ObjectiveTo perform a meta-analysis on the positive rate of hepatitis C virus (HCV) antibody among pregnant females in China from 2008 to 2018, so as to provide scientific references for the prevention and treatment of HCV infection among pregnant females.MethodsDatabases including PubMed, Web of Science, SinoMed, CNKI, VIP, and WanFang Data were electronically searched to collect observational studies on the positive rate of HCV antibody among pregnant females in China from January, 2008 to December, 2018. Two reviewers independently screened literature, extracted data and evaluated risk of bias of included studies. Meta-analysis was then performed using Stata 15.0 software.ResultsA total of 108 studies involving 657 765 individuals were included. Results of meta-analysis showed that the overall positive rate of HCV antibody among pregnant females in Chinese was 0.235% (95%CI 0.189% to 0.286%). Subgroup analysis showed that the positive rate of HCV antibody among pregnant females in western China to be the highest 0.291% (95%CI 0.221% to 0.378%), the northeast China to be 0.240% (95%CI 0.099% to 0.442%), the central China to be 0.235% (95%CI 0.016% to 0.319%), and the east China to be the lowest 0.193 % (95%CI 0.119% to 0.281%). The HCV antibody positive rate of pregnant females from hospital was 0.291% (95%CI 0.221% to 0.372%) and was higher than that from AIDS surveillance site which was 0.164% (95%CI 0.122% to 0.207%).ConclusionsThe prevalence of HCV antibody among pregnant females maintains at a low level in China.
Objective To investigate the methodological characteristics of observational studies on the correlation between drug exposure during pregnancy and birth defects. Methods The PubMed database was searched from January 1, 2020 to December 31, 2020 to identify observational studies investigating the correlation between drug use during pregnancy and birth defects. Literature screening and data extraction were conducted by two researchers and statistical analysis was performed using R 3.6.1 software. Results A total of 40 relevant articles were identified, of which 8 (20.0%) were published in the four major medical journals and their sub-journals, 21 (42.5%) were conducted in Europe and the United States, and 4 were conducted (10.0%) in China. Cohort studies (30, 75.0%) and case-control studies (10, 25%) were the most commonly used study designs. Sixteen studies (40.0%) did not specify how the databases were linked. Sixteen studies (40.0%) did not report a clear definition of exposure, while 17 studies (42.5%) defined exposure as prescribing a drug that could not be guaranteed to have been taken by the pregnant women, possibly resulting in misclassification bias. Six studies (15.0%) did not report the diagnostic criteria for birth defects and 18 studies (45.0%) did not report the types of birth defects. In addition, 33 studies (82.5%) did not control for confounding factors in the study design, while only 19 studies (47.5%) considered live birth bias. Conclusion Improvements are imperative in reporting and conducting observational studies on the correlation between drug use during pregnancy and birth defects. This includes the methods for linking data sources, definition of exposure and outcomes, and control of confounding factors. Methodological criteria are needed to improve the quality of these studies to provide higher quality evidence for policymakers and researchers.
ObjectiveTo understand the distribution of demographic sociological characteristics and co-morbidities among primiparous and multiparous pregnant women under the China's universal two-child policy, to provide baseline data for clinical high-risk management and medical resources allocation.MethodsWe included pregnant women from 24 hospitals in 16 provinces (municipality, autonomous region) of China and collected their demographic sociological characteristics and obstetrics information by questionnaires between September 19th, and November 20th, 2016. Then, we used descriptive analysis to present the distribution of demographic sociological characteristics and pregnancy co-morbidities among primiparous and multiparous women and compared differences between groups by t test or Chi-square test.ResultsAmong 12 403 investigated pregnant women, 8 268 (66.7%) were primiparous and 4 135 (33.3%) were multiparous, with highest proportion in East (931/2 008, 46.4%) and lowest in Northeast (385/2 179, 17.7%). Multiparous women, comparing to primiparous women, were more likely to be elderly than 35 years (accounting for 30.6% vs. 6.5%), lower educated with high school or below (29.7% vs. 16.9%), occupied in physical labor or unemployed (49.2% vs. 42.5%), non-local residents (12.7% vs. 10.5%), family annual income higher than 120 thousand yuan (41.3% vs. 33.3%), pre-pregnancy body mass index≥24 kg/m2 (13.6% vs. 9.9%), history of artificial abortions (44.9% vs. 24.0%), or pregnancies≥4 times (23.8% vs. 3.1%) and were less likely to receive assisted reproductive technology (2.3% vs. 4.7%). The most common co-morbidities were gynecology disease (5.5%), thyroid disease (5.4% in all women), blood system disease (5.0%), digestive system disease (4.2%) and hepatitis B infection (2.5%). Multiparous women, comparing to primiparous women, had higher proportions with blood system disease (5.7% vs. 4.7%), hepatitis B infection (3.1% vs. 2.2%) and chronic hypertension (0.6% vs. 0.2%), but lower proportions with thyroid diseases, polycystic ovary syndrome, and immune system diseases, whose distribution also showed regional differences.ConclusionThere existed distribution differences regarding demographic sociological characteristics and co-morbidities proportions between primiparous and multiparous women. Therefore, we should improve clinical risk management and medical resources allocation based on pregnant women’s baseline and gestational characteristics.
Objective To provide evidence for establ ishing a health care system for pregnant women after disasters by evidence-based evaluation on the comparison of programs in different countries of the world. Methods We electronically searched The Cochrane Library (Issue 2, 2008), MEDLINE (1966 to June 2008), EMbase (1984 to June 2008), VIP ( 1989 to June 2008), CBM ( 1978 to June 2008), Wangfang database (1997 to June 2008), CNKI (1994 to June 2008) and handsearched Journals such as Chinese Journal of Obstetrics and Gynecology to identify l iteratures and guidel ines on pregnant women healthy care system after calamity. The qual ity of l iteratures and guidel ines was assessed. Results A total of 293 studies were searched, of which 25 studies were identified with the focuses on the consequence of pregnancy, development of fetus and first-aid of injuries of pregnant women. We found the studies on pregnant women’s health care were l imited, and most of them were retrospective and cohort studies, which was related to the paroxysmal ity, rarity and complexity of the disaster.? Conclusions The high proportion of pregnant women among displaced persons underscores the importance of examining how behavioral changes and difficulties in access to health care influencing the maternal and infant health, which needs comprehensive planning and arrangement.
ObjectiveTo compare and observe the changes in choroidal thickness between healthy pregnant women and healthy non-pregnant women.MethodsA prospective clinical study. From January 2019 to August 2019, healthy pregnant women (pregnant women group) and healthy non-pregnant women age-matched were enrolled during the same period (the normal group) in the obstetrics of Zhuji People's Hospital. All patients were enrolled with their right eyes. Frequency-domain OCT-enhanced depth imaging technology was used to measure the subfoveal macular and 1000 μm above, below, nasal, and temporal choroidal thickness and foveal retinal thickness (CMT). The choroidal thickness and CMT of the pregnant women group and the normal group were compared by t test, and the choroidal thickness and CMT of the normal group and the eyes of different gestational weeks were compared by one-way analysis of variance.ResultsThe pregnant women group and the normal group included 161 patients (161 eyes) and 40 patients (40 eyes). According to the different gestational weeks, the pregnant women were divided into the first trimester group, the second trimester group, and the third trimester group, with 47 patients (47 eyes), 66 patients (66 eyes), and 48 patients (48 eyes) respectively. There was no significant difference in age, axial length, intraocular pressure, and CMT between the different gestational week groups and the normal group (F=1.433, 1.558, 0.416, 2.288; P＞0.05). The subfoveal choroidal thickness (SFCT) of the pregnant women group and normal group were 317.7±73.9 μm and 279.7±44.1 μm, respectively, and the difference was statistically significant (t=3.113, P=0.002). Compared with the normal group, the choroid at the upper, lower, nasal, and temporal sides of the pregnant group 1000 μm from the fovea was thickened. The difference between the upper, nasal and temporal sides was statistically significant (t=2.699, 3.474, 2.595; P＜0.05). The SFCT of the eyes in the first trimester group, the middle group, and the late group were 305.8±72.3, 327.7±69.8, 315.8±80.5 μm, respectively. Compared with the normal group, the difference was statistically significant (F=4.180, P=0.007). Pairwise comparison between the two groups, the second trimester group was significantly different from the normal group (P=0.003). There was no significant difference among the first trimester group、the third trimester group and the other groups (P＞0.05).ConclusionThe choroidal thickness of pregnant women is thicker than normal, and the choroidal thickness in the second trimester reaches the maximum value; while the macular CMT during pregnancy has no significant change.
ObjectiveTo construct and verify the nomogram prediction model of pregnant women's fear of childbirth. MethodsA convenient sampling method was used to select 675 pregnant women in tertiary hospital in Tangshan City, Hebei Province from July to September 2022 as the modeling group, and 290 pregnant women in secondary hospital in Tangshan City from October to December 2022 as the verification group. The risk factors were determined by logistic regression analysis, and the nomogram was drawn by R 4.1.2 software. ResultsSix predictors were entered into the model: prenatal education, education level, depression, pregnancy complications, anxiety and preference for delivery mode. The areas under the ROC curves of the modeling group and the verification group were 0.834 and 0.806, respectively. The optimal critical values were 0.113 and 0.200, respectively, with sensitivities of 67.2% and 77.1%, the specificities were 87.3% and 74.0%, and the Jordan indices were 0.545 and 0.511, respectively. The calibration charts of the modeling group and the verification group showed that the coincidence degree between the actual curve and the ideal curve was good. The results of Hosmer-Lemeshow goodness of fit test were χ2=6.541 (P=0.685) and χ2=5.797 (P=0.760), and Brier scores were 0.096 and 0.117, respectively. DCA in modeling group and verification group showed that when the threshold probability of fear of childbirth were 0.00 to 0.70 and 0.00 to 0.70, it had clinical practical value. ConclusionThe nomogram model has good discrimination, calibration and clinical applicability, which can effectively predict the risk of pregnant women's fear of childbirth and provide references for early clinical identification of high-risk pregnant women and targeted intervention.
Objective To compare the economic effectiveness of universal screening, high-risk population screening, and no screening strategies for thyroid disease prevention and control among pregnant women in China through cost-effectiveness analysis, providing evidence-based support for optimizing health policy decisions on prenatal thyroid disease screening. Methods Based on the characteristics of thyroid disorders during pregnancy, a combined decision tree and Markov model was developed to conduct a lifetime cost-effectiveness analysis across three strategies: no screening, high-risk population screening, and universal screening. Sensitivity analyses were performed on key parameters. Results Base-case analysis demonstrated that universal screening was the most cost-effective strategy when the World Health Organization (WHO)-recommended payment threshold of 1×gross domestic product (GDP) per capita was used, with an incremental cost-effectiveness ratio (ICER) of 20636.18 yuan per quality-adjusted life year (QALY) compared to no screening, followed by high-risk population screening (ICER=21071.71 yuan/QALY). The results of the sensitivity analysis showed a strong stability of the model. Conclusions Of the 3 screening programs for thyroid disease in pregnancy, universal screening is the most cost-effective when the WHO-recommended payment threshold of 1×GDP per capita is used.
ObjectiveTo analyze the clinical data of pregnant females and children infected with H1N1 during the global pandemic in 2009, and summarize the epidemiological characteristics.MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP and WanFang Data databases were searched to collect studies on H1N1 infection in pregnant females and children during the 2009 pandemic from January 1st, 2009 to February 17th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, epidemiological characteristics were descriptively analyzed.ResultsA total of 33 studies involving 939 children, 5 newborns and 2 416 maternal infections were included. The results showed that the age span of children was 0 to 18, the male-to-female ratio was 1.2:1, and the history of close contact accounts was 18.8% (80/425). The primary symptoms were fever, cough, headache, vomiting and other symptoms in some children. More than half of the children received oseltamivir antiviral treatment (545/807, 67.5%), and 6 died (6/861, 0.7%). The primary symptoms of pregnant females were fever, cough, sore throat, muscle pain, fatigue, headache, diarrhea, and so on. The majority of patients received antiviral therapy (1 571 to 1 783, 88.1%). A total of 178 mortalities (178/2 335, 7.6%), 48 stillbirths (48/966, 5.0%), and 9 live birth mortalities (9/494, 1.8%) were reported. All 5 newborns were positive for RT-PCR detection, including 4 premature infants. The mode of transmission was close contact in 3 cases (including 1 case in contact with sick medical staff), 1 case of vertical transmission from mother to child, and 1 case of unknown. The primary clinical manifestation of newborns was dyspnea. After treatment with oseltamivir, 4 cases were cured and 1 case deceased.ConclusionsPregnant females and children are at high risk of serious complications of H1N1 influenza. H1N1 infection in pregnancy is associated with an increased risk of adverse pregnancy outcomes. The symptoms of H1N1 infection in children and pregnant females are similar to those in adults, primarily respiratory and systemic symptoms. Oseltamivir and zanamivir are effective antiviral drugs.
ObjectivesTo systematically review the correlation between maternal serum selenium levels during pregnancy and premature birth.MethodsDatabases including PubMed, The Cochrane Library, EMbase, Web of Science, CNKI and CBM were searched to collect studies on correlation between maternal serum selenium levels during pregnancy with preterm birth in the offspring from inception to January, 2020. Two reviewers independently screened literature, extracted data and evaluated risk of bias of the included literature. Then, meta-analysis was conducted by using RevMan 5.3 software.ResultsA total of 12 studies involving 2 484 patients were included. The results of meta-analysis showed that compared with control group, the preterm group had lower serum selenium levels in pregnant females (SMD=−0.89, 95%CI −1.56 to −0.22, P=0.01). The results of the subgroup analysis showed that heterogeneity among subjects was still large when grouped accorcding to the continent to which a country belongs, the time of blood sample collection and test method in pregnant females.ConclusionsLow maternal serum selenium levels during pregnancy may increase the risk of preterm birth. Due to the limitation of the quantity and quality of the included studies, the above conclusions are required to be verified by more high quality studies.
ObjectiveTo explore the relationship between the diet during pregnancy and gestational diabetes mellitus (GDM), and analyze the effect of GDM on weight gain, outcome and complication of mother and infant. MethodsWe selected 128 GDM pregnant women and 267 non-GDM pregnant women who were investigated by semi-quantitative food frequency method during September 2009 to March 2011. Then, we collected relevant information and the data were analyzed by t-test and chi-square test. ResultsThere were statistically significant differences between the two groups in total calorie, carbohydrate, fat and protein intakes per day (P<0.05). In general, the rates of insufficient weight gain and excessive weight gain during pregnancy in the GDM group were significantly higher than the non-GDM group (P<0.05), while proper weight gain rate was significantly lower (P<0.01). The risk of hydramnion, intrahepatic cholestasis and pregnancy-induced hypertension in the GDM group was significantly higher than the non-GDM group (P<0.05), while there was no significant difference between the two groups in premature delivery, cesarean section or premature membrane ruptures (P>0.05). Apgar scores were significantly different at minute 1 and 5 between the infants in the two groups (P<0.05). The incidence of fetal death, malformation, mild neonatal asphyxia and fetal macrosomia in the GDM group was significantly higher than the non-GDM group (P<0.05). No significant differences between the two groups in low birth weight infant, cord entanglement and fetal distress were detected (P>0.05). ConclusionGDM can lead to high incidence of poor outcome and complication. It is vital to strengthen the examination and keep balanced dietary structure, in order to reduce the complication and improve the health of mother and child.