant women and 10 gestational diabetes mellitus (GDM) mothers requiring regular insulin (RI) treatment during pregnancy were recruited. A comparative study of the daily RI requirement was carried out in women breast-feeding (BF) or not (non-BF) at different periods: before pregnancy, during gestation, postpartum and at present. Results showed no difference of RI requirement between BF and non-BF groups before pregnancy, during gestation and currently, but a significant decrease of RI requirement (P < 0.05) among BF mothers in postpartum period. Of the 10 GDM cases, 3 of them who did not breast feed their babies required further RI for 4-7 days in the postpartum period, whereas 7 BF mothers did not need any RI after delivery with blood glucose levels remaining within normal range. Based on the above analysis one may conclude that BF can reduce the RI requirement of IDDM and GDM mothers in the postpartum period. It is thought that more energy is needed in the process of producing milk, and serum glucose is the main substance for lactose synthesis, thus blood glucose level of BF mother is decreased, and so is the RI requirement. Therefore, mothers with diabetes mellitus are encouraged to breast feed their babies.

[Fetal arrhythmia].

Nineteen cases of fetal arrhythmia discovered by antenatal auscultation were analyzed. Among them, 14 alive babies were followed up. The occurrence, diagnosis and prognosis of fetal arrhythmia were discussed. 14 cases had normal FHR with arrhythmia, 1 case with tachycardia, 4 with bradycardia. Ultrasonocardiography (USC) was performed in 12 cases. 3 of them had sinus bradycardia with structural abnormalities of heart, they showed fetal distress in labor, neonatal asphyxia and perinatal death. 14 cases were followed up for a period of less than one year to 5 years. Only 2 babies had aurical premature beat by USC, others remain normal.

[Intrauterine deaths: a clinical and pathologic analysis].

Twenty four cases of intrauterine death occurred in 3,834 deliveries from Jan. 1985 to Dec. 1987 in our hospital. The causes of fetal deaths were analysed on the basis of maternal complications and pathologic findings. Maternal complications, such as pregnancy induced hypertension, abnormal glucose tolerance test, anemia, infection ............ were observed in 18 cases (75.0%). At delivery, 4 babies (16.6%) were found to have cord around neck and 1 with short umbilical cord. Marked abnormalities of placenta were demonstrated in 12 cases (50.0%) and fetal abnormalities in 4 cases (16.6%). Clinically, intrauterine deaths were often preceded by signs of growth retardation, reduced fetal movements and abnormal NST test. Gravidography, fetal movement counting, non-stress test, and ultrasonic scanning may be helpful in predicting this catastrophe.

Clinicopathological analysis of causes of perinatal death.

The perinatal mortality rates and causes of deaths in our hospital within the three 5-year periods (1955-1959, 1976-1980, 1981-1985) were reported as well as the total number of births (16,846), deaths (457), and autopsies (393, autopsy rate 85.9%). The perinatal mortality for the three 5-year periods was 44.5%, 23.8%, and 17.2% respectively; it declined more significantly in 1981-1985 than in 1976-1980. Anoxia was the first cause of death for the three 5-year periods. Other causes in sequence in 1955-1959 were traumatic intracranial hemorrhage and pulmonary diseases, in 1976-1980 malformation and pulmonary diseases, and in 1981-1985 anoxia, pulmonary diseases and hyaline membrane disease. Results suggest that accurate analysis of causes of deaths depends on meticulous systematic fetal and neonatal autopsy, including macerated fetuses, extensive discussion by pathologists, obstetricians and neonatalogists, and indispensable placental examination.