Maternal-fetal medicine (Wolters Kluwer Health, Inc.)最新文献

Objective: To obtain insights into the knowledge and attitudes of obstetricians towards "kangaroo mother care" (KMC), and to identify their role in it in India.

Methods: A cross-sectional observational study in the form of a comprehensive, structured questionnaire-based survey was conducted and disseminated to several obstetricians across various cities in India between January and June 2023 using an online survey tool by the "snowball" sampling method. Data were analyzed using descriptive statistics. Each response was assigned a specific weight. A scoring system was developed using the partial credit model. Scores were categorized using the Jenks break classification into "low", "moderate", and "high". The Mann-Whitney U test was carried out to explore the relationship between participant scores with age and location of practice.

Results: The final dataset consisted of 215 obstetricians across India. Most respondents (89.30%, 192/215) were aware of the impact of KMC on reducing neonatal mortality (though the precise figures were less known). The term "KMC" was used interchangeably with skin-to-skin contact at birth by 69.77% (150/215) of respondents. The "Belief section" received a positive response, with most participants advocating for antenatal counselling on KMC and its inclusion in obstetrics and gynecology, and pediatrics curricula. We found that 98 (45.6%) and 90 (41.9%) respondents scored moderate-to-high in the Science and Observations sections, respectively, and 90 (41.9%) excelled in the Beliefs section. There were significant associations (P = 0.011 and 0.018, respectively) between the age of the practitioner and his/her knowledge and practices of KMC, and between those who worked in academic centers compared with those who did not in terms of their beliefs towards KMC practices (P = 0.020), suggesting that exposure and experience in the field enhanced the understanding of KMC, highlighting the need for targeted training for new obstetricians.

Conclusion: Obstetricians exhibited positive attitudes and beliefs towards KMC and were ready to increase their knowledge and practices. It is crucial to collaborate and harness this potential to ensure their greater involvement in KMC implementation.

Objective: To evaluate the independent effects of prepregnancy obesity and gestational weight gain on fetal growth patterns and explore whether prepregnancy obesity can modify the association between gestational weight gain and fetal growth trajectories.

Methods: A multicenter retrospective cohort was established, consisting of 9075 women with singleton pregnancies across 24 tertiary hospitals in 18 Chinese provinces. Each participant underwent a minimum of three ultrasound examinations between gestational week 12 and the conclusion of pregnancy. Fetal anthropometric measurements included biparietal diameter, abdominal circumference, head circumference, and femur length, with the estimated fetal weight (EFW) calculated using the Hadlock formula. Fetal growth trajectories were modeled using a linear mixed model with cubic splines, adjusted for maternal characteristics. Differences in trajectories were compared across categories of prepregnancy body mass index (BMI) and gestational weight gain. Global and week-specific comparisons were evaluated using the likelihood ratio test and the Wald test, while effect modification was assessed through stratified analysis.

Results: Fetal weight was positively associated with prepregnancy BMI and gestational weight gain. From gestational week 12 through week 40, the EFW significantly differed among the offspring of women categorized as underweight, normal weight, overweight, or obese. Specifically, fetuses of women with obesity presented a significantly higher EFW than those of women in the other groups. When stratified by gestational weight gain (inadequate, adequate, and excessive), significant differences in EFW were observed from gestational week 16 until the conclusion of the pregnancy. Stratified analysis indicated that prepregnancy BMI modified the association between gestational weight gain and fetal growth trajectories. In women without obesity, gestational weight gain was significantly and positively associated with EFW and abdominal circumference; however, in women with obesity, gestational weight gain did not demonstrate a significant effect on fetal growth trajectories.

Conclusion: Our data showed that prepregnancy BMI and gestational weight gain were positively associated with fetal growth. Furthermore, prepregnancy BMI acted as an effect modifier in the relationship between gestational weight gain and fetal growth trajectories. These findings suggested that weight control before conception carries greater clinical significance than the management of gestational weight gain.

Objective: To summarize the clinical characteristics of early-onset severe hemolytic disease of the fetus and newborn (HDFN) in a Chinese cohort and identify factors influencing intrauterine transfusion (IUT) frequency and pregnancy outcomes.

Methods: This retrospective cohort study included cases managed between 2013 and 2022. Factors affecting IUT efficacy were analyzed with regard to subsequent IUT risk and adverse pregnancy outcomes. Survival analysis for recurrent events was performed to assess subsequent IUT risk.

Results: Of the 97 cases included, 38 were identified as early-onset severe HDFN. Compared with non-early-onset severe HDFN, early-onset severe HDFN was characterized by higher anti-D titer (1:1024 vs. 1:512, respectively, P = 0.006), multiple alloantibodies (50.00% vs. 20.34%, respectively, P = 0.002), and an earlier gestational age at initial IUT (22.4 ± 3.2 vs. 29.0 ± 3.5 weeks, respectively, P < 0.001). In addition, early-onset severe HDFN correlated with increased IUT frequency (hazard ratio (HR): 2.01, 95% confidence interval (CI): 1.26-3.20, P = 0.003). Factors prolonging IUT intervals included transfused volume (HR: 0.99, 95% CI: 0.97-0.99; P < 0.001), hematocrit after IUT (HR: 0.96, 95% CI: 0.95-0.98; P < 0.001), and immunotherapy (HR: 0.59, 95% CI: 0.38-0.93; P = 0.024).

Conclusion: The characteristics of early-onset severe HDFN in Chinese patients are different from those observed in western cohorts. These patients frequently present with higher anti-D titers and a more complex spectrum of multiple alloantibodies. The occurrence of early-onset severe HDFN is associated with an increased frequency of IUT and lower live birth rates. Therefore, exploring effective interventions to delay the first IUT is critical to optimizing the timing and efficacy of intrauterine management for these high-risk cases.

Exercise during pregnancy and the postpartum period is important for maternal and infant health. To standardize clinical practice regarding exercise for pregnant and postpartum women in China, the Chinese Society of Perinatal Medicine of the Chinese Medical Association and the China Institute of Sport Science, General Administration of Sport of China, jointly developed this expert consensus. This consensus was informed by the latest evidence from clinical research, relevant guidelines, and expert opinion. It was developed using the Delphi method through three rounds of expert consultation, together with multidisciplinary discussions, resulting in the expert consensus. This consensus addresses key topics, including eligible populations for exercise during pregnancy, exercise contraindications, exercise prescription components, and postpartum exercise, and provides 10 key recommendations. It aims to offer scientific, practical, and actionable guidance for exercise interventions among pregnant and postpartum women in China and to promote the integration of sports and medicine in perinatal health management.

Objective: To explore the specific impact of sexually transmitted infections (STIs) on infertility including differences in disease burden among different regions and populations and temporal trends.

Methods: Data on STI-attributable infertility were extracted from the Global Burden of Diseases Study 2021. The study focused on two types of infertility (primary and secondary) and three STIs (chlamydia, gonococcal, and other STIs). The disease burden was measured using the age-standardized prevalence rate (ASPR) and the age-standardized years lived with disability (YLD) rate (ASYR). The estimated annual percent change (EAPC) was calculated to determine temporal variations. Temporal trends were modeled using joinpoint analysis and the age-period-cohort-Web tool. Finally, future trends were predicted using the Bayesian age-period-cohort model.

Results: In 2021, there were 18,413,845 (95% uncertainty interval (UI): 15,765,620-21,547,032) prevalent cases and 102,961 (95% UI: 40,469-213,098) YLDs associated with STI-attributable infertility globally. The corresponding ASPR and ASYR per 100,000 population were 225.44 (95% UI: 193.19-262.80) and 1.26 (95% UI: 0.50-2.61), with EAPCs from 1990 to 2021 of 0 (95% confidence interval (CI): -0.05-0.06) and -0.01 (95% CI: -0.07-0.04), respectively. Chlamydia infection was identified as the primary contributor to this burden. Nationally, Guinea-Bissau had the highest burden, followed by Guinea and Mauritania. A significant inverse correlation was observed between the ASPR and socio-demographic index (SDI) levels. From 1990 to 2021, the disease burden exhibited an upward trend. Notably, the model predicted this increasing trend would continue across all age groups until 2050, with individuals aged 40 to 44 being the most affected.

Conclusion: Infertility attributable to STIs remains a critical public health challenge, with a projected increasing trend through 2050. Global efforts to reduce the burden of infertility should focus on improving STI prevention, diagnosis, and treatment strategies, especially in regions with low and middle SDI levels.