• Clinical and Experimental Pediatrics
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• 제45권12호
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• pp.1512-1518
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• 2002

목 적 : 쌍태 임신에서 일측 태아가 자궁내 사망한 경우 생존아의 사망률이 높고 범발성 혈관내 응고병증, 패혈증 및 뇌손상 등을 증가시킨다고 알려져 있다. 본 연구는 일측 태아의 자궁내 사망 후 생존아들의 주산기 합병증 및 이와 연관된 위험 인자들에 대해 알아보고자 하였다. 방 법 : 1995년 1월부터 2000년 12월까지 쌍태 임신 중 일측 태아가 자궁내 사망한 후 생존 출생한 15례의 의무 기록지를 후향적으로 분석하였다. 생존아에서는 말초 혈액과 혈액 응고계 검사, 두부 초음파 및 뇌 자기공영상 검사를, 그리고 산모에서는 말초 혈액과 혈액 응고계 검사 및 임신과 관련된 합병증에 대해 의무 기록지를 통하여 후향적으로 조사하였고, 생존아에서 주산기 합병증에 대한 위험 인자로 융모막 상태, 출생 체중, 재태 주령 및 일측 태아의 자궁내 사망 후 분만까지의 기간에 대해 관찰하였다. 결 과 : 1) 일측 태아의 자궁내 사망 후 생존 출생아 15례의 재태 주령은 $33.7{\pm}3.2$주, 출생 체중은 $1,992{\pm}592g$, 분만까지의 기간은 $32.4{\pm}29.5$일이었고, 조산아 11례(73.3%), 만삭아 4례(26.7%)로 조산의 원인은 조기 진통과 조기 양막 파수가 주였다. 2) 산모에서 시행한 혈액 검사상 범발성 혈관내 응고병증은 1례도 없었고, 산모의 말초 혈액 검사(백혈구수, 혈소판수, PT, aPTT, fibrongen, FDP) 소견과 생존아의 범발성 혈관내 응고병증 및 뇌연화증 발생과는 연관이 없었다. 3) 생존아 총 15례 중 6례(40.0%)는 정상이었고, 범발성 혈관내 응고병증 3례(20.0%), 뇌연화증 3례(20.0%), 자궁내 발육 지연 1례, 쌍태아간 수혈 증후군(recepient) 1례, 선천성 심장기형(심방 중격 결손 및 폐동맥 협착)이 동반된 경우 1례 있었다. 4) 생존 출생아에서 범발성 혈관내 응고장애 및 뇌연화증의 발생은 융모막 상태, 출생 체중, 재태 주령 및 일측 태아의 자궁내 사망 후 생존아 분만까지의 기간과 통계학적 유의성이 없었다. 결 론 : 본 연구에서는 자궁내에서 일측 태아가 사망한 경우 산모에서 혈액학적 이상은 발견할 수 없었고 생존아에서 주산기 합병증을 예측할 수 있는 의의 있는 위험 인자를 발견할 수 없었지만 약 20.0%에서 뇌연화증 및 범발성 혈관내 응고병증이 발생하였기에 쌍태 임신 중 임신 제2, 3기에 일측 태아가 자궁내 사망한 경우 생존 출생아에 대한 면밀한 혈액학적 및 신경학적 검사가 필요하다고 사료되었다.

• 대한지역사회영양학회지
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• 제7권5호
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• pp.686-695
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• 2002

The purpose of this study is to assess the maternal iron status during pregnancy and to evaluate the relationships bet-ween the iron indices of maternal, umbilical cord serum, placenta and pregnancy outcomes. Venous bloods samples were drawn from 54 pregnant women just before delivery and cord bloods of their newborn babies were collected immediately after birth. And also, placental tissues were extracted. We investigated the difference of the iron status indices of maternal, umbilical cord serum and placental tissue between two gestational age group (PT group, NT group : preform delivery and normal term delivery at 34.9wk and 39.0wk of mean gestational length, respectively) and also assessed correlations of iron status indices of maternal, umbilical cord serum and placenta tissue. And lastly, we related between birth weight and iron status indices of maternal, umbilical cord serum and placental tissue. The concentrations of maternal serum ferritin and of placental iron were significantly higher in NT group (32.1 $\pm$ 21.1 ng/ml, 68.5 $\pm$ 16.7 $\mu$g/g), than those of NT group (20.8 $\pm$ 11.6 ng/ml, 53.2 $\pm$ 17.4 $\mu$/g) respectively (p<0.001). However the serum ferritin of umbilical cord were significantly higher in NT group (PT : 109.4 $\pm$ 65.7 ng/ml, NT : 147.0 $\pm$ 56.8 ng/ml) than those of PT group (p<0.05). Our results showed that a negative association between birth weight (r=-0.361) and maternal serum ferritin and that a positive association between birth weight and umbilical cord serum ferritin (r=0.261). Despite not a significant difference, there was tendency that highest concentration of maternal serum ferritin was associated with the lowest birth weight. These findings indicate that birth weight of newborn is dependent of multiple factors such as maternal iron status during pre-pregnancy, body size, general nutritional status. Although for women who enter pregnancy with low iron stores, enough intakes of iron during pregnancy could produce undesirable pregnancy outcome. Therefore we suggest for successful pregnancy outcome and delivery differential iron supplementation program will be carried out individual pregnant women on the basis of pre-pregnancy nutritional status.

• Asian-Australasian Journal of Animal Sciences
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• 제33권5호
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• pp.742-752
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• 2020

Objective: This study investigated the effects of vitamin A (VA) supplementation during late-stage pregnancy on longissimus dorsi muscle tissue development, birth traits, and growth performance of postnatal Korean native calves. Methods: In the preliminary experiment, twenty-six pregnant cattle (initial body weight [BW] = 319 kg (standard deviation [SD] = 30.1; 1st parity) were randomly assigned to the control and treatment groups. The treatment group received VA supplementation at 24,000 IU/d from gestational day 225 until delivery. In the main experiment, twelve pregnant cattle (initial BW = 317 kg [SD = 31.3]; 1st parity) were treated with VA supplementation at 24,000 IU/d (gestational days 150 to 225) and at 78,000 IU/d (gestational day 225 until delivery). Serum VA levels were analyzed in pregnant cattle, and the growth performance, gene expression, and serum VA levels were analyzed in the offspring. Results: Serum VA levels in pregnant cattle decreased the late gestation in both experiments (p<0.001). In the main experiment, pregnant cattle at parturition and offspring at birth in the treatment group had higher serum VA levels than those in the control group (p<0.05). In the treatment groups, an increased birth weight was observed in the main experimental group (p = 0.022), and a tendency (p = 0.088) toward an increased birth weight was observed in the preliminary experimental group. However, no differences were observed in the feed intake, average daily gain, gain-to-feed ratio, or BW of 31-day-old calves. Gene expression was analyzed in longissimus dorsi muscles of 31-day-old calves. VA supplementation in pregnant cattle stimulated postnatal muscle development in offspring by elevating myogenic factor 5 (MYF5), MYF6, and myoblast determination levels (p<0.05). Moreover, preadipocyte-related marker genes such as extracellular signal-regulated kinase 2 and krüppel-like factor 2 were higher in the treatment group than in the control group (p<0.05). Conclusion: VA supplementation (78,000 IU/d) in late-stage pregnant cattle maintained serum VA levels. In addition, 78,000 IU/d VA supplementation increased the birth weight and expression of genes related to muscle and preadipocyte development in offspring. Overall, 78,000 IU/d VA supplementation in pregnant cattle is beneficial to newborn calves.

• 대한지역사회영양학회지
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• 제22권3호
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• pp.207-217
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• 2017

Objectives: The aim of this study was to examine self-management status, nutritional knowledge, barrier factors in dietary management and needs of nutritional management program for women with Gestational Diabetes Mellitus (GDM). Methods: A total of 100 women with GDM were recruited from secondary and tertiary hospitals in Seoul. The questionnaire composed of general characteristics, status of self-management, dietary habits, nutrition knowledge, barrier factors in dietary management, needs for nutrition information contents and nutritional management programs. Data were collected by a self-administered questionnaire. All data were statistically analyzed using student's t-test and chi-square test using SAS 9.3. Results: About 35% of the subjects reported that they practiced medical nutrition and exercise therapy for GDM control. The main sources of nutrition information were 'internet (50.0%)' and 'expert advice (45.0%)'. More than 70% of the subjects experienced nutrition education. The mean score of nutrition knowledge was 7.5 point out of 10, and only about half of the subjects were reported to be correctly aware of some questions such as 'the cause of ketosis', 'the goal of nutrition management for GDM', 'the importance of sugar restriction on breakfast'. The major obstructive factors in dietary management were 'eating more than planned when dining out', 'finding the appropriate menu when dining out'. The preferred nutrition information contents in developing management program were 'nutritional information of food', 'recommended food by major nutrients', 'the relationship between blood glucose and food', 'tips on menu selection at eating out'. The subjects reported that they need management program such as 'example of menu by calorie prescription', 'recommended weight gain guide', 'meal recording and dietary assessment', 'expert recommendation', 'sharing know-how'. Conclusions: Based on the results of this study, it is necessary to develop a program that provide personalized information by identifying the individual characteristics of the subjects and expert feedback function through various information and nutrition information contents that can be used in real life.

• 한국환경보건학회지
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• 제33권4호
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• pp.227-234
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• 2007

Recent epidemiologic studies show that gestational exposure to air pollution adversely affects pregnancy outcomes including low birth weight in preform birth. In this study, we evaluated the effect of air pollutants on LBW (low birth weight) on firstborn fetus throughout the gestational period using the birth cohort between 1999 and 2003 in Seoul. Using birth cohort data from the National Statistics Office of Korea we identified 288,346 firstborn births (excluded missing data on lack of information for birth weight and discordance between residential and certificated address from a total of 316,451) during 1999 to 2003 with complete covariate (gender, parity, date of birth, gestational age, parental age and educational level, maternal occupation etc.) and maternal residential history data. Our subjects were defined as more than 37 weeks and less than 44 weeks of completed gestation and we identified 5,457 persons (1.89%) by low birth weight (<2.5 kg) in this study. Using logistic regression, we estimated the risk of mean (entire pregnancy and trimester period) air pollution concentrations for CO, $O_3,\;PM_{10},\;NO_2\;and\;SO_2$. In terms of trimester-specific exposure, we found that some air pollutants exposure in each trimester would increase the risk for LBW. Results also showed that the effect size of air pollutants exposure during the first and third trimester is higher than during the second trimester. In all trimester, the estimated risk of LBW was 1.831 (95% CI=1.573-2.132) with unit increase for CO, 1.139 (95% CI=1.107-1.172) for 50, and 1.009 (95% CI=1.001-1.017) for $O_3$. Our results suggest that exposure during the gestation period to relatively low levels of some air pollutants may be associated with a reduction in birth weight on first-born fetus. These findings implicate the effective risk management strategies should be applied to minimize the public health impacts for pregnant women.

• 한국인구학
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• 제35권1호
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• pp.131-149
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• 2012

본 연구는 2000년 초반과 후반 우리나라의 출산결과와 영아사망에 대한 부모의 사회경제적 지위의 영향력 변화를 파악하고자 하였다. 이를 위해 통계청의 2001-2003년(T1), 2006-2008년(T2) 출생통계와 사망원인통계가 연계된 자료를 활용하였다. 출산결과는 정상아, 부당경량아, 부당중량아, 자궁내발육부전으로 분류하였으며, 영아사망은 생후 1년 이내 사망으로 정의하였다. 자료의 제약으로 인해 부모의 사회경제적 지위는 학력과 직종으로 국한하였다. 분석결과, 불량한 출산결과인 부당경량아와 자궁내발육부전 출생아의 영아사망 위험은 T1 보다 T2에 상대적으로 증가하였다. 이는 미숙아(재태연령 37주 미만), 저체중아(출생 시 체중 2,500g 미만) 중에서도 더 빨리, 더 작게 태어나는 출생아가 최근 증가함으로써 인구의 질이 더욱 악화되었음을 의미한다. 게다가 T1 대비 T2의 영아사망에 대한 모 연령이 지닌 영향력은 사라진 대신 부모의 사회경제적 지위가 지닌 영향력은 증가하여, 궁극적으로 사회계층 간 영아사망 불평등이 심화되고 있음을 의미한다. 부모의 사회경제적 지위에 따른 출산결과와 영아사망의 격차가 향후 어떻게 전개될지에 대한 지속적인 연구가 필요하다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권10호
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• pp.4265-4269
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• 2014

Purpose: This study aimed at summarizing epidemiological evidence of the association between gestational diabetes mellitus (GDM) and subsequent risk of cancer. Materials and Methods: We searched Medline, Embase, Cancer Lit and CINAHL for epidemiological studies published by February 1, 2014 examining the risk of cancer in patients with history of GDM using highly inclusive algorithms. Information about first author, year of publication, country of study, study design, cancer sites, sample sizes, attained age of subjects and methods used for determining GDM status were extracted by two researchers and Stata version 11.0 was used to perform the meta-analysis and estimate the pooled effects. Results: A total of 9 articles documented 5 cohort and 4 case-control studies containing 10,630 cancer cases and 14,608 women with a history of GDM were included in this review. Taken together, the pooled odds ratio (OR) between GDM and breast cancer risk was 1.01 (0.87-1.17); yet the same pooled ORs of case-control and cohort studies were 0.87 (0.71-1.06) and 1.25 (1.00-1.56) respectively. There are indications that GDM is strongly associated with higher risk of pancreatic cancer (HR=8.68) and hematologic malignancies (HR=4.53), but no relationships were detected between GDM and other types of cancer. Conclusions: Although GDM increases the risk of certain types of cancer, these results should be interpreted with caution becuase of some methodological flaws. The issue merits added investigation and coordinated efforts between researchers, antenatal clinics and cancer treatment and registration agencies to help attain better understanding.

• Advances in pediatric surgery
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• 제19권2호
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• pp.81-89
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• 2013

The purposes of this study was to describe the clinical correlation of mass size and gestational age, prognostic factors in sacrococcygeal teratoma (SCT) at a tertiary pediatric surgery, University of Ulsan College of Medicine and Asan Medical Center (AMC), Seoul, Korea. Fifty five patients admitted to the AMC with a SCT between May 1989 and April 2013 were included in this retrospective review. Mean follow up was 861 days. Mean maternal age at delivery was $30{\pm}2.7$ year, mean gestational age (GA) was $36.9{\pm}3.6$ wks, and preterm delivery was 21.8%. Birth body weight was $3182{\pm}644$ g and male vs. female ratio was 1:2.05. We can't find significant difference between Caesarean section and maternal age at delivery (p =0.817). But, caesarean section was favored by gestational age (p = 0.002), larger tumor size (p =0.029) or higher tumor weight fraction rate to birth body weight (p =0.024). Type I was 13, II 21, III 17, and IV 3 according to Altman et al. classification. The tumor component was predominantly cystic(> 50%) in 73.1 %. And the majority histological classification of tumors were mature teratoma (70.3%). The motality rate was 5.5%. Three patients expired because of postpartum bleeding, post-op bleeding related complication such as DIC. SCT recurred in four patients. The interval between first and second operation was $206.2{\pm}111.0$ d (range 53~325 d). In two patients, serum AFP levels were elevated at a regular checkup without any symptom, and subsequent imaging studies revealed SCT. The most common cause of death was bleeding and bleeding related complication. So Caesarean section and active peripartum and perioperative management will be needed for huge solid SCT. In the case of Yolk sac tumor or huge immature teratoma, possibility of recurrence have to be always considered, so follow up by serial AFP and MRI is important for SCT management.

• Journal of Genetic Medicine
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• 제12권2호
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• pp.92-95
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• 2015

Purpose: Increased maternal age is a major risk factor for chromosomal abnormalities. The maternal age-specific risk of fetal trisomy was theoretically calculated. We investigated the actual frequency of fetal trisomy between 16 and 24 gestational weeks in pregnant women over the age of 34 at delivery. Materials and Methods: We retrospectively, over a four-year period, reviewed the medical records of women with singleton pregnancies that started their antenatal care before the 10th week of pregnancy. Pregnant women aged 34 to 45 years at the time of delivery were enrolled and divided into groups of one-year intervals. We investigated the frequency of Down syndrome and all trisomies as a function of the maternal age and compared with the theoretical maternal-age-specific risk. Results: Of the 5,858 pregnant women enrolled in the study, the rate of trisomy 21 was 0.29% (17 cases). The observed frequencies of trisomy 21 in women with maternal ages of 35 years and 40 years were 1:1,116 and 1:141, respectively. The rate of all trisomies was 0.39% (23 cases). The observed frequencies of all trisomies in women with maternal ages of 35 years and 40 years were 1:372 and 1:56, respectively. Conclusion: The frequencies of Down syndrome and all trisomies were proportional to the maternal age. However, the observed frequencies of Down syndrome and all trisomies between the 16 and 24 gestational weeks were lower than the theoretical rates.

• Clinical and Experimental Reproductive Medicine
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• 제34권3호
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• pp.173-178
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• 2007

목 적: 체외수정으로 출산한 쌍태아와 자연임신으로 출산한 쌍태아 간의 산과적 결과의 차이를 비교하고자 한다. 연구방법: 2000년 1월부터 2005년 6월까지 출산한 146건의 쌍태아에 관한 산과적 기록을 검토한 후, 출생 시 재태연령이 24주 이상이며 체외수정으로 임신한 72건을 연구군 (체외수정군), 자연임신한 51건을 대조군 (자연임신이군)으로 나누어 연구를 시행하였다. 결 과: 두 군 간에 산모 연령, 출산 시 재태 연령, 태아체중 등의 차이는 없었지만, 임신성 고혈압과 임신성 당뇨의 발생 위험도는 체외수정군에서 높았다 (OR 2.59; 95% CI 1.01$\sim$6.66). 20% 이상 태아 체중 차이와 같은 성의 쌍태아 발생의 위험도는 체외수정군에서 낮았다 (OR 0.37; 95% CI 0.14$\sim$0.96, OR 0.45; 95% CI 0.21$\sim$0.99). 결 론: 본 연구의 결과로는 체외수정으로 출생한 쌍태아는 자연임신으로 출생한 경우보다 태아 체중 차이의 빈도 및 같은 성 출생의 빈도가 낮았다.