BACKGROUND Neonatal hyperinsulinism can result from perinatal stress,genetic disorders,or syndromes,which can lead to persistent or intractable hypoglycemia in newborns.Mutations in the ABCC8 gene result in abnormal f...BACKGROUND Neonatal hyperinsulinism can result from perinatal stress,genetic disorders,or syndromes,which can lead to persistent or intractable hypoglycemia in newborns.Mutations in the ABCC8 gene result in abnormal functioning of potassium channel proteins in pancreaticβ-cells,leading to an overproduction of insulin and congenital hyperinsulinemia.CASE SUMMARY We report a case of a high-birth-weight infant with postnatal hypoglycemia and hyperinsulinemia,whose mother had pregestational diabetes mellitus with poor glycemic control and whose sister had a similar history at birth.Whole-exome sequencing revealed a new mutation in the ABCC8 gene in exon 8(c.1257T>G),which also occurred in his sister and mother;thus,the patient was diagnosed with neonatal hyperinsulinism with an ABCC8 mutation.With oral diazoxide treatment,the child’s blood glucose returned to normal,and the pediatrician gradually discontinued treatment because of the child’s good growth and development.CONCLUSION We report a new mutation locus in the ABCC8 gene.This mutation locus warrants attention for genetic disorders and long-term prognoses of hypoglycemic children.展开更多
BACKGROUND Chronic kidney disease(CKD)affects almost 3%of females of child-bearing age,who have a high risk of adverse maternal and fetal outcomes.Additionally,high renal burden as a result of pregnancy may lead to de...BACKGROUND Chronic kidney disease(CKD)affects almost 3%of females of child-bearing age,who have a high risk of adverse maternal and fetal outcomes.Additionally,high renal burden as a result of pregnancy may lead to deterioration of renal function.An increasing number of women with CKD stages 3 to 5 have a strong desire to conceive,and both obstetricians and nephrologists are faced with enormous challenges in terms of their treatment and management.CASE SUMMARY The case of a 35-year-old pregnant woman with a 10-year history of mild mesangial proliferative glomerulonephritis is described here.CKD progressed from stage 3 to stage 5 rapidly during pregnancy,and protective hemodialysis was started at 28 wk of gestation.Due to preeclampsia at 34 wk of gestation,cesarean section was performed and a healthy baby was delivered.Hemodialysis was discontinued at 4 wk postpartum.After 1 year of follow-up,her renal function was stable,and her baby exhibited good growth and development.CONCLUSION Protective hemodialysis during pregnancy can prolong gestational age and improve maternal and fetal outcomes in women with advanced CKD.展开更多
BACKGROUND Uterine myoma is the most common benign tumor among women and is often accompanied by anemia.Here,we report the case of a patient with a very large leiomyoma but with a hemoglobin level as high as 197 g/L.A...BACKGROUND Uterine myoma is the most common benign tumor among women and is often accompanied by anemia.Here,we report the case of a patient with a very large leiomyoma but with a hemoglobin level as high as 197 g/L.After undergoing hysterectomy,all her hematological parameters returned to normal.Immunohistochemical staining of her myoma for erythropoietin showed strong positivity,which suggested that erythropoietin may be the cause of her erythrocytosis.A multidisciplinary team played a significant role in treating the disease.CASE SUMMARY A 47-year-old woman visited our department complaining that her abdomen had been continuously growing for the past 2 years.After careful examinations,she was suspected of having a very large leiomyoma.She was also diagnosed with erythrocytosis because her RBC count was 6.49×10^(12)/L,hemoglobin was 197 g/L.Following a multidisciplinary team consultation,bilateral ureteral stents were placed,and 800 m L blood was removed by phlebotomy.The patient then underwent hysterectomy and bilateral salpingectomy.She recovered well from the operation,and her hemoglobin level decreased sharply following the surgery.Low-molecular-weight heparin was administered daily to prevent postoperative thrombosis.She was discharged from the hospital on the fourth postoperative day.Two months later,all her hematological parameters returned to normal.Pathological analysis of the myoma revealed that it was a benign leiomyoma,with partial hyalinization,and strong positivity for erythropoietin in immunohistochemical staining suggested that erythropoietin may be responsible for the erythrocytosis.CONCLUSION Erythropoietin ectopically produced from the myoma was responsible for the erythrocytosis in this patient.A multidisciplinary team is strongly recommended.展开更多
BACKGROUND Cervical squamous cell carcinoma(SCC)is the most common type of cervical carcinoma and is generally derived from a precancerous stage called cervical high-grade squamous intraepithelial lesion(HSIL).Usually...BACKGROUND Cervical squamous cell carcinoma(SCC)is the most common type of cervical carcinoma and is generally derived from a precancerous stage called cervical high-grade squamous intraepithelial lesion(HSIL).Usually,the cancer metastasizes through lymphatic or hematogenous dissemination,but rarely spreads upward into the uterus.Here,we report a case of cervical HSIL extending into the endometrium and finally progressing to SCC in the uterine cavity.CASE SUMMARY A 57-year-old postmenopausal woman visited our department and requested a routine cervical check-up.Four years ago,she had undergone a cervical loop electrosurgical excision procedure because of HSIL found during the gynecological examination,and she had not been checked again since.This time,a relapse of the cervical HSIL was diagnosed along with uterine pyometra and endometrial polyps.After 2 wk of antibiotic treatment,a laparoscopic hysterectomy was performed,and the final pathological examination revealed that the cervical HSIL had spread directly upward into the uterine cavity,gradually developing into cervical SCC in the endometrium.CONCLUSION Cervical HSIL/SCC can directly spread upward into the uterus with the most common symptoms of pyometra and cervical stenosis.More attention should be given to the early detection and prevention of this disease.展开更多
BACKGROUND A population-based comparative study in United States shows that the prevalence and incidence of autoimmune encephalitis are comparable to those of infectious encephalitis and its detection is increasing ov...BACKGROUND A population-based comparative study in United States shows that the prevalence and incidence of autoimmune encephalitis are comparable to those of infectious encephalitis and its detection is increasing over time.Some patients are complicated with ovarian teratoma.The younger the patient is,the less likely a tumor will be present.CASE SUMMARY This case report describes the successful treatment of anti-N-methyl-D-aspartatereceptor(NMDAR)encephalitis by early laparoscopic ovarian cystectomy and immunotherapy in a 4-year-old female child.And to the best of our knowledge,this detailed case report describes the youngest patient to date with anti-NMDAR encephalitis who underwent laparoscopic ovarian cystectomy.CONCLUSION Although the younger the patient is,the less likely a tumor will be detected,we still emphasize that all patients with suspected or confirmed anti-NMDAR encephalitis should be screened for ovarian tumors if possible.Prompt initiation of immunotherapy and tumor removal are crucial for good outcomes.展开更多
Gallium oxide(Ga_(2)O_(3)),a novel ultrawide-bandgap(UWBG)semiconductor,has attracted considerable attention owing to its large bandgap of up to 4.9 eV,a high breakdown electric field of 8 MV/cm,and a high Baliga'...Gallium oxide(Ga_(2)O_(3)),a novel ultrawide-bandgap(UWBG)semiconductor,has attracted considerable attention owing to its large bandgap of up to 4.9 eV,a high breakdown electric field of 8 MV/cm,and a high Baliga's figure of merit exceeding 3000[1,2].These remarkable properties strongly support its potential applications in power electronics,extreme environmentresistance devices,and solar-blind detectors[1–3].展开更多
Background： Hyperglycemia is associated with adverse pregnancy outcomes. However, the relationships between them remain ambiguous. This study aimed to analyze the effect of different oral glucose tolerance test （OGT...Background： Hyperglycemia is associated with adverse pregnancy outcomes. However, the relationships between them remain ambiguous. This study aimed to analyze the effect of different oral glucose tolerance test （OGTT） results on adverse perinatal outcomes. Methods： This retrospective cohort study included data from 15 hospitals in Beijing from June 20, 2013 to November 30, 2013. Women with gestational diabetes mellitus （GDM） were categorized according to the number and distribution of abnormal OGTT values, and the characteristics of adverse pregnancy outcomes were evaluated. Chi-square test and logistic regression analysis were used to determine the associations. Results： in total, 14,741 pregnant women were included in the study population, 2927 （19.86%） of whom had G DM. As the number of hyperglycemic values in the OGTT increased, the risk of cesarean delivery, preterm births, large-for-gestational age （LGA）, macrosomia, and neonatal complications significantly increased. Fasting hyperglycemia bad clear associations with macrosomia （odds ratios [ORs]：1.84, 95% confidence intervals [CIs]： 1.39-2.42, P 〈 0.001）, L（SA （OR： 1.70, 95% CI： 1.29-2.25. P 〈 0.001）, and cesarean delivery （OR： 1.33, 95% CI： 1.15-1.55, P 〈 0.001）. The associations were stronger as tasting glucose increased. GDM diagnosed by hyperglycemia at OGTT-2 h was more likely to lead to preterm birth （OR： 1.50, 95% Cl： 1. 11-2.03, P 〈 0.01）. Conclusions： Various characteristics of OGTTs are associated with different adverse outcomes. A careful reconsideration ofGDM wiih hierarchical and individualized management according to OGTT characteristics is needed.展开更多
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:Gestational diabetes mellitus(GDM)is usually diagnosed between 24th and 28th gestational week using the 75-g oral glucose tolerance test(OGTT).It is difficult to predict GDM before 24th gestational week bec...Background:Gestational diabetes mellitus(GDM)is usually diagnosed between 24th and 28th gestational week using the 75-g oral glucose tolerance test(OGTT).It is difficult to predict GDM before 24th gestational week because fast plasma glucose(FPG)decreases as the gestational age increases.It is controversial that if FPG≥5.1 mmol/L before 24th gestational week should be intervened or not.The aim of this study was to evaluate the value of FPG to screen GDM before 24th gestational week in women with different pre-pregnancy body mass index(BMI).Methods:This was a multi-region retrospective cohort study in China.Women who had a singleton live birth between June 20,2013 and November 30,2014,resided in Beijing,Guangzhou and Chengdu,and received prenatal care in 21 selected hospitals,were included in this study.Pre-pregnancy BMI,FPG before the 24th gestational week,and one-step GDM screening with 75 g-OGTT at the 24th to 28th gestational weeks were extracted from medical charts and analyzed.The pregnant women were classified into four groups based on pre-pregnancy BMI:Group A(underweight,BMI<18.5 kg/m^2),Group B(normal,BMI 18.5-23.9 kg/m^2),Group C(overweight,BMI 24.0-27.9 kg/m^2)and Group D(obesity,BMI≥28.0 kg/m^2).The trend of FPG before 24th week of gestation was described,and the sensitivity and specificity of using FPG before the 24th gestational week to diagnose GDM among different pre-pregnancy BMI groups were reported.Differences in the means between groups were evaluated using independent sample t-test and analysis of variance.Pearson Chi-square test was used for categorical variables.Results:The prevalence of GDM was 20.0%(6806/34,087)in the study population.FPG decreased gradually as the gestational age increased in all pre-pregnancy BMI groups until the 19th gestational week.FPG was higher in women with higher pre-pregnancy BMI.FPG before the 24th gestational week and pre-pregnancy BMI could be used to predict GDM.The incidence of GDM in women with FPG≥5.10 mmol/L in the 19th to 24th gestational weeks and pre-pregnancy overweight or obesity was significantly higher than that in women with FPG≥5.10 mmol/L and pre-pregnancy BMI<24.0 kg/m^2(78.5%[62/79]vs.52.9%[64/121],χ^2=13.425,P<0.001).Conclusions:FPG decreased gradually as the gestational age increased in all pre-pregnancy BMI groups until the 19th gestational week.Pre-pregnancy overweight or obesity was associated with an increased FPG value before the 24th gestational week.FPG≥5.10 mmol/L between 19 and 24 gestational weeks should be treated as GDM in women with pre-pregnancy overweight and obesity.展开更多
Background: Serum human chorionic gonadotrophin (hCG) is higher in twin than that in singleton pregnancies. As hCG stimulates the thyroid to produce more free thyroxine (FT4), which may lead to decreased thyroid-stimu...Background: Serum human chorionic gonadotrophin (hCG) is higher in twin than that in singleton pregnancies. As hCG stimulates the thyroid to produce more free thyroxine (FT4), which may lead to decreased thyroid-stimulating hormone (TSH) levels, the reference ranges of thyroid-related indicators may differ between singleton and twin pregnancies in the first trimester. This study aimed to establish reference ranges for thyroid-related indicators in early twin pregnancies and to compare them with singleton pregnancies. Methods: Data of 820 twin-pregnant women were extracted from the established database of all pregnant women who delivered at Peking University First Hospital from October 2013 to May 2018;160 who met National Academy of Clinical Biochemistry criteria were included to establish TSH and FT4 reference ranges. We screened 480 (3:1 paired) women with singleton pregnancies from the same database as controls. The Mann-Whitney test for TSH and FT4 levels was applied for comparisons between singleton and twin pregnancies. Results: First-trimester reference ranges (4–12 gestational weeks) for twin pregnancies were: TSH 0.69 (0.01–3.35) mIU/L and FT4 16.38 (12.45–23.34) pmol/L. Median TSH was significantly lower at 7 to 12 gestational weeks than that at 4 to 6 gestational weeks (0.62 vs. 0.96 mIU/L, Z =-1.964, P = 0.049);FT4 was not significantly different between the two groups. Compared to singleton pregnancies, median TSH was significantly lower (0.69 vs. 1.27 mIU/L, Z =-6.538, P = 0.000), and FT4 was significantly higher (16.38 vs. 14.85 pmol/L, Z =-7.399, P = 0.000) in twin pregnancies in the first trimester. Conclusions: Specific reference ranges for thyroid-related indicators for twin pregnancies are needed to avoid a misdiagnosis of thyroid dysfunction. Moreover, establishment of separate reference ranges for 4 to 6 and 7 to 12 gestational weeks in twin pregnancies may be considered.展开更多
Background： The reports on massive transfusions （MTs） in obstetrics have recently been an increasing trend. We aimed to define the clinical features, risk factors, main causes, and outcomes of MTs due to severe pos...Background： The reports on massive transfusions （MTs） in obstetrics have recently been an increasing trend. We aimed to define the clinical features, risk factors, main causes, and outcomes of MTs due to severe postpartum hemorrhage （PPH） and the frequency trends over the past 10 years. Methods： We retrospectively analyzed the data of 3552 PPH patients who were at ≥28 weeks of gestation in the Obstetric Department of Peking University First Hospital from January 2006 to February 2015. The clinical records of patients receiving MT with ≥5 units （approximately 1000 ml） of red blood cells within 24 h of giving birth were included. The Pearson＇s Chi-square and Fisher＇s exact tests were used to compare the frequency distributions among the categorical variables of the clinical features. Results： One-hundred six women were identified with MT over the 10-year period. The MT percentage was stable between the first 5-year group （2006-2010） and the second 5-year group （2011-2015） （2.5‰ vs. 2.7‰, χ^2 = 154.85, P = 0.25）. Although uterine atony remained the main cause of MT, there was a rising trend for placental abnormalities （especially placenta accreta） in the second 5-year group compared with the first 5-year group （34% vs. 23%, χ^2 = 188.26, P = 0.03）. Twenty-four （23%） women underwent hysterectomy, and among all the causes of PPH, placenta accreta had the highest hysterectomy rate of 70% （17/24）. No maternal death was observed. Conclusions： There was a rising trend for placental abnormalities underlying the stable incidence of MT in the PPH cases. Placenta accreta accounted for the highest risk of hysterectomy. It is reasonable to have appropriate blood transfusion backup for high-risk patients, especially those with placenta accreta.展开更多
Background： The endometriosis fertility index （EFI） has a predictive value for pregnancy after surgery. In vitro fertilization and embryo transfer （IVF-ET） is a good treatment to infertility. This study aimed to ...Background： The endometriosis fertility index （EFI） has a predictive value for pregnancy after surgery. In vitro fertilization and embryo transfer （IVF-ET） is a good treatment to infertility. This study aimed to provide external validation of EFI, assess the factors affecting the ability of EFI to predict cumulative spontaneous pregnancy rates （PRs）, and propose reasonable advice for treatment by evaluating the effect of infertility management combining surgery and IVF-ET. Methods： This retrospective study enrolled 345 endometriosis-related infertile women after laparoscopic surgery from January 2012 to January 2016. Among them, 234 patients tried to conceive naturally and were divided into six groups according to their different EFI scores. Of the 345 patients, 307 with an EFI score 〉5 were divided into non-IVF-ET group （n = 209） and IVE-ET group （n = 98） to compare the cumulative PRs. Cumulative PRs＇ curves were calculated using the Kaplan-Meier product limit estimate and the differences were evaluated by log-rank test. Independent predictive factors for pregnancy were assessed using the Cox regression model. Results： Significant differences in spontaneous PRs among different EFI scores were identified （χ2 = 29.945, P 〈 0.05）. The least function score was proved to be the most important factor for EFI （χ2 = 6.931, P 〈 0.05） staging system. In patients with an EFI score ≥5 after 12 months from surgery, the cumulative PRs of those who received both surgery and IVF-ET were much higher than the spontaneous PRs of those who received surgery alone （χ2 =4.160, P = 0.041）. Conclusions： The EFI is a reliable staging system to predict the spontaneous PR of patients. The least function score was the most influential factor to predict the spontaneous PR. Patients with an EFI score ≥5 after 12 months from surgery are recommended to receive IVF-ET to achieve a higher PR.展开更多
Background： The cesarean section rate （CSR） bas been a main concern worldwide. The present study aimed to investigate the CSR in Beijing, China, and to analyze the related lactors of CS delivery. Methods： An obser...Background： The cesarean section rate （CSR） bas been a main concern worldwide. The present study aimed to investigate the CSR in Beijing, China, and to analyze the related lactors of CS delivery. Methods： An observational study was conducted in 15 medical centers in Beijing using a systemic cluster sampling naethod. In total, 15, 194 pregnancies were enrolled in the study between ,lune 20, 2013 and November 30, 2013. Independent t-tests and Pearson＇s Chi-square test were nsed to examine differences between two groups, and related factors of the CSR were examined by multivariable logistic regression. Results： The CSR was 41.9% （4471/10,671） in singleton primiparae. Women who were more than 35 years old had a 7.4-fold increased risk of CS delivery compared with women 〈25 years old （odd ratio [OR] 7.388, 95% confidence interval [Cl] = 5.561-9.816, P 〈 0.001 ）. Prepregnancy obese women had a 2-1bid increased risk of CS delivery compared with prepregnancy normal weight women （OR = 2.058. 95% CI = 1.640-2.584, P〈 0.001 ）. The excessive weight gain group had a 1.4-fold increased risk of CS delivery compared with the adequate weight gain group （OR 1.422, 95% CI = 1.289 1.568, P〈 0.001 ）. Gestational diabetes mellitus （GDM） women and DM women had an increased risk of CS delivery （ 1.2- and 1.7-fold, respectively） compared with normal blood glucose women. Women who were born in rural areas had a lower risk of CS delivery than did those who were born in urban areas （OR 0.696, 95% CI = 0.625-0.775, P 〈 0.001 ）. The risk of CS delivery gradually increased with a decreasing education level. Neonates weighing 3000-3499 g had the lowest CSR （36.2%）. Neonates weighing 〈2500 g had a 2-fold increased risk of CS delivery compared with neonates weighing 3000 3499 g （OR - 2.020, 95% CI=1.537 2.656, P 〈 0.001 ）. Neonates weighing ≥4500 g had an 8.3-fold increased risk of CS delivery compared with neonates weighing 3000-3499 g （OR = 8.313.95% CI= 4.436-15.579, P 〈 0.001）. Conclusions： Maternal age, prepregnancy body mass index, geslational weight gain, blood glncose levels, residence, education level, and singleton fetal birth weight arc all factors that might significantly affect the CSR.展开更多
Objective:To compare the adverse maternal and neonatal outcomes of multiple pregnancy and singleton pregnancy from multiple medical centers in Beijing.Methods:Data concerning maternal and neonatal adverse outcomes in ...Objective:To compare the adverse maternal and neonatal outcomes of multiple pregnancy and singleton pregnancy from multiple medical centers in Beijing.Methods:Data concerning maternal and neonatal adverse outcomes in multiple and singleton pregnancies were collected from 15 hospitals in Beijing by a systemic cluster sampling survey conducted from 20 June to 30 November 2013.The SPSS software (version 20.0) was used for data analysis.The x2 test was used tbr statistical analyses.Results:The rate of caesarean deliveries was much higher in women with multiple pregnancies (85.8％) than that in women with singleton pregnancies (42.6％,X2 =190.8,P ＜ 0.001).The incidences of anemia (X2 =40.023,P ＜ 0.001),preterm labor (X2 =1021.172,P ＜ 0.001),gestational diabetes mellitus (X2 =9.311,P ＜ 0.01),hypertensive disorders (X2 =122.708,P ＜ 0.001)and post-partum hemorrhage (X2-48.550,P ＜ 0.001) was significantly increased with multiple pregnancy.In addition,multiple pregnancy was associated with a significantly higher rate of small-for-gestational-age infants (X2 =92.602,P ＜ 0.001),low birth weight (X2 =1141.713,P ＜ 0.001),and neonatal intensive care unit (NICU) admission (X2 =340.129,P＜ 0.001).Conclusions:Multiple pregnancy is a significant risk factor for adverse maternal and neonatal outcomes in Beijing.Improving obstetric care for multiple pregnancy,particularly in reducing preterm labor,is required to reduce the risk to mothers and infants.展开更多
Gestational diabetes mellitus (GDM) refers to diabetes diagnosed in the second or third trimester of pregnancy that is not clearly either type 1 or type 2 diabetes. GDM is a common medical complication in pregnancy th...Gestational diabetes mellitus (GDM) refers to diabetes diagnosed in the second or third trimester of pregnancy that is not clearly either type 1 or type 2 diabetes. GDM is a common medical complication in pregnancy that has been rapidly increasing worldwide. GDM is associated with both short-and long-term health issues for both mothers and offspring. Consistent with type 2 diabetes, peripheral insulin resistance contributes to the hyperglycemia associated with GDM. Accordingly, it is important to identify strategies to reduce the insulin resistance associated with GDM. To date, observational studies have shown that exercise can be a non-invasive therapeutic option for preventing and managing GDM that can be readily applied to the antenatal population. However, the relevant mechanisms for these outcomes are yet to be fully elucidated. The present review aimed to explain the potential mechanisms of exercise from the perspective of reducing the insulin resistance, which is the root cause of GDM. Exercise recommendations and opinions of exercise during pregnancy are briefly summarized.展开更多
Gestational diabetes mellitus(GDM)manifests as different degrees of carbohydrate intolerance during pregnancy.According to several studies,GDM affects 4%to 25%of pregnant women.The majority of patients with GDM have v...Gestational diabetes mellitus(GDM)manifests as different degrees of carbohydrate intolerance during pregnancy.According to several studies,GDM affects 4%to 25%of pregnant women.The majority of patients with GDM have varying levels of insulin resistance and chronic low-grade inflammation,which are related to vascular injury and dysfunction and subsequent platelet activation.[1]Consequently,platelet activation may be closely related to GDM severity.The mean platelet volume(MPV)is one of the indexes used to evaluate platelet morphology and activity.An elevated MPV has been demonstrated to be related to cardiovascular diseases and other conditions,such as hypertension and nonalcoholic fatty liver disease.展开更多
To the Editor:In recent years,as marriage and childbearing have been delayed,the ages of primiparous women have,in general,increased.In addition,with changes in the dietary habits of pregnant women,the body mass index...To the Editor:In recent years,as marriage and childbearing have been delayed,the ages of primiparous women have,in general,increased.In addition,with changes in the dietary habits of pregnant women,the body mass index (BMI)during pregnancy,and birth weight of newborns have also increased.A retrospective multi-center study demonstrated the effects of obstetric characteristics (increased maternal age and the BMI)and clinical treatment (labor induction and painless delivery)on labor duration:cervical dilatation was slower than that described previously,especially during cervical dilatation of 4 to 6 cm.This new information on labor duration could provide new research directions pre-pregnancy.That is, whether the BMI can become an indicator of the optimization and management of labor duration.This research aimed to assess the effects of pre-pregnancy body mass index (BMI)and gestational weight gain (GWG)on primipara duration of labor.展开更多
Hyperglycemia in pregnancy is one of the most common pregnancy disorders, including gestational diabetes mellitus （GDM） and diabetes in pregnancy （DIP）. Either preexisting diabetes （Type I or Type II） which ante...Hyperglycemia in pregnancy is one of the most common pregnancy disorders, including gestational diabetes mellitus （GDM） and diabetes in pregnancy （DIP）. Either preexisting diabetes （Type I or Type II） which antedates pregnancy or is first detected during pregnancy, it is associated with adverse outcomes both in mother and child, not only for the short-term consequences but also for the long-term consequences. During the past few decades, some progress has been achieved in the management in hyperglycemia in pregnancy, and severe complications of mothers and offspring were significantly reduced.展开更多
Objective: The study was to examine whether gestational diabetes mellitus (GDM) can be prevented by early trimester lifestyle counseling in a high-risk population.Methods: From September 2012 to January 2013, 1664 pre...Objective: The study was to examine whether gestational diabetes mellitus (GDM) can be prevented by early trimester lifestyle counseling in a high-risk population.Methods: From September 2012 to January 2013, 1664 pregnancies in the Department of Obstetrics and Gynecology of First Hospital of Peking University were enrolled in the study during their first prenatal care visit before the 8 gestational weeks visit and asked to fill out a questionnaire on GDM risk evaluation.According to the questionnaire and medical records, those with at least one risk factor of GDM were included in the intervention study and randomly allocated to two groups, intervention group and control group.Routine prenatal care was offered, while standardized two-step lifestyle intervention was provided to the intervention group during 6-8 gestational weeks, and at 12-13 gestational weeks, enforcement intervention based on maternal anthropometrics were offered.Both groups were followed until 75 g oral glucose tolerance test (OGTT) testing at 24-28 gestational weeks.The weight gain after intervention and the prevalence of GDM were used to evaluate the effect.Results: (1) According to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, the positive rate of GDM for the intervention group was 17.16％ (23/134), lower than the control group which was 23.91％ (33/138), P =0.168.(2) The weight gain during the first and second trimester for the intervention group was (1.38 ± 2.34) kg and (5.51 ± 2.18) kg, lower than in the control group which was (1.41 ± 2.58) kg and (5.66 ± 2.25) kg, (P =0.905, P =0.567).(3) Positive rate of GDM for those fasting plasma glucose (FPG) ≥5.1 mmol/L during early pregnancy was 11/36 (30.55％) for the intervention group that was lower than 17/37 (45.95％) for the control group, but the statistical difference was not significant (P =0.076).Conclusion: The positive rate of GDM could be reduced by a certain amount lifestyle intervention from the beginning of pregnancy.More validated effective intervention should be explored in the high-risk pregnant women.Copyright 2015, Chinese Medical Association Production.Production and hosting by Elsevier B.V.on behalf of KeAi Communications Co., Ltd.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).展开更多
文摘BACKGROUND Neonatal hyperinsulinism can result from perinatal stress,genetic disorders,or syndromes,which can lead to persistent or intractable hypoglycemia in newborns.Mutations in the ABCC8 gene result in abnormal functioning of potassium channel proteins in pancreaticβ-cells,leading to an overproduction of insulin and congenital hyperinsulinemia.CASE SUMMARY We report a case of a high-birth-weight infant with postnatal hypoglycemia and hyperinsulinemia,whose mother had pregestational diabetes mellitus with poor glycemic control and whose sister had a similar history at birth.Whole-exome sequencing revealed a new mutation in the ABCC8 gene in exon 8(c.1257T>G),which also occurred in his sister and mother;thus,the patient was diagnosed with neonatal hyperinsulinism with an ABCC8 mutation.With oral diazoxide treatment,the child’s blood glucose returned to normal,and the pediatrician gradually discontinued treatment because of the child’s good growth and development.CONCLUSION We report a new mutation locus in the ABCC8 gene.This mutation locus warrants attention for genetic disorders and long-term prognoses of hypoglycemic children.
文摘BACKGROUND Chronic kidney disease(CKD)affects almost 3%of females of child-bearing age,who have a high risk of adverse maternal and fetal outcomes.Additionally,high renal burden as a result of pregnancy may lead to deterioration of renal function.An increasing number of women with CKD stages 3 to 5 have a strong desire to conceive,and both obstetricians and nephrologists are faced with enormous challenges in terms of their treatment and management.CASE SUMMARY The case of a 35-year-old pregnant woman with a 10-year history of mild mesangial proliferative glomerulonephritis is described here.CKD progressed from stage 3 to stage 5 rapidly during pregnancy,and protective hemodialysis was started at 28 wk of gestation.Due to preeclampsia at 34 wk of gestation,cesarean section was performed and a healthy baby was delivered.Hemodialysis was discontinued at 4 wk postpartum.After 1 year of follow-up,her renal function was stable,and her baby exhibited good growth and development.CONCLUSION Protective hemodialysis during pregnancy can prolong gestational age and improve maternal and fetal outcomes in women with advanced CKD.
文摘BACKGROUND Uterine myoma is the most common benign tumor among women and is often accompanied by anemia.Here,we report the case of a patient with a very large leiomyoma but with a hemoglobin level as high as 197 g/L.After undergoing hysterectomy,all her hematological parameters returned to normal.Immunohistochemical staining of her myoma for erythropoietin showed strong positivity,which suggested that erythropoietin may be the cause of her erythrocytosis.A multidisciplinary team played a significant role in treating the disease.CASE SUMMARY A 47-year-old woman visited our department complaining that her abdomen had been continuously growing for the past 2 years.After careful examinations,she was suspected of having a very large leiomyoma.She was also diagnosed with erythrocytosis because her RBC count was 6.49×10^(12)/L,hemoglobin was 197 g/L.Following a multidisciplinary team consultation,bilateral ureteral stents were placed,and 800 m L blood was removed by phlebotomy.The patient then underwent hysterectomy and bilateral salpingectomy.She recovered well from the operation,and her hemoglobin level decreased sharply following the surgery.Low-molecular-weight heparin was administered daily to prevent postoperative thrombosis.She was discharged from the hospital on the fourth postoperative day.Two months later,all her hematological parameters returned to normal.Pathological analysis of the myoma revealed that it was a benign leiomyoma,with partial hyalinization,and strong positivity for erythropoietin in immunohistochemical staining suggested that erythropoietin may be responsible for the erythrocytosis.CONCLUSION Erythropoietin ectopically produced from the myoma was responsible for the erythrocytosis in this patient.A multidisciplinary team is strongly recommended.
文摘BACKGROUND Cervical squamous cell carcinoma(SCC)is the most common type of cervical carcinoma and is generally derived from a precancerous stage called cervical high-grade squamous intraepithelial lesion(HSIL).Usually,the cancer metastasizes through lymphatic or hematogenous dissemination,but rarely spreads upward into the uterus.Here,we report a case of cervical HSIL extending into the endometrium and finally progressing to SCC in the uterine cavity.CASE SUMMARY A 57-year-old postmenopausal woman visited our department and requested a routine cervical check-up.Four years ago,she had undergone a cervical loop electrosurgical excision procedure because of HSIL found during the gynecological examination,and she had not been checked again since.This time,a relapse of the cervical HSIL was diagnosed along with uterine pyometra and endometrial polyps.After 2 wk of antibiotic treatment,a laparoscopic hysterectomy was performed,and the final pathological examination revealed that the cervical HSIL had spread directly upward into the uterine cavity,gradually developing into cervical SCC in the endometrium.CONCLUSION Cervical HSIL/SCC can directly spread upward into the uterus with the most common symptoms of pyometra and cervical stenosis.More attention should be given to the early detection and prevention of this disease.
文摘BACKGROUND A population-based comparative study in United States shows that the prevalence and incidence of autoimmune encephalitis are comparable to those of infectious encephalitis and its detection is increasing over time.Some patients are complicated with ovarian teratoma.The younger the patient is,the less likely a tumor will be present.CASE SUMMARY This case report describes the successful treatment of anti-N-methyl-D-aspartatereceptor(NMDAR)encephalitis by early laparoscopic ovarian cystectomy and immunotherapy in a 4-year-old female child.And to the best of our knowledge,this detailed case report describes the youngest patient to date with anti-NMDAR encephalitis who underwent laparoscopic ovarian cystectomy.CONCLUSION Although the younger the patient is,the less likely a tumor will be detected,we still emphasize that all patients with suspected or confirmed anti-NMDAR encephalitis should be screened for ovarian tumors if possible.Prompt initiation of immunotherapy and tumor removal are crucial for good outcomes.
基金supported by the National Key R&D Program of China(2023YFB3611700)the National Natural Science Foundation of China(92163206,62101044,12321004)。
文摘Gallium oxide(Ga_(2)O_(3)),a novel ultrawide-bandgap(UWBG)semiconductor,has attracted considerable attention owing to its large bandgap of up to 4.9 eV,a high breakdown electric field of 8 MV/cm,and a high Baliga's figure of merit exceeding 3000[1,2].These remarkable properties strongly support its potential applications in power electronics,extreme environmentresistance devices,and solar-blind detectors[1–3].
文摘Background： Hyperglycemia is associated with adverse pregnancy outcomes. However, the relationships between them remain ambiguous. This study aimed to analyze the effect of different oral glucose tolerance test （OGTT） results on adverse perinatal outcomes. Methods： This retrospective cohort study included data from 15 hospitals in Beijing from June 20, 2013 to November 30, 2013. Women with gestational diabetes mellitus （GDM） were categorized according to the number and distribution of abnormal OGTT values, and the characteristics of adverse pregnancy outcomes were evaluated. Chi-square test and logistic regression analysis were used to determine the associations. Results： in total, 14,741 pregnant women were included in the study population, 2927 （19.86%） of whom had G DM. As the number of hyperglycemic values in the OGTT increased, the risk of cesarean delivery, preterm births, large-for-gestational age （LGA）, macrosomia, and neonatal complications significantly increased. Fasting hyperglycemia bad clear associations with macrosomia （odds ratios [ORs]：1.84, 95% confidence intervals [CIs]： 1.39-2.42, P 〈 0.001）, L（SA （OR： 1.70, 95% CI： 1.29-2.25. P 〈 0.001）, and cesarean delivery （OR： 1.33, 95% CI： 1.15-1.55, P 〈 0.001）. The associations were stronger as tasting glucose increased. GDM diagnosed by hyperglycemia at OGTT-2 h was more likely to lead to preterm birth （OR： 1.50, 95% Cl： 1. 11-2.03, P 〈 0.01）. Conclusions： Various characteristics of OGTTs are associated with different adverse outcomes. A careful reconsideration ofGDM wiih hierarchical and individualized management according to OGTT characteristics is needed.
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:Gestational diabetes mellitus(GDM)is usually diagnosed between 24th and 28th gestational week using the 75-g oral glucose tolerance test(OGTT).It is difficult to predict GDM before 24th gestational week because fast plasma glucose(FPG)decreases as the gestational age increases.It is controversial that if FPG≥5.1 mmol/L before 24th gestational week should be intervened or not.The aim of this study was to evaluate the value of FPG to screen GDM before 24th gestational week in women with different pre-pregnancy body mass index(BMI).Methods:This was a multi-region retrospective cohort study in China.Women who had a singleton live birth between June 20,2013 and November 30,2014,resided in Beijing,Guangzhou and Chengdu,and received prenatal care in 21 selected hospitals,were included in this study.Pre-pregnancy BMI,FPG before the 24th gestational week,and one-step GDM screening with 75 g-OGTT at the 24th to 28th gestational weeks were extracted from medical charts and analyzed.The pregnant women were classified into four groups based on pre-pregnancy BMI:Group A(underweight,BMI<18.5 kg/m^2),Group B(normal,BMI 18.5-23.9 kg/m^2),Group C(overweight,BMI 24.0-27.9 kg/m^2)and Group D(obesity,BMI≥28.0 kg/m^2).The trend of FPG before 24th week of gestation was described,and the sensitivity and specificity of using FPG before the 24th gestational week to diagnose GDM among different pre-pregnancy BMI groups were reported.Differences in the means between groups were evaluated using independent sample t-test and analysis of variance.Pearson Chi-square test was used for categorical variables.Results:The prevalence of GDM was 20.0%(6806/34,087)in the study population.FPG decreased gradually as the gestational age increased in all pre-pregnancy BMI groups until the 19th gestational week.FPG was higher in women with higher pre-pregnancy BMI.FPG before the 24th gestational week and pre-pregnancy BMI could be used to predict GDM.The incidence of GDM in women with FPG≥5.10 mmol/L in the 19th to 24th gestational weeks and pre-pregnancy overweight or obesity was significantly higher than that in women with FPG≥5.10 mmol/L and pre-pregnancy BMI<24.0 kg/m^2(78.5%[62/79]vs.52.9%[64/121],χ^2=13.425,P<0.001).Conclusions:FPG decreased gradually as the gestational age increased in all pre-pregnancy BMI groups until the 19th gestational week.Pre-pregnancy overweight or obesity was associated with an increased FPG value before the 24th gestational week.FPG≥5.10 mmol/L between 19 and 24 gestational weeks should be treated as GDM in women with pre-pregnancy overweight and obesity.
文摘Background: Serum human chorionic gonadotrophin (hCG) is higher in twin than that in singleton pregnancies. As hCG stimulates the thyroid to produce more free thyroxine (FT4), which may lead to decreased thyroid-stimulating hormone (TSH) levels, the reference ranges of thyroid-related indicators may differ between singleton and twin pregnancies in the first trimester. This study aimed to establish reference ranges for thyroid-related indicators in early twin pregnancies and to compare them with singleton pregnancies. Methods: Data of 820 twin-pregnant women were extracted from the established database of all pregnant women who delivered at Peking University First Hospital from October 2013 to May 2018;160 who met National Academy of Clinical Biochemistry criteria were included to establish TSH and FT4 reference ranges. We screened 480 (3:1 paired) women with singleton pregnancies from the same database as controls. The Mann-Whitney test for TSH and FT4 levels was applied for comparisons between singleton and twin pregnancies. Results: First-trimester reference ranges (4–12 gestational weeks) for twin pregnancies were: TSH 0.69 (0.01–3.35) mIU/L and FT4 16.38 (12.45–23.34) pmol/L. Median TSH was significantly lower at 7 to 12 gestational weeks than that at 4 to 6 gestational weeks (0.62 vs. 0.96 mIU/L, Z =-1.964, P = 0.049);FT4 was not significantly different between the two groups. Compared to singleton pregnancies, median TSH was significantly lower (0.69 vs. 1.27 mIU/L, Z =-6.538, P = 0.000), and FT4 was significantly higher (16.38 vs. 14.85 pmol/L, Z =-7.399, P = 0.000) in twin pregnancies in the first trimester. Conclusions: Specific reference ranges for thyroid-related indicators for twin pregnancies are needed to avoid a misdiagnosis of thyroid dysfunction. Moreover, establishment of separate reference ranges for 4 to 6 and 7 to 12 gestational weeks in twin pregnancies may be considered.
文摘Background： The reports on massive transfusions （MTs） in obstetrics have recently been an increasing trend. We aimed to define the clinical features, risk factors, main causes, and outcomes of MTs due to severe postpartum hemorrhage （PPH） and the frequency trends over the past 10 years. Methods： We retrospectively analyzed the data of 3552 PPH patients who were at ≥28 weeks of gestation in the Obstetric Department of Peking University First Hospital from January 2006 to February 2015. The clinical records of patients receiving MT with ≥5 units （approximately 1000 ml） of red blood cells within 24 h of giving birth were included. The Pearson＇s Chi-square and Fisher＇s exact tests were used to compare the frequency distributions among the categorical variables of the clinical features. Results： One-hundred six women were identified with MT over the 10-year period. The MT percentage was stable between the first 5-year group （2006-2010） and the second 5-year group （2011-2015） （2.5‰ vs. 2.7‰, χ^2 = 154.85, P = 0.25）. Although uterine atony remained the main cause of MT, there was a rising trend for placental abnormalities （especially placenta accreta） in the second 5-year group compared with the first 5-year group （34% vs. 23%, χ^2 = 188.26, P = 0.03）. Twenty-four （23%） women underwent hysterectomy, and among all the causes of PPH, placenta accreta had the highest hysterectomy rate of 70% （17/24）. No maternal death was observed. Conclusions： There was a rising trend for placental abnormalities underlying the stable incidence of MT in the PPH cases. Placenta accreta accounted for the highest risk of hysterectomy. It is reasonable to have appropriate blood transfusion backup for high-risk patients, especially those with placenta accreta.
基金This work was supported by a grant from the National Natural Science Foundation of China （No. 81671427）.
文摘Background： The endometriosis fertility index （EFI） has a predictive value for pregnancy after surgery. In vitro fertilization and embryo transfer （IVF-ET） is a good treatment to infertility. This study aimed to provide external validation of EFI, assess the factors affecting the ability of EFI to predict cumulative spontaneous pregnancy rates （PRs）, and propose reasonable advice for treatment by evaluating the effect of infertility management combining surgery and IVF-ET. Methods： This retrospective study enrolled 345 endometriosis-related infertile women after laparoscopic surgery from January 2012 to January 2016. Among them, 234 patients tried to conceive naturally and were divided into six groups according to their different EFI scores. Of the 345 patients, 307 with an EFI score 〉5 were divided into non-IVF-ET group （n = 209） and IVE-ET group （n = 98） to compare the cumulative PRs. Cumulative PRs＇ curves were calculated using the Kaplan-Meier product limit estimate and the differences were evaluated by log-rank test. Independent predictive factors for pregnancy were assessed using the Cox regression model. Results： Significant differences in spontaneous PRs among different EFI scores were identified （χ2 = 29.945, P 〈 0.05）. The least function score was proved to be the most important factor for EFI （χ2 = 6.931, P 〈 0.05） staging system. In patients with an EFI score ≥5 after 12 months from surgery, the cumulative PRs of those who received both surgery and IVF-ET were much higher than the spontaneous PRs of those who received surgery alone （χ2 =4.160, P = 0.041）. Conclusions： The EFI is a reliable staging system to predict the spontaneous PR of patients. The least function score was the most influential factor to predict the spontaneous PR. Patients with an EFI score ≥5 after 12 months from surgery are recommended to receive IVF-ET to achieve a higher PR.
文摘Background： The cesarean section rate （CSR） bas been a main concern worldwide. The present study aimed to investigate the CSR in Beijing, China, and to analyze the related lactors of CS delivery. Methods： An observational study was conducted in 15 medical centers in Beijing using a systemic cluster sampling naethod. In total, 15, 194 pregnancies were enrolled in the study between ,lune 20, 2013 and November 30, 2013. Independent t-tests and Pearson＇s Chi-square test were nsed to examine differences between two groups, and related factors of the CSR were examined by multivariable logistic regression. Results： The CSR was 41.9% （4471/10,671） in singleton primiparae. Women who were more than 35 years old had a 7.4-fold increased risk of CS delivery compared with women 〈25 years old （odd ratio [OR] 7.388, 95% confidence interval [Cl] = 5.561-9.816, P 〈 0.001 ）. Prepregnancy obese women had a 2-1bid increased risk of CS delivery compared with prepregnancy normal weight women （OR = 2.058. 95% CI = 1.640-2.584, P〈 0.001 ）. The excessive weight gain group had a 1.4-fold increased risk of CS delivery compared with the adequate weight gain group （OR 1.422, 95% CI = 1.289 1.568, P〈 0.001 ）. Gestational diabetes mellitus （GDM） women and DM women had an increased risk of CS delivery （ 1.2- and 1.7-fold, respectively） compared with normal blood glucose women. Women who were born in rural areas had a lower risk of CS delivery than did those who were born in urban areas （OR 0.696, 95% CI = 0.625-0.775, P 〈 0.001 ）. The risk of CS delivery gradually increased with a decreasing education level. Neonates weighing 3000-3499 g had the lowest CSR （36.2%）. Neonates weighing 〈2500 g had a 2-fold increased risk of CS delivery compared with neonates weighing 3000 3499 g （OR - 2.020, 95% CI=1.537 2.656, P 〈 0.001 ）. Neonates weighing ≥4500 g had an 8.3-fold increased risk of CS delivery compared with neonates weighing 3000-3499 g （OR = 8.313.95% CI= 4.436-15.579, P 〈 0.001）. Conclusions： Maternal age, prepregnancy body mass index, geslational weight gain, blood glncose levels, residence, education level, and singleton fetal birth weight arc all factors that might significantly affect the CSR.
文摘Objective:To compare the adverse maternal and neonatal outcomes of multiple pregnancy and singleton pregnancy from multiple medical centers in Beijing.Methods:Data concerning maternal and neonatal adverse outcomes in multiple and singleton pregnancies were collected from 15 hospitals in Beijing by a systemic cluster sampling survey conducted from 20 June to 30 November 2013.The SPSS software (version 20.0) was used for data analysis.The x2 test was used tbr statistical analyses.Results:The rate of caesarean deliveries was much higher in women with multiple pregnancies (85.8％) than that in women with singleton pregnancies (42.6％,X2 =190.8,P ＜ 0.001).The incidences of anemia (X2 =40.023,P ＜ 0.001),preterm labor (X2 =1021.172,P ＜ 0.001),gestational diabetes mellitus (X2 =9.311,P ＜ 0.01),hypertensive disorders (X2 =122.708,P ＜ 0.001)and post-partum hemorrhage (X2-48.550,P ＜ 0.001) was significantly increased with multiple pregnancy.In addition,multiple pregnancy was associated with a significantly higher rate of small-for-gestational-age infants (X2 =92.602,P ＜ 0.001),low birth weight (X2 =1141.713,P ＜ 0.001),and neonatal intensive care unit (NICU) admission (X2 =340.129,P＜ 0.001).Conclusions:Multiple pregnancy is a significant risk factor for adverse maternal and neonatal outcomes in Beijing.Improving obstetric care for multiple pregnancy,particularly in reducing preterm labor,is required to reduce the risk to mothers and infants.
文摘Gestational diabetes mellitus (GDM) refers to diabetes diagnosed in the second or third trimester of pregnancy that is not clearly either type 1 or type 2 diabetes. GDM is a common medical complication in pregnancy that has been rapidly increasing worldwide. GDM is associated with both short-and long-term health issues for both mothers and offspring. Consistent with type 2 diabetes, peripheral insulin resistance contributes to the hyperglycemia associated with GDM. Accordingly, it is important to identify strategies to reduce the insulin resistance associated with GDM. To date, observational studies have shown that exercise can be a non-invasive therapeutic option for preventing and managing GDM that can be readily applied to the antenatal population. However, the relevant mechanisms for these outcomes are yet to be fully elucidated. The present review aimed to explain the potential mechanisms of exercise from the perspective of reducing the insulin resistance, which is the root cause of GDM. Exercise recommendations and opinions of exercise during pregnancy are briefly summarized.
文摘Gestational diabetes mellitus(GDM)manifests as different degrees of carbohydrate intolerance during pregnancy.According to several studies,GDM affects 4%to 25%of pregnant women.The majority of patients with GDM have varying levels of insulin resistance and chronic low-grade inflammation,which are related to vascular injury and dysfunction and subsequent platelet activation.[1]Consequently,platelet activation may be closely related to GDM severity.The mean platelet volume(MPV)is one of the indexes used to evaluate platelet morphology and activity.An elevated MPV has been demonstrated to be related to cardiovascular diseases and other conditions,such as hypertension and nonalcoholic fatty liver disease.
文摘To the Editor:In recent years,as marriage and childbearing have been delayed,the ages of primiparous women have,in general,increased.In addition,with changes in the dietary habits of pregnant women,the body mass index (BMI)during pregnancy,and birth weight of newborns have also increased.A retrospective multi-center study demonstrated the effects of obstetric characteristics (increased maternal age and the BMI)and clinical treatment (labor induction and painless delivery)on labor duration:cervical dilatation was slower than that described previously,especially during cervical dilatation of 4 to 6 cm.This new information on labor duration could provide new research directions pre-pregnancy.That is, whether the BMI can become an indicator of the optimization and management of labor duration.This research aimed to assess the effects of pre-pregnancy body mass index (BMI)and gestational weight gain (GWG)on primipara duration of labor.
文摘Hyperglycemia in pregnancy is one of the most common pregnancy disorders, including gestational diabetes mellitus （GDM） and diabetes in pregnancy （DIP）. Either preexisting diabetes （Type I or Type II） which antedates pregnancy or is first detected during pregnancy, it is associated with adverse outcomes both in mother and child, not only for the short-term consequences but also for the long-term consequences. During the past few decades, some progress has been achieved in the management in hyperglycemia in pregnancy, and severe complications of mothers and offspring were significantly reduced.
文摘Objective: The study was to examine whether gestational diabetes mellitus (GDM) can be prevented by early trimester lifestyle counseling in a high-risk population.Methods: From September 2012 to January 2013, 1664 pregnancies in the Department of Obstetrics and Gynecology of First Hospital of Peking University were enrolled in the study during their first prenatal care visit before the 8 gestational weeks visit and asked to fill out a questionnaire on GDM risk evaluation.According to the questionnaire and medical records, those with at least one risk factor of GDM were included in the intervention study and randomly allocated to two groups, intervention group and control group.Routine prenatal care was offered, while standardized two-step lifestyle intervention was provided to the intervention group during 6-8 gestational weeks, and at 12-13 gestational weeks, enforcement intervention based on maternal anthropometrics were offered.Both groups were followed until 75 g oral glucose tolerance test (OGTT) testing at 24-28 gestational weeks.The weight gain after intervention and the prevalence of GDM were used to evaluate the effect.Results: (1) According to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, the positive rate of GDM for the intervention group was 17.16％ (23/134), lower than the control group which was 23.91％ (33/138), P =0.168.(2) The weight gain during the first and second trimester for the intervention group was (1.38 ± 2.34) kg and (5.51 ± 2.18) kg, lower than in the control group which was (1.41 ± 2.58) kg and (5.66 ± 2.25) kg, (P =0.905, P =0.567).(3) Positive rate of GDM for those fasting plasma glucose (FPG) ≥5.1 mmol/L during early pregnancy was 11/36 (30.55％) for the intervention group that was lower than 17/37 (45.95％) for the control group, but the statistical difference was not significant (P =0.076).Conclusion: The positive rate of GDM could be reduced by a certain amount lifestyle intervention from the beginning of pregnancy.More validated effective intervention should be explored in the high-risk pregnant women.Copyright 2015, Chinese Medical Association Production.Production and hosting by Elsevier B.V.on behalf of KeAi Communications Co., Ltd.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).
