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与时俱进的出生缺陷三级预防
出生缺陷 / 产前筛查 / 产前诊断 / 三级预防 / 干预
birth defect / prenatal screening / prenatal diagnosis / three-grade prevention / intervention
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Approximately 3%–6% of infants were born with congenital birth defects worldwide every year, which ranked as the third leading cause of deaths among the population under 20 years of age in 2021.
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高瑜阳, 朱军. 全国妇幼健康监测及年报通讯[R/OL]. 成都: 全国妇幼卫生监测办公室,2022:第4期,总第108期.
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吕华胜, 冀伟, 孙丰宇, 等. 1990—2021年全球与中国新生儿先天性出生缺陷疾病负担趋势分析[J]. 西安交通大学学报(医学版), 2025, 46(6):1045-1052.DOI:10.7652/jdyxb202506023.
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刘雯, 房格, 李晓, 等. 高龄对男性精子DNA甲基化及后续对胚胎和子代发育的影响[J]. 中华男科学杂志, 2025, 31(2):172-176.DOI:10.13263/j.cnki.nja.2025.02.011.
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Preterm birth (PTB), a multi-causal syndrome, is one of the global epidemics. Maternal nutrition, but also neonatal and placental telomere length (TL), are among the factors affecting PTB risk. However, the exact relationship between these factors and the PTB outcome, remains obscure. The aim of this review was to investigate the association between PTB, maternal nutrition, and placental-infant TL. Observational studies were sought with the keywords: maternal nutrition, placental TL, newborn, TL, and PTB. No studies were found that included all of the keywords simultaneously, and thus, the keywords were searched in dyads, to reach assumptive conclusions. The findings show that maternal nutrition affects PTB risk, through its influence on maternal TL. On the other hand, maternal TL independently affects PTB risk, and at the same time PTB is a major determinant of offspring TL regulation. The strength of the associations, and the extent of the influence from covariates, remains to be elucidated in future research. Furthermore, the question of whether maternal TL is simply a biomarker of maternal nutritional status and PTB risk, or a causative factor of PTB, to date, remains to be answered.
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| [6] |
The short-term impact of famines on death and disease is well documented, but estimating their potential long-term impact is difficult. We used the setting of the man-made Ukrainian Holodomor famine of 1932-1933 to examine the relation between prenatal famine and adult type 2 diabetes mellitus (T2DM). This ecological study included 128,225 T2DM cases diagnosed from 2000 to 2008 among 10,186,016 male and female Ukrainians born from 1930 to 1938. Individuals who were born in the first half-year of 1934, and hence exposed in early gestation to the mid-1933 peak famine period, had a greater than twofold likelihood of T2DM compared with that of unexposed controls. There was a dose-response relationship between severity of famine exposure and increase in adult T2DM risk.
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中华人民共和国国家卫生健康委员会. 妊娠期妇女体重增长推荐值标准(WS/T801-2022)卫生行业标准[EB/OL].(2022-07-28)[2026-01-10]. https://www.nhc.gov.cn/wjw/c100311/202208/deb61e5c2299451ea1b957b0672272b3/files/1743494774215_39007.pdf.
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Maternal preconceptional cytomegalovirus (CMV) immunity does not protect the fetus from acquiring congenital CMV infection (cCMV). Nonprimary infections due to recurrence of latent infections or reinfection with new virus strains during pregnancy can result in fetal infection. Because the prevalence of cCMV increases with increasing maternal CMV seroprevalence, the vast majority of the cases of cCMV throughout the world follow nonprimary maternal infections and is more common in individuals of lower socioeconomic background. Horizontal exposures to persons shedding virus in bodily secretions (young children, sexual activity, household crowding, low income) probably increase the risk of acquisition of an exogenous nonprimary CMV infection and fetal transmission. In addition, more frequent acquisition of new antibody reactivities in transmitter mothers suggest that maternal reinfection by new viral strains could be a major source of congenital infection in such populations. However, the exact frequency of CMV nonprimary infection in seroimmune women during pregnancy and the rate of intrauterine transmission in these women are yet to be defined. Usually, the birth prevalence of cCMV is high (≥7:1000) in highly seropositive populations. There is increasing evidence that the frequency and severity of the clinical and laboratory abnormalities in infants with congenital CMV infection born to mothers with nonprimary CMV infection are similar to infants born after a primary maternal infection. This is particularly true for sensorineural hearing loss, which contributes to one third of all early-onset hearing loss in seropositive populations. This brief overview will discuss the need for more research to better clarify the natural history of cCMV in highly seropositive populations, which, in almost all populations, remains incompletely defined.
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Objective: In this systematic review, we aimed to summarize the evidence on the association between being a daycare educator working with children and the possible increased risk of parvovirus B19 infection compared to the general population. Methods: The Medline and Embase databases were searched using a defined search to find studies published since 2000. Two reviewers evaluated the search hits using predefined inclusion and exclusion criteria. The resulting studies were extracted and were assessed in eight domains of bias. A pooled relative risk (RR) of parvovirus infection for daycare workers compared to the general population was calculated. Results: After evaluating the 7781 search hits and manual search, four methodologically-adequate studies were identified: three cross-sectional studies and one retrospective cohort study. Of the three studies investigating the risk of infection, one evaluated parvovirus B19 seroconversion rates for daycare workers. There was an indication for an increased risk for daycare workers compared to the unexposed population (RR = 1.12, 95% CI 0.98–1.27) using prevalence estimators. Furthermore, daycare workers had a higher seroconversion rate compared to the unexposed population (RR = 2.63, 95% CI 1.27–5.45) in the low risk of bias study. Conclusions: Our findings suggest a higher risk of parvovirus B19 infection for daycare workers compared to an unexposed comparison population, which necessitate preventative efforts. Considering the underestimation of the occupational seroconversion risk by prevalence-based estimators, parvovirus B19 infections among daycare workers might mostly be occupationally acquired.
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中华预防医学会出生缺陷预防与控制专业委员会产前筛查和诊断学组. 孕前及孕早期常见隐性单基因遗传病携带者筛查临床应用专家共识[J]. 中华围产医学杂志, 2024, 27(1):3-12.DOI:10.3760/cma.j.cn113903-20230922-00228.
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\n Cell‐free fetal\n DNA\n (cff\n DNA\n ) non‐invasive prenatal testing (\n NIPT\n ) is rapidly expanding, and is being introduced at varying rates depending on country and condition.\n
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袁碧波, 李娜, 龙英霞, 等. 拷贝数变异测序技术在无创产前筛查高风险且超声表现正常胎儿产前诊断中的价值研究[J]. 中国实用妇科与产科杂志, 2022, 38(4):447-450.DOI:10.19538/j.fk2022040114.
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American Diabetes Association Professional Practice Committee. 15. Management of diabetes in pregnancy:standards of care in diabetes-2025[J]. Diabetes Care, 2025, 48(1Suppl 1): S306-S320.DOI: 10.2337/dc25-S015.
The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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中国医师协会妇产科医师分会, 中国医师协会营养医师专业委员会, 中华医学会围产医学分会. 孕前和孕期主要微量营养素补充专家共识(2024)[J]. 中华妇产科杂志, 2024, 59(10):737-746.DOI:10.3760/cma.j.cn112141-20240611-00326.
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谢予乐, 刘洋, 倪天翔, 等. 胚胎植入前非整倍体检测技术能否改善复发性流产患者的活产率[J]. 中国实用妇科与产科杂志, 2025, 41(11):1073-1079.DOI:10.19538/j.fk2025110105.
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Clinical whole-exome sequencing is increasingly used for diagnostic evaluation of patients with suspected genetic disorders.To perform clinical whole-exome sequencing and report (1) the rate of molecular diagnosis among phenotypic groups, (2) the spectrum of genetic alterations contributing to disease, and (3) the prevalence of medically actionable incidental findings such as FBN1 mutations causing Marfan syndrome.Observational study of 2000 consecutive patients with clinical whole-exome sequencing analyzed between June 2012 and August 2014. Whole-exome sequencing tests were performed at a clinical genetics laboratory in the United States. Results were reported by clinical molecular geneticists certified by the American Board of Medical Genetics and Genomics. Tests were ordered by the patient's physician. The patients were primarily pediatric (1756 [88%]; mean age, 6 years; 888 females [44%], 1101 males [55%], and 11 fetuses [1% gender unknown]), demonstrating diverse clinical manifestations most often including nervous system dysfunction such as developmental delay.Whole-exome sequencing diagnosis rate overall and by phenotypic category, mode of inheritance, spectrum of genetic events, and reporting of incidental findings.A molecular diagnosis was reported for 504 patients (25.2%) with 58% of the diagnostic mutations not previously reported. Molecular diagnosis rates for each phenotypic category were 143/526 (27.2%; 95% CI, 23.5%-31.2%) for the neurological group, 282/1147 (24.6%; 95% CI, 22.1%-27.2%) for the neurological plus other organ systems group, 30/83 (36.1%; 95% CI, 26.1%-47.5%) for the specific neurological group, and 49/244 (20.1%; 95% CI, 15.6%-25.8%) for the nonneurological group. The Mendelian disease patterns of the 527 molecular diagnoses included 280 (53.1%) autosomal dominant, 181 (34.3%) autosomal recessive (including 5 with uniparental disomy), 65 (12.3%) X-linked, and 1 (0.2%) mitochondrial. Of 504 patients with a molecular diagnosis, 23 (4.6%) had blended phenotypes resulting from 2 single gene defects. About 30% of the positive cases harbored mutations in disease genes reported since 2011. There were 95 medically actionable incidental findings in genes unrelated to the phenotype but with immediate implications for management in 92 patients (4.6%), including 59 patients (3%) with mutations in genes recommended for reporting by the American College of Medical Genetics and Genomics.Whole-exome sequencing provided a potential molecular diagnosis for 25% of a large cohort of patients referred for evaluation of suspected genetic conditions, including detection of rare genetic events and new mutations contributing to disease. The yield of whole-exome sequencing may offer advantages over traditional molecular diagnostic approaches in certain patients.
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中国妇幼保健协会生育保健分会. 新一代无创产前筛查技术NIPT2.0临床应用策略专家共识[J]. 中华医学遗传学杂志, 2024, 41(10):1155-1163.DOI:10.3760/cma.j.cn511374-20240626-00353.
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罗刚, 赵宏卫, 泮思林, 等. 儿童常见先天性心脏病介入封堵治疗相关血管并发症(附4例报告)[J]. 中国实用儿科杂志, 2021, 36(2):121-124.DOI:10.19538/j.ek2021020609.
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利益冲突 作者声明不存在利益冲突
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