Background： Gestational diabetes mellitus （GDM） is associated with both short- and long-term adverse health consequences for both the mother and her offspring. The aim was to study the prevalence and risk factors f...Background： Gestational diabetes mellitus （GDM） is associated with both short- and long-term adverse health consequences for both the mother and her offspring. The aim was to study the prevalence and risk factors for GDM in Beijing. Methods： The study population consisted of 15,194 pregnant women attending prenatal care in 15 hospitals in Beijing, who delivered between June 20, 2013, and November 30, 2013, after 28 weeks of gestation. The participants were selected by cluster sampling from the 15 hospitals identified through random systematic sampling based on the number of deliveries in 2012. A questionnaire was designed to collect information. Results： A total of 2987 （19.7%） women were diagnosed with GDM and 208 （1.4%） had diabetes in pregnancy （DIP）, Age （OR： 1.053, 95% CI： 1.033-1.074, P 〈 0.01）, family history of diabetes mellitus （OR： 1.481, 95% CI：1.254 1.748, P 〈 0.01）, prepregnancy body mass index （BMI） （OR： 1.481, 95% CI：1.254 1.748, P 〈 0.01）, BMI gain before 24 weeks （OR： 1.126, 95% CI： 1.075-1.800, P 〈 0.01 ）, maternal birth weight （P 〈 0.01）, and fasting plasma glucose at the first prenatal visit （P 〈 0.01） were identified as risk factors for GDM. In women with birth weight 〈3000 g, GDM rate was significantly higher. Conclusions： One out of every five pregnant women in Beijing either had GDM or DIP and this constitutes a huge health burden for health services. Prepregnancy BMI and weight gain before 24^th week are important modifiable risk factors for GDM. Ensuring birth weight above 3000 g may help reduce risk for future GDM among female offsprings.展开更多
Background In the last few decades,there has been a delay in first-time pregnancies,and the average age of women at the time of delivery has increased in many countries.Advanced maternal age is associated with adverse...Background In the last few decades,there has been a delay in first-time pregnancies,and the average age of women at the time of delivery has increased in many countries.Advanced maternal age is associated with adverse pregnancy outcomes.This study aimed to determine the present trends and pregnancy outcomes related to maternal age in China.Methods Data were collected from 39 hospitals in mainland of China.All deliveries were performed after 28 completed weeks of gestation and between January 1 and December 31,2011.In total,110 450 of 112 441 cases were included in the study.All enrolled cases were divided into 6 age groups with 5-year intervals.The x2 test or Fisher＇s exact test and unadjusted binary-Logistic regression were used for statistical analysis.Results The mean age at the time of delivery was 28.18±4.70 years （range,14-52 years）.The teenage group （15-19 years） had a higher risk than the 25-29-year old group for anemia （odds ratio （OR）,1.4）,preeclampsia （OR,1.6）,preterm birth （OR,2.1）,low birth weight neonates （OR,2.3）,and perinatal mortality （OR,3.6）.The 35-39-year old group and ≥40-year-old group had a higher risk than the 25-29-year-old group for leiomyoma （OR,4.2 vs.5.8）,pregestational diabetes （OR,2.2 vs.3.8）,chronic hypertension （OR,4.6 vs.6.5）,gestational diabetes （OR,2.6 vs.3.5）,preeclampsia （OR,2.5 vs.3.6）,premature delivery （OR,1.8 vs.2.4）,postpartum hemorrhage （OR,1.5 vs.1.7）,placenta previa （OR,2.7 vs.4.0）,placental abruption （OR,1.4 vs.2.5）,cesarean delivery （OR,2.1 vs.2.5）,macrosomia （OR,1.2 vs.1.2）,low birth weight neonates （OR,1.6 vs.2.3）,and perinatal mortality （OR,1.6 vs.3.7）.Conclusion Maternal and neonatal risks are higher during the teenage years and at an advanced maternal age; 20-30 years of age is the lowest risk period for pregnancy and delivery.展开更多
Objective:Labor is a complex process and labor pain presents challenges for analgesia.Epidural analgesia(EA)has a well-known analgesic effect and is commonly used during labor.This review summarized frequently encount...Objective:Labor is a complex process and labor pain presents challenges for analgesia.Epidural analgesia(EA)has a well-known analgesic effect and is commonly used during labor.This review summarized frequently encountered and controversial problems surrounding EA during labor,including the labor process and maternal intrapartum fever,to build knowledge in this area.Data sources:We searched for relevant articles published up to 2019 in PubMed using a range of search terms(eg,“labor pain,”“epidural,”“analgesia,”“labor process,”“maternal pyrexia,”“intrapartum fever”).Study selection:The search returned 835 articles,including randomized control trials,retrospective cohort studies,observational studies,and reviews.The articles were screened by title,abstract,and then full-text,with a sample independently screened by two authors.Thirty-eight articles were included in our final analysis;20 articles concerned the labor process and 18 reported on maternal pyrexia during EA.Results:Four classic prospective studies including 14,326 participants compared early and delayed initiation of EA by the incidence of cesarean delivery.Early initiation following an analgesia request was preferred.However,it was controversial whether continuous use of EA in the second stage of labor induced adverse maternal and neonatal outcomes due to changes in analgesic and epidural infusion regimens.There was a high incidence of maternal pyrexia in women receiving EA and women with placental inflammation or histologic chorioamnionitis compared with those receiving systemic opioids.Conclusions:Early EA(cervical dilation≥1 cm)does not increase the risk for cesarean section.Continuous epidural application of low doses of analgesics and programmed intermittent epidural bolus do not prolong second-stage labor duration or impact maternal and neonatal outcomes.The association between EA and maternal pyrexia remains controversial,but pyrexia is more common with EA than without.A non-infectious inflammatory process is an accepted m展开更多
鉴于孕产妇死亡率的增加,美国妇产科医师学会(American College of Obstetricians and Gynecologists,ACOG)及其委员会建议创建产科快速反应团队,并建议快速反应团队应进行定期演练以提高其应急能力。产房快速反应团队的建立,可以早期...鉴于孕产妇死亡率的增加,美国妇产科医师学会(American College of Obstetricians and Gynecologists,ACOG)及其委员会建议创建产科快速反应团队,并建议快速反应团队应进行定期演练以提高其应急能力。产房快速反应团队的建立,可以早期识别孕产妇病情恶化的征兆并快速做出反应,能够大大改善母婴结局,降低不良妊娠结局的发生率。展开更多
AIM: To determine the parental transmission of diabetes mellitus (DM) and evaluate its influence on the clinical characteristics. METHODS: This was a cross sectional study. The survey was carried out in urban and semi...AIM: To determine the parental transmission of diabetes mellitus (DM) and evaluate its influence on the clinical characteristics. METHODS: This was a cross sectional study. The survey was carried out in urban and semi-urban primary health care centers. Of the 2400 registered with diagnosed diabetes, 1980 agreed and gave their consent to take part in this study, thus giving a response rate of 82.5%. Face to face interviews were conducted using a structured questionnaire followed by laboratory tests. DM was defined according to the World Health Organization expert group. A trained nurse performedphysical examinations and measurements. RESULTS: Of the study population, 72.9% reported a family history of DM. Family history of DM was significantly higher in females (54.2%; P = 0.04) and in the age group below 30 years (24%; P < 0.001). The prevalence of diabetes was higher among patients with a diabetic mother (25.4% vs 22.1%) and maternal aunts/uncles (31.2% vs 22.2%) compared to patients with a diabetic father and paternal aunts/ uncles. Family history of DM was higher in patients of consanguineous parents (38.5%) than those of non-consanguineous parents (30.2%). The development of type 2 diabetes mellitus (T2DM) complications was higher in patients with either a paternal or maternal history of DM than in those without. No significant difference was observed in the metabolic characteristics of patients with/without family history of DM except for hypertension. Complications were higher in diabetic patients with a family history of DM. CONCLUSION: The present study found a significant maternal effect in transmission of T2DM. Family history is associated with the increased incidence of diabetes.展开更多
文摘Background： Gestational diabetes mellitus （GDM） is associated with both short- and long-term adverse health consequences for both the mother and her offspring. The aim was to study the prevalence and risk factors for GDM in Beijing. Methods： The study population consisted of 15,194 pregnant women attending prenatal care in 15 hospitals in Beijing, who delivered between June 20, 2013, and November 30, 2013, after 28 weeks of gestation. The participants were selected by cluster sampling from the 15 hospitals identified through random systematic sampling based on the number of deliveries in 2012. A questionnaire was designed to collect information. Results： A total of 2987 （19.7%） women were diagnosed with GDM and 208 （1.4%） had diabetes in pregnancy （DIP）, Age （OR： 1.053, 95% CI： 1.033-1.074, P 〈 0.01）, family history of diabetes mellitus （OR： 1.481, 95% CI：1.254 1.748, P 〈 0.01）, prepregnancy body mass index （BMI） （OR： 1.481, 95% CI：1.254 1.748, P 〈 0.01）, BMI gain before 24 weeks （OR： 1.126, 95% CI： 1.075-1.800, P 〈 0.01 ）, maternal birth weight （P 〈 0.01）, and fasting plasma glucose at the first prenatal visit （P 〈 0.01） were identified as risk factors for GDM. In women with birth weight 〈3000 g, GDM rate was significantly higher. Conclusions： One out of every five pregnant women in Beijing either had GDM or DIP and this constitutes a huge health burden for health services. Prepregnancy BMI and weight gain before 24^th week are important modifiable risk factors for GDM. Ensuring birth weight above 3000 g may help reduce risk for future GDM among female offsprings.
文摘Background In the last few decades,there has been a delay in first-time pregnancies,and the average age of women at the time of delivery has increased in many countries.Advanced maternal age is associated with adverse pregnancy outcomes.This study aimed to determine the present trends and pregnancy outcomes related to maternal age in China.Methods Data were collected from 39 hospitals in mainland of China.All deliveries were performed after 28 completed weeks of gestation and between January 1 and December 31,2011.In total,110 450 of 112 441 cases were included in the study.All enrolled cases were divided into 6 age groups with 5-year intervals.The x2 test or Fisher＇s exact test and unadjusted binary-Logistic regression were used for statistical analysis.Results The mean age at the time of delivery was 28.18±4.70 years （range,14-52 years）.The teenage group （15-19 years） had a higher risk than the 25-29-year old group for anemia （odds ratio （OR）,1.4）,preeclampsia （OR,1.6）,preterm birth （OR,2.1）,low birth weight neonates （OR,2.3）,and perinatal mortality （OR,3.6）.The 35-39-year old group and ≥40-year-old group had a higher risk than the 25-29-year-old group for leiomyoma （OR,4.2 vs.5.8）,pregestational diabetes （OR,2.2 vs.3.8）,chronic hypertension （OR,4.6 vs.6.5）,gestational diabetes （OR,2.6 vs.3.5）,preeclampsia （OR,2.5 vs.3.6）,premature delivery （OR,1.8 vs.2.4）,postpartum hemorrhage （OR,1.5 vs.1.7）,placenta previa （OR,2.7 vs.4.0）,placental abruption （OR,1.4 vs.2.5）,cesarean delivery （OR,2.1 vs.2.5）,macrosomia （OR,1.2 vs.1.2）,low birth weight neonates （OR,1.6 vs.2.3）,and perinatal mortality （OR,1.6 vs.3.7）.Conclusion Maternal and neonatal risks are higher during the teenage years and at an advanced maternal age; 20-30 years of age is the lowest risk period for pregnancy and delivery.
基金supported by the grants from the National Natural Scientific Foundation of China(No.81500944)the Nanjing Municipal Health Bureau General Project(No.YKK14127).
文摘Objective:Labor is a complex process and labor pain presents challenges for analgesia.Epidural analgesia(EA)has a well-known analgesic effect and is commonly used during labor.This review summarized frequently encountered and controversial problems surrounding EA during labor,including the labor process and maternal intrapartum fever,to build knowledge in this area.Data sources:We searched for relevant articles published up to 2019 in PubMed using a range of search terms(eg,“labor pain,”“epidural,”“analgesia,”“labor process,”“maternal pyrexia,”“intrapartum fever”).Study selection:The search returned 835 articles,including randomized control trials,retrospective cohort studies,observational studies,and reviews.The articles were screened by title,abstract,and then full-text,with a sample independently screened by two authors.Thirty-eight articles were included in our final analysis;20 articles concerned the labor process and 18 reported on maternal pyrexia during EA.Results:Four classic prospective studies including 14,326 participants compared early and delayed initiation of EA by the incidence of cesarean delivery.Early initiation following an analgesia request was preferred.However,it was controversial whether continuous use of EA in the second stage of labor induced adverse maternal and neonatal outcomes due to changes in analgesic and epidural infusion regimens.There was a high incidence of maternal pyrexia in women receiving EA and women with placental inflammation or histologic chorioamnionitis compared with those receiving systemic opioids.Conclusions:Early EA(cervical dilation≥1 cm)does not increase the risk for cesarean section.Continuous epidural application of low doses of analgesics and programmed intermittent epidural bolus do not prolong second-stage labor duration or impact maternal and neonatal outcomes.The association between EA and maternal pyrexia remains controversial,but pyrexia is more common with EA than without.A non-infectious inflammatory process is an accepted m
文摘鉴于孕产妇死亡率的增加,美国妇产科医师学会(American College of Obstetricians and Gynecologists,ACOG)及其委员会建议创建产科快速反应团队,并建议快速反应团队应进行定期演练以提高其应急能力。产房快速反应团队的建立,可以早期识别孕产妇病情恶化的征兆并快速做出反应,能够大大改善母婴结局,降低不良妊娠结局的发生率。
基金Supported by Qatar Diabetic Association and Qatar National Research Fund, QNRF UREP 07-099-3-023
文摘AIM: To determine the parental transmission of diabetes mellitus (DM) and evaluate its influence on the clinical characteristics. METHODS: This was a cross sectional study. The survey was carried out in urban and semi-urban primary health care centers. Of the 2400 registered with diagnosed diabetes, 1980 agreed and gave their consent to take part in this study, thus giving a response rate of 82.5%. Face to face interviews were conducted using a structured questionnaire followed by laboratory tests. DM was defined according to the World Health Organization expert group. A trained nurse performedphysical examinations and measurements. RESULTS: Of the study population, 72.9% reported a family history of DM. Family history of DM was significantly higher in females (54.2%; P = 0.04) and in the age group below 30 years (24%; P < 0.001). The prevalence of diabetes was higher among patients with a diabetic mother (25.4% vs 22.1%) and maternal aunts/uncles (31.2% vs 22.2%) compared to patients with a diabetic father and paternal aunts/ uncles. Family history of DM was higher in patients of consanguineous parents (38.5%) than those of non-consanguineous parents (30.2%). The development of type 2 diabetes mellitus (T2DM) complications was higher in patients with either a paternal or maternal history of DM than in those without. No significant difference was observed in the metabolic characteristics of patients with/without family history of DM except for hypertension. Complications were higher in diabetic patients with a family history of DM. CONCLUSION: The present study found a significant maternal effect in transmission of T2DM. Family history is associated with the increased incidence of diabetes.
