Prepregnancy Risk Factors, Pregnancy Outcomes, And Childhood Neurodevelopment

Background: In recent years,more and more researchers pay attention to the influence of prepregnancy risk factors on pregnancy outcomes.But previous studies mostly focus on maternal prepregnancy factors,and less involved the influence of paternal prepregnancy factors on pregnancy outcomes.Prepregnancy health examination aims at mastering the conditions of reproductive health of childbearing age couples before pregnancy,discovering and correcting the adverse factors to adverse pregnancy outcomes.With the development of the pregnancy health care,men in the role of eugenics also gradually are taken seriously.Father not only could pass genetic risk for the next generation,some environmental factors can also affect the next generation through his father.Furthermore,mother exposed to adverse factors before pregnancy in addition to affect pregnancy outcomes,may also affect children’s long-term result of neurodevelopment.But there’s almost no related research.Objectives: 1.To master the reproductive health of couples of child-bearing age who participated prepregnancy health examination in Shanghai.2.To evaluate the improvement of living behavior during preparation for pregnancy and early pregnancy and the pregnancy outcomes.3.To access the association between the prepregnancy factors of couples and infertility,spontaneous abortion and other adverse pregnancy events.4.To explore the effects of maternal pregnancy weight change during a special period(the duration between two consecutive pregnancy)on pregnancy outcomes and the neurodevelopment of their children.Methods: 1.Evaluated the basic situation and reproductive health of the couples of child-bearing age by analyzing the prepregnancy health examination data(family achieves)of 20467 couples in shanghai through cross-sectional survey research methods.2.This was a prospective study,based on the cross-sectional survey in 2012.After three and six months of the prepregnancy health examination,followed up the couples’ situation of life behavior change and early pregnancy.The couples will continued to be followed up to delivery if they were pregnancy.By analyzing the follow-up results of family archives,evaluated the influence of preprenancy health examination on life behavior of couples during preparation of pregnancy and early pregnancy and evaluated the basic situation of their early pregnancy and pregnancy outcomes.3.Followed up the 6319 couples in 8 districts in shanghai in 2015 who voluntary participated the prepregnancy health examination in 2012.Combined the data of pregnancy health examination and used multivariable Logistic regression model analysis the association of prepregnancy risk factors and infertility,spontaneous abortion and other adverse pregnancy outcomes.4.Data were obtained from the Collaborative Perinatal Project,a multicenter prospective cohort study in the U.S.from 1959 to 1976.A logistic regression analysis was used to explore the association of maternal body mass index(BMI)change between two consecutive pregnancies with the perinatal outcomes and the child neurodevelopment.Results: 1.There was about eighty percent of 20467 couples who participated the preprenancy health examination had risk factors to pregnancy,including 13.1% of women had family diabetic history,2.3% of women had hyperglycemia;passive smokers accounted for 58.7%,and only 1.8% of women smoking.Women with induced abortion experience accounted for 18.5%,stillbirth and spontaneous abortion accounted for 10.1%;Cervical erosion has the highest detection rate(34.7%)of gynecological disease.The percent of male smokers as high as 30.4%;Male overweight/obesity(30.1%)is relatively common;semen quality is not optimistic that 24.2% of male occurred semen volume decrease,oligspermia accounted for 4.3% and asthenozoospermia accounted for 7.8%.2.There were 20467 couples participated the prepregnancy health examination in 17 districts in Shanghai in 2012,except the zhabei district,19771 couples of the other 16 districts participated the telephone follow-up.Early pregnancy cases are 5242(26.5%).The bad living habits during preparation of pregnancy and pregnancy(such as pet exposure,passive smoking,etc.)and environmental harmful substances contact were decreased obviously compared with these when they participated the prepregnancy health examination.4897 cases(24.8%)were followed up to birth.13 cases(0.3%)of ectopic pregnancy;133 cases(2.7%)of spontaneous abortion;42 cases(0.9%)of medical abortion;7 cases(0.1%)of therapeutic induced labor.9 cases(0.2%)of stillbirth;Cesarean delivery rate was 47.1%(1986 cases);5 cases(0.1%)of birth defect;249 cases(5.3%)of preterm birth;54 cases(1.2%)of postterm birth;104 cases(2.7%)of low birth weight;300 cases(6.4%)of macrosomia.3.In women,irregular menstruation(adjusted odds ratio [a OR] 1.5,95% confidence interval 1.2-1.9),2nd degree leucorrhea cleanliness(a OR 1.3,95% CI 1.1-1.6),halitosis(a OR 1.4,95% CI 1.0-1.9)and older than 30 increased the risk of infertility.In men,family history of neonatal death or infant death(a OR 6.0,95% CI 1.8-19.9)increased the risk of infertility.As women get older,the risk of infertility increased gradually.In women,Hepatitis B surface antibody negative(a OR 1.9,95% CI 1.2-3.3),history of adverse pregnancy outcomes(a OR 2.5,95% CI 1.7-3.7),history of spontaneous abortion(a OR 2.7,95% CI 1.8-4.0),family history of diabetes(a OR 1.6,95% CI 1.1-2.5),3rd degree leucorrhea cleanliness(a OR 1.6,95% CI 1.0-2.7)increased the risk of miscarriage.In men,Hepatitis B surface antibody negative(a OR 2.2,95% CI 1.3-3.9),exposure to heavy metals(a OR 3.3,95% CI 1.1-9.7),and interpersonal tension(a OR 2.3,95% CI 1.1-4.5)increased the risk of miscarriage of their wives.4.Compared with women whose BMI gained 0 to 1 unit between the two pregnancies,those who gained more than 2 units were at increased risks for offspring low IQ(IQ < 70,a OR 2.0,CI 1.1-3.6),pregnancy-induced hypertension(a OR 1.6,95% CI 1.2-2.0)and macrosomia(a OR 2.1,95% CI 1.5-3.0).Women with interpregnancy BMI lost 1 unit or more also had elevated risks for low IQ(a OR 2.3,95% CI 1.2-4.1),preterm birth(a OR 1.7,95% CI 1.3-2.3)and low birth weight(a OR 2.2,95% CI 1.5-3.2)in the second pregnancy.Conclusion: 1.Most of the couples of child-bearing age had risk factors for adverse pregnancy and need to accept prepregnancy health guidance.This suggest that implementation of prepregnancy health examination is very importment.2.Prepregnancy health examination improved the life behavior during preparation of pregnancy and early pregnancy.It was helpful to reducing the rate of adverse prepregnancy.3.Couples’ bad living habit,contact with harmful substances and other prepregnancy risk factor increased the risk of infertility,spontaneous abortion,preterm birth,low birth weight and macrosomia.4.Interprepregnancy BMI increased 1 unit or less can get best children’ neurodevelopment.Interprepregnancy BMI increased more than 2 units or decreased more than 1 unit may be risk factors of delayed development of children’neurobehavior.