目的 探讨产后抑郁症的危险因素及其对儿童体格发育和喂养方式的影响.方法 招募对象为2019年1月至2020年12月在浙江省嘉兴市妇幼保健院进行体检的产妇及其子代,产妇在产后42 d填写爱丁堡产后抑郁量表,将评分≥13分归入抑郁组,入组人员经过心理医生评估;记录产妇人口学特征及分娩的基本情况,在42d、3月龄及6月龄进行随访并记录儿童的喂养方式、身长及体质量.结果 共纳入研究对象272例,其中抑郁组63例,对照组209例.年龄、文化程度及在职情况与产后抑郁相关,适龄、文化程度高及有工作为产后抑郁的保护因素;抑郁组儿童体质量在42d、3月龄及6月龄均低于对照组(均P＜0.05);抑郁症组母亲在42d、3月龄及6月龄纯母乳喂养率均低于对照组(均P＜ 0.05).结论 适龄、文化程度高及有工作为产后抑郁的保护因素,母亲产后抑郁症与儿童早期体格发育不良有关,同时放弃纯母乳喂养的概率更高.

目的 探讨互联网医疗对孕产期保健利用及不良妊娠结局的影响,提高孕期保健的水平和效果.方法 选取2017年1月1日-2017年9月30日自愿参加互联网医疗并在嘉兴市妇幼保健院参加全程孕期体检和分娩的1 011例居住在嘉兴地区半年以上的孕产妇为观察组,并随机从该院分娩的其他孕产妇中选取1 008例作为对照组.结果 观察组初产妇的比例高于对照组,差异有统计学意义(P＜0.05);而两组孕妇年龄、孕次、文化程度和BMI方面比较,差异均无统计学意义(均P＞0.05).观察组孕妇对孕期合理饮食营养、合理行为方式、合理身体护理方式、合理休闲娱乐方式及合理衣着穿戴方式的知晓程度高于对照组,差异均有统计学意义(均P＜0.05).观察组孕妇早产率和剖宫产率低于对照组,新生儿出生体质量优于对照组,差异均有统计学意义(均P＜0.05).两组孕妇产后出血发生率比较,差异无统计学意义(P＞0.05).结论 在孕期保健中运用互联网医疗,可以有效降低妊娠并发症发生率和剖宫产率,提升健康教育效果,保障母婴安全.

Background The early life risk factors of childhood obesity among preterm infants are unclear and little is known about the influence of the feeding practices. We aimed to identify early life risk factors for childhood overweight/obesity among preterm infants and to determine feeding practices that could modify the identified risk factors. Methods A total of 338,413 mother-child pairs were enrolled in the Jiaxing Birth Cohort (1999 to 2013), and 2125 eligible singleton preterm born children were included for analyses. We obtained data on health examination, anthropometric measurement, lifestyle, and dietary habits of each participant at their visits to clinics. An interpretable machine learning-based analytic framework was used to identify early life predictors for childhood overweight/obesity, and Poisson regression was used to examine the associations between feeding practices and the identified leading predictor. Results Of the eligible 2125 preterm infants (863 [40.6%] girls), 274 (12.9%) developed overweight/obesity at age 4–7 years. We summarized early life variables into 25 features and identified two most important features as predictors for childhood overweight/obesity: trajectory of infant BMI (body mass index) Z -score change during the first year of corrected age and maternal BMI at enrollment. According to the impacts of different BMI Z -score trajectories on the outcome, we classified this feature into the favored and unfavored trajectories. Compared with early introduction of solid foods (≤ 3 months of corrected age), introducing solid foods after 6 months of corrected age was significantly associated with 11% lower risk (risk ratio, 0.89; 95% CI, 0.82 to 0.97) of being in the unfavored trajectory. Conclusions The trajectory of BMI Z -score change within the first year of life is the most important predictor for childhood overweight/obesity among preterm infants. Introducing solid foods after 6 months of corrected age is a recommended feeding practice for mitigating the risk of being in the unfavored trajectory.

目的 分析2015—2018年嘉兴市高危孕产妇的特征,为高危孕产妇管理和高危因素干预提供依据.方法 通过嘉兴市妇幼保健管理信息平台收集2015—2018年嘉兴市高危孕产妇资料,对高危孕产妇的人群特征、高危等级、危重孕产妇发生率、 妊娠结局和危险因素等情况进行描述性分析.结果 2015—2018年嘉兴市常住孕产妇212014人,其中高危孕产妇105808人,高危发生率为49.91％.2015—2018年高危孕产妇发生率呈上升趋势(P<0.05).轻度高危孕产妇97377人,占92.03％;中度6859人,占6.48％;重度1572人,占1.49％.高危经产妇62785人,占59.34％,2015—2018年高危经产妇比例呈上升趋势(P<0.05).危重孕产妇、围产儿死亡、巨大儿和剖宫产发生率分别为0.48％、0.94％、6.29％和51.11％,均呈逐年下降趋势(P<0.05);严重产后出血发生率为0.45％,呈逐年上升趋势(P<0.05);早产发生率为6.27％,变化趋势无统计学意义(P>0.05).高危孕产妇危险因素及妊娠期并发症排名前五位分别为瘢痕子宫、体重异常、血液系统疾病、年龄<18岁或>35岁和妊娠糖尿病.结论 2015—2018年嘉兴市高危孕产妇发生率呈上升趋势,高危经产妇比例逐年增加,不良妊娠结局减少;瘢痕子宫、体重异常和血液系统疾病是危险孕产妇最主要的高危因素.

To identify early life risk factors for childhood overweight/obesity among preterm infants and to determine feeding practices that could modify the identified risk factors. Jiaxing Birth Cohort is a prospective cohort involving 338,413 mother-child pairs who were enrolled in between 1999 and 2013, of whom 2125 singleton preterm born children with adequate information documented were included in the analyses. Infant and maternal variables were summarized into 25 features. The LightGBM model based on a gradient-boosting framework was used to link input features with future overweight/obesity and a novel unified framework, SHAP (Shapley Additive exPlanations), was used to interpret predictions and identify predictive factors from the summarized features. Poisson regression model was used to examine the association between feeding practices and the identified leading predictive factor. Of the eligible 2125 preterm infants, 274 (12.9%) developed overweight/obesity at age 4–7 years. Using an interpretable machine learning-based analytic framework, we identified two most important features as predictors of Childhood overweight/obesity: trajectory of infant BMI Z-score change during the first year of corrected age and maternal BMI at enrollment. The identified features in the model showed similar predictive capacity compared with all features. According to the impacts of different BMI Z-score trajectories on model outputs, we classified this feature into favored and unfavored trajectory. Compared with early introduction of solid foods (≤3 months of corrected age), introducing solid foods after 6 months of corrected age was significantly associated with 11% lower risk (risk ratio, 0.89; 95% CI, 0.82 to 0.97, P < 0.01) of being in the unfavored trajectory. Our results suggest that the trajectory of BMI Z-score change within the first year of life is the most important predictor for childhood overweight/obesity among preterm infants. Introducing solid foods after 6 months of corrected age is a recommended feeding practice for mitigating the risk of unfavored trajectories of BMI Z-score change early in life. This study was funded by the Open Project Program of China-Canada Joint Lab of Food Nutrition and Health, Beijing Technology and Business University (BTBU) (KFKT-ZJ-201,801).

Context:Maternal hypertensive disorders during pregnancy are suggested to affect obesity risk in offspring. However, little is known about the prospective association of rise in maternal blood pressure within normal range during pregnancy with this risk for obesity.Objective:To clarify the associations of diastolic and systolic blood pressure during pregnancy among normotensive women with the risk for obesity in offspring.Design:Prospective cohort study.Setting:Southeast China.Participants:Up to 2013, a total of 88,406 mother-child pairs with anthropometric measurements of offspring age 4 to 7 years were included in the present analysis.Main Outcome Measures:Overweight/obesity risk in offspring.Results:Among normotensive women, second- and third-trimester diastolic and systolic blood pressures were positively associated with risk for overweight/obesity in offspring: odds ratios per 10-mm Hg higher second- and third-trimester diastolic blood pressure were 1.05 [95% confidence interval (CI), 1.01 to 1.09] and 1.05 (95% CI, 1.02 to 1.10), respectively, and for systolic blood pressure were 1.08 (95% CI, 1.05 to 1.11) and 1.06 (95% CI, 1.03 to 1.09). Each 10-mm Hg greater rise in blood pressure between first and third trimesters was associated with a higher risk for offspring overweight/obesity: diastolic, 1.06 (95% CI, 1.01 to 1.10); systolic, 1.05 (95% CI, 1.02 to 1.07). Among all women (combining normotensive and hypertensive women), maternal hypertension in the second and third trimesters was associated with 49% and 14% higher risks for overweight/obesity in offspring, respectively.Conclusions:These results suggest that rise in maternal blood pressure during pregnancy and hypertension during pregnancy, independent of maternal body size before pregnancy, are risk factors for offspring childhood obesity.

Objective To assess the association of exclusive breastfeeding duration with risk of anemia in infants of 12 months and children aged 48–71 months in mainland China. Methods 65256 children enrolled in the Jiaxing Birth Cohort provided detailed breastfeeding information and anthropometry data at 1, 3, and 6 months of age. Hemoglobin was measured in 28105 children at 12 months and in 36128 children within 48–71 months thereafter. Anemia was defined as hemoglobin concentrations <110 g/L for children aged <60 months and <115 g/L for children aged ≥60 months. Results Overall anemia prevalence at 12 months and 48–71 months was 24.9% and 10.0%, respectively. Exclusive breastfeeding≥6 months, but not 3–5 months, was significantly associated with a higher risk of anemia in infants at 12 months age (OR: 1.17; 95% CI: 1.04–1.31), compared with exclusive breastfeeding<3 months. While for young children of 48–71 months of age, it was only marginally significant (OR: 1.14; 95% CI: 0.99–1.30).Prolonged exclusive breastfeeding duration was also associated with a decreased hemoglobin concentration of −0.60 g/L (95% CI: −1.12‐‐0.07) for infants at 12 months ageand −0.97 g/L (95% CI: −1.41‐‐0.53) for young children of 48–71 months of age. Conclusions Exclusive breastfeeding ≥6 months was associated with an increased risk of anemia in infants aged 12 months and lower hemoglobin concentrations in both infants and young children aged 48–71 months. Parents should be vigilant to prevent infant anemia and iron deficiency in infants exclusively breastfed for longer than 6 months. Support or Funding Information This study was funded by the Ph.D. Programs Foundation of Ministry of Education of China (J20130084).

Abstract Associations of folic acid supplementation with risk of preterm birth (PTB) and small-for-gestational-age (SGA) birth were unclear for the Chinese populations. The aim of the present study was to investigate the associations in a large Chinese prospective cohort study: the Jiaxing Birth Cohort. In the Jiaxing Birth Cohort, 240 954 pregnant women visited local clinics or hospitals within their first trimester in Southeast China during 1999–2012. Information on anthropometric parameters, folic acid supplementation and other maternal characteristics were collected by in-person interviews during their first visit. Pregnancy outcomes were recorded during the follow-up of these participants. Multinomial logistic regression was used to examine the association of folic acid supplementation with pregnancy outcomes. The prevalence of folic acid supplementation was 24·9 % in the cohort. The prevalence of PTB and SGA birth was 3·48 and 9·2 %, respectively. Pre-conceptional folic acid supplementation was associated with 8 % lower risk of PTB (relative risk (RR) 0·92; 95 % CI 0·85, 1·00; P=0·04) and 19 % lower risk of SGA birth (RR 0·81; 95 % CI 0·70, 0·95; P=0·008), compared with non-users. Higher frequency of pre-conceptional folic acid use was associated with lower risk of PTB (P trend=0·032) and SGA birth (P trend=0·046). No significant association between post-conceptional initiation of folic acid supplementation and either outcome was observed. In conclusion, the present study suggests an association between pre-conceptional, but not post-conceptional, folic acid supplementation and lower risk of PTB and SGA birth in the Jiaxing Birth Cohort. Further research in other cohorts of large sample size is needed to replicate these findings.

目的通过对流动人口贫血孕妇孕期的管理和干预,进行效果评价,探讨对孕期常见疾病管理模式,有效降低流动人口孕期贫血的发生,减少母婴并发症,提高人口素质。方法将已确诊贫血的流动人口孕产妇397例根据依从性,分为2组,一组为进入系统管理的孕期管理干预组193例,另一组为同期对照组204例,两组进行效果对比。结果孕早期轻、中、重度贫血发生率差异均无统计学意义(均>0.05)。孕中期贫血发生率差异有统计学意义(<0.01),孕晚期贫血发生率差异有统计学意义(<0.01),产后贫血发生率差异有统计学意义(<0.01)。妊娠高血压综合征生发率差异有统计学意义(<0.05);产后出血发生率差异有统计学意义(<0.05)。管理组分娩孕周较对照组长(<0.05)。新生儿体质量差异有统计学意义(<0.05);新生儿窒息发生率差异有统计学意义(<0.01),早产发生率差异无统计学意义(>0.05)。结论对流动人口贫血孕妇管理干预有效,具有可操作性,值得在基层推广。

高危孕产妇的筛查,管理的质量如何,直接关系到围产儿死亡率、孕产妇合并症及孕产妇死亡率的高低.因而,加强对高危妊娠的管理,是围产期保健的重点.近几年大批流动人口涌入长三角地区工作和生活,形成新的社会群体和工作难点.流动人口因生活水平、教育、经济及社会因素所限,成为不可忽视的弱势群体,流动人口中孕产妇围产保健管理尤其是高危孕产妇管理更是一个薄弱环节,在孕产妇死亡案例中流动人口高危孕产妇占了绝大多数.