BACKGROUND:Maternal Graves' disease (GD) has been linked to neonatal thyroid dysfunction, but its relationship with offspring neurodevelopment remains unclear. We examined the associations of maternal GD-related thyroid factors with neonatal thyroid function and neurodevelopment at 24 months. We also explored whether neonatal thyroid function might partly explain this association. METHODS:This single-center bidirectional cohort study included pregnant women with GD and their offspring delivered between January 1, 2019, and December 31, 2023. Maternal thyroid-related variables, including thyrotropin (TSH), free T4, thyrotropin receptor antibodies (TRAbs), and antithyroid drug exposure, were collected across pregnancy. Neonatal thyroid function was assessed at 7-14 days after birth, and neurodevelopmental screening at a corrected age of 24 months was performed using the Ages and Stages Questionnaire, Third Edition. Logistic regression was used to identify factors associated with neonatal thyroid dysfunction and abnormal neurodevelopmental screening results. Covariates were selected with guidance from a directed acyclic graph, and exploratory mediation analysis was performed using PROCESS Model 4. RESULTS:Among 159 neonates, 60 (37.7%) had thyroid dysfunction, with hyperthyrotropinemia as the most common abnormality (28.9%). Higher maternal third-trimester TRAb was independently associated with neonatal thyroid dysfunction (odds ratio [OR] = 1.59 [confidence interval or CI: 1.29-1.97], p < 0.001). Of the 143 offspring with follow-up data, 23 (16.1%) had abnormal neurodevelopmental screening results at 24 months. Higher maternal third-trimester TRAb (OR = 1.15 [CI: 1.04-1.27], p = 0.005) and higher neonatal TSH (OR = 1.11 [CI: 1.02-1.20], p = 0.016) were independently associated with abnormal neurodevelopmental screening results. Exploratory mediation analysis did not support a significant mediating role of neonatal TSH. CONCLUSIONS:Higher maternal third-trimester TRAb levels were associated with both neonatal thyroid dysfunction and abnormal neurodevelopmental screening results at 24 months in offspring of mothers with GD. This association with neurodevelopmental screening results may not be explained primarily by neonatal thyroid function alone.

The effect of particulate matter 2.5 (PM2.5) on thyroid function has been reported. However, thyroid function can be affected by iron and iodine, which are essential for the synthesis of thyroid hormones. This study aimed to investigate the relationship between PM2.5 exposure and thyroid function during the first trimester (T1) and evaluate whether iron or iodine status mediate this association. Demographic information, serum ferritin (SF), and thyroid function, including free thyroxine (FT4) and thyroid-stimulating hormone (TSH), were collected from 3922 pregnant women at Peking University First Hospital between October 2017 to August 2018. Serum iodine (SI) levels were additionally measured in women with hypothyroxinemia. Ambient PM2.5 concentrations were estimated by monitor stations. The general linear models were employed to assess the association between PM2.5 exposure and thyroid function. Furthermore, mediation analysis was performed to evaluate the potential mediating roles of iron status in the relationship between PM2.5 exposure and thyroid function. In the first trimester, per 1-interquartile range (IQR) increase in PM2.5 exposure was associated with a significant decrease in maternal FT4 levels (β = − 0.166; 95

The objective of this study was to explore whether combined assessment of TgAb and TPOAb perform a higher predictive value to adverse pregnancy outcomes than isolated TPOAb during early pregnancy. This was a retrospective study of 4678 pregnant women receiving prenatal care at Peking University First Hospital from October 2017 to August 2018. Demographic and clinical data, including thyroid hormone levels, were retrieved from electronic medical records. The general information and incidence of adverse pregnancy outcomes were compared between different subgroups of thyroid function and antibody status. In total, 2673 women were enrolled. 6.70

INTRODUCTION: Transient congenital hypothyroidism (CH) caused by maternal thyrotropin receptor-blocking antibody (TBAb) has been uncommonly reported. Goiter is a significant indicator of fetal thyroid dysfunction that may facilitate early identification, but some cases present without this manifestation. This report describes a case of CH attributed to maternal elevated levels of thyroid-stimulating hormone receptor antibody (TRAb) with normal thyroid size, and further provides a systematic review of neonatal thyroid size classification in other CH cases from the literature. CASE PRESENTATION: The mother had a history of hypothyroidism related to Hashimoto's thyroiditis and elevated TRAb levels. Maternal TRAb level exceeded 40 IU/L in the first trimester. The circumference of fetal thyroid gland maintained within the normal range throughout pregnancy. However, the secondary ossification centers were not visible at 37 weeks of gestation. CH was confirmed through thyroid function testing on postnatal day 9. Neonatal TRAb levels became undetectable by 3 months after birth, and levothyroxine (LT4) treatment was discontinued at 7 months of age. The young child demonstrated appropriate intellectual development during 18 months of follow-up. We conducted an analysis of 17 TRAb-related CH cases from PubMed, Web of Science and Embase. Most maternal TRAbs (13/17) were detected postpartum, and TBAb levels were measured in nine women with values ranging from 1.13 to 9.94 times of the upper limit of the reference range (ULRR). Neonatal TBAb levels ranged from 1.1 to 8.15 times ULRR. Twelve cases (70.6%) exhibited normal thyroid size, three (17.6%) presented with small thyroids, and two cases (11.8%) displayed goiter. CONCLUSIONS: The majority of TBAb-induced CH cases present with normal thyroid size. In the absence of goiter, monitoring additional signs of hypothyroidism and early evaluation of neonatal thyroid function remain essential.

Abstract Disclosure: N. Zhou: None. W. Sun: None. H. Meng: None. Y. Huang: None. J. Zhao: None. Y. Gao: None. H. Yang: None. Y. Zhang: None. A Survey on the current status of universal screening thyroid indicators during pregnancy in real world study Background: Thyroid dysfunction and thyroid auto-immunity (TAI) are common in women of childbearing age, which have been proven to increase the risk of maternal and fetal adverse pregnancy outcomes. China has adhered to the strategy of universal screening for early pregnancy thyroid indicators since 2012, and is currently the only country that recommends universal screening. This study aimed to investigate the implementation situation of universal screening for thyroid indicators during pregnancy in real world study. Methods: We retrospectively collected medical record information from 18,932 women who underwent regular prenatal examinations at Peking University First Hospital from January 2014 to December 2016 until the end of pregnancy, grouping based on whether thyroid indicators were screened during pregnancy, and comparing the general characteristics and pregnancy outcomes. Furthermore, the treatment compliance status of women who took levothyroxine and antithyroid drugs (ATD) before pregnancy was also analyzed. Results: The screening rate for thyroid indicators in pregnancy was 88.7% in our hospital, 93.3% of pregnant women underwent screening in early pregnancy, with a median gestational age of 7.0 (6.6, 10.1) weeks. Non-screening ones were more inclined to be aged>40 years or <25 years, with a BMI ≥24 kg/m2, pluriparity (≥2), and without thyroid disease history prior to conception (P < 0.05). After correcting covariates, the risks of early miscarriage (8-12 weeks) (OR=21.96, 95% CI: 19.2, 25.1) and late miscarriage (12-28 weeks) (OR=3.0, 95% CI: 2.5, 3.6) were significantly higher in non-screening group than in the screening group, but there was no significant difference in the risk of preterm labor between the two groups (P=0.985). The achievement rate (0.23≤TSH<2.5uIU/mL, FT4 within normal range, 53.7%-64.2%) of early pregnancy thyroid function among levothyroxine intervention participants increased from 2014 to 2016. Compared with those in the thyroid function controlled group, the patients in the uncontrolled group had earlier screening gestational weeks (6.7 vs. 8.0 weeks), higher TPOAb positivity (58.6% vs. 44%), and a greater incidence of other autoimmune disorders (14.2% vs. 9.8%) (P<0.05). The achievement rate of early pregnancy thyroid function among ATD intervention participants ranged from 63.6 to 71.2%. Conclusions: The screening rate for thyroid indicators in pregnancy is nearly 90% in comprehensive hospitals. The lack of screening may be related to miscarriage to some extent. The current treatment compliance status pre-pregnancy neither for levothyroxine nor ATDs was not satisfactory. Presentation: 6/2/2024

Objective:To investigate the metabolic adaptation of normal pregnancy and the pathogenesis of gestational diabetes mellitus (GDM) from the first to the third trimester.Methods:This was a case-control study. A total of 1 471 pregnant women who visited at the Department of Obstetrics of Peking University First Hospital in the first trimester from September 2017 to June 2018. Those with complete serum samples in the first, second and third trimester and who delivered in the hospital were taken as research objects. They were divided into a GDM group and a normal control group according to their glucose metabolism status. Fasting plasma glucose (FPG) and fasting insulin (FINS) in first, second and third trimester were detected, and 75 g oral glucose tolerance test (OGTT) was performed at 24 weeks and later to explore metabolic adaptation in pregnancy and the pathogenesis of GDM. Homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of β-cell function (HOMA-β) were calculated. T-test and Mann-Whitney U test were used to compare between groups. Results:A total of 510 subjects were included in the study. There were 260 cases in GDM group and 250 cases in normal control group. In terms of blood glucose, FPG, 1 h-postprandial plasma glucose (1hPG) and 2 h-postprandial plasma glucose (2hPG) of 75g OGTT in GDM group were significantly higher than those in control group [5.14 (4.80, 5.34) vs 4.63 (4.43, 4.84), 9.56 (8.17, 10.48) vs 7.64 (6.57, 8.63), 8.05 (6.88, 9.08) vs 6.46 (5.82, 7.22) mmol/L, P<0.001]. The level of FPG in both GDM and normal control groups decreased gradually with gestational age (FPG of different trimesters were all P<0.017), but the level of FPG in GDM group was significantly higher than that in control group from first to third trimester[5.27 (4.99, 5.55) vs 5.10 (4.87, 5.30), 5.14 (4.80, 5.34) vs 4.63 (4.43, 4.84),4.77 (4.52, 5.08) vs 4.48 (4.31, 4.70) mmol/L, P<0.001]. In terms of insulin resistance and dynamic changes in islet beta cell function, all FINS levels, HOMA-IR and HOMA-β increased gradually from the first to the third trimester, peaking in the third trimester, whether GDM or normal control group. FINS in the second trimester and HOMA-IR from the first to the third trimester in GDM group were higher than those in control group (all P<0.05), whereas HOMA-β in the second and the third trimesters were lower than those in control group (all P<0.001). Conclusions:Physiological insulin resistance occurs in normal pregnancy, and beta cells compensate to maintain normal blood glucose. However, there was more severe insulin resistance and higher FPG in GDM group from the first trimester, and beta cell insufficiency in the second and third trimesters. It is suggested that although GDM is diagnosed in second trimester and later, its pathological and physiological abnormalities are already present in the first trimester.

With the advances in fetal medicine, there will be more cases of congenital hypothyroidism (CH) diagnosed in the fetal period. However, there is no consensus on the management protocol. We present a successful case of conservatively managed fetal goitrous hypothyroidism due to compound heterozygous TG mutations. Goiter was observed in a fetus at 23 weeks of gestation. Because there was no evidence of transplacental passage of antithyroid antibody and drugs, iodine overload, and iodine deficiency, the fetus was highly suspected to have CH. Considering the potential risks of amniocentesis/cordocentesis, and lack of available parenteral levothyroxine in China, the fetus was closely monitored thereafter. A male neonate was delivered vaginally without complications at 39 weeks of gestation. We verified severe hypothyroidism in the infant and immediately initiated levothyroxine therapy. His growth and mental development were normal at the age of 8 month. Whole-exome sequencing showed that the neonate had two compound heterozygous mutations in the TG gene. We also performed a literature review of the prognosis of postnatal treatment of CH due to TG mutations and the result showed that postnatal treatment of CH due to TG mutations has a favorable prognosis. However, further prospective studies are warranted to verify this conclusion.

Objective:To investigate the glucose metabolic status in patients with previous gestational diabetes mellitus (GDM) in the 5-6 years after delivery, and to explore the changes in insulin resistance and islet β cell function from postpartum short-term (6-12 weeks) to the long-term (5-6 years) after delivery, as well as the relationship with glucose metabolic status.Methods:A total of 72 patients with a history of GDM who delivered in Peking University First Hospital and had complete short-and long-term postpartum follow-up data were included. They were divided into normal glucose metabolism (NGT) and abnormal glucose metabolism (AGT) groups according to their glucose metabolism status in 5-6 years after delivery. Pre-pregnancy, pregnancy, perinatal, short-and long-term postpartum clinical data were collected and compared between the two groups, including demographic indicators, glucose and lipid metabolism indicators [oral glucose tolerance test (OGTT) fasting blood glucose (FPG), 1-hour blood glucose (1hPG), 2-hour blood glucose (2hPG), 3-hour blood glucose (3hPG), total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol], insulin use ratio, fasting insulin (FINS), OGTT 2-hour insulin (2hINS), insulin sensitivity index (ISI), homeostasis model assessment of insulin resistance index (HOMA-IR) and homeostasis model assessment of β cell function index (HOMA-β) were calculated. The comparison between the two groups was conducted using independent sample t-test, rank sum test χ2 test or Fisher′s exact probability test. Multivariate logistic regression analysis was used to analyze the influence factors of abnormal glucose metabolism. Results:There were 38 (52.78%) cases in NGT group and 34 (47.22%) cases in AGT group. Compared with the NGT group, there are differences in related metabolic indicators in AGT group from pregnancy to long-term postpartum period: During pregnancy, 3hPG in 75 g OGTT and the proportion of insulin users were higher in AGT group. As for 6-12 weeks postpartum, OGTT 2hPG and the incidence of blood glucose abnormalities and the proportion of hypertriglyceridemia were higher (all P<0.05). However, there was no statistically significant difference in HOMA-IR and HOMA-β between the two groups( P>0.05). At 5-6 years postpartum, FPG, OGTT 2hPG, and FINS were all higher, with a higher degree of insulin resistance and lower insulin sensitivity (ISI) in AGT group (all P<0.05). Compared with short-term postpartum period (6-12 weeks), FPG, FINS, HOMA-IR, HOMA-β were all significantly increased regardless of glucose metabolic status at 5-6 years postpartum, while OGTT 2hPG and 2hINS increased further in the AGT group (all P<0.05). OGTT 2hPG and insulin use during pregnancy were risk factors for abnormal glucose metabolism 5-6 years postpartum according to multivariate logistic regression analysis, with OR values (95%CI) of 1.646 (1.015-2.671) and 3.570 (1.009-12.624), respectively. Conclusions:The incidence of AGT was still high in patients with previous GDM 5-6 years after delivery. Insulin resistance progressed gradually after delivery regardless of glucose metabolism, especially in patients with abnormal glucose metabolism. OGTT 2hPG and insulin use in pregnancy were risk factors for abnormal glucose metabolism in postpartum 5-6 years, suggesting that there is continuity in time and similarity in pathogenesis between GDM and T2DM.

We report a fetus with recurrent intraparenchymal hemorrhage and cystic leukomalacia during pregnancy who was postnatally detected with a de novo mutation in the COL4A1 gene by genetic testing of umbilical cord blood. Multiple fresh hemorrhagic foci were detected in the fetal brain parenchyma and cerebellar hemisphere by ultrasound at 25 gestational weeks. Regular re-examination of the nervous system's ultrasound and magnetic resonance imaging (MRI) indicated recurrent multiple intraparenchymal hemorrhages followed by cystic leukomalacia. However, karyotyping and chromosomal microarray analysis of amniotic fluid showed no abnormality. The newborn was born by cesarean section at 37 +3 gestational weeks with an Apgar score of 10 at 1 and 5 min. Repeated apnea occurred after birth. MRI detected new intraparenchymal hemorrhage and cystic leukomalacia on the six-day of life. The infant's limb muscle tone remained low on the 90-day follow-up. The patient was lost to follow up. Whole-exome sequencing of the cord blood identified a de novo heterozygous mutation- c.4738G>A in the COL4A1 gene (NM_001845.4; p.G1580S) neither parent carried. It suggests that the genetic test of the COL4A1 mutation should be considered for fetuses with intracranial hemorrhage in the prenatal diagnosis, especially those with recurrent fetal intraparenchymal hemorrhage followed by cystic leukomalacia. Genetic tests could help analyze the fetal prognosis, and guide the delivery mode.

Neonatal hyperthyroidism is an extension of fetal disease. Most cases of neonatal hyperthyroidism are transient but may excessively harm multiple organ functions through the actions of maternal thyroid-stimulating hormone receptor antibodies on the neonatal thyroid gland. The hyperthyroid mother underwent subtotal thyroidectomy before pregnancy and regularly took levothyroxine to avoid hypothyroidism, but still had a high-level thyroid-stimulating hormone receptor antibody (TRAb). The neonate suffered from hyperthyroidism due to the transplacental TRAb. After a regular medication schedule of an antithyroid drug, combined with a β-blocker to control the ventricular rate, the infant gradually recovered, allowing normal motor and intellectual development. Maternal subtotal thyroidectomy cannot prevent the secretion of thyroid receptor antibodies, which may cause either hypothyroidism or hyperthyroidism. The balance between antithyroid drugs and levothyroxine is critical in clinical practice.

目的 探讨长航保存去白细胞悬浮红细胞的不同储存期对游离血红蛋白浓度和红细胞溶血率的影响.方法 根据《献血者健康检查要求》(GB 18467-2011),于出海前一天,随机采集和制备去白细胞悬浮红细胞5人份.每份血液等分为2份,标记为对照组和试验组,分别于储存第28、35和42天取样进行游离血红蛋白浓度测定和计算红细胞溶血率.结果(1)试验组和对照组的游离血红蛋白浓度随保存时间的增加逐渐增大(P<0.01),2组的游离血红蛋白浓度之间的差异具有统计学意义(P=0.004);(2)试验组和对照组的红细胞溶血率随保存时间的延长逐渐增大(P<0.01),2组的红细胞溶血率之间的差异也具有统计学意义(P=0.002),但均小于国标《全血及成分血质量要求》(GB 18469-2012)的0.8％.结论 在复杂海洋气候条件下,长航对保存的去白细胞悬浮红细胞的游离血红蛋白浓度和红细胞溶血率有一定的影响,与科室专用储血冰箱保存的血液相比变化比较明显,差异均具有统计学意义.该试验的结果,对于进一步研究海上血液运输与存储具有重要意义.

Thyroid diseases in fetuses and newborns are rare but can be severe in some cases. Early diagnosis and treatment are the keys to improve the prognosis. This review focuses on the diagnosis and treatment strategies of this disease during the fetal and neonatal periods. For fetuses with goiter, the main clinical issue is to differentiate hyperthyroidism or hypothyroidism and offer appropriate management on this basis. Management of maternal, fetal, and neonatal thyroid diseases requires an experienced multidisciplinary team including adult and pediatric endocrinologists, obstetricians, and sonographers.

Abstract The gestational diabetes mellitus (GDM) diagnostic criteria recommended by the International Association of Diabetes and Pregnancy Study Group (IADPSG) were established based on the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study and have been the most commonly used criteria for determining GDM worldwide. Although individuals from mainland China were not included in the HAPO study, the IADPSG criteria have been used in China since 2011. However, the appropriateness of the criteria for evaluating maternal postpartum outcomes in mainland China are unknown. We conducted this study to determine whether the IADPSG criteria are appropriate for Chinese patients for evaluating long-term maternal postpartum outcomes. Eighty-four patients who were diagnosed with hyperglycemia during pregnancy and had delivery in Peking University First Hospital from February 2007 to December 2009 were enrolled in the study. For patients in Group A, GDM was diagnosed using both the National Diabetes Data Group (NDDG) and the IADPSG criteria, while patients in Group B, gestational impaired glucose tolerance (GIGT) was diagnosed using the NDDG criteria while GDM was diagnosed based on the IADPSG criteria. Anthropometric data, glucose metabolism, lipid profiles, β cell function, and insulin resistance index were evaluated and compared to baseline after 5- to 6-year postpartum period. Patients in group A had significantly higher oral glucose tolerance test (OGTT) fasting, 2-hour and 3-hour plasma glucose levels compared to patients in group B at 24 to 28 weeks of gestation (P < .05). No significant differences were observed between the groups for anthropometric data, postpartum abnormal glucose metabolism (50.91% vs 44.83%, P = .596), type 2 diabetes mellitus (T2DM) (16.36% vs 3.45%, P = .167), lipid profiles, β cell function (homeostasis model assessment β-cell function index (HOMA-β) 1.04 vs 0.99, P = .935) and insulin resistance (homeostasis model assessment insulin resistance index (HOMA-IR) 2.01 vs 1.69, P = .583). Patients diagnosed with GDM using either the NDDG or IADPSG criteria had abnormal glucose levels and lipid metabolism after delivery. Patients with mild hyperglycemia had similar postpartum β-cell functional impairment and insulin resistance to those with moderate hyperglycemia during pregnancy. Hence, with respect to maternal long-term postpartum outcomes, the IADPSG diagnostic criteria for GDM could be appropriate for patients in mainland China.

羊水栓塞发病罕见,大多数医生都缺少直接处理该类案例的临床经验,临床上突然遭遇羊水栓塞时处理常常存在一定不足.文章旨在为临床医师提供帮助,以期提高及早诊断的能力,并为羊水栓塞患者建立适当的高级生命支持治疗,以改善产妇和围产儿结局.

Context: The impact of mild TSH elevation (2.5-4.08 mIU/L) on pregnancy outcomes is unclear. The treatment strategy for mild TSH elevation is dependent on thyroid peroxidase antibody (TPOAb) status according to the guidelines. Objective: To assess the effects of mild thyroid dysfunction combined with TPOAb status in the first trimester on pregnancy outcomes and the impact of levothyroxine (L-T4) treatment on pregnancy outcomes. Design: The study retrospectively evaluated 3562 pregnant women. A total of 3296 untreated women were divided into 4 subgroups: group A: 4.08 < TSH <10 mIU/L, TPOAb(+/-); group B: 2.5 < TSH <= 4.08 mIU/L, TPOAb(+); group C: 2.5 < TSH <= 4.08 mIU/L, TPOAb(-); and group D: 0.23 <= TSH <= 2.5 mIU/L, TPOAb(+/-). The other 266 women with L-T4 treatment were divided into TSH 4.08 to 10 mIU/L and 2.5 to 4.08 mIU/L subgroups. Setting: The study was conducted at Peking University First Hospital in China. Patients: A total of 3562 pregnant women were evaluated. Main Outcome Measures: The incidence of pregnancy outcomes in the untreated subgroups (groups A-D) and treated subgroups were measured. Results: Miscarriage and maternal composite outcome risks were 3.53 (1.85-6.75) and 2.19 (1.26-3.81) times greater in group A; 1.58 (1.17-2.13) and 1.27 (1.04-1.54) times greater in group C than in group D. L-T4 improved the miscarriage risk in the TSH 4.08 to 10 and 2.5 to 4.08 mIU/L groups but doubled the risk of gestational diabetes mellitus in the TSH 2.5 to 4.08 mIU/L treated group compared with the untreated group. Conclusions: TSH 2.5 to 4.08 mIU/L combined with TPOAb- during early pregnancy was associated with miscarriages and maternal composite outcomes. The advantages and disadvantages of L-T4 administration in TSH 2.5 to 4.08 mIU/L pregnant women remain uncertain.

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. 0.96mIU/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. 1.27mIU/L, Z=-6.538, P=0.000), and FT4 was significantly higher (16.38 vs. 14.85pmol/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.

Objective: We adopted the area under the curve (AUC) of oral glucose tolerance test (OGTT) as a measure method of the severity of maternal hyperglycemia and investigated its relationship with adverse perinatal outcomes among women with and without gestational diabetes mellitus (GDM). Research design and methods: This is a retrospective cohort study. Our study group collected the medical records of 15,296 women who received perinatal care in 15 hospitals in Beijing and who delivered from July 1, 2013, to December 31, 2013. And several original articles on this cohort have been published. In this study, we analyze the relationship between AUC and adverse perinatal outcomes, so that in multiple pregnant cases, patients with pre-pregnancy diabetes, hypertension, and abnormal kidney function and those who did not receive a 75-g OGTT were excluded. A Chi-squared test and logistic regression analysis were used to determine the associations. Results: In total, 13,561 women were included. As the AUC of OGTT increased, the prevalence of macrosomia (odds ratio [OR] 1.059, 95% confidence interval [95% CI] 1.029 - 1.090, p < 0.001) and hypertensive diseases (OR 1.106, 95% CI 1.064 - 1.149, p < 0.001) also increased. For patients with same levels of AUC values, no significant differences in the risk of macrosomia, preterm birth and neonatal complications were observed between the GDM and non-GDM groups. Women with an AUC higher than 14.20 (mmol * h/L) had a higher risk of adverse outcomes regardless of the presence of GDM. Conclusions: The AUC could be a measure method of the severity of maternal hyperglycemia, and women with a high AUC should undergo aggressive management to avoid adverse outcomes regardless of the presence of GDM.

羊水栓塞是产科严重致死性并发症,需要全院医护人员熟练掌握羊水栓塞的抢救流程和细节,在救治时能够形成一个高水平的团队,以减少羊水栓塞患者的不良结局. 及时识别羊水栓塞是抢救成功的基础,羊水栓塞的临床表现多种多样,很多症状、体征在临床很常见,如心肺功能衰竭、肺动脉高压,尤其凝血功能障碍在临床上较为常见. 产科的医护人员在处理临床病例时,需要有能力识别出典型和不典型的羊水栓塞,并针对患者不同的临床表现,采取个体化处理原则,抢救时需快速对症处理.

目前,我国大多数医院都在对妊娠早期妇女进行甲状腺疾病的筛查,有些孕妇并不了解其中的原因,笔者在这里给大家作个介绍.甲状腺关乎神经系统发育 首先需要了解的是,甲状腺素对人类神经系统的发育起到重要的、不可替代的作用.

Objective To investigate the long-term outcome of postpartum glucose metabolism and predictive factors in patients with gestational diabetes mellitus (GDM).Methods A total of 1 191 patients diagnosed with GDM in the First Hospital of Peking University between November 2006 and October 2013,320 (26.9％) patients were followed up and glucose metabolic data were collected during pregnancy,short-term postpartum (6-12 weeks) and long-term postpartum (1-6 years) periods.With type 2 diabetes mellitus (T2DM) as the end point event,the survival curve was drawn by Kaplan-Meier method to analyze the incidence of postpartum T2DM year by year,and Cox multivariate regression was used to analyze the predictive factors of postpartum T2DM.Results In 1-6 years of postpartum period,9 (2.8％) cases had impaired fasting glucose (IFG),71 (22.2％) had impaired glucose tolerance (IGT) and 14 (4.3％) had T2DM.Both of fasting plasma glucose (FPG) and 2 hour postprandial glucose (2hPG) elevated year by year in postpartum period.Kaplan-Meier survival curve indicated the cumulative incidence of T2DM were 0,0.9％,2.7％,4.6％,7.0％ and 18.8％ in 1-6 years of postpartum period,respectively.Early pregnancy weight,FPG/2hPG during pregnancy,FPG/2hPG/waist/hip ratio in early postpartum period were risk factors of long-term postpartum T2DM (all P＜0.05).Body weight ≥72 kg in early pregnancy and FPG ≥5.2 mmol/L in early postpartum period were independent predictive factors,hazard ratio (HR) were 14.9 [95％ confidence interval (CI)O 2.3-96.1] and 18.2(1.9-173.0),respectively.Conclusions The cumulative incidence of T2DM in GDM patients increases annually,especially in the 5th-6th year of postpartum period.High body weight in early pregnancy and postpartum short-term FPG ≥5.2 mmol/L have important significance to predict the long-term outcome of postpartum glucose metabolism.