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Prevalence rate of gestational diabetes mellitus in China: a meta-analysis

ObjectiveTo systematically review the prevalence rate of gestational diabetes mellitus in Chinese population.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect relevant literature of the prevalence rate of gestational diabetes in Chinese population from inception to October 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using R 3.4.1 software.ResultsA total of 27 studies were included involving 183 338 peoples, of whom 23 834 were diagnosed as gestational diabetes mellitus by oral glucose tolerance test (75g). The prevalence rate was 13% (95%CI 10 to 16). The prevalence rate of gestational diabetes mellitus in north area was 13% (95%CI 9 to 19), central area was 11% (95%CI 2 to 39), east area was 15% (95%CI 12 to 19), south area was 12% (95%CI 11 to 14), northwest area was 5% (95%CI 3 to 8) and southwest area was 4% (95%CI 3 to 4). The prevalence rate of gestational diabetes mellitus during January 2005 to December 2012 was 11% (95%CI 7 to 16), during December 2012 to June 2016 was 17% (95%CI 14 to 20). The prevalence of specialist hospitals was 9% (95%CI 6 to 14), and which of comprehensive hospital was 14% (95%CI 11 to 18). The prevalence of gestational diabetes screening at 24 to 28 weeks gestation remained at 13% (95%CI 10 to 17).ConclusionThe prevalence rate of gestational diabetes mellitus is high in China. The prevalence rate of gestational diabetes mellitus in north China, central China and east China is significantly higher than that in southern China, northwest China and southwest China. The prevalence rate during 2012-2016 is significantly higher than that in 2005 to 2012. Improvement of lifestyle and living standard should be considered be closely related with that. The prevalence of comprehensive hospitals is higher than specialist hospitals. It is related to the China’s economic conditions, medical care situations and the medical habits of patients.

Diagnosis and Treatment Strategy of Acute Pancreatitis in Pregnancy

Analysis of Atypical Placental Abruption

目的　探討不典型胎盤早剝的臨床特點。 方法　對2008年5月－2009年5月收治的55例胎盤早剝患者的臨床資料進行回顧性分析。其中產前漏診30例，疑診15例，確診10例。胎盤早剝的產前確診率為18.2%，漏診率為54.5%。所有患者均經產后證實。 結果　重度子癇前期（25.5%）、胎膜早破（12.7%）是胎盤早剝的主要發病誘因；陰道流血（52.7%）、腰腹痛（47.3%）及胎心異常（36.4%）是其常見的臨床表現。胎盤早剝者，剖宮產率、胎兒窘迫及早產率均增加。 結論　不典型胎盤早剝病情隱匿。后壁胎盤、早剝面積小及B型超聲檢查陰性是漏診的主要原因。對此患者應提高認識，動態監測，及時處理，以改善母嬰結局。

Research progress on the relationship between serum uric acid level and hypertensive disorder of pregnancy

Hypertensive disorder of pregnancy (HDP) is a type of disease unique to women during pregnancy. The most common clinical types are gestational hypertension and preeclampsia, which seriously threaten the health of pregnant women and fetuses. At present, there are no established criteria for the prediction and prevention of HDP. In recent years, a large number of studies have been carried out on HDP around the world, and many studies have shown a close correlation between serum uric acid and HDP. This article reviews the results of existing literature, elucidates the relationship between serum uric acid and the pathogenesis of HDP, prediction of HDP occurrence and development, and adverse pregnancy outcomes.

Literature Analysis of Antimicrobial Agents Application during Pregnancy

目的　了解國內妊娠期抗菌藥物的應用現狀。 方法　通過檢索1994年－2012年國內醫學文獻，篩選出妊娠期間使用抗菌藥物的原始病例報道，對收集的病例按照用藥原因、抗菌藥物品種、妊娠安全性分級進行統計分析。其中妊娠安全性分級是根據美國藥物和食品管理局（FDA）頒布的藥物危害等級標準，分為A、B、C、D、X級。 結果　妊娠期使用抗菌藥物的常見原因為泌尿系統感染，選用的抗菌藥物以頭孢菌素和青霉素類為主（B類），但仍有部分病例選用C類、D類藥物及超說明書用藥。 結論　存在妊娠期抗菌藥物不合理應用現象，妊娠合并感染性疾病需用抗菌藥物時，醫生應權衡抗菌藥物對胎兒的可能危害及對母體的治療作用，最大限度地避免用藥對胎兒造成不良影響。

妊娠期糖尿病胰島素治療特點及對母嬰結局的影響

摘要： 目的：研究妊娠期糖尿病（GDM）胰島素治療特點及對母嬰結局的影響。方法：回顧性總結我院住院分娩的妊娠期糖尿病患者胰島素治療特點，并與飲食治療（對照組）對比，分析胰島素治療（研究組）對母嬰結局的影響。結果：胰島素使用率23.29%，隨孕周增加逐漸增加（Plt;0.05），使用劑量及方法個體差異較大。兩組孕婦年齡、分娩孕周、新生兒體重差異無顯著性（Pgt;0.05）。研究組孕婦酮癥、胎膜早破發生率較對照組減少(Plt;0.05）；妊高癥、胎兒窘迫、羊水過多、剖宮產、巨大兒、低體重兒、新生兒窘迫、早產兒發生率差異無顯著性（Pgt;0.05）。結論：胰島素使用應遵循個體化原則，及時正確加用胰島素可有效控制血糖、改善母嬰預后。

急性妊娠脂肪肝的臨床分析

【摘要】目的 通過分析總結急性妊娠脂肪肝(acute fatty liver of pregnancy,AFLP)的臨床特點,為臨床確定有〖JP2〗效的治療方案及減少母嬰死亡提供依據。方法 對2006年1月-2009年10月收治7例AFLP患者,年齡23~32歲。〖JP〗初產婦5例,經產婦2例(宮內死胎1例)。孕周33~38周。對6例產前發病患者以剖宮產終止妊娠,給予對癥處理；1例產后發病患者直接入ICU治療。結果 6例產前發病者,5例各項指標較快恢復正常,母嬰存活,術后10 d出院；1例剖宮取胎后轉ICU治療,術后好轉出院。1例產后發病患者因多臟器衰竭、彌散性血管內凝血搶救無效死亡。結論 AFLP是妊娠晚期特發性致死的嚴重并發癥,早期診斷和積極有效的處理是良好預后的關鍵,應引起產科工作者的重視。

Diagnosis and Treatment for Pregnancy-Associated Breast Cancer

Objective　To summarize the recent studies on diagnosis and treatment for pregnancy-associated breast cancer （PABC） to provide evidence for diagnosis and treatment for PABC. Methods　By PubMed， Medline， and CNKI retrieval system， with “pregnancy-associated breast cancer or PABC， diagnosis of pregnancy-associated breast cancer or PABC， treatment of pregnancy-associated breast cancer or PABC” as key words to retrieval for the recent researches about PABC. All of the publications about studies on diagnosis and treatment for PABC were reviewed and summarized. Results　Diagnosis of PABC included ultrasound， mammography， magnetic resonance imaging， needle biopsy， and so on， and the treatment contained surgery， chemotherapy， endocrine therapy， radiation therapy， and targeted therapy. However， when diagnosis and treatment for PABC involved， the impact to patients with pregnancy and fetus must be considered in priority. Conclusions　By reviewing the studies of relevant papers about diagnosis and treatment for PABC which can provide a clinical guidance for clinicians. Usage of bevacizumab and lapatinib still needs to further be studied.

ANALYSIS OF FACTORS INFLUENCING PROGNOSIS OF BREAST CANCER ASSOCIATED WITH PREGNANCY AND LACTATION

The authors studied retrospectively clinical data of seventy cases with breast cancer during pregnancy and lactation.They were treated and diagnosed by operation and pathology.Primary factors influencing prognosis were analyzed.It was demonstrated that 5year survival rate of the patients were significantly influenced by clinical stage , month of pregnancy and lactation, time of symptoms, type of operation, type of pathology, histological grade of malignancy, recurrence and metastasis, and estrogen receptor status (Ｐ＜0.05).Age and termination of pregnancy had no beneficial effect on survival (Ｐ＞0.05).The prognosis of pregnant and lactating breast cancer was poorer than ordinary breast cancer.Their 5year survival rate were 55.7% and 74.3%, respectively. After they were matched for stage and for age, no difference in survival was found.Early diagnosis and radical operation combined with radiotherapy, chemotherapy and hormonal therapy have better prognosis.The method can shorten time of treatment and improve survival rate.Termination of pregnancy has not been shown to improve survival and shall not be advised routinely.Future pregnancy may be detrimental and shall be discouraged.

Clinical Evidence on the Prognosis of a Patient with Gestational Diabetes Mellitus

Objective　Based on the methodology of evidence-based medicine, we explored the prognosis of a patient with gestational diabetes mellitus (GDM). Methods　We searched ACP Journal Club (1991 to October 2006), The Cochrane Library (Issue 4, 2006), MEDLINE (1990 to October 2006) and Chinese Biomedicine database (CBM). Cohort studies, case-control studies and case series studies involving the prognosis of patients with GDM were collected. The available evidence was critically appraised. Results　During the period from 6 weeks to 28 years after delivery, the incidence of type 2 diabetes mellitus appeared to vary from 2.6% to 70%. Patients with GDM suffered from an increased incidence of spontaneous premature delivery, hypertension, metabolic syndrome and vaginal infection. Conclusion　Patients with GDM appears to be more liable to overt diabetes mellitus, and to suffer fromspontaneous premature delivery, hypertension, metabolic syndrome and vaginal infection than women with normal glucose tolerance during pregnancy. Further studies of the long-term follow-up data from GDM trials are needed.