Trend and outcome of multiple pregnancies in Beijing, 1996-2010

The purpose of this study was to understand the risk factors of Preterm and Low Birth Weight Newborn on Singleton and Multiple Births. Twins are usually divided into high risk population of Preterm and Low birth Weight Newborns. However, the previous studies rarely concentrate on the cooperation between singleton and twins. This study based on the birth registration data between 2004 and 2005 from bureau of health promotion, department of health, R.O.C. (Taiwan). The analysis method is used SPSS12.0, The results as followed: First of all, the percentage of Preterm for those pregnant weeks less than 37 weeks are listed as all (9.6%), singleton (8.0%), twins (63.3%) and multiple births (97.3%). Under the consideration of Low birth weight (under 2500g), the percentage of all is 8.2% when singleton is 6.6%, twins at 66% and multiple births at 96.3%. Moreover, this study founds that no matter of all newborn ,singleton and twins, the risk of preterm birth (<37 weeks’ gestation) is increased by the factors of male sex, Taiwanese gravida, maternal age, low birth weight, heart disease, pneumonopathy, amniotic fluid anomaly, thalassemia, interogestate smoking, interogestate drink, interogestate drug addiction, previous preterm or low birth weight experience, diabetes mellitus, gestational diabetes mellitu, syphilis, pre-eclampsia, nephritic disease, gestation hypertension and cervical incompetence. Furthermore, the significant risks of low birth weight among all newborns are female sex , maternal age, preterm, maternal pneumonopathy, amniotic fluid anomaly, thalassemia, interogestate smoking, interogestate drink, interogestate drug addiction, had preterm or birth weight, pre-eclampsia, nephritic disease, chronic hypertension, gestation hypertension and cervical incompetence. No matter preterm or low weight birth, singleton has similar situation as all birth, but twins has slightly differences on OR rates compared with singleton. Other differences between twins and singleton are included that maternal age has no relation with preterm birth on twins, while the rate of twins’ low weight birth has changing by maternal age. When maternal age is younger, the risk of low weight birth for twins becomes higher. Otherwise, caesarean will increase preterm and low birth weight risk on singleton, but twins is opposite. Maternal anemia and chronic hypertension also increase preterm and low birth weight risk on singleton ,but not in twins. In the sector of low birth weight, Taiwanese Nationality gravida, maternal anemia, heart disease, gestational diabetes mellitu,no experience on overweight birth, diabetes mellitus and syphilis will increase low birth weight risk on singleton ,but twins is not. This result is different with those analyses on singleton. This study uses cross analysis between preterm birth and low weight birth group, as well as compares the differences within singleton, twins and multiple births. I suggest that further researches can focus on the health relative studies on singleton, twins and multiple birth comparison.

Objective To explore the clinical application of selective fetal reduction guided by transvaginal ultrasound in multiple pregnancies. Methods A retrospective analysis was performed on 52 cases of multiple pregnancies within 10 weeks from January 2013 to December 2018 at the Reproduction Medical Center of our hospital. All patients underwent selective reduction under the guidance of transvaginal ultrasound. After operation, they were divided into either a single-fetus group or a multiple-fetus group. In addition, 82 cases of single and twin pregnancies within 10 weeks after treatment were randomly selected as a single-fetus control group and multiple-fetus control group, respectively. Fetal birth weight, low birth weight rate, premature birth rate, and late abortion rate, as well as the related complications during pregnancy, including gestational diabetes mellitus, gestational hypertension, postpartum hemorrhage, and premature rupture of membranes, were recorded. The four groups of subjects were compared for the above indicators. Results The successful rate of fetal reduction in the 52 cases of multiple pregnancies was 100%. In the twin pregnancy group after fetal reduction, there was one case of early spontaneous abortion and four cases of late spontaneous abortion. The incidence of fetal birth weight in the multiple-fetus group was significantly lower than that in the single-fetus group [(2.52±0.48) kg vs (3.41±0.31) kg, t=2.495, P 0.05). There was no difference between the single-fetus group and multiple-fetus group in pregnancy hypertension, gestational diabetes mellitus, or postpartum hemorrhage (P>0.05), but the incidence of premature rupture of membranes was significantly higher in the multiple-fetus group than in the single-fetus group (45.2% vs 6.3%, χ2=5.672, P=0.017). Conclusion Vaginal ultrasound-guided selective fetal reduction can significantly improve the pregnancy outcome of multiple pregnancies, representing a safe and effective clinical procedure. Key words: Multiple pregnancy; Fetal reduction; Pregnancy outcome

Objective To determine the peripheral blood level of carnitine in neonates and to analyze its influencing factors. Methods All newborns (n=46 250) born in Hunan provincial maternal and child healthcare hospital from 2015 to 2017 were included in this study, except for those primary carnitine deficiency and motherhood carnitine deficiency. Heel prick blood samples were collected 48 hours after birth for determination of carnitine by tandern mass spectrometry. All subjects were grouped according to gender, gestational age, birth weight, number of pregnancies, sample collecting time and whether to be hospitalized. The level of carnitine was analyzed with Mann-Whitney U test, Kruskal-Wallis H test and mutiple linear regression. Results The free carnitine levels of 46 250 neonates were ranged from 5.21 to 56.32 μmol/L, with a geometric mean of 16.05(15.99 to 16.10)μmol/L; males (n=24 375) and females (n=21 875) were 16.68 μmol/L and 15.38 μmol/L; multiple pregnancies (n=3 552) and single pregnancies (n=42 698) were 19.22 μmol/L and 15.81 μmol/L, respectively; hospitalized patients (n=6 409 cases) and non-hospitalized patients (n=3 9841 cases) were 20.10 μmol/L and 15.48 μmol/L respectively. The levels of serum free carnitine were higher in male, multifetal and hospitalized patients (Z=23.739, 30.260, 51.336, P<0.05). Comparing the concentration of free carnitine in 8 groups with different gestational age, 7 groups with different birth weight and 5 groups with different blood collecting age, the differences were statistically significant (H=2369.832, 3032.716, 967.440, P<0.05). Multivariate linear regression showed that all the six factors entered the regression equation, and the sequence was hosp-italization, birth weight, gestational age, number of pregnancies, sex, blood collection age. Conclusions The peripheral blood level of carnitine in neonates is affected by many factors, such as whether to be hospitalized, birth weight, gestational age and so on. Key words: Carnitine/BL; Infant, newborn; Factor analysis, statistical

Objective To investigate the birth rate of full-term low birth weight infants,and to analyze its risk factors.Methods 14062 newborns who were born in our hospital were studied retrospectively.The birth rate of low birth weight infants and its related risk factors.Results The birth rate of low birth weight infants was 2.52％.The risk factors for low birth weight were intrahepatic cholestasis of pregnancy, pregnancy-induced hypertension, anemia, uterine malformation, multiple induced abortion, fewer prenatal examinations, multiple pregnancy, fetal malformation,oligohydramnios,umbilical cord abnormalities,and abnormal placental location,shape,and weight.Conclusions The birth rate is higher in low birth weight infants.The risk factors for low birth weight are various and the result of action of different factors. Key words: Low birth weight infant; Birth rate; Risk factors

Objective To investigate the related factors of preterm birth and neonatal outcomes in single pregnancy after in vitro fertilization and embryo transfer (IVF-ET). Method A retrospective analysis was conducted in 250 pregnant women in the Sun Yat-sen Memorial Hospital from August 2013 to August 2015. The patients were divided into preterm birth of single pregnancy after IVF-ET (group A, 50 cases), preterm birth of single pregnancy after natural pregnancy (group B, 100 cases) and full-term birth of single pregnancy after IVF-ET (group C, 100 cases). By recording the incidence of gestational diabetes mellitus, gestational hypertension, premature rupture of membranes, placenta praevia or low-positioned placenta, as well as neonatal outcome, analyze the factors related to preterm delivery of single pregnancy after IVF-ET. Results There were no significant differences in pregnancy complications, birth weight of premature infants and gestational weeks between group A and group B. The incidences of gestational hypertension in group A and group C were (14% and 3%), premature rupture of membranes (42% and 14%), placenta praevia or low-positioned placenta (12% and 2%), birth weight of newborn [(2225±622) g and (3231±482) g], 1 min Apgar score [(8.61±1.77) and (9.49±0.94)], 5 min Apgar score [(9.66±0.94) and (9.93±0.29)], and the differences between the two groups were statistically significant (P<0.05). Logistic regression analysis showed that gestational hypertension, premature rupture of membranes, placenta praevia or low-positioned placenta, cervical incompetence were associated with preterm birth of single pregnancy after IVF-ET. The incidences of cervical cerclage in pregnancies due to cervical incompetence were 22%, 9% and 4% in group A, group B and group C, respectively. There were significant difference between group A and group B, group C (P<0.05), respectively. Conclusions Gestational hypertension, premature rupture of membranes, placenta praevia or low-positioned placenta and cervical incompetence are high risk factors for preterm birth of single pregnancy after IVF-ET. The birth weight, Apgar score at 1 min and 5 min were all worse in preterm infants than in full term infants of single pregnancy after IVF-ET. Key words: Reproductive techniques, assisted; Premature birth; Pregnancy complications; Uterine cervical incompetence

Objective To determine whether fetuses with an isolated single umbilical artery (SUA) were associated with fetal growth. Methods Eighty singleton pregnancies with isolated SUAs diagnosed and delivered from January 2009 to December in our hospital were selected as experimental group. Multiple pregnancies, fetuses with other system malformation and abnormal placenta or amniotic fluid were excluded. For control group, 80 normal singleton pregnancies were searched and paired at a ratio of 1∶1 during the same period in the same hospital The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital, Sichuan University. Informed consent was obtained from the parents of each participating neonate.. The statistical analysis was used in two groups collected by retrospective analysis. Results ①The accuracy of diagnose was 95.2% (80/84) in this study. ②There were no significant differences in age, pregnant, pregnancy, gestational diabetes mellitus(GDM) and gestational hypertension(GH) between two groups (P>0.05). ③No significant difference was observed in neonatal sex between the two groups(P>0.05). ④There were significant differences in birth weight and height between SUA group and control group(P<0.05). Conclusions Compared with the normal fetuses, the birth weight is lighter and the birth height is shorter in fetuses with an isolated SUA. Key words: single umbilical artery; birth weight; birth height; ultrasonography, prenatal

Objective: To investigate the youngest gestational age associated with the highest survival rate and the lowest major morbidity rate in triplets and quadruplets. Methods: Retrospective review of charts was performed to record the gestational age (GA), birth weight (BW), mode of delivery, mortality and neonatal complications of triplets and quadruplets. The cut off levels of GA and BW for survival and neonatal complications were determined by receiver operating characteristic curve. Results: All triplets and quadruplets who had been admitted to our neonatal intensive care unit from January 1995 to May 2005, were enrolled in this study. There was a total of 32 sets of triplets and 2 sets of quadruplets. Their mean GA was 31.4±3.2 weeks, mean BW 1527±492gms and mean hospitalization 37.5±30 days. The overall mortality rate was 8.4%. There were significant differences in GA and BW between infants who survived and those who died but there was no significant difference in the mode of delivery, or whether they were inborn or out born. The cut off values at which mortality significantly increased were GA ＜ 30 weeks (OR: 26.8; confidence interval: 3.1, 232.3) and BW＜1200gms (OR, 24.32; confidence interval: 2.81, 210.12). The cut off levels at which severe intraventricular hemorrhage significantly increased were GA＜29 weeks (OR: 32.47; confidence interval: 3.80, 277.51) and BW＜120gms (OR, 11.97; confidence interval: 2.29, 62.50). The cut off levels at which severe chronic lung disease significantly increased were GA＜28 weeks (OR: 37; confidence interval: 6.67, 205.1) and BW＜1100gms (OR, 172.66; confidence interval: 15.78, 1888.55). The cut off levels at which severe retinopathy of prematurity significantly increased were GA＜28 weeks (OR: 61; confidence interval: 5.75, 659.39) and BW＜1000gms (OR: 76; confidence interval: 6.82, 846.99). Conclusion: In triplet or quadruplet pregnancies, the pregnancy should continue to as close to 30 weeks as possible to prevent neonatal mortality. In order to prevent severe morbidity in premature babies, the gestational age should not be shorter than 28 weeks.

Objective To investigate the trend in birth weight of term infants delivered in Miyun Hospital in recent ten years, and its relationship with cesarean section rate, to provide evidence for health care during pregnancy and lowering the cesarean section rate. Methods Singleton term live-birth newborns in Beijing Miyun Hospital from January 1, 2000 to December 31, 2009 were admitted into this study. Trends of birth weight, microsomia rate and cesarean section rate were analyzed. Results (1) There were 14 716 singleton term live-birth newborns delivered in the tenyear period, among which 7642 males and 7074 females with the proportion of male and female of 1.08 : 1. One thousand seven hundred and seventy-three (12.0％) microsomia were delivered, and the number of low birth weight infants was 180 (1.2％). (2) The birth weight of term infants was from 1200 g to 5850 g and the average birth weight was (3422±447) g. The average birth weight of each year increased, and the differences among each year showed statistical significance (F= 15. 337,P＜0.01). (3) The percentage of microsomia of each year increased, and the differences among each year also showed statistical significance (x2= 125. 285, P＜0. 01). (4) The cesarean section rate increased from 49.9％ in 2000 to 57.1％ in 2009 with statistical difference (x2 =180. 883, P＜0.01).(5) The cesarean section rate increased with the average birth weight of the singleton live-birth term infants in the 10 years from 52.2 ％ in those ＜2500 g to 85.4 ％ in those 4500 g～, and the differences had statistical significance (x2 =518. 519, P＜0. 01). Conclusions Cesarean section rate had close correlation with birth weight in term birth infants. It is suggested that prenatal care should be strengthened and nutrition guidance during pregnancy should be paid more attention. Key words: Birth weight ; Infant,newborn; Cesarean section

Objective To investigate the situation and the causes of neonatal death in Henan Province. Methods This study retrospectively analyzed the clinical data of 277 neonates who died at 18 hospitals in Henan Province in 2017. Distribution and causes of neonatal deaths, differences between perinatal conditions of premature and term/post-term infants, causes of early (<7 d) and late (7-28 d) neonatal deaths and the differences in neonatal death cases between Maternal and Child Health Care Hospitals and General/Children's Hospitals were analyzed. We used t, rank-sum and Chi-square test (or corrected Chi-square test, or Fisher's exact test) for statistical analysis. Results (1) A total of 50 993 newborns were admitted to the 18 hospitals in 2017, 297 of which died with a mortality of 5.82‰. After excluding 20 cases with uncertain birth or maternal pregnancy history or clinical data, 277 cases with complete data were analyzed. Among them, 168 (60.6%) were preterm neonates and 109 (39.4%) were term/post-term ones. Early and late neonatal deaths accounted for 74.0% (205 cases) and 26.0% (72 cases), respectively. (2) The top five causes of neonatal deaths were infection (78 cases, 28.2%), asphyxia (54 cases, 19.5%), neonatal respiratory distress syndrome (NRDS, 33 cases, 11.9%), severe congenital malformations (26 cases, 9.4%) including cyanotic congenital heart diseases, digestive malformations, airway malformations and neural tube defects and pulmonary hemorrhage (23 cases, 8.3%). Among them, the top three causes of early neonatal deaths were asphyxia (48 cases, 23.4%), infection (43 cases, 21.0%) and NRDS (33 cases, 16.1%), while the main causes of late neonatal deaths were infection (35 cases, 48.6%), major congenital malformations (9 cases, 12.5%) and chromosome abnormities/inherited metabolic diseases (7 cases, 9.7%). (3) Maternal complications during pregnancy accounted for 79.1% (219 cases) and the predominant types were pregnancy-induced hypertension (43 cases, 19.6%), followed by infection (36 cases, 16.4%), placental-related conditions (32 cases, 14.6%), gestational diabetes mellitus (23 cases, 10.5%), hypothyroidism (20 cases, 9.1%), fetal distress (18, 8.2%), twin-twin transfusion syndrome (10 cases, 4.6%) and cholestasis syndrome (9 cases, 4.1%). (4) Compared with the term/post-term cases, the preterm cases had higher proportions of multiple births [27.4% (46/168) vs 6.4% (9/109), χ2=14.016, P<0.05], assisted reproduction [7.1% (12/168) vs 0.9% (1/109), χ2=4.421, P<0.05] and maternal hypertensive disorders of pregnancy [21.4% (36/168) vs 6.4% (7/109), χ2=11.353, P<0.05], infection [16.7% (28/168) vs 7.3% (8/109), χ2=4.295, P<0.05] and twin-to-twin transfusion syndrome [6.0% (10/168) vs 0.0% (0/109), χ2=6.707, P<0.05]. (5) Among all the early neonatal deaths, preterm cases had a higher incidence of NRDS than term/post-term neonates [20.3% (27/133) vs 8.3% (6/72), χ2=11.937, P<0.05], but lower incidence of meconium aspiration syndrome (MAS), severe congenital malformations and chromosome abnormalities/inherited metabolic diseases [0.8% (1/133) vs 5.6% (4/72), χ2=4.508; 3.8% (5/133) vs 16.7% (12/72), χ2=10.233; 1.5% (2/133) vs 6.9% (5/72), χ2=4.172; all P<0.05]. Among the late neonatal deaths, the incidence of severe intracranial hemorrhage in preterm infants was higher than that in term/post-term neonates [7.1% (3/42) vs 0.0% (0/30), χ2=2.205, P<0.05]. (6) Compared with the cases in General/Children's Hospitals, those in Maternal and Child Health Care Hospitals showed a higher proportion of preterm neonatal deaths [67.3% (105/156) vs 52.1% (63/121), χ2=6.010, P<0.05], younger gestational age [(32.8±5.3) weeks vs (34.6±4.9) weeks, t=3.072, P<0.05], lower birth weight [(2 132.6±1 014.5) g vs (2 409.4±987.3) g, t=2.513, P<0.05], and higher average age of death [M (P25-P75), 3 (1-8) d vs 2 (1-4) d, Z=3.710, P<0.05]. Conclusions Neonatal death occurs mainly within one week after birth in those with maternal complications. Late preterm deaths and term/post-term cases account for nearly half of total neonatal deaths. The causes of death for preterm and term/post-term newborns vary with postnatal age. Infection, asphyxia and severe congenital malformations are important causes of neonatal deaths. Key words: Infant mortality; Cause of death; Inpatients; Retrospective studies

Objective To study the incidence and risk factors for extrauterine growth retardation (EUGR) at discharge in moderate and late preterm infants. Methods A retrospective analysis was performed on 607 premature infants who were admitted to the neonatal intensive care unit between January 1st, 2016 and December 31st, 2016.These subjects were classified into EUGR (n=159) and non-EUGR groups (n=448) based on the body weight at discharge.The risk factors for the occurrence of EUGR were studied by multivariate logistic regression analysis. Results Based on the body weight, the incidence of EUGR at discharge was 26.2%(159/607). The incidence of EUGR in intrauterine growth restriction (IUGR) infants was significantly higher than in non-IUGR infants (P<0.001). The very low birth weight (VLBW) infants had a higher incidence of EUGR than non-VLBW infants (P<0.05). Compared with the non-EUGR group, the fasting time, the age to achieve full enteral feeds, the length of mechanical ventilation, oxygen therapy and the length of hospital stays were significantly greater in the EUGR group (P<0.05). The percentages of caesarean section, multiple gestation, pregnancy-induced hypertension, intrahepatic cholestasis of pregnancy and umbilical cord abnormality in the EUGR group were higher than in the non-EUGR group(P<0.05). The incidences of septicemia, hypoalbuminemia, anemia, retinopathy of prematurity, brain injury in premature infants and mechanical ventilation in the EUGR group were higher than in the non-EUGR group(P<0.05). The logistic regression analysis showed that birth weight, IUGR, multiple gestation, abnormality of umbilical cord and the length of hospital stays were the independent risk factors for EUGR. Conclusion The causes of EUGR are multi-factorial.To strengthen pregnancy care, aggressive and reasonable nutritional strategy, prevention and treatment of complications may facilitate to reduce the occurrence of EUGR. Key words: Premature infant; Extrauterine growth retardation; Intrauterine growth retardation; Retinopathy of prematurity

Maternal and neonatal outcomes in multiple pregnancy: A multicentre study in the Beijing population

To study the health status of children of the first 12 months of life born after in vitro fertilization from single and multiple pregnancies, the authors analyzed obstetric and gynecological anamnesis of mothers, peculiarities of the procedure of extracorporal fertilization, the results of a prospective clinical observation of children under 1 year with the assessment of physical, neuro-psychological development, morbidity and disability. It was found that multiple pregnancy due after in vitro fertilization is a risk factor for preterm birth, birth of children with low body weight and the formation of perinatal pathology. Children born from a single pregnancy after in vitro fertilization, at the age of 1 year did not differ from children born from spontaneous pregnancy, in terms of physical and neuropsychological development parameters, and absence of disability. Morbidity, disability, physical and neuropsychic development of children with a birth weight of less than 1,500 g from multiple pregnancies after in vitro fertilization did not differ from children from multiple natural pregnancies in the first 12 months of life. The procedure of in vitro fertilization is not a negative factor for the formation of the health of children born from single and multiple pregnancies. In this regard, the multiple pregnancy and the associated prematurity is the main factor affecting the health of children born after in vitro fertilization.

Pre-pregnant BMI, body mass gain during pregnancy and maternal serum level of HDL-C may affect the neonatal birth body mass whose mothers were complicated with abnormal glucose metabolism during pregnancy.

&lt;p&gt;This study aims to analyse the relationship of nutritional status of pregnant women with the prevalence of LBW. A quantitative study with the descriptive analytic design was conducted using cross-sectional approach in primary health care(Puskesmas) Sugihwaras, Bojonegoro.The subject of this study is all babies with Low Birth Weight (LBW) at Puskesmas Sugihwaras Bojonegoro. Hence, the sampling technique was total sampling. Data was collected using secondary data instrument such as medical record and mother-child healthreport (KIA)from Puskesmas Sugihwaras. Nutritional status of pregnant women was assessed based on measurement of Mid-upper Arm Circumference. The spearman rank correlation test showed that there is a significant correlation (p-value &lt;0,05) between nutritional status of pregnant mother with the prevalence of LBW in Puskesmas of Sugihwaras, Bojonegoro.&lt;/p&gt;

Objective To analyze the effect of blastomeres loss of frozen-thawed cleavage-stage embryos on patients’ pregnancy outcomes and the birth condition of newborn infants. Methods A total of 873 frozen-thawed embryo transfer (FET) cycles in Reproductive Medicine Center of the First Maternity and Infant Hospital Affiliated to Tongji University from January 2016 to December 2017 were analyzed retrospectively, then they were divided into two groups: group A (the blastomeres in both the transferred embryos were intact, n=809), and group B (the blastomeres in both the transferred embryos were partly injured, n=64). The general situations, clinical outcomes and birth condition of newborn infants between the two groups were compared. Results There was no statistically significant difference in the general situations between the two groups (P>0.05). And there were also no significantly differences between group A and group B in the biochemical pregnancy rate, the clinical pregnancy rate, the multiple pregnancy rate, the ectopic pregnancy rate and the abortion rate (P>0.05). However, the embryo implantation rate (35.3%) and the neonatal birth rate (29.9%) in group A were significantly higher than those in group B (25.8%, P=0.033; 20.3%, P=0.026). There were no statistically significant difference in gestational week, birth weight and birth height, the low birth weight infant rate, the premature birth rate, the birth defect rate between the two groups (P>0.05). Conclusion Blastomeres loss in frozen-thawed embryos would affect the development potential, and reduce the implantation rate and the birth rate, but it would not affect the the birth condition of newborn infants.