| Section 1.Investigation on prevalence of clinical incidence of iron deficiency and iron deficiency anemia among 800 women during second and third trimestersObjectiveTo study the incidence of iron deficiency,iron deficiency anemia and anemia in local pregnant women during second and third trimesters,and their correlation with adverse pregnancy outcomes,to provide clinical evidence for early diagnosis and prompt treatment.Methods1 800 cases of pregnant women,who received prenatal care and delivered at Southeast University Affiliated Zhongda Hospital from June 2015 to November 2016 were retrospectively collected and analyzed.Epidemiological investigation includes:age,height,pre-pregnancy weight,pre-pregnancy BMI,gravidity and parity,delivery weight,delivery BMI and pregnancy outcomes.The routine blood tests and serum ferritin were determined by sodium lauryl sulfate method and chemiluminescence method both at the second(20-24 weeks)and third trimesters(32-34 weeks and 38-40 weeks),respectively,to understand the prevalence of iron deficiency,iron deficiency anemia and the level of Hb,SF in the different stages of pregnancy,the correlation between SF and Hb in different gestational weeks was analyzed and relevant treatment was offered to those diagnosed as anemia,iron deficiency and iron deficiency anemia pregnant women.We analyzed the correlation between iron deficiency and iron deficiency anemia with adverse pregnancy outcomes.2 SPSS 22.0 software is used to statistical analysis.GraphPad Prism 6.01 is used to do chart.The chi-square test,Fisher’s exact statistic test,Paired t test,Repeated measurement data and Linear-regression analysis were performed for statistics.And the magnitude of effect was estimated by odds ratios and their 95%confidence intervals.Results1 Pregnant women with a BMI<18.5kg/m2 had a higher risk of acquiring anemia during 20-24 GW[P=0.019,ORF=1.736,95%CI(1.089,2.768)].But,maternal age,gravidity and parity were not risk factors for anemia.2 The highest prevalence of anemia(16%)was at 20-24 GW(128/800)and the prevalence of mild and moderate anemia were 13.75%and 2.25%respectively.During 32-34 GW the incidence of ID and IDA were the highest at 70.63%and 11.25%respectively.There was marked improvement in the prevalence of anemia during 38-40 GW at 6.63%(53/800)with the prevalence of mild and moderate anemia at 5.13%and 1.5%respectively.In the third trimester,new onset of anemia was 4.8%(32/672)and the total prevalence was 20%(160/800).3 After grouping the SF levels for 20-24 GW were analysed.We discovered that the group with SF<10 μg/L had a higher incidence rate of acquiring anemia as compared to other groups,with a prevalence rate of 21.2%(44/208).The prevalence rate was indirectly proportional to the levels of SF.The group with SF≥20-30 μg/L showed increased rate of anemia correction and the recovery rate among the groups had clinical significance(P<0.05).4 20-24 weeks of pregnancy in pregnant women with different levels of SF regardless of whether the anemia,and it’s not associated with adverse pregnancy outcomes significantly(gestational hypertension,premature birth,thyroid function abnormal,gestational diabetes,premature rupture of membranes,oligohydramnios,postpartum hemorrhage,neonatal asphyxia,fetal macrosomia).5 The lowest level of SF at the 32-34 week of pregnancy was 13.96 ± 0.33(μg/L),which was in the iron deficiency in pregnancy.The difference of Hb,SF and Hct levels in different gestational weeks was statistically significant(P<0.05).6 The correlation between SF and Hb in different gestational weeks was analyzed.We found that there was a correlation between SF level and Hb at the 32-34 week of pregnancy,the difference was statistically significant(P<0.05)and the regression equation used was Y=0.1617X+117.5.Conclusions1 The highest prevalence of anemia was 16%at 20-24 GW.During 32-34 GW the incidence of ID and IDA were the highest at 70.63%and 11.25%respectively.In the third trimester,new onset of anemia was 4.8%and the total prevalence was 20%.2 Pregnant women with a BMI<18.5kg/m2 had a higher risk of acquiring anemia.3 20-24 weeks of pregnancy in pregnant women with different levels of SF is not associated with adverse pregnancy outcomes significantly.It is suggest that the therapy of iron supplementation is effective,and the severity of anemia has an influence on the outcome of pregnancy.4 We discovered that the group with SF<10μg/L had the highest prevalence of anemia during 20-24 GW.The prevalence rate was indirectly proportional to the levels of SF.The group with SF≥20-30 μg/L during 20-24 GW had the highest of anemia correction rate in the second trimester.It is suggested that SF level is important in the diagnosis of ID and IDA during pregnancy.Section 2.Evaluation of the effectiveness of serum ferritin in gestational diabetes mellitus screening during the second trimesterObjectiveTo analyse serum ferritin,blood glucose,haemoglobin levels and other indicators in pregnant women with gestational diabetes in the second trimester,investigate the correlation between serum ferritin and risk of gestational diabetes,investigate whether serum ferritin has clinical significance in early prediction of gestational diabetes.Methods1 224 cases of Pregnant women in their second trimester(24-28 weeks)undergoing prenatal care in Southeast University affiliated Zhongda Hospital from March 2015 to December 2015 were included in clinical case control study.Epidemiological investigation includes:age,height,pre-pregnancy weight,pre-pregnancy BMI,OGTT gestational weeks,delivery weight,delivery BMI and pregnancy outcomes.According to 75g OGTT test,they were divided into two groups.112 patients with gestational diabetes(GDM group)and 112 patients without gestational diabetes(Control group),the differences between the clinical data,SF level,OGTT level,blood routine test related indicators were compared.We analyzed the correlation between SF and the incidence of GDM,and the pregnancy outcomes of the two groups were compared.2 SPSS 22.0 software is used to statistical analysis.Wilcoxon paired rank test,Speraman correlation,Multivariate logistic regression analysis,The chi-square test,Receiver operating characteristic curve analysis were performed for statistics.Results1 The level of pre-pregnancy weight,pre-pregnancy BMI in the second trimester in the GDM group was significantly higher than that in the control group(P<0.05),the difference has statistical significance.There was no significant difference between two groups in the age,OGTT gestational weeks and height(P>0.05).2 The level of SF,Hb,FPG,1hPG,2hPG,RBC,WBC,Hct in the second trimester in the GDM group was significantly higher than that in the control group(P<0.05),the difference has statistical significance.There was no significant difference between the GDM group and the control group in the level of MCV、MCH、MCHC(P>0.05).3 Spearman correlation analysis revealed that SF levels in the second trimester were positively associated with the levels of FPG,1hPG,2hPG,Hb,WBC,pre-pregnancy weight,pre-pregnancy BMI,delivery weight,delivery BMI(rs=0.399,0.459,0.365,0.207,0.191,0.239,0.263,0.229,0.248,P<0.01).4 Receiver operating characteristic curve analysis of the correlation between different SF levels and risk of GDM in pregnant women showed that the area under the curve(AUC)was 0.872[P=0.000,95%CI(0.824～0.920)].At all the cut-off points,the maximum value of Youden’s index was 0.705,the sensitivity was 71.4%,specificity was 99.1%,the corresponding SF value is 17.15μg/L.5 Multivariable logistic analysis showed that,pre-pregnancy BMI,SF and WBC are risk factors for GDM(OR values were 1.391,1.317,1.212,respectively.95%CI 1.168～1.656,1.198～1.447,1.011～1.454,respectively),but age and delivery gestational age are the protective factors in GDM(OR values were 0.858,0.858,respectively.95%CI 0.737～0.999,0.509～0.976,respectively).6 Pregnant weeks,delivery weight,delivery BMI,cesarean section,premature rupture of membranes,24 hours postpartum hemorrhage volume in the GDM group was significantly higher than that in the control group(P<0.05).There were no significant in hypertension,neonatal birth weight,postpartum hemorrhage,birth defects.There were no significant differences in pregnancy-induced hypertension,neonatal birth weight,rate of postpartum hemorrhage and birth malformation between two groups(P>0.05).Conclusions1 Pre-pregnancy BMI,SF level and WBC are risk factors for GDM.GDM can lead to premature rupture of membranes,premature delivery,cesarean section rate,postpartum hemorrhage,the incidence of macrosomia increased significantly.2 SF levels in the second trimester were positively associated with the levels of FPG,1hPG,2hPG,it is suggested that there may be have a relationship between SF level and glucose metabolism during pregnancy.3 We found that the level of SF in the second trimester in the GDM group was significantly higher than that in the control group,and there has a certain accuracy of GDM prediction. |
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