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This article presents a case of acute ST-segment elevation myocardial infarction (STEMI) in a pregnant woman caused by coronary artery dissection. The 41-year-old patient had undergone cardiac valve surgery at the age of 1 and had no risk factors such as hypertension, diabetes, smoking, alcohol use, or a family history of coronary artery disease. At 31 +1 weeks of gestation, she experienced sudden chest pain for 4 hours and was emergently referred to Peking University First Hospital on June 1, 2021. Electrocardiogram revealed ST-segment elevation in leads I, aVL, and V 2 to V 6. Biochemical assays showed elevated levels of high-sensitivity cardiac troponin I and creatine kinase-MB. Echocardiography indicated segmental ventricular wall motion abnormalities (apical) and reduced left ventricular function, confirming the diagnosis of acute anterior wall STEMI. The patient promptly underwent emergency coronary angiography and percutaneous coronary intervention and confirmed coronary artery dissection. Postoperative care included antiplatelet, anticoagulation, and supportive treatment. At 34 +3 weeks of gestation, with the condition of acute anterior wall STEMI being relatively stable, a cesarean section was successfully performed. Regular cardiology follow-ups were scheduled postpartum, and cardiac function was normal in two years after discharge.
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The "Clinical Practice Guidelines for Hypertension in China", released in 2022, has lowered the diagnostic criteria for hypertension. However, no adjustments were made to the diagnostic criteria for hypertension during pregnancy. The impact of adult hypertension diagnostic criteria on the diagnosis of gestational hypertension and pregnancy outcomes remains unclear. Borderline hypertension includes elevated blood pressure and stage 1 hypertension. Compared to pregnant women with normal blood pressure, women with borderline hypertension have an increased risk of adverse pregnancy outcomes. Still, there are no associated guidelines for pregnancy management for now. This article explores the influence of borderline hypertension on pregnancy outcomes and the optimal level for blood pressure control during pregnancy, aiming to improve maternal and fetal outcomes and optimize the management of borderline hypertension during pregnancy.
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Obesity and iron deficiency are the most common pregnancy complications. Iron deficiency can lead to anemia and affects the growth and development of offspring, especially the nervous system. Maternal obesity induces mild inflammation and can up-regulate the expression of hepcidin, which leads to maternal iron deficiency. At present, the correlation between obesity-related iron deficiency and adverse pregnancy outcomes is controversial. Therefore, this review focuses on the research progress in obesity-related iron deficiency and its effect on pregnancy outcomes.
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Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among reproductive-age women, characterized by obesity, insulin resistance, chronic low-grade inflammation, and hyperandrogenemia. Studies have revealed that women with PCOS may experience an increased risk of various adverse pregnancy outcomes, such as gestational diabetes, hypertensive disorders of pregnancy, miscarriages, and preterm births. Preterm birth is an important cause of adverse outcome among perinatal infants. However, due to the complexity of its pathogenesis, the current intervention treatment of preterm birth often yields unsatisfactory results. Recent studies have discovered that women with PCOS have a higher risk of preterm birth than those without, suggesting that PCOS is a risk factor for preterm birth. This article reviews the research progress of PCOS-related preterm birth to offer new insights into the prevention and treatment of preterm birth in women caused by PCOS.
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Objective:To evaluate the efficacy of low-dose radiotherapy in patients with advanced hypopharyngeal cancer without high-risk factors.Methods:Clinical data of 235 patients diagnosed with advanced hypopharyngeal cancer treated in Department of Head and Neck Surgery of Shandong Provincial ENT Hospital from December 2013 to August 2018 were retrospectively analyzed. All patients were divided into two groups: low-dose radiotherapy group (50 Gy, n=158) and high-dose radiotherapy group (>60 Gy, n=77). Clinical baseline characteristics, treatment, follow-up and survival of patients were collected. Survival curve was delineated using the Kaplan-Meier method, and the differences in survival between two groups were calculated using the log-rank test. Clinical baseline characteristics between two groups were compared by χ2 test. Univariate and multivariate analyses of prognostic factors were conducted by logistic regression model. Results:The median follow-up time was 45 months (5-94 months). The 3-year overall survival (OS) rate of the whole group was 68.5%, and 70.3% and 64.9% in the low-dose and high-dose groups, respectively ( P=0.356). The 3-year progression-free survival (PFS) rate of the whole group was 64.3%, and 65.8% and 61.0% in the low-dose and high-dose groups, respectively ( P=0.361). Univariate analysis showed that T stage, N stage, lesion location and degree of pathological differentiation significantly affected clinical prognosis (all P<0.05), whereas there was no significant relationship between age, sex, radiotherapy dose, interval between surgery and radiotherapy and survival. Multivariate analysis showed that T stage, N stage and the degree of pathological differentiation were the independent prognostic factors (all P<0.05) of the 3-year OS and PFS. Sex, radiotherapy dose and interval between surgery and radiotherapy were not correlated with OS and PFS. Conclusion:This study showed that for hypopharyngeal cancer patients without positive surgical margins and extracapsular extension, postoperative radiotherapy at a dose of 50 Gy given to tumor bed and selective lymph node drainage area does not compromise local disease control and OS.
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Objective:To explore and compare the reference ranges of four coagulation tests in normal pregnant women during early and late pregnancy and the influence of age.Methods:Values of four coagulation tests from 4 974 pregnant women, who gave single birth at Peking University First Hospital, Obstetrics and Gynecology Hospital of Fudan University, West China Second University Hospital, Peking University Third Hospital and Shengjing Hospital of China Medical University from February 2017 to July 2020, were measured and analyzed in this study, including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib) and thrombin time (TT). The four normal reference ranges of coagulation during early and late pregnancy phases were expressed as P2.5- P97.5. The difference of two pregnancy phases was compared by non-parametric test of two related samples. And the difference between pregnant women of advanced and non-advanced age in the same pregnancy phase was compared by independent sample non-parametric test. Chi-square test was used to compare the incidence of pregnancy complications in different coagulation reference ranges. Results:The reference ranges of PT of normal pregnant women′s early and late pregnancy were 10.0-13.9 s and 9.6-12.3 s, the reference ranges of APTT were 22.6-35.3 s and 22.4-30.9 s, the reference ranges of Fib were 2.4-5.0 g/L and 3.0-5.7 g/L, the reference ranges of TT were 12.0-19.0 s and 11.5-18.4 s. Compared with early pregnancy, PT, APTT and TT shortened significantly, while the Fib significantly increased in late pregnancy (all P<0.001). PT, APTT and TT of advanced and non-advanced age pregnant women were significantly different (all P<0.01). Compared with the ranges of non-pregnant population, more pregnant women were included in the normal pregnant reference ranges of PT in early pregnancy and APTT in the early and late pregnancy, while the incidence of pregnancy complications had no significant differences (all P>0.05). The incidence of fetal distress was higher and the incidence of preterm birth was lower in the reference range of PT in late pregnancy. The incidence of gestational diabetes mellitus was higher in the early and late gestational Fib reference ranges, and the incidence of hypertensive disorders in pregnancy was higher in the late gestational Fib reference range (all P<0.05). Conclusions:The coagulation function of pregnant women increases significantly with the growth of pregnancy, and there is a significant difference between advanced significantly and non-advanced age pregnant women. The recommended ranges of normal pregnant women′s early and late pregnancy PT are 10.0-13.9 s and 9.6-12.3 s, the recommended ranges of APTT are 22.6-35.3 s and 22.4-30.9 s, the recommended ranges of TT are 12.0-19.0 s and 11.5-18.4 s. The appropriate ranges of normal pregnant women′s early and late pregnancy Fib still need further exploration.
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Objective:To explore the appropriate fetal weight of twin pregnancies at different gestational weeks and the association with pregnancy complications and outcomes.Methods:Fetal weight at different gestational weeks and related pregnancy complications and outcomes from 1 225 twin pregnancies, who gave birth at Peking University First Hospital from January 2004 to December 2020, were analyzed in this study, including hypertensive disorders in pregnancy, gestational diabetes mellitus (GDM), fetal growth restriction (FGR), fetal distress, preterm birth and neonatal asphyxia. The appropriate fetal weight of twin pregnancies at different gestational weeks were analysed based on the information from 616 twin pregnancies without complications (except preterm birth), and were expressed as P10~ P90. The chi-square test was used to compare the risk of pregnancy complications and adverse outcomes in large for gestational age (LGA), appropriate for gestational age (AGA) and small for gestational age (SGA) twin pregnancies and the difference in incidence of pregnancy complications and adverse outcomes in different years. Results:The appropriate fetal weights of normal twin pregnancies at 28 to 37 weeks and 38-40 weeks of gestation were 910-1 255 g, 996-1 518 g, 1 105-1 785 g, 1 295-1 825 g, 1 336-2 000 g, 1 754-2 321 g, 1 842-2 591 g, 1 913-2 615 g, 2 150-2 847 g, 2 350-3 130 g and 2 450-3 250 g, respectively. The incidences of hypertensive disorders in pregnancy, FGR, fetal distress and neonatal asphyxia related to SGA twin pregnancies were significantly higher than AGA twin pregnancies (all P<0.05). The incidence of GDM in twin pregnant from 2017 to 2020 was higher than that from 2004 to 2009 or from 2010 to 2016, but the incidence of fetal distress and neonatal asphyxia were lower than those from 2010 to 2016, and the differences were statistically significant (all P<0.05). Conclusions:The appropriate weights of twin fetuses at different gestational weeks are different from singleton. The incidence of pregnancy complications and adverse outcomes in AGA fetuses is significantly lower than that in SGA fetuses under the specific weight standard for twin fetuses, which could provide a practical basis for clinical management of twin pregnancy.
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Objective:To explore the effect of exercise intervention on regulation of Toll-like receptor 4 (TLR4) signaling pathway in overweight and obese pregnant women.Methods:The cohort was based on a randomized controlled trial (RCT) carried out by the same research group in Peking University First Hospital from December 2014 to July 2016. Overweight and obese patients who delivered by elective cesarean section without pregnancy complications were recruited, among which 12 cases in the exercise group and 11 cases in the control group were selected. Real-time polymerase chain reaction, Western Blot, and Luminex experiments were used to compare the expression of TLR4-myeloid differentiation factor 8(MyD88)-nuclear factor-κB(NF-κB) pathway in peripheral blood mononuclear cell (PBMC), rectus abdominis muscle, omental adipose, and subcutaneous adipose, as well as the levels of inflammatory factors (TNF-α, IL-1β, IL-10) in plasma between the two groups. Two independent samples t-test, generalized estimating equation, Chi-square test, and Pearson correlation analysis were adopted for statistical analysis. Results:(1) The expression of inflammatory factors TNF-α and IL-1β in the exercise group showed a downward trend compared with the control in the second and third trimester, but none of the differences were statistically significant (all P>0.05). (2) The mRNA expression of TLR4, MyD88, and NF-κB and the protein expression of TLR4 and NF-κB in PBMC of the exercise group were significantly lower than those in the control group during pregnancy (TLR4 mRNA: 0.06±0.03 vs 0.10±0.04 in the second trimester, 0.05±0.02 vs 0.11±0.05 in the third trimester, χ2=8.07; MyD88 mRNA: 0.09±0.03 vs 0.11±0.03 in the second trimester, 0.10±0.04 vs 0.17±0.06 in the third trimester, χ2=5.81; NF-κB mRNA: 0.10±0.03 vs 0.17±0.08 in the second trimester, 0.08±0.03 vs 0.20±0.08 in the third trimester, χ2=14.71; TLR4 protein: 1.7±0.5 vs 1.9±0.8 in the second trimester, 1.7±0.4 vs 2.3±0.8 in the third trimester, χ2=5.83; NF-κB protein: 1.0±0.4 vs 1.5±0.4 in the second trimester, 1.2±0.3 vs 1.5±0.5 in the third trimester, χ2=4.73; all P<0.05). Moreover, the differences in the mRNA expression of TLR4, MyD88, and NF-κB and TLR4 protein expression in PBMC between the two groups gradually increased. (3) NF-κB in rectus abdominis and omental adipose tissue (0.04±0.02 vs 0.08±0.04, t=－3.72; 0.25±0.05 vs 0.63±0.21, t=－5.41; both P<0.05) and TLR4 and MyD88 in subcutaneous adipose tissue (0.12±0.03 vs 0.30±0.10, t=－5.30; 0.24±0.09 vs 0.44±0.08, t=－5.38; both P<0.05) were observed a decreased mRNA level in the exercise group compared with the control group. The protein level of MyD88 and NF-κB in omental adipose tissue and NF-κB in subcutaneous adipose tissue in the exercise group were significantly lower than those in the control group (1.1±0.5 vs 2.0±0.8, t=－3.15; 1.3±0.5 vs 2.0±0.9, t=－2.23; 1.2±0.5 vs 1.9±0.8, t=－2.80, all P<0.05). (4) The expressions of TLR4 and NF-κB mRNA ( r=0.453 and 0.485) in rectus abdominis muscle, NF-κB mRNA, TLR4 and MyD88 protein ( r=0.539, 0.437 and 0.527) in omental adipose in the two groups were positively correlated with the level of fasting blood glucose ( P<0.05). Conclusions:Regular exercise during pregnancy can down-regulate the expression and activation of the TLR4-MyD88-NFκB pathway in overweight and obese pregnant women. The expression of related factors along this pathway has a certain correlation with fasting blood glucose.
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BACKGROUND@#Gestational diabetes mellitus (GDM) brings health issues for both mothers and offspring, and GDM prevention is as important as GDM management. It was shown that a history of GDM was significantly associated with a higher maternal risk for GDM recurrence. The incidence of GDM recurrence was unclear because of the incidence of second-child was low before 2016 in China. We aim to investigate the prevalence of GDM recurrence and its associated high-risk factors which may be useful for the prediction of GDM recurrence in China.@*METHODS@#A retrospective study was conducted which enrolled participants who underwent regular prenatal examination and delivered twice in the same hospital of 18 research centers. All participants were enrolled from January 2018 to October 2018, where they delivered the second baby during this period. A total of 6204 women were enrolled in this study, and 1002 women with a history of GDM were analyzed further. All participants enrolled in the study had an oral glucose tolerance test (OGTT) result at 24 to 28 weeks and were diagnosed as GDM in the first pregnancy according to the OGTT value (when any one of the following values is met or exceeded to the 75-g OGTT: 0 h [fasting], ≥5.10 mmol/L; 1 h, ≥10.00 mmol/L; and 2 h, ≥8.50 mmol/L). The prevalence of GDM recurrence and development of type 2 diabetes mellitus were calculated, and its related risk factors were analyzed.@*RESULTS@#In 6204 participants, there are 1002 women (1002/6204,16.15%) with a history of GDM and 5202 women (5202/6204, 83.85%) without a history of GDM. There are significant differences in age (32.43 ± 4.03 years vs. 33.00 ± 3.34 years vs. 32.19 ± 3.37 years, P < 0.001), pregnancy interval (4.06 ± 1.44 years vs. 3.52 ± 1.43 years vs. 3.38 ± 1.35 years, P = 0.004), prepregnancy body mass index (BMI) (27.40 ± 4.62 kg/m2vs. 23.50 ± 3.52 kg/m2vs. 22.55 ± 3.47 kg/m2, P < 0.001), history of delivered macrosomia (22.7% vs. 11.0% vs. 6.2%, P < 0.001) among the development of diabetes mellitus (DM), recurrence of GDM, and normal women. Moreover, it seems so important in the degree of abnormal glucose metabolism in the first pregnancy to the recurrence of GDM and the development of DM. There are significant differences in OGTT levels of the first pregnancy such as area under the curve of OGTT value (18.31 ± 1.90 mmol/L vs. 16.27 ± 1.93 mmol/L vs. 15.55 ± 1.92 mmol/L, P < 0.001), OGTT fasting value (5.43 ± 0.48 mmol/L vs. 5.16 ± 0.49 mmol/L vs. 5.02 ± 0.47 mmol/L, P < 0.001), OGTT 1-hour value (10.93 ± 1.34 mmol/L vs. 9.69 ± 1.53 mmol/L vs. 9.15 ± 1.58 mmol/L, P < 0.001), OGTT 2-hour value (9.30 ± 1.66 mmol/L vs. 8.01 ± 1.32 mmol/L vs. 7.79 ± 1.38 mmol/L, P < 0.001), incidence of impaired fasting glucose (IFG) (fasting plasma glucose ≥5.6 mmol/L) (31.3% vs. 14.6% vs. 8.8%, P < 0.001), and incidence of two or more abnormal OGTT values (68.8% vs. 39.7% vs. 23.9%, P < 0.001) among the three groups. Using multivariate analysis, the factors, such as age (1.07 [1.02-1.12], P = 0.006), prepregnancy BMI (1.07 [1.02, 1.12], P = 0.003), and area under the curve of OGTT in the first pregnancy (1.14 [1.02, 1.26], P = 0.02), have an effect on maternal GDM recurrence; the factors, such as age (1.28 [1.01-1.61], P = 0.04), pre-pregnancy BMI (1.26 [1.04, 1.53], P = 0.02), and area under the curve of OGTT in the first pregnancy (1.65 [1.04, 2.62], P = 0.03), have an effect on maternal DM developed further.@*CONCLUSIONS@#The history of GDM was significantly associated with a higher maternal risk for GDM recurrence during follow-up after the first pregnancy. The associated risk factors for GDM recurrence or development of DM include age, high pre-pregnancy BMI, history of delivered macrosomia, the OGTT level in the first pregnancy, such as the high area under the curve of OGTT, IFG, and two or more abnormal OGTT values. To prevent GDM recurrence, women with a history of GDM should do the preconception counseling before preparing next pregnancy.
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Adulto , Feminino , Humanos , Masculino , Gravidez , Glicemia/metabolismo , China/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Gestacional , Macrossomia Fetal , Intolerância à Glucose , Estudos RetrospectivosRESUMO
Objective:To explore the effects of interpregnancy interval (IPI) on pregnancy outcomes of subsequent pregnancy.Methods:A multicenter retrospective study was conducted in 21 hospitals in China. Information of age, height, pre-pregnancy weight, IPI, history of diseases, complications of pregnancy, gestational age of delivery, delivery mode, and pregnancy outcomes of the participants were collected by consulting medical records of pregnant women who had two consecutive deliveries in the same hospital during 2011 to 2018. The participants were divided into 4 groups according to IPI:<18 months, 18-23 months, 24-59 months and ≥60 months. According to the WHO′s recommendation, with the IPI of 24-59 months group as a reference, to the effects of IPI on pregnancy outcomes of subsequent pregnancy were analyzed. Stratified analysis was further carried out based on age, history of gestational diabetes mellitus (GDM), macrosomia, and premature delivery, to explore the differences in the effects of IPI on pregnancy outcomes among women with different characteristics.Results:A total of 8 026 women were included in this study. There were 423, 623, 5 512 and 1 468 participants in <18 months group, 18-23 months group, 24-59 months group and ≥60 months group, respectively. (1) The age, pre-pregnancy body mass index (BMI), history of cesarean section, GDM, gestational hypertension and cesarean section delivery rate of <18 months group, 18-23 months group, 24-59 months group and ≥60 months group were gradually increased, and the differences were statistically significant ( P<0.05). (2) After adjusting for potential confounding factors, compared with women in the IPI of 24-59 months group, the risk of premature delivery, premature rupture of membranes, and oligohydramnios were increased by 42% ( OR=1.42, 95% CI: 1.07-1.88, P=0.015), 46% ( OR=1.46, 95% CI: 1.13-1.88, P=0.004), and 64% ( OR=1.64, 95% CI: 1.13-2.38, P=0.009) respectively for women in the IPI≥60 months group. No effects of IPI on other pregnancy outcomes were found in this study ( P>0.05). (3) After stratified by age and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of oligohydramnios for women with advanced age ( OR=2.87, 95% CI: 1.41-5.83, P=0.004); and <18 months could increase the risk of premature rupture of membranes for women under the age of 35 ( OR=1.59, 95% CI: 1.04-2.43, P=0.032). Both the risk of premature rupture of membranes ( OR=1.58, 95% CI: 1.18-2.13, P=0.002) and premature delivery ( OR=1.52, 95% CI: 1.07-2.17, P=0.020) were significantly increased in the IPI≥60 months group. After stratified by history of GDM and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would lead to an increased risk of postpartum hemorrhage for women with a history of GDM ( OR=5.34, 95% CI: 1.45-19.70, P=0.012) and an increased risk of premature rupture of membranes for women without a history of GDM ( OR=1.44, 95% CI: 1.10-1.90, P=0.009). After stratified by history of macrosomia and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months could increase the proportion of cesarean section for women with a history of macrosomia ( OR=4.11, 95% CI: 1.18-14.27, P=0.026) and the risk of premature rupture of membranes for women without a history of macrosomia ( OR=1.46, 95% CI: 1.12-1.89, P=0.005). After stratified by history of premature delivery and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of premature rupture of membranes for women without a history of premature delivery ( OR=1.47, 95% CI: 1.13-1.92, P=0.004). Conclusions:Both IPI≥60 months and <18 months would increase the risk of adverse pregnancy outcomes in the subsequent pregnancy. Healthcare education and consultation should be conducted for women of reproductive age to maintain an appropriate IPI when they plan to pregnant again, to reduce the risk of adverse pregnancy outcomes in the subsequent pregnancy.
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Objective@#To investigate the changes of coagulation indexes in normal pregnant women in early and late pregnancy.@*Methods@#The coagulation indexes in early and late pregnancy including activated partial thromboplastin time (APTT), APTT ratio, prothrombin time (PT), PT ratio, prothrombin activity, international normalized ratio, fibrinogen (Fib) and thrombin time (TT) were retrospectively collected from 196 normal pregnant women delivered in Peking University First Hospital from August 2013 to September 2014. Differences in these indexes before and after the seventh gestational week of early pregnancy and in early and late pregnancy were compared. In addition, the normal reference values were calculated. Paired t test and sum-rank test were used for statistical analysis. The reference values were presented with P2.5-P97.5.@*Results@#In early pregnancy, some coagulation indexes after the seventh weeks were shorter than those before, such as APTT [30.3 (26.1-35.5) vs 32.1 (27.9-36.8) s, Z=25.850, P<0.001] and TT [13.8 (12.2-16.0) vs 14.5 (12.3-16.4) s, Z=16.720, P<0.001], but Fib [3.3 (2.5-4.3) vs 2.9 (2.2-3.8) g/L, Z=43.180, P<0.001] became higher. APTT [(27.5±1.6) vs (31.4±2.4) s, t=24.736, P<0.001], PT [(9.7±0.5) vs (11.0±0.8) s, t=18.647, P<0.001] and TT [(13.3±0.8) vs (14.2±1.0) s, t=9.255, P<0.001] were significantly shorter, while Fib [(4.4±0.5) vs (3.1±0.4) g/L, t=-29.152, P<0.001] was higher in late pregnancy than in early pregnancy. The reference values of APTT, PT, Fib and TT in early pregnancy were 26.5-36.0 s, 9.4-12.4 s, 2.4-4.0 g/L and 12.3-16.4 s, and those in late pregnancy were 25.0-31.2 s, 8.8-10.6 s, 3.4-5.4 g/L and 12.0-14.9 s, respectively.@*Conclusions@#The coagulation indexes of pregnant women change significantly since the beginning of early pregnancy. APTT, PT and TT are shorter, while Fib is higher in late pregnancy than in early pregnancy.
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Objective To investigate the changes of coagulation indexes in normal pregnant women in early and late pregnancy.Methods The coagulation indexes in early and late pregnancy including activated partial thromboplastin time (APTT),APTT ratio,prothrombin time (PT),PT ratio,prothrombin activity,international normalized ratio,fibrinogen (Fib) and thrombin time (TT) were retrospectively collected from 196 normal pregnant women delivered in Peking University First Hospital from August 2013 to September 2014.Differences in these indexes before and after the seventh gestational week of early pregnancy and in early and late pregnancy were compared.In addition,the normal reference values were calculated.Paired t test and sum-rank test were used for statistical analysis.The reference values were presented with P2.5-P97.5.Results In early pregnancy,some coagulation indexes after the seventh weeks were shorter than those before,such as APTT [30.3 (26.1-35.5) vs 32.1 (27.9-36.8) s,Z=25.850,P＜0.001] and TT [13.8 (12.2-16.0) vs 14.5 (12.3-16.4) s,Z=16.720,P＜0.001],but Fib [3.3 (2.5-4.3) vs 2.9 (2.2-3.8) g/L,Z=43.180,P＜0.001] became higher.APTT [(27.5± 1.6) vs (31.4±2.4) s,t=24.736,P＜0.001],PT [(9.7±0.5) vs (11.0±0.8) s,t=1 8.647,P＜0.001] and TT [(13.3 ±0.8) vs (14.2±1.0) s,t=9.255,P＜0.001] were significantly shorter,while Fib [(4.4±0.5) vs (3.1 ±0.4) g/L,t=-29.152,P＜0.001] was higher in late pregnancy than in early pregnancy.The reference values ofAPTT,PT,Fib and TT in early pregnancy were 26.5-36.0 s,9.4-12.4 s,2.4-4.0 g/L and 12.3-16.4 s,and those in late pregnancy were 25.0-31.2 s,8.8-10.6 s,3.4-5.4 g/L and 12.0-14.9 s,respectively.Conclusions The coagulation indexes of pregnant women change significantly since the beginning of early pregnancy.APTT,PT and TT are shorter,while Fib is higher in late pregnancy than in early pregnancy.
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Objective To explore the characteristics of neonatal birth weight (BW) in two consecutive term singleton pregnant women and to investigate the influencing factors of macrosomia in the second birth.Methods In this case-control study,medical records of 1 920 singleton full-term pregnant women who gave birth twice in Peking University First Hospital from January 2005 to December 2017 were reviewed.All subjects were divided into two groups according to neonatal BW at the second birth regardless of the first one:macrosomia group (n=122) and non-macrosomia group (n=l 798).Then,those two groups were further divided into four sub-groups based on the neonatal BW in the first birth:macrosomia at both deliveries (n=27),macrosomia at the second time and non-macrosomia at the first time (n=95),non-macrosomia at the second time and macrosomia at the first time (n=90) and non-macrosomia at both deliveries (n=l 708).The differences of delivery interval,and the maternal age,pre-pregnancy body mass index (BMI),weight gain during pregnancy,area under the curve of oral glucose tolerance test results,weight retention,the incidence of diabetes in pregnancy (including gestational diabetes mellitus and diabetes mellitus complicated with pregnancy),incidence of hypertensive disorders during pregnancy and cesarean section rate at the second pregnancy between the groups and sub-groups were compared with t-test,Chi-square test and logistic regression analysis.Results (1) The total average neonatal BW in the second pregnancy was higher than that in the first [(3 443 ± 378) vs (3 403 ± 396) g,t=-4.119,P＜0.001].However,the proportion of macrosomia in each group was similar [6.4％ (122/ 1 920) vs 6.1％ (117/1 920),x2=3.237,P=0.198].The pre-pregnancy BMI,weight gain during pregnancy and proportion of previous macrosomia in the macrosomia group were significantly higher than those in non-macrosomia group [(23.6±3.4) vs (22.7±3.1) kg/m2,t=-2.882,P=0.004;(13.4±5.0) vs (12.4± 4.1) kg,t=-2.522,P=0.037;22.1％ (27/122) vs 5.0％ (90/1 798),x2=58.554,P＜0.001].Logistic regression analysis showed that previous macrosomia (OR=4.979,95％CI:3.052-8.122,P＜0.001),pre-pregnancy BMI (OR=1.084,95％CI:1.023-1.149,P=0.001) and weight gain during pregnancy (OR=1.077,95％CI:1.031-1.125,P=0.007) were influencing factors for macrosomia in the index delivery.(2) The pre-pregnancy BMI in the subgroup of macrosomia at both deliveries was significantly higher comparing to the subgroup of non-macrosomia at the second time and macrosomia at the first time [(25.8±4.3) vs (23.9±2.9) kg/m2,t=-2.600,P=0.011].Women in the subgroup of macrosomia at the second time and non-macrosomia at the first time had higher weight gain during second pregnancy than the subgroup of non-macrosomia at both deliveries [(13.5 ± 4.2) vs (12.5 ±4.1) kg,t=-2.404,P=0.016].Conclusions For two consecutive term singleton pregnancies,the average neonatal BW in the second time is slightly higher than that in the first,but the incidence of macrosomia is similar.Pre-pregnancy BMI,weight gain during pregnancy and macrosomia in the first birth are influencing factors for macrosomia in the second pregnancy.More attention should be paid to pre-pregnancy BMI reduction in women with history of macrosomia.For women without a history of macrosomia,weight management should be emphasized during the second pregnancy.
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Objective To investigate the long-term effects of regular exercise during pregnancy on overweight and obese gravidas. Methods This study was based on a previous randomized controlled trial (RCT) regarding Effect of Regular Exercise Commenced in Early Pregnancy on the Incidence of Gestational Diabetes Mellitus in Overweight and Obese Pregnant Women conducted at Peking University First Hospital from December 2014 to July 2016. Totally 265 women whose prepregnant body mass index (BMI) ≥24.0 kg/m2 were enrolled in the RCT and were randomly assigned to exercise group (n=132) and control group (n=133). This study was a follow-up of all the participants at one year after delivery from March 2016 to August 2017. Body weight, body fat, fasting and 2 h glucose level in 75 g oral glucose tolerance test (OGTT), insulin resistance index and lipid profiles were compared. We also evaluated their physical activities with International Physical Activity Questionnaire (IPAQ), their dietary habits with modified Adult Dietary Behavior Assessment Scale and depression condition with Postpartum Depression Screen Scale (PDSS). Two independent samples t-test, Mann-Whitney U test and Chi-square test were used for statistical analysis. ResuLts The overall follow-up rate was 51.7% (137/265), while 64.4% (85/132) in the exercise group and 39.1% (52/133) in the control group. No significant difference in body weight loss [2.3 ( － 6.0 to 5.0) vs 1.0 ( － 1.3 to 4.7) kg], body fat percentage [(38.04±4.54)% vs (37.51±4.90) %], 2 h glucose level in 75 g OGTT [(7.30±2.80) vs (7.32±1.61) mmol/L], abnormal glucose tolerance ratio [30.0% (9/30) vs 28.8% (17/59)] or insulin resistance index (2.92±1.77 vs 2.86±1.92) was found between the control and exercise group (t or Z= － 0.940, 0.312, 3.415, 0.005, 1.743, all P>0.05). However, the fasting blood glucose in 75 g OGTT was higher in the control group [(5.53±0.92) vs (5.28±0.43) mmol/L, t=9.268, P=0.003]. The two groups showed no significant difference (exercise group vs control group) in physical activity level [219 (99-504) vs 195 (99-351)], total score of dietary habits [79.00 (72.50-87.50) vs 76.00 (70.00-82.00)] or PDSS score of depression [55.00 (41.00-77.00) vs 70.00 (46.25-84.75)] at follow-up (Z=－0.808, －1.822, －1.620, all P>0.05). Moreover, there was no significant difference in the level of serum triglyceride [(1.25±1.04) vs (1.42±0.85) mmol/L], total cholesterol [(4.56±0.71) vs (4.40±0.67) mmol/L], high density lipoprotein-cholesterol [(1.32±0.29) vs (1.22±0.21) mmol/L] or low density lipoprotein-cholesterol [(2.67±0.56) vs (2.55±0.52) mmol/L] between the exercise and control group (t=0.001, 0.020, 3.255, 0.303, all P>0.05). ConcLusions Regular exercise during pregnancy has no long-term effect on maternal health in the absence of continuing lifestyle intervention after delivery. Therefore, postpartum follow-up and continued education on healthy lifestyle should be emphasized.
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Objective@#To investigate the relation between hemoglobin (Hb) levels in the third trimester and associated adverse pregnancy outcomes.@*Methods@#A retrospective analysis was conducted on 38 624 singleton gravidas recruited from 21 hospitals in three major cities in China from June 2013 to May 2015. Hb levels of all subjects were determined in the third trimester (≥28 weeks). Demographic data and clinical information were collected individually. The recruited gravidas were divided into four groups as follows: anemic group: Hb <110 g/L (n=6 256), control group: 110 g/L≤ Hb <130 g/L (n=22 484), high-level group: 130 g/L ≤ Hb <150 g/L (n=9 460), and super high-level group: Hb ≥ 150 g/L (n=424). One-way ANOVA and Chi-square test were used for statistical analysis.@*Results@#(1) Compared with the control group, anemic group had significantly higher incidences of preterm labor, low birth weight, neonatal admission and neonatal complications [4.9% (1 095/22 484) vs 6.9% (431/6 256), 3.1% (708/22 484) vs 4.3% (272/6 256), 6.2% (1 392/22 484) vs 9.2% (577/6 256), and 7.7% (1 741/22 484) vs 10.2% (640/6 256); χ2=930.905, 21.360,70.506 and 39.837, all P<0.001]; high-level group showed significantly increased incidences of hypertensive disorders of pregnancy and preeclampsia [2.3% (515/22 484) vs 3.2% (305/9 460) and 1.4% (313/22 484) vs 1.7% (161/9 460); χ2=23.203 and 6.072, both P<0.017], but decreased incidences of preterm labor, neonatal admission and neonatal complications [4.9% (1 095/22 484) vs 3.7% (346/9 460), 6.2% (1 392/22 484) vs 5.5% (517/9 460) and 7.7% (1 741/22 484) vs 6.7% (631/9 460); χ2=331.947, 6.245 and 11.154, all P<0.017]; super high-level group had significantly raised incidences of hypertensive disorders of pregnancy, preeclampsia and low birth weight [2.3% (515/22 484) vs 4.7% (20/424), 1.4% (313/22 484) vs 3.5% (15/424) and 3.1% (708/22 484) vs 5.2% (20/424); χ2=10.742, 13.575 and 6.512, all P<0.017]. (2) A concentration gradient analysis was performed to further analyze Hb levels in the third trimester in relation to adverse pregnancy outcomes and the results revealed that with the increase of Hb concentration, the incidences of hypertensive disorders of pregnancy, preeclampsia and low birth weight showed U-shaped distributions, while the incidences of preterm birth, neonatal admission and neonatal complications showed decreasing trends (χ2=31.233, 16.147, 25.618, 85.383, 97.824 and 68.677, respectively; all P<0.05).@*Conclusions@#Abnormal levels of Hb in the third trimester of pregnancy, including anemia and elevated Hb concentration are related to adverse pregnancy outcomes.
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Objective To investigate the relation between hemoglobin (Hb) levels in the third trimester and associated adverse pregnancy outcomes.Methods A retrospective analysis was conducted on 38 624 singleton gravidas recruited from 21 hospitals in three major cities in China from June 2013 to May 2015.Hb levels of all subjects were determined in the third trimester (≥ 28 weeks).Demographic data and clinical information were collected individually.The recruited gravidas were divided into four groups as follows:anemic group:Hb ＜110 g/L (n=6 256),control group:110 g/L ≤ Hb ＜130 g/L (n=22 484),high-level group:130 g/L ≤ Hb ＜150 g/L (n=9 460),and super high-level group:Hb ≥ 150 g/L (n=424).One way ANOVA and Chi-square test were used for statistical analysis.Results (1) Compared with the control group,anemic group had significantly higher incidences of preterm labor,low birth weight,neonatal admission and neonatal complications [4.9％ (1 095/22 484) vs 6.9％ (431/6 256),3.1％ (708/22 484) vs 4.3％ (272/6 256),6.2％(1 392/22 484) vs 9.2％ (577/6 256),and 7.7％ (1 741/22 484) vs 10.2％ (640/6 256);x2=930.905,21.360,70.506and 39.837,all P＜0.001];high-level group showed significantly increased incidences of hypertensive disorders of pregnancy and preeclampsia [2.3％ (515/22 484) vs 3.2％ (305/9 460) and 1.4％ (313/22 484) vs 1.7％ (161/9 460);x2=23.203 and 6.072,both P＜0.017],but decreased incidences of preterm labor,neonatal admission and neonatal complications [4.9％ (1 095/22 484) vs 3.7％ (346/9 460),6.2％ (1 392/22 484) vs 5.5％ (517/9 460) and 7.7％ (1 741/22 484) vs 6.7％ (631/9 460);x2=331.947,6.245 and 11.154,all P＜0.017];super high-level group had significantly raised incidences of hypertensive disorders of pregnancy,preeclampsia and low birth weight [2.3％ (515/22 484) vs 4.7％ (20/424),1.4％ (313/22 484) vs 3.5％ (15/424) and 3.1％ (708/22 484) vs 5.2％(20/424);x2=10.742,13.575 and 6.512,all P＜0.017].(2) A concentration gradient analysis was performed to further analyze Hb levels in the third trimester in relation to adverse pregnancy outcomes and the results revealed that with the increase of Hb concentration,the incidences of hypertensive disorders of pregnancy,preeclampsia and low birth weight showed U-shaped distributions,while the incidences of preterm birth,neonatal admission and neonatal complications showed decreasing trends (x2=31.233,16.147,25.618,85.383,97.824 and 68.677,respectively;all P＜0.05).Conclusions Abnormal levels of Hb in the third trimester of pregnancy,including anemia and elevated Hb concentration are related to adverse pregnancy outcomes.
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Objective To analyze the characteristics of pre-gestational diabetes mellitus (PGDM) diagnosed during pregnancy (missed diagnosis before pregnancy), and to evaluate the effects of diagnostic time on pregnancy outcomes. Methods A retrospective study of 746 pregnant women who were diagnosed PGDM and delivered in Peking University First Hospital from January 1st, 2005 to December 31st, 2015 was conducted. The patients were divided into 2 group. Those diagnosed PGDM before pregnancy were defined as Group diagnosed before pregnancy, and those diagnosed during pregnancy were defined as Group diagnosed during pregnancy. In Group diagnosed during pregnancy, those diagnosed before 24 gestational weeks were defined as Group diagnosed during pregnancy A, and those diagnosed after 24 weeks were defined as Group diagnosed during pregnancy B. The prevalence of adverse pregnancy outcomes in each group were analyzed. Results (1) Rate of missed diagnosis for PGDM:the incidence of PGDM diagnosed before pregnancy was 32.2% (240/746), and those diagnosed during pregnancy (missed diagnosis before pregnancy) was 67.8% (506/746). (2) Blood glucose control during pregnancy: ①Group diagnosed before pregnancy and Group diagnosed during pregnancy: the highest glycosylated hemoglobin (HbA1c) in Group diagnosed before pregnancy was (6.6±1.1)%, higher than that in Group diagnosed during pregnancy [(6.3± 1.0)%, P=0.019]. However, there was no significant difference in the average HbA1c level between the 2 groups (P=0.616). The insulin needed percentage [90.8%(218/240) vs. 53.8%(272/506)] in Group diagnosed before pregnancy were higher than that in Group diagnosed during pregnancy (P<0.01).②Group diagnosed during pregnancy A and B:the highest HbA1c in Group diagnosed during pregnancy A was (6.9± 1.3)%, higher than that in Group diagnosed during pregnancy B [(6.1 ± 0.8)%, P<0.05]. And the average HbA1c in Group diagnosed during pregnancy A [(6.4±0.8)%] was also higher than that in Group diagnosed during pregnancy B [(6.0 ± 0.8)%, P<0.05]. In Group diagnosed during pregnancy B, 46.1%(187/406) used insulin, lower than the percentage in Group diagnosed during pregnancy A (85.0%, 85/100;P<0.01). ③There were no significant differences in the highest HbA1c and the average HbA1c between Group diagnosed during pregnancy A and Group diagnosed before pregnancy (P=0.020, P=0.037). There was neither no significant difference in the percentage used insulin during pregnancy between them (P=0.128). There were significant differences in the highest HbA1c and the average HbA1c between Group diagnosed during pregnancy B and Group diagnosed before pregnancy (P<0.01, P=0.014). There was also significant difference in the percentage used insulin during pregnancy between them (P<0.01). (3) Pregnancy outcome:①Group diagnosed before pregnancy and Group diagnosed during pregnancy: the cesarean section rate [72.5% (174/240) vs. 59.7% (302/506)] in Group diagnosed before pregnancy were higher than those in Group diagnosed during pregnancy (P<0.01). However, there were no significant differences in preterm birth rate, pre-eclampsia, macrosomia percentage, percentage of neonates being hospitalized between the 2 groups (P=0.546,P=1.000,P=0.671,P=0.804). ②There was no significant difference in preterm birth rate, cesarean delivery rate, macrosomia percentage, pre-eclampsia rate, percentage of neonates being hospitalized between Group diagnosed during pregnancy A and Group diagnosed during pregnancy B (P=0.887, P=0.495, P=0.841, P=1.000, P=1.000).③There was no significant difference in preterm birth rate, cesarean delivery rate, macrosomia percentage, pre-eclampsia rate, percentage of neonates being hospitalized between Group diagnosed during pregnancy A and Group diagnosed before pregnancy (P=0.875, P=0.093, P=0.662, P=1.000, P=0.837). The cesarean delivery rate was lower in Group diagnosed during pregnancy B than that in Group diagnosed before pregnancy (P=0.001). However, there were no significant differences in preterm birth rate, macrosomia percentage, pre-eclampsia rate, percentage of neonates being hospitalized between them (P=0.530, P=0.776, P=1.000, P=0.797). Conclusions The diagnosis of PGDM is commonly missed before pregnancy. Fasting plasma glucose should be used as screening test to identify PGDM at pre-pregnancy examination or first antenatal care. Using abnormal value of 2-hour glucose after 24 gestational weeks as the only way to diagnose PGDM is not suitable.
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Heterogeneity is one of the important features of malignant tumors.MRI texture analysis (MTA) is a new imaging post-processing technique to quantify heterogeneity of tumor.Increasing number of studies have shown that MTA is a potentially useful tool in tumor imaging,and can provide important and valuable information including tumor characteristics,prognosis assessment,prediction or monitoring of tumor treatment response,and so on.In this article,we review the literatures about MTA in evaluating heterogeneity of tumor.The correlation between MTA and tumor response to chemotherapy,prognosis and survival time,and the role of MTA as imaging markers in clinical practice are summarized,to further explore its potential in clinical application.
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Heterogeneity is one of the important features of malignant tumors.MRI texture analysis (MTA) is a new imaging post-processing technique to quantify heterogeneity of tumor.Increasing number of studies have shown that MTA is a potentially useful tool in tumor imaging,and can provide important and valuable information including tumor characteristics,prognosis assessment,prediction or monitoring of tumor treatment response,and so on.In this article,we review the literatures about MTA in evaluating heterogeneity of tumor.The correlation between MTA and tumor response to chemotherapy,prognosis and survival time,and the role of MTA as imaging markers in clinical practice are summarized,to further explore its potential in clinical application.
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ObjectiveTo investigate the influence of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on lipid variations of first and third trimester.MethodsA retrospective analysis was conducted on 2 593 singleton pregnant women without diabetes from 15 hospitals in Beijing from June 20 to November 30 in 2013. Serum lipid levels were determined in all of these women at the first trimester (<14 weeks) and the third trimester (≥28 weeks). Demographic data and medical information were collected individually through questionnaires. The recruited gravidas were divided into normal pre-pregnant BMI group (BMI<25) and pre-pregnant overweight and obese group (BMI≥25) according to recommendations of the Institute of Medicine (IOM). Based on the same recommendations on normal GWG, the pregnant women in the two groups were further assigned to two subgroups including normal GWG and over GWG group. The serum lipid levels in both first and third trimester and the increases from first to third trimester were compared between the normal and abnormal BMI groups with two independent samplet-test.Results(1) The levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C) in the third trimester were all significantly higher than those in the first trimester in the normal BMI group [(6.47±1.17) vs (4.63±0.80), (3.14±1.19) vs (1.22±0.70), (1.94±0.44) vs (1.85±0.49) and (3.56±1.00) vs (2.29±0.67) mmol/L,t=-61.250,-65.909,-6.448 and-49.952, allP<0.01]. And the same results were shown in the abnormal BMI group [(6.20±1.14) vs (4.75±0.88), (3.31±1.20) vs (1.44±0.70), (1.86±0.44) vs (1.65±0.37) and (3.30±0.89) vs (2.51±0.82) mmol/L, t=-18.756,-25.165,-6.905 and-12.191,allP<0.01]. Significant differences were identified between the normal and abnormal pre-pregnant BMI groups both in first and third trimester (allP<0.05). (2) The increases of TC from early to late pregnancy in the abnormal BMI group was lower than that in the normal BMI group [(1.45±1.01) vs (1.84±1.02) mmol/L,t=6.664,P<0.01], but the increase of HDL-C was higher [(0.21±0.39) vs (0.09±0.51) mmol/L,t=-4.301,P<0.01]. (3) In the normal BMI group, the increase of TC and HDL-C between the third and the first trimester was lower in the over GWG subgroups than in the normal GWG subgroups [(1.77±0.96) vs (1.89±1.05) mmo/L,t=-2.802,P=0.005; (0.06±0.41) vs (0.12±0.58) mmo/L,t=-2.588,P=0.010], but the increase of TG was higher [(2.00±1.07) vs (1.86± 1.18) mmo/L,t=3.015,P=0.003]. While in the abnormal BMI group, smaller increase of HDL-C was found in the over GWG subgroup than in the normal GWG subgroup [(0.17±0.35) vs (0.29±0.44) mmo/L,t=-2.664, P=0.008].ConclusionsThe lipid levels during pregnancy are significantly higher in late pregnancy than in early pregnancy. Pre-pregnancy BMI has much more effect on lipid variations during pregnancy than GWG, which primarily affect the lipid levels of women with normal pre-pregnancy BMI.