维生素D与母体妊娠相关疾病关系的研究进展

维生素D（Vitamin D,VD）作为人体所必需的营养素之一,参与调节体内多种生物学过程,其补充剂主要应用于预防和治疗佝偻病、骨质疏松症等疾病。VD受体广泛分布于机体组织细胞中,研究发现VD在调节免疫系统功能方面发挥重要的生理作用,同时参与了神经系统、内分泌系统及循环系统疾病的发病过程。妊娠期间,VD对维持母体及胎儿发育同样至关重要。有文献报道孕产妇VD水平偏低或缺乏与妊娠相关疾病发病率增加有关,严重的VD缺乏还可导致孕妇及胎儿不良妊娠结局。结合近年发表的国内外文献,对VD的不足或缺乏与母体妊娠相关疾病的关系进行综述,探讨疾病发生的病理机制,为早期预防、早期诊断和及时治疗提供理论依据。     

孕产妇补充维生素D的研究进展

妊娠期孕妇维生素D严重缺乏,可造成母儿不良结局,增加妊娠并发症发病率,如早产、妊娠糖尿病、子痫前期、细菌性阴道病等;增加低出生体重,婴儿佝偻病、神经发育不良、骨矿含量降低、骨质疏松性骨折风险。孕产妇补充维生素D3,有益于改善母儿不良结局。本文结合国内外最新文献,介绍了妊娠期维生素D代谢、孕妇维生素D缺乏及其严重后果、补充维生素D3改善妊娠不良结局,以及国内外权威学术机构的相关指南,提供产科医师参考。     

维生素D与男性不育关系的研究进展

维生素D(vitamin D,VD)作为一类常见的营养元素,不仅在调节钙稳态和骨骼健康方面具有明确的作用,近年来有研究表明其与男性生殖可能存在密切关系。本文通过阐述VD的代谢、VD与男性性激素、精子质量以及妊娠结局的关系,以进一步说明VD对男性生育力的重要影响。了解VD对男性生殖的影响及其机制可为临床诊疗提供新的思路和方法。     

维生素D及其受体与妇科肿瘤

化疗是治疗妇科肿瘤的主要手段之一.但是,目前临床所应用的化疗药物存在较严重的毒性,限制了其在临床上的应用.近年研究发现维生素D(VD)和维生素D受体(VDR)除了已熟知的维持血清钙离子平衡和骨结构的生理功能外,还与肿瘤有密切关系.体内外试验证明VD有抑制肿瘤细胞增殖和诱导分化的作用.VD和VDR与妇科肿瘤关系的研究.     

妊娠期抑郁症的研究进展

妊娠期抑郁症以其逐年增高的发病率、对母婴的严重危害而日益引起人们的关注。雌激素为孕产期一种重要的性激素,已证明与女性抑郁关系密切,其机制可能与影响5羟色胺系统有关。现就妊娠期抑郁症的流行病学现状、诊断、治疗,雌激素与5羟色胺系统作用机制的研究进展作一综述。     

妊娠期营养干预循证医学评价方法

妊娠期营养缺乏或过剩均可导致后代的不良结局。妊娠期营养缺乏近期可导致出生低体重儿、早产、出生先天畸形、围生期死亡。尽管人类流行病学研究的证据还不确定，但动物实验研究表明，必需脂肪酸的缺乏可导致胎儿发育迟缓及视觉功能障碍。妊娠期营养缺乏者的后代患2型糖尿病、心血管疾病、中心性肥胖和脂代谢异常的危险性明显增高。某些微量元素的缺乏也可能会导致智力发育异常。也有学者提出免疫系统疾病也可能与宫内营养缺乏有关。妊娠期膳食营养素摄入不足，亦可引起孕妇营养性贫血、骨软化症、营养性水肿等。     

维生素D及其受体与妇科肿瘤

化疗是治疗妇科肿瘤的主要手段之一。但是，目前临床所应用的化疗药物存在较严重的毒性．限制了其在临床上的应用。近年研究发现维生素D（VD）和维生素D受体（VDR）除了已熟知的维持血清钙离子平衡和骨结构的生理功能外，还与肿瘤有密切关系。体内外试验证明VD有抑制肿瘤细胞增殖和诱导分化的作用。综述VD和VDR与妇科肿瘤关系的研究。     

妊娠期抑郁症与分娩方式及产后抑郁症的关系

目的 探讨妊娠期抑郁症与分娩方式、产后抑郁症发病的关系.方法 对2006年1月至2007年7月在中国医科大学附属盛京医院产科定期进行产前检查并分娩的1005例孕妇进行抑郁自评量表(SDS)的评定.抑郁症筛查阳性者此后每周进行1次SDS评定,直至分娩前.于产后6周时对所有研究对象进行爱丁堡产后抑郁量表(EPDS)评定,并调查分娩方式,后进行统计学分析.结果 妊娠期抑郁症筛查阳性率为26.4%,抑郁症筛查阳性者采取剖宫产终止妊娠者是筛查阴性者的3.407倍,其产后抑郁症发生率为抑郁症筛查阴性者的4.460倍.结论 妊娠期抑郁症发病率较高,并可能导致剖宫产率增加及产后抑郁症等不良后果.     

雌激素受体及五羟色胺转运蛋白基因多态性与围产期抑郁的相关性研究进展

围产期抑郁为高发病率、高致残率、高治愈率疾病,发病率约为20%~36.5%。围生期雌激素水平的急剧波动是围产期抑郁发生的特征性生理诱因,雌激素及其受体基因多态性与围产期抑郁可能相关。研究显示,五羟色胺转运蛋白基因多态性与抑郁症的发病相关,集中在五羟色胺转运体基因连锁多肽性区域,但是否与围产期抑郁症有关,尚待进一步证实。本文对雌激素受体、五羟色胺转运体基因多态性及两者之间与围产期抑郁症的相关性的研究进展做一综述。     

维生素D在子宫内膜癌发生发展中的作用研究进展

正子宫内膜癌(endometrial carcinoma,EC)是妇科常见恶性肿瘤,发病率和病死率均呈上升趋势,严重危害妇女健康~([1-2])。文献报道,维生素D(vitamin D,VD)在多种肿瘤发生和进展中发挥重要作用,循环中VD水平升高与乳腺癌、卵巢癌等恶性肿瘤发生风险降低有关~([3-4])。VD可通过调节细胞增殖、凋亡、黏附、侵袭和血管生成、炎性反应等参与肿瘤发生~([5])。目前,VD与子宫内膜癌发生风险之间的关系仍有争议。故在VD对子宫内膜癌有局部作用的基础上,对其潜在的分子机制进行研究可能具有一定应用价值。     

Maternal omega-3 fatty acid supplementation and risk for perinatal maternal depression

Objective.?A systematic review was conducted to assess the possible association between omega-3 polyunsaturated fatty acid (PUFA) supplementation and intake in the perinatal period and the risk of maternal perinatal depression.

Methods.?Two PubMed searches and a BIOSIS Preview, a Web of Science and a PsychInfo search were conducted with the search terms ‘DHA, pregnancy and depression’ and ‘omega-3 fatty acids, pregnancy and depression’.

Results.?Ten articles – three longitudinal cohort studies, five randomized controlled trials and two pilot trials– that met selection criteria were reviewed. Six found no association, two found mixed results, and two found a positive association between omega-3 PUFAs and reduced incidence of maternal perinatal depression. The heterogeneity of results can be explained by dissimilar study designs, including differences in study duration, time period of measurement and number of participants, and in varied dosages and types of supplemental PUFAs. Some of the larger studies and those that found a positive effect were more likely to be using higher doses, close to 2?g of docosahexaeonic acid (DHA)+?eicosapentaenoic acid (EPA), and began the supplementation earlier in pregnancy.

Conclusions.?Future RCTs to investigate the role of PUFA supplementation and risk for maternal perinatal depression should begin supplementation early in pregnancy and use a dosage closer to 2?g of DHA?+?EPA. Depression should also be measured using a diagnostic interview schedule in addition to a screener.     

Update of pre- and postnatal iron supplementation in malaria endemic settings

This review focuses on pre- and post-natal iron supplementation in malaria endemic settings. Although iron supplementation can reduce iron deficiency, malaria infection may counteract this effect by the increase of hepcidin, and iron supplementation may further worsen malaria infection by providing additional iron for the parasites. However, most iron supplementation intervention studies in pregnant women with malaria have not shown a negative impact, although malaria treatment with iron supplementation may be beneficial in terms of improving birth outcomes. In infants and young children in malaria endemic settings, the adverse effects of iron supplementation has been well documented and malaria prevention and treatment with iron supplementation is recommended. Besides fostering the growth of malaria parasites, iron may also promote potential pathogens in the gut and cause an inflammatory response in young children. Overall, iron supplementation is beneficial for treating iron deficiency, but needs to be considered in the context of malaria prevention and treatment in pregnant women, infants and young children for safety and effectiveness.     

妊娠期贫血常见病因及诊断

贫血是妊娠期较常见的合并症,严重威胁母儿健康。贫血对母体、胎儿及新生儿均可造成近远期的影响,是孕产期预防保健的重要内容。妊娠期贫血常见的病因有多种,其中以缺铁性贫血最为常见,占妊娠期贫血的绝大多数;而在中国长江以南地区,地中海贫血也是较为常见的原因;巨幼细胞性贫血及溶血性贫血所占比例较小。缺铁性贫血最主要的防治方法为补充铁剂;而地中海贫血由于基因缺陷严重影响母儿健康,孕期筛查尤为关键。因此,提高产科医生识别妊娠期贫血病因的能力对母儿健康具有重要意义。     

What interventions may reduce postpartum depression.

Postnatal depression is a major public health problem affecting about one in seven women after childbirth. Depression is also common during pregnancy and throughout the perinatal period it is associated with symptoms of anxiety. Apart from the adverse consequences for women themselves becoming depressed when they are going through demanding physical and social changes, there are additional concerns. There is the possible negative impact of maternal depression on the relationship between mother and child and on the child's emotional, behavioural and cognitive development. Primary prevention and early intervention/secondary prevention strategies are potentially important in view of the frequent contact pregnant women, new mothers and infants have with health services, but the effectiveness of these strategies needs to be tested. In the past year there have been five new studies of antenatal screening for postnatal depression. These studies are consistent with nine earlier studies in showing that there is no evidence to support routine antenatal screening for postnatal depression. Seven new primary prevention/early intervention trials add evidence on a wide range of interventions ranging from practical support to individual interpersonal therapy, but without identifying significant differences in depression as an outcome. Two new trials of secondary prevention, one involving interpersonal therapy and the other including partners in a series of psychoeducational visits, show promise but neither is large enough to form a basis for practice change. Novel interventions, or promising findings, with a strong basis in theory need to be tested in trials which are appropriately sized and which comply with internationally accepted design and reporting guidelines.     

Calcium, magnesium, and zinc supplementation and perinatal outcome

The overall importance of nutrition to favorable perinatal outcome is only beginning to be fully appreciated. Although nutritional status can be linked to such things as socioeconomic class and education, it is nutrition directly that exerts a biologic effect. This review has attempted to look at three elements and their relationship to maternal and fetal outcome. At the present time, there does not seem to be a role for routine magnesium supplementation during pregnancy. Magnesium deficiency, as an isolated nutritional deficiency, is rare, and the evidence is, at best, weak that magnesium supplementation reduces the risk of poor perinatal outcome. Zinc deficiency is also a very rare isolated nutritional finding. Our ability to measure zinc accurately, be it in leukocytes or serum, is improving, but the routine use of zinc supplements during pregnancy cannot be recommended at this time. It may be that zinc will be a useful diagnostic marker, rather than a therapeutic intervention. There is substantial evidence that the average American diet does not contain sufficient calcium. An expansive literature continues to grow in the areas of calcium and colon cancer, calcium and breast cancer, calcium and hypertension, and calcium and osteoporosis. Is it possible that our susceptibilities to these problems begin in utero? Obviously, the answer is unknown. What is known is that supplemental calcium to some degree is needed in the diets of most Americans and in about two thirds of pregnant women. Calcium supplementation seems to affect blood pressure favorably and, pending confirmation with larger trials, may significantly reduce prematurity and preeclampsia risk, thus improving perinatal outcome for a large number of our high-risk patients.     

Omega-3 long-chain polyunsaturated fatty acids and fish oil supplementation during pregnancy: which evidence?

Objective: The aim of this study was to provide evidence-based recommendations for omega-3 supplementation during pregnancy through a systematic review of level-1 data published on this topic.

Methods: We reviewed all randomized-controlled trials (RCTs) including women who were randomized to treatment with either omega-3 supplementation or control (placebo or no treatment) during pregnancy and analyzed all the outcomes reported in the trials, separately. We planned to evaluate the effect of omega-3 on: preterm birth (PTB); pre-eclampsia (PE) and intrauterine growth restriction (IUGR); gestational diabetes; perinatal mortality; small for gestational age (SGA) and birth weight; infant eye and brain development; and postpartum depression.

Results: We identified 34 RCTs including 14 106 singletons and 2578 twins. These level-1 data showed that omega-3 was not associated with prevention of PTB, PE, IUGR, gestational diabetes, SGA, post-partum depression or better children development. Data about birth weight, perinatal mortality and childhood cognitive outcome were limited. Women with gestational diabetes who received omega-3 had significantly lower serum C-reactive protein concentrations, low incidence of hyperbilirubinemia in newborns and decreased newborns’ hospitalization rate.

Conclusions: There was not enough evidence to support the routine use of omega-3 supplementation during pregnancy. Given the 73% significant decrease in perinatal death in the singleton gestations who started omega-3 supplementation ≤?20 weeks, further research is needed. Large RCTs in multiple gestations and longer follow-up are also required.     

Progesterone for the prevention of threatened miscarriage

Miscarriage, defined as the loss of a pregnancy before 24 weeks of gestation, is the most common complication of early pregnancy, affecting approximately 15% of clinically recognized pregnancies. The steroid hormone progesterone is essential for the maintenance of pregnancy, and progesterone deficiency is associated with miscarriage. Two important clinical risk factors for miscarriage are a history of previous miscarriages and vaginal bleeding in early pregnancy. Progesterone supplementation has therefore been attempted to prevent miscarriages in asymptomatic women with a history of miscarriages and in women who have started to bleed in early pregnancy. The latest evidence from high quality clinical trial research has shown that vaginal micronized progesterone treatment of women with the dual risk factors of early pregnancy bleeding and a history of one or more previous miscarriages increases the likelihood of a successful live birth (relative rate 1.08, 95% CI 1.02 to 1.15, high-certainty evidence). This treatment has also been shown to be cost-effective, leading to the National Institute for Health and Care Excellence committee for the guideline ‘Ectopic pregnancy and miscarriage: diagnosis and initial management (NG126)’ updating their guidance to recommend the use of vaginal micronized progesterone to treat women with the dual risk factors of a history of one or more previous miscarriages and early pregnancy bleeding. This change in practice has the potential to prevent up to 8,450 miscarriages a year in the UK.     

Postnatal depression: an update

Apart from causing emotional suffering, postnatal depression strains marriage, undermines the mother's confidence, impairs her social functioning and quality of life, and in serious cases contributes to infant abuses, infanticides and suicidal behaviour. Recent studies also show that postnatal depression adversely affects emotional, behavioural and cognitive development of the newborn. In addition, there is growing awareness that depression can occur during pregnancy, and antenatal depression can adversely affect obstetric and neonatal outcomes. Antenatal depressive symptoms are also the strongest predictor of postnatal depression. This paper reviews the epidemiology, clinical presentation, risk factors, prevention and treatment of perinatal depression. The latest development in research and practice related to this condition are also highlighted.     

Levels of serum vitamin D and calcium in pregnancies complicated with fetal congenital diaphragmatic hernia and normal pregnancies

Objective: Vitamin D (VD) deficiency is a common public health problem worldwide in all age groups. Receptors and enzymes related to VD metabolism have been shown in many cells and tissues of the body. VD plays a crucial role in cellular growth and differentiation during embryogenesis. It has been suggested that VD deficiency may be associated with various diseases, and that lower maternal serum levels may be associated with adverse perinatal outcomes. In this study, we aimed to compare serum VD levels of pregnant women whose pregnancies complicated by congenital diaphragmatic hernia (CDH) with healthy pregnant women. We also evaluated perinatal outcomes of these pregnancies.

Methods: Total of 77 patients was included in this prospective and cross-sectional case-controlled study. 24 pregnant women having a fetus with CDH diagnosed prenatally formed the study group, and 53 healthy pregnants were eligible for the control group. Demographics and clinical characteristics of the cases with some laboratory parameters were recorded. Perinatal outcomes were also investigated.

Results: No significant differences were observed between two groups in terms of demographics and clinical features. Mean maternal serum VD levels were significantly lower in the study group than in the controls (p: 0.019). Ionized calcium and corrected calcium levels were also found to be lower in pregnant women with CDH (p?Conclusions: Maternal serum VD and calcium levels were significantly lower in pregnancies complicated by CDH than healthy pregnant women. Hipovitaminosis D may play a vital role in the pathogenesis of CDH.