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Objective:To analyze the lipid levels, adverse perinatal outcome and their correlation in Tibetan pregnant women in high altitudes in late pregnancy.Methods:Retrospective analysis was performed on clinical and laboratory data of 523 Tibetan singleton pregnant women who delivered after 28 weeks at the Department of Obstetrics and Gynecology, Chaya People's Hospital, Changdu City. The subjects were divided into three groups according to the altitude of their long-term residence, including altitude<3 500 m (Group A, n=161), altitude ≥3 500 m and <4 000 m (Group B, n=203) and altitude≥4 000 m (Group C, n=159). In addition, the subjects were also grouped into high TG group (TG≥3.23 mmol/L, n=80) and control group (TG<3.23 mmol/L, n=443). The baseline information, levels of lipid and perinatal outcome were compared among Group A,B and C, and also between the high TG and control group, respectively, using Mann-whitney U test, Kruskal-Wallis H test, LSD- t, Chi-square test, or Fisher exact test. Multivariate logistic regression analysis was also applied to analyze the correlation between hypertriglyceridemia and adverse perinatal outcome. Results:The maternal age, gravidity and parity, body mess index, blood pressure on admission and total cholesterol (TC), TG, high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), TG/HDL-C ratio and LDL-C/HDL-C ratio in late pregnancy and the occurrence of adverse perinatal outcome did not show any significant differences among Group A, B and C (all P>0.05). However, the hemoglobin (Hb) level increased with the elevation of altitude as expected, and that in Group C was higher than that in Group A and B [121.0 g/L (108.0-132.0 g/L) vs 115.0 g/L (103.5-128.0 g/L) and 117.0 g/L (101.0-127.0 g/L), H=2.37 and 1.97, both P<0.05]. The proportion of women with hypertriglyceridemia, the high TG group, in late pregnancy was 15.3% (80/523), and no significant difference was found in HDL-C or Hb levels between the high TG and control group [1.7 mmol/L (1.5-2.0 mmol/L) vs 1.8 mmol/L (1.5-2.1 mmol/L), Z=－1.51;123.5 g/L (110.0-131.8 g/L) vs 117.0 g/L (104.0-128.0 g/L), Z=1.69; both P>0.05]. Higher rates of cesarean section [13.8% (11/80) vs 6.6% (29/443), χ2＝4.98], hypertensive disorders of pregnancy (HDP) [16.3% (13/80) vs 7.5% (33/443), χ2＝6.54], preeclampsia (PE) [8.8% (7/80) vs 1.6% (7/443), χ2＝13.37], hyperglycemia during pregnancy [11.3%( 9/80) vs 3.6% (16/443), χ2＝8.69], preterm birth (PB) [7.5% (6/80) vs 2.0% (9/443), χ2＝7.27], microsomia [5.0% (4/80) vs 0.9% (4/443), Fisher exact test] and neonatal asphyxia [8.8%(7/80) vs 2.5% (11/443), χ2＝8.01] were observed in the high TG group than in the control group (all P<0.05). Regarding the pregnant women at different altitude, TG was negatively correlated with Hb ( r=－0.17, P=0.037) only in Group C .Multivariate logistic regression analysis revealed higher risk of HDP ( OR=2.42,95% CI:1.17-5.00), PE ( OR=5.25, 95% CI:1.73-16.00), hyperglycemia during pregnancy ( OR=3.77, 95% CI:1.56-9.09), PB ( OR=4.33, 95% CI:1.42-13.22), microsomia ( OR=4.33, 95% CI:1.42-13.22), neonatal asphyxia ( OR=3.45, 95% CI:1.27-9.35) and fetal demise ( OR=4.94, 95% CI:1.01-24.21) in women with high TG level in late pregnancy (all P<0.05). Conclusions:There were no differences in adverse perinatal outcomes or serum lipid levels in late pregnancy among women living at different high altitudes. However, hypertriglyceridemia at the third trimester is closely associated with the incidence of HDP, PE, hyperglycemia during pregnancy, PB, microsomia, neonatal asphyxia and fetal demise in this group of women.
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Objective:To study the relationship between maternal hemoglobin concentration, anemia rate in the third trimester and the altitudes, pregnancy outcomes among pregnant women in Tibet rural areas.Methods:This prospective study collected clinical and laboratory data of 390 Tibetan pregnant women who delivered after 28 gestational weeks at Chaya People's Hospital, Changdu city, Tibet autonomous region, from May 2020 to March 2021. Blood routine examination was performed at admission and 24-72 h postpartum using an automatic hematologic analyzer. According to the hemoglobin standard adjusted for altitude by World Health Organization (WHO), the association between pregnancy outcomes and maternal hemoglobin levels and anemia rate before and after adjustment were analyzed using Mann-Whitney U one-way analysis of variance, Chi-square, Pearson correlation, and Spearman correlation tests. Results:(1) In these women, the mean actual hemoglobin concentration in the third trimester was (121±16) g/L, and the prevalence of anemia and microcytic hypochromic anemia was 23.8% (93/390) and 20.3% (79/390), respectively. (2) After adjustment, the mean hemoglobin concentration was (93±17) g/L, and the prevalence of anemia and microcytic hypochromic anemia was 84.4% (329/390) and 30.5% (119/390), respectively. (3) Actual hemoglobin levels showed an increasing tendency as the altitude rose. At the altitude of 3 000-3 500 m, >3 500-4 000 m, and >4 000 m, the mean hemoglobin levels were (118±15) g/L, (119±17) g/L, and (124±16) g/L, respectively ( Ftrend=7.38, P=0.007). However, the prevalence of anemia and microcytic hypochromic anemia did not differ significantly between different altitude ( P>0.05). (4) Corrected hemoglobin levels were negatively associated with the altitude ( r=－0.31, P<0.001). At the altitude of 3 000~3 500 m, 3 500~4 000 m and >4 000 m, the mean corrected hemoglobin levels were (100±15) g/L, (92±17) g/L, and (87±18) g/L, respectively ( Ftrend=30.36, P<0.001). The prevalence of anemia increased with altitude ( χ2trend=15.44, P<0.001), but no association was observed between microcytic hypochromic anemia and altitudes ( P>0.05). (5) No association was found between actual or corrected anemia in the third trimester and adverse pregnancy outcomes, nor the hemoglobin level before or after adjustment and neonatal birth weight. Conclusions:In Tibet rural areas, the mean actual hemoglobin level in pregnant women tends to increase with the altitude. However, the prevalence of anemia and microcytic hypochromic anemia remains high and more attention should be paid to iron supplementary during pregnancy. After adjusting hemoglobin concentration based on WHO standard, more women were diagnosed as having anemia during pregnancy in this area, and the applicability of the diagnostic criteria for Tibetan residents requires further investigations.
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Objective To investigate current status and the influencing factors of Helicobacter pylori (H.pylori) infection in Lhasa region.Methods From November 2015 to July 2016,a questionnaire survey was conducted among 1 000 individuals in Lhasa region and H.pylori infection was detected by 13C urea breath test.Chi-square test and multivariate Logistic regression analysis were performed for statistical analysis.Results Among 1 000 individuals,576 (67.60％) cases were infected by H.pylori.The H.pylori infection rate in people less than 60 years old was 59.32％ (538/907),which was higher than that of people no less than 60 years old (40.86％,38/93),and the difference was statistically significant (x2=11.765,P＜0.01).The higher the education level,the lower the infection rate of H.pylori (x2=16.381,P =0.001).The difference in the infection rate of H.pylori in different occupations was statistically significant (x2 =28.699,P＜0.01).The infection rate of H.pylori was lowest in mental workers (45.77％,119/260) and was highest in heavy labor worker (79.35％,123/ 155),and the difference was statistically significant (x2 =44.985,P＜0.01).The lower the family annual income,the higher the infection rate of H.pylori (x2 =84.472,P＜0.01).Raw meat intake (odd ratio (OR)=1.725,95％ confidence interval (CI) 1.192 to 2.249),dietary taste (OR=1.316,95％CI 1.056 to 1.564) and sharing dishware (OR=2.723,95％CI 1.973 to 3.431) were positively correlated with H.pylori infection (all P＜0.01),and family income was negatively correlated with H.pylori infection (OR=3.205,95％CI 2.358 to 4.056,P＜0.01).Conclusion The infection rate of H.pylori decreased in Lhasa region compared to that of 10 years ago,which may be due to the improved dietary habit as well as social-economic condition.
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Objective To know the quality of iodized salt and the current situation of the salt coverage in Tibet,and to provide scientific basis for proposing proper prevention and control measures to Iodine dificiency disorders(IDD). Methods In 2008, according to the "Sampling Methods of the Main Products in the Salt Industry",one batch fifteen salt samples were collected in iodized salt processing factory in Tibet. Five townships were chosen in each county based on 5 different directions of east, south, west, north and center. If the monitoring county has less than five townships, then all of the townships were sampled. In each township, four villages were selected withrandom sampling and importance sampling. In each township, 15 households were selected for salt collection. Results A batch of 15 salt samples in a salt processing plant were tested, and all of them were qualified with salt iodine(34.6±1.58) mg/kg. A total of 21 107 edible salt samples were tested, and 11 203 of them were qualified iodized salt. These results meant that the provincial iodized salt coverage rate was 53.08%. Shannan iodized salt coverage rate was 94.31% (3395/3600) which was the highest in Tibet. Those of Nagqu, Changdu, Ngari were lower, they were 29.84% (897/3006), 24.94% (823/3300) and 17.08% (205/1200), respectively. Conclusions The quality of iodized salt in Tibet is up to the national standard, but the coverage rate of iodized salt is very low.We suggest that the strategy should be carried out according to the national overall program strategy and supplement iodized oil capsule for special groups.