孕妇被动吸烟与小于胎龄儿关系的Meta分析

目的 探讨孕妇孕期被动吸烟与小于胎龄儿之间的关系,分析不同孕期和不同地点被动吸烟的效应.方法 利用Meta分析方法综合分析国内外8篇关于孕妇孕期被动吸烟与小于胎龄儿关系的回顾性研究文献.结果 孕妇孕期被动吸烟与小于胎龄儿之间的粗合并效应值OR=1.45(95%CI:1.05～2.01),调整合并效应值OR=1.76(95%CI:1.15～2.69);孕妇孕早期被动吸烟的合并效应值OR=1.85(95%CI:1.25～2.72),孕中晚期被动吸烟的合并效应值OR=2.12(95%CI:1.43～3.13);家庭和工作中被动吸烟与小于胎龄儿之间的关系均没有统计学意义.结论 孕妇孕期被动吸烟可增加发生小于胎龄儿的危险性.除了家庭和工作环境外,还应注意其他环境的被动吸烟.     

孕妇被动吸烟与胎儿出生体重关系的Meta分析

目的分析孕妇不同孕期的被动吸烟情况对新生儿出生体重的影响,以及探讨不同测量方式对被动吸烟效应的影响。方法对NCBI、OVID-MEDLINE、CNKI、VIP以及CBM数据库进行检索（截止日期为2008年4月）,通过Meta分析结果报告综合差值及95%CI。结果共获得38篇文献,其中19篇为前瞻性研究,19篇属回顾性研究。总合并效应值为-68.84g（95%CI:-89.84～-47.84）,调整合并效应值为-44.92g（95%CI:-67.07～-22.77）;生物标志测量的合并效应值为-73.87g（95%CI:-113.41～-34.34）;问卷调查的合并效应值为-62.93g（95%CI:-84.49～-41.37）;最低和最高水平暴露的合并效应值分别为-44.61g（95%CI:-78.36～-10.87）和-116.37g（95%CI:-180.74～-52.01）;孕早期暴露的合并效应值为-2.70g（95%CI:-37.74～32.33）,但没有统计学意义。结论孕妇被动吸烟能降低新生儿出生体重,问卷调查会低估真实暴露水平,孕中晚期可能是被动吸烟的效应期,被动吸烟引起低...     

我国低出生体质量儿危险因素的元分析

目的探讨我国低出生体质量儿发生的危险因素,为进一步完善我国孕期保健工作提供循证依据。方法系统检索国内公开发表的有关我国低出生体质量儿危险因素的文献,检索数据库包括中国知网、万方、维普等中文数据库,共检索到218篇文献。所纳入的研究文献采用Stata软件进行统计分析,计算合并OR(95%CI)值。结果最终共纳入文献20篇,元分析结果如下:影响我国低出生体质量儿发生的危险因素主要有:被动吸烟,合并OR值及95%CI为2.22(1.65,2.99);妊娠期高血压疾病,合并OR值及95%CI为2.87(2.14,3.85);孕期贫血,合并OR值及95%CI为2.21(1.69,2.89);孕期不良情绪,合并OR值及95%CI为2.89(2.02,4.13);多胎妊娠,合并OR值及95%C为4.07(1.86,8.89);孕期检查次数少(5次),合并OR值及95%CI为2.24(1.19,4.22);孕期体重增加偏少,合并OR值95%CI为2.71(1.95,3.78);早产,合并OR值及95%CI为10.52(3.05,36.29)。结论被动吸烟、孕期体重增加偏少、孕期检查次数少(5次)、妊娠期高血压疾病、贫血、孕期不良情绪、多胎妊娠、早产均是我国低出生体质量儿临床常见的主要危险因素。     

孕妇被动吸烟与胎儿出生体重关系的Meta分析

目的分析孕妇不同孕期的被动吸烟情况对新生儿出生体重的影响,以及探讨不同测量方式对被动吸烟效应的影响。方法对NCBI、OVID—MEDLINE、CNKI、VIP以及CBM数据库进行检索（截止日期为2008年4月）,通过Meta分析结果报告综合差值及95％CI。结果共获得38篇文献,其中19篇为前瞻性研究,19篇属回顾性研究。总合并效应值为-68．84g（95％CI：89．84～47．84）,调整合并效应值为-44．92g（95％CI：67．07～-22．77）;生物标志测量的合并效应值为-73．87g（95％CI：-113．41-～34．34）;问卷调查的合并效应值为62．93g（95％CI：-84．49～-41．37）;最低和最高水平暴露的合并效应值分别为44．61g（95％CI：78．36～-10．87）和116．37g（95％CI：-180．74～-52．01）;孕早期暴露的合并效应值为-2．70g（95％CI：-37．74～32．33）,但没有统计学意义。结论孕妇被动吸烟能降低新生儿出生体重,问卷凋查会低估真实暴露水平,孕中晚期可能是被动吸烟的效应期,被动吸烟引起低出生体重的阈值尚不明确。     

上海某区足月新生儿低出生体重的影响因素分析

[目的]探讨孕期健康及行为相关因素对足月新生儿低出生体重的影响. [方法]采用队列研究,将上海某区孕期＜20周的孕早期妇女纳入队列,最后分娩单胎足月活产儿的孕妇共2768人.采用x2检验和logistic回归分析孕期被动吸烟、文化程度、经济状况等因素和低出生体重的关系. [结果]在2768名产妇中,有1284人(46.4％)至少在孕早期或孕晚期有二手烟暴露的情况,孕妇低身高(模型1:OR=0.9,95％CI为0.840～0.996;模型2:OR=0.9,95％CI为0.860～0.998)及怀孕后患有疾病(模型1:OR=2.7,95％CI为1.1～6.5;模型2:OR=2.7,95％CI为1.1～6.6)会增加发生低出生体重儿的风险,孕早期或孕晚期的被动吸烟史对胎儿的出生体重没有影响. [结论]本研究并未发现孕期被动吸烟与胎儿低出生体重发生率之间的关联.     

大气污染对低出生体重和早产影响的Meta分析

目的 研究各主要大气污染物对低出生体重(LSW)和早产的影响.方法 通过计算机检索收集国内外1999-2009年公开发表的有关大气污染对不良妊娠结局影响的相关文献14篇,按照制定的纳入排除标准对文献进行筛选,利用Stata9.0的Meta模块对人选文献进行异质性检验和相应的效应值合并.采用Meta分析获得的合并OR值作为最终的合并效应值.结果 建立各主要污染物与低出生体重和早产的暴露.反应关系,其中PM10浓度每升高50μg/m3,所对应的低出生体重及早产发生的合并OR值分别为1.07(95%CI:1.024～1.119,P＜0.01)、1.217(95%CI:1.045～1.415,P＜0.05);SO2浓度每升高43λg/m3(15 ppb),所对应的低出生体重或早产发生的合并OR值分别为1.137(95%CI:1.047～1.235,P＜0.05)、1.163(95%CI:1.082～1.250,P＜0.01);NO2每升高21μg/m3(10 ppb),所对应的低出生体重发生的合并OR值为1.03(95%CI:1.008～1.054,P＜0.01);CO每升高1.25 mg/m3(1 ppm),所对应的低出生体重发生的合并OR值为1.066(95%C1:1.016～1.117,P＜0.01);NO2以及CO对早产影响的合并效应值无统计学意义(P＞0.05).结论 本研究综合定量分析的结果 表明,大气污染能够增加低出生体重和早产发生的危险,妊娠期妇女有必要采取有效的措施减少大气污染的暴露.     

妊娠期轮班作业与低出生体重关系的meta分析

目的研究妊娠期轮班作业与低出生体重的关系。方法检索英文和中文数据库,按照预先制定的纳入排除标准筛选妊娠期轮班作业与低出生体重关系的文献(1977—2015年),提取纳入文献的数据,利用Stata 12.0的meta模块合并效应值,并对文献进行异质性分析。结果纳入8篇文献,妊娠期轮班作业与低出生体重关系的粗效应值合并为OR为1.15(95%CI:0.83~1.47),校正后的合并效应值OR为1.16(95%CI:0.79~1.53)。结论目前证据显示妊娠期轮班作业与新生儿低出生体重不相关,但还需要更高质量的研究证据。     

妊娠期被动吸烟与出生缺陷关系的Meta分析

目的探讨孕期被动吸烟与出生缺陷的关系。方法运用计算机检索1980年至2010年4月国内外关于孕期被动吸烟与出生缺陷关系的研究文献,采用Cochrane协作网提供的RevMan5.0分析软件对入选的文献进行异质性检验,经Meta分析计算合并效应OR值及其95%CI。结果国内外25篇文献入选。森林图显示纳入文献是异质的(χ2=243.98,P0.000 01),采用随机效应模型计算孕期被动吸烟与出生缺陷关联性的合并效应的OR值为1.70,95%CI:1.34~2.15。其中,国内和国外不同研究人群合并效应的OR值分别为3.62(95%CI:1.71~7.68)和1.28(95%CI:1.04~1.57)。结论孕期被动吸烟可能会增加出生缺陷发生风险。     

孕早期母体尿铬与新生儿出生指标相关性

目的探讨孕妇孕早期尿铬水平与新生儿出生指标的关联性。方法于2018年6—10月选取佛山市某区妇幼保健院154名孕妇为研究对象,收集孕20周前尿液,采用电感耦合等离子体质谱法测定尿铬水平,并根据其浓度三分位数将孕妇分为尿铬低、中和高暴露组,分娩时记录新生儿出生体重、出生身长、出生头围和出生胸围等出生指标,分析母体尿铬水平与新生儿出生指标的关联。结果孕妇孕早期尿铬均数为1.58μg/g肌酐(范围:0.42～4.83μg/g cr),尿铬与新生儿出生体重(r=-0.173,P0.05)、头围均呈负相关(r=-0.170,P0.05)。将新生儿按性别分层后,发现孕妇孕早期尿铬与女性新生儿出生体重(r=-0.299,P0.05)和出生头围(r=-0.253,P0.05)也均呈负相关,未发现孕妇孕早期尿铬与男性新生儿出生指标的相关性。logistic回归显示,在排除混杂因素影响后,孕妇孕早期尿铬水平是新生儿出生体重(OR=0.584,95%CI:0.359～0.952)和出生胸围(OR=0.618 95%CI:0.389～0.983)减少的危险因素(P0.05)。结论本次调查的孕妇孕早期尿铬水平相对较高,孕早期尿铬与新生儿出生体重相关,且这种关联在女性新生儿中更加明显。孕早期尿铬可能与出生头围和出生胸围有关,有待今后进一步进行探究。     

谷胱甘肽-S-转移酶基因多态性与低出生体重儿易感性的Meta分析

目的探讨谷胱甘肽-S-转移酶M1和T1与低出生体重儿易感性的关系。方法按照纳入排除标准全面检索Pub Med、Web of Science、EMBASE、中国生物医学文献数据库和CNKI等数据库相关文献,收集谷胱甘肽-S-转移酶M1和T1与低出生体重儿的关联性研究,应用Revman5.1及Stata11.0软件进行合并效应值估计、发表偏倚的检验和敏感性分析。结果共纳入符合条件的文献10篇,母亲携带GSTM1null基因型新生儿低出生体重发病风险增加(OR=1.19,95%CI:1.04~1.38,P=0.01),新生儿GSTM1基因多态性与低出生体重的关联性差异无统计学意义(OR=0.85,95%CI:0.55~1.30,P=0.45);母亲GSTT1基因多态性与低出生体重的关联性差异无统计学意义(OR=1.15,95%CI:0.98~1.35,P=0.09),新生儿携带GSTT1null基因型低出生体重的发病风险增加(OR=2.50,95%CI:1.12~5.59,P=0.03)。结论母亲GSTM1null基因型和新生儿GSTT1null基因型是新生儿低出生体重发生的危险因素。     

孕期被动吸烟对妊娠并发症及妊娠结局的影响

目的了解孕期被动吸烟发生情况,并探讨其对妊娠并发症及结局的影响。方法选取2012年4月―2013年3月在我国15家医疗保健机构分娩的8926例单胎活产产妇作为研究对象,使用自制调查问卷收集孕期被动吸烟发生情况、妊娠并发症和结局等信息,采用单因素和多因素Logistic回归分析模型分析孕期被动吸烟对妊娠并发症及结局的影响。结果共1801例产妇在孕期经历被动吸烟。控制混杂因素后,孕期经历被动吸烟的产妇妊娠期糖尿病(gestational diabetes mellitus,GDM)的发生风险是非被动吸烟者的1.359倍(95%CI:1.146~1.612,P<0.001),胎膜早破的风险为1.290倍(95%CI:1.095~1.520,P=0.002),早产的风险为1.367倍(95%CI:1.155~1.619,P<0.001),娩出低出生体重儿的风险为1.341倍(95%CI:1.079~1.668,P=0.008)。与非被动吸烟者相比,平均每周被动吸烟天数≥4天者胎膜早破、早产和低出生体重儿的发生风险分别为非被动吸烟者的1.402倍(95%CI:1.104~1.780,P=0.006)、1.690倍(95%CI:1.339~2.132,P<0.001)和1.584倍(95%CI:1.172~2.141,P=0.023)。结论被调查产妇孕期被动吸烟率较高,孕期经历被动吸烟能够增加妊娠期糖尿病、胎膜早破、早产和低出生体重儿的发生风险。     

胎儿脐带缠绕与环境暴露因素的关联

  目的  了解中国胎儿脐带缠绕现状及其与环境暴露因素的相关性,为预防和干预脐带缠绕提供科学的指导。  方法  以中国孕产妇队列研究·协和项目的孕妇为研究对象,在孕早期收集孕妇的一般人口学信息和环境暴露信息,随访获取脐带缠绕相关结局,应用多因素非条件Logistic回归分析模型分析胎儿脐带缠绕的影响因素。  结果  胎儿脐带缠绕的发生率为9.00%。Logistic回归分析模型分析结果显示:调整混杂因素后,与孕期没有暴露于被动吸烟或噪声的孕妇相比,暴露于被动吸烟(OR=1.199, 95% CI: 1.010~1.423, P=0.038)或噪声(OR=1.242, 95% CI: 1.002~1.541, P=0.048)的孕妇发生脐带缠绕的风险较高。  结论  孕妇孕期被动吸烟和接触噪声对胎儿脐带缠绕有影响,应加强孕期教育,减少孕妇孕期被动吸烟和噪声环境暴露。     

妊娠期被动吸烟与母亲血清和脐带血清炎性因子的关系

目的探讨母亲孕期被动吸烟（passive smoking）与母亲外周血清及脐带血清中炎性因子水平的关系。方法调查79名孕产妇的一般人口学、妇产科学特征及在孕期的被动吸烟情况,采集孕产妇外周静脉血及脐带静脉血,检测血清单核细胞趋化因子-1（monocyteche motactic protein-1,MCP-1）、白介素-6（interleukin-6,IL-6）、肿瘤坏死因子-α（tumor necrosis factor—α,TNF-α）、白介素1β（interleukin-1β,IL-1β）、C反应蛋白（C—reactive protein,CRP）和血管细胞粘附因子-1（soluble vascular cell adhesion molecule-1,VCAM-1）。在控制年龄、孕周、婚姻状态、教育水平、家庭收入、孕产妇孕前体质指数（body mass index,BMI）、产次、胎儿性别等？昆杂因素后,采用有序Logistic回归模型分析母亲孕期被动吸烟暴露与母亲血清及脐血清中炎性因子水平的关系。结果79名调查对象中46人（58．2％）报告其在孕期有被动吸烟暴露,28人（35．4％）报告被动吸烟暴露平均每天为1～15min,18人（22．8％）报告被动吸烟暴露平均每天超过15min。在控制混杂因素后,与非暴露者相比,每天平均暴露1～15min者母血清中IL－1β（OR=3．00,95％C／：1．10—8．14）和CRP（OR=4．10,95％C／：1．47～11．47）水平升高,平均每天暴露超过15min者母血清IL-6（OR=5．19,95％C／：1．56—17．29）和TNF-α（OR：6．87,95％C／：1．97～23．96）水平升高。与非暴露者相比,平均每天暴露超过15min者脐带血清IL－1β（OR=0．21,95％CI：0．07～0．59）水平降低。结论母亲孕期被动吸烟暴露对母亲和胎儿的炎性反应有所不同,对母亲的炎性反应影响较大,对胎儿的炎性反应影响较小。     

Psychosocial factors, lifestyle, and fetal growth: the added value of both pre- and post-natal assessments

BACKGROUND: Psychosocial resources as well as lifestyle habits during pregnancy have been shown to effect the risk of having a small-for-gestational-age (SGA) child. Most previous studies are based on a single assessment of these exposures, which does not take into account the possibility of different effects during early and late stages of pregnancy. METHODS: The impact of psychosocial and lifestyle factors on the risk of giving birth to an SGA child (as measured by ultrasound) was examined among 747 nulliparous Swedish women who completed both a prenatal baseline, and a post-partum assessment. RESULTS: Those registering low social participation on both assessments showed increased risk of giving birth to an SGA infant (OR = 2.44 and 95% CI: 1.06-5.66), while at one assessment (OR = 1.70 and 95% CI: 0.74-3.91). Maternal smoking confirmed by both or one assessments yielded an OR = 2.72 and 95% CI: 1.37-5.39 and OR = 1.60 and 95% CI: 0.58-4.46, respectively. During early pregnancy, poor instrumental support, maternal smoking, or passive smoking yielded increased risks of SGA, adjusted for confounding (OR = 2.39 and 95% CI: 1.11-5.17; OR = 2.38 and 95% CI: 1.27-4.49; OR = 2.92 and 95% CI: 1.17-7.32, respectively). In late pregnancy, only maternal smoking yielded a significant association (OR = 2.34 and 95% CI: 1.24-4.41). CONCLUSION: Scheduling repeated assessments of psychosocial resources and lifestyle factors during pregnancy yielded additional information. The findings suggest that there can be differential effects of such exposures depending on gestational stage. This information is of importance when designing appropriate intervention strategies for maternal health services as well as for public health relevant policy formulation (e.g. regarding exposure to environmental tobacco during pregnancy).     

Severe vomiting during pregnancy: antenatal correlates and fetal outcomes.

Neither the cause nor the effect of severe vomiting during pregnancy is well understood. This study examines possible causes of severe vomiting and associations between this disorder and fetal outcomes. One thousand eight hundred sixty-seven women with normal singleton live births were included in the analysis. The cumulative incidence of severe vomiting during pregnancy was 10.8%. Women with chronic liver disease had a threefold increased risk of severe vomiting during pregnancy. Paternal smoking was associated with a twofold increased risk of maternal vomiting. A modest association between severe vomiting and fetal growth retardation was identified (OR = 1.4, 95% CI: 0.9-2.3). Severe vomiting was also found to be associated with preeclampsia (OR = 1.5, 95% CI: 1.0-2.4). Our study indicates that passive smoking is a risk factor for vomiting during pregnancy, which may, in turn, increase the risk of fetal growth retardation.     

Passive smoking, cytochrome P450 gene polymorphisms and dysmenorrhea

PURPOSE: This study investigated whether the association between passive smoking exposure and dysmenorrhea is modified by two susceptibility genes, CYP1A1MspI and CYP1A1HincII. METHODS: This report includes 1,645 (1,124 no dysmenorrhea, 521 dysmenorrhea) non-smoking and non-drinking newly wedding female workers at Anqing, China between June 1997 and June 2000. Multiple logistic regression models were used to estimate the associations of passive smoking exposure and genetic susceptibility with dysmenorrhea, adjusting for maternal age, BMI, age of menarche, education, vibration exposure, shift work, noise exposure, pregnancy history, perceived stress and physical laboring stress. RESULTS: In the passive smoking group, women who have C/C6235 genotype (OR = 1.8, 95% CI = 1.0-3.3) in CYP1A1MspI and Ile/Ile462 genotype (OR = 2.9, 95% CI = 1.1-7.7) in CYP1A1HincII was associated with an increased risk of dysmenorrhea. When stratified by women genotype, the adjusted OR of dysmenorrheal was 1.6 (95% CI = 1.2-2.1) for passive smoking group with Ile/Ile462 genotype, and 1.5 (95% CI = 1.0-2.1) with C/C6235 genotype, compared to non-passive smoking group, respectively. The data further showed that there was a significant combined effect between passive smoking and the CYP1A1 Msp1C/C6235 (OR = 1.5, 95% CI = 1.0-2.1), and HincII Ile/Ile462 (OR = 1.6, 95% CI = 1.2-2.1), respectively. CONCLUSION: CYP1A1 MspI and HincII genotypes modified the association between passive smoking and dysmenorrhea.     

基于倾向性评分法的藏族非吸烟人群被动吸烟暴露与失眠的关联研究

  目的  描述中国藏族非吸烟人群被动吸烟暴露与失眠症状的分布特征,探究被动吸烟暴露与失眠症状的关联程度。  方法  基于“西南区域自然人群队列”项目2018年5月―2019年8月在拉萨市调查的7 737名藏族居民数据,采用倾向性评分逆概率加权法和边际结构模型分析被动吸烟暴露与失眠症状的关联,并比较该关联在不同年龄、性别、BMI、负性生活事件、社会支持组别之间的差异。  结果  调查人群中被动吸烟暴露率为22.50%,失眠检出率为33.67%。利用倾向性评分均衡潜在混杂因素后,被动吸烟暴露组发生失眠症状的风险为非被动吸烟暴露组的1.24倍(OR=1.24, 95% CI: 1.14~1.34);年龄≥50岁(OR=1.25, 95% CI: 1.01~1.54)、男性(OR=1.60, 95% CI: 1.17~2.18)、超重(OR=1.24, 95% CI: 1.05~1.47)、有过1次负性生活事件(OR=1.46, 95% CI: 1.01~2.10)和中等社会支持(OR=1.46, 95% CI: 1.12~1.92)人群被动吸烟暴露与失眠有显著关联。  结论  在藏族非吸烟人群中被动吸烟暴露是失眠的危险因素,应该采取相关降低被动吸烟暴露的干预措施去促进人群睡眠健康。     

孕前及孕早期母体因素与子代复杂先天性心脏病的相关性研究

目的 探讨孕前及孕早期母体环境暴露因素与子代复杂先心病的关系,为先天性心脏病（congenital heart disease ,CHD）的科学预防和干预提供依据。方法 选取2017年1月-2018年12月产前超声诊断为子代复杂先心病的孕妇62例为病例组,按照1∶2匹配正常孕妇为对照组,问卷调查后通过多因素logstic回归分析复杂先心病可能的危险因素和保护因素。结果 母亲不良生育史（OR:6.981, 95%CI:3.621～11.017）、孕前吸烟饮酒史（OR:2.418,95%CI:1277～6.757）、孕早期呼吸道感染（OR:3.906, 95%CI:1.115～5.242）、噪音环境（OR:2.391, 95%CI:0.898～4.710）、不良精神心理因素（OR:4.791, 95%CI:2.242～8.597）为子代复杂先心独立危险因素。而孕前及孕早期食用蛋、奶类等高蛋白物质（OR:0.517,95%CI:0.311～0.803）和补充叶酸及其它营养素（OR:2.979,95%CI:1.537～5.016）为子代复杂先心保护因素。结论 孕前及早孕期孕妇需避免上述危险因素的接触,增加高蛋白和叶酸摄入量,对降低及预防复杂CHD有重要价值。     

Folic acid supplements modify the adverse effects of maternal smoking on fetal growth and neonatal complications

Maternal smoking during pregnancy leads to increased risks of neonatal complications. The use of folic acid supplements might reduce the adverse effects of smoking. We examined whether folic acid supplement use modifies the associations of maternal smoking with first trimester plasma homocysteine concentrations, fetal growth characteristics, and risks of neonatal complications. The associations were studied in 6294 mothers participating in a prospective population-based cohort study in The Netherlands. Main outcomes measurements were first trimester plasma homocysteine concentrations, fetal growth characteristics, and neonatal complications, including preterm birth, low birth weight, and small-size-for-gestational-age. Continued maternal smoking was associated with higher first trimester plasma homocysteine concentrations [difference 0.52 μmol/L (95% range = 0.20, 2.14)], lower third trimester fetal weight (difference -44 g (95% CI = -57, -31)], and birth weight [difference -148 g (95% CI = -179, -118)]. There were significant interactions between maternal smoking and folic acid supplements on all outcome measures (all P-interaction < 0.040). Among mothers who continued smoking during pregnancy, those who did not use folic acid supplements had the highest risk of delivering a child with low birth weight [OR = 3.45 (95% CI = 1.25, 9.54)] compared to those who did use periconceptional folic acid supplements. No significant effects were observed for the risks of preterm birth and small-size-for-gestational-age at birth. Our results suggest that some adverse effects of maternal smoking on fetal growth and neonatal outcomes might be reduced by the use of folic acid supplements. The observed interaction seems to be mainly driven by smoking in the first trimester only.