CHD???

1
?????????
?????????????? ?? ????
2
??

• ?????
• ?????????????
• ????????????
• ????????????
• ????????????
• ???????
• ?????
• ??????????

3
????
????\??\????
????\??\??
????\??\??
???????
????
???? ????
????
4
???????
??? ??? ???
????
????
?? ??
???
?????
??
?????? ????????
???????
?? ??? ????
?????? CHD??? ?????
?????????? ????????
5
??????????????
6
???????

• ????
• ??????
• ????
• ??????

7
?????????3???
1
2
3

• 1??????? ?????(?????) ??????
• 2????? ??????????,?????
• 3?????????????????,??????,???????????

8
?????????????????????????
9
??????????????????????????????????????????
10
??0-6?
11
??7?
12
??7?
13
??8?
14
??12?
15
??16?
16
??20?
17
??24?
18
??28-40?
19
???? ??
???????
???????
?????????
?????
20
?????????

• ???????????????,???????
• ????????,????????????
• ???????????????,??????????????,????????
• ????????????????,???????????????????????

21
?????????
???????????????,??????
1
????????,????????????
2
???????????????,??????????????,???????
3
????????????????,??????????????????????
4
22
????
????
?? ?? ???? ?????? ?? ?? ?? ???? ????
???????? ???????? ?? GDM?????? ???????????????????
???????????
?????
23
???????????

• ??????
• ???????????
• ??????????
• ?????????
• ??????,??????????????
• ??????
• ???? ?????,NTD??
• ??????????????????
• ????????????

The newborns in this study were small but
healthy. 1Cunningham FG et al. 1997. Williams
Obstetrics, 20th ed. Appleton Lange Stamford,
Connecticut 2Susser M, Stein Z. Timing in
prenatal nutrition a reprise of the Dutch Famine
Study. Nutr Rev. 1994 Mar52(3)84-94.
24
???????????

• ???????????
• ?????????????????,????????????????????????
• ??3???266??????????????????????????????,?????????
  ?????,???????????
• ????????????????????????????????????? ?

Kramer et al 2000 de Onis, Villar and Gülmezoglu
1998.
25
???????????

• ??????????????
• ??????/?????????????,?????????
• ???????? ?????????? (30 g) and????????????(OR
  0.77 95CIl 0.58-1.01)?
• ????????????????/?????????

26
???????????

• ?????????????????????????????
• ??????????????,???????????????????????????????????
  ?????

27
??????????????
Weight Prepregnancy BMI Total Weight Gain (kg)
Underweight lt19.8 12.5-18
Normal weight 19.826.0 11.5-16
Overweight gt 26.029.0 11-11.5
Obese gt29 At least 6-7
Source AAP, ACOG 1997
28
?????????
Prepregnancy Weight lt Ideal Weight Gain (lb)
Underweight lt12.7
Normal weight lt11.3
Overweight/Obese lt6.8
?????????
Prepregnancy Weight gt Ideal Weight Gain (lb)
Underweight gt18.1
Normal weight gt15.8
Overweight/Obese gt11.3
Source AAP, ACOG 1997
29
????
????????????????????
30
???????
????? ???????,????????,???????????
??? ?????,??????????????????
?? ????????????,???????????????????
?????? ??????,????
??? ??????????????????????
??? ?????????????????
??? ???????????????????
??? ??????????
???A?? ??????????????????????
???D?? ???????????
???E?? ????????????????
???B12?? ???????
???? ???????????????????????
???B2?? ??????
31
???????

• ?????
• ??????,?/?MTHFR??,??????????????
• DNA?RNA??
• ????????
• ???????
• ?????????????,????(neural crest)?????
  NTD
• ?????????????SAM?????????

OG Survey 200762434
32
??????B2?B6?B12???????????????(??)
?????????,?????????????????????????
???? ????
????
????
(???)
(???)
???B2??? ?????????? ??5-??-???? ???????
???B12??? ???????? ?????
????? ?????????? ??5-??-???? ??????
???B6??? ????????? ????
33
???????

• ?????
• ?????????,??4H???
• ??4H?????(MTHFR)
• ?????? ???(?????)
• ?????????????
• S-??-???(SAM)??????
• SAM???????????,??60?????,
• ?????
• ??DNA?RNA
• ??????
• ???????,???????????????????????????????

34
???????

• ??
• ???????????????????????????????,??????????????????
  ??
• ?????????????????????????
• ??????????????????

USPHS/CDC(??)??
400 ?g/? ???????? 1 mg/? ?? 4 mg/?
?????????????????????
35
?????????(2002)
()
???. ???????????2002??????????????. ???????,
2008
36
?????

• ?????
• ???
• WHO2080 ??2050
• 02???22.5(??18.4???24.5)
• ??
• ??????(??)
• ??????(????????B12)
• ???
• ??????????
• ???????????????

37
??CDC?????????
Pregnancy Trimester Hemoglobin Hematocrit
First 11.0 33.0
Second 10.5 32.0
Third 11.0 33.0
Postpartum Age Hemoglobin Hematocrit
12 - lt 15 yrs 11.8 35.7
15 - lt 18 yrs 12.0 35.9
gt 18 yrs 12.0 37.7
38
???????

• ???????????(??????)
• ???????
• ?????????
• ????????????????????????????????
• ?????????
• ?????????
• ??????????????
• ?????????????????????

Enkin et al 2000 Mahomed 2000a.
39
???????

• WHO ????
• ? Hb 10.0-11.9 g/dl ,???3?????10.0-10.9 g/dl
• ? Hb 7.0-9.9 g/dl
• ? Hblt 7.0 g/dL
• ?????
• ???(Hgb 711 g/dL) ?????
• ????
• ??????
• ???
• ?????
• ??????????

DeMaeyer EM, Dallman PR, Gurney JM, et al.
Preventing and controlling iron deficiency
anaemia through primary health care a guide for
health administrators and programme managers.
Geneva, Switzerland World Health Organization,
1989.
40
??

• ???
• ????????
• 800 ?g ???/d
• ???????500?g/d
• ????????
• ?????
• ???????
• ????

Mahomed 2000b WHO 1994.
41
?????????

• ????C????E???,????????????????????????????????
• ???C??????????2???????????,?????????????
• ????????,???????????????
• ??????????????????????????

42
?????? ????, ????
????? ???????????????????????????????1.8?,
??????????15? ??,?????????80?????????????
????????,??????????????!
????????,?????????????????????,?????????,????????
43
?????????
???
?????????
????
????
????
From Nelson and Holmes, NEJM January 5, 1989
44
????
????????????????????
45
?

• SOGC??????????????(I-A)
• ???????????????
• lt600 mg/d??????,???????2???
• ??1g/d??
• ?????????????
• ?????????
• ????????????????,?????????????

Magee LA, Helewa M, Moutquin JM, etal.Diagnosis,
Evaluation,and Management of the Hypertensive
Disorders of Pregnancy. J Obstet Gynaecol Can
2008 30(3 Suppl 1)S1-48
46

?

• ??????????????(??1g/d )
• 7???, 14 619???,????CPEP??
• (RR 0.68 95 CI 0.490.94)
• ?????????????
• 1???, 8312???
• (RR 0.80 95 CI 0.650.97)
• ?????????????????????????,?????????????
• ?????????????????,??3-4 ???/?,???250300 mg?

Magee LA, Helewa M, Moutquin JM, etal.Diagnosis,
Evaluation,and Management of the Hypertensive
Disorders of Pregnancy. J Obstet Gynaecol Can
2008 30(3 Suppl 1)S1-48
47
???????????

• ?????????????????????????,?????,?????????
• ?????????,????????????????
• ????????????????,?????????????????????????,???????
  ????
• ???????????????????????,?????????????,????????????
  

48
??????????

• ??????????????????,????????????
• ???????B6?????????????????????

Magee LA, Helewa M, Moutquin JM, etal.Diagnosis,
Evaluation,and Management of the Hypertensive
Disorders of Pregnancy. J Obstet Gynaecol Can
2008 30(3 Suppl 1)S1-48
49
?

• ?????????,????????????????????????????(????),7???,
  2689????
• ????????????????
• ???? (RR0.73 95 CI 0.570.94)
• ??????? (RR 0.67 95 CI 0.460.96)
• ??????? (RR 0.70 95 CI 0.530.93)
• ??????????????,??????????

Magee LA, Helewa M, Moutquin JM, etal.Diagnosis,
Evaluation,and Management of the Hypertensive
Disorders of Pregnancy. J Obstet Gynaecol Can
2008 30(3 Suppl 1)S1-48
50
?

• ?????????????????,7???, 1962???
• ?2090mg???????????????????????
• ?????(RR 0.73 95 CI 0.540.98)
• ?????? (RR 0.69 95 CI 0.490.96)

Magee LA, Helewa M, Moutquin JM, etal.Diagnosis,
Evaluation,and Management of the Hypertensive
Disorders of Pregnancy. J Obstet Gynaecol Can
2008 30(3 Suppl 1)S1-48
51
Vit C and E

• ???????????????
• 1???, 1877???,?1422????????VitC(1g/d)?E(400IU/d)?
  RCT???
• ????????????
• ???????????,VitC?E???????????????
• NIH??????9-16?VitC?E???????????????(CAPPS)??????

Magee LA, Helewa M, Moutquin JM, etal.Diagnosis,
Evaluation,and Management of the Hypertensive
Disorders of Pregnancy. J Obstet Gynaecol Can
2008 30(3 Suppl 1)S1-48
52
?

• 5???,587???,????
• ??????(RR 0.22 95 CI 0.120.42)
• ????(RR 0.45 95 CI 0.240.83)
• ????????????
• ?????????????????,??3-4 ???/?,???250300 ???/?

53
??????????

• ????????????, 7???, 2689?????
• ??????????
• ???? (RR0.73 95 CI 0.570.94)
• ?????? (RR 0.67 95 CI 0.460.96)
• ??????? (RR 0.70 95 CI 0.530.93) ().
• ??????????????,??????????
• ???100???(52/48)????,???????????????
• ????????????B6??????A??????(????????)???????????

Magee LA, Helewa M, Moutquin JM, etal.Diagnosis,
Evaluation,and Management of the Hypertensive
Disorders of Pregnancy. J Obstet Gynaecol Can
2008 30(3 Suppl 1)S1-48
54
VitC and E

• ?????????RCT???(2???,483???)????VitC(1g/d)?E(400IU
  /d)?????????
• ???RCT?????????????????????????(??VitC?E)?????????
  
• ???????????????RCT???,VitC?E????????????,????,VitC
  ?E?????????

55
?????

• ???????????????????????????
• ?????????????
• ????????,??????
• ??????
• ???????
• ??
• ?????
• ?????

56
(No Transcript)
57
(No Transcript)
58

• ??????????????????50-70?NTD
• ??????????????,????????????????
• ????CDC???????????????0.4mg??

59
????

• ??????????????????,????????7????
• 1.???????????????????????????????????
• 2.?????,??????????????

60
????????
???? ????
???? ??????,???? ????????,???????? ?????????,???? ?????????????????? ???????
???? ????,????? ????????????,????????????? ????? ?????,??????? ??????,??????
???? ??????? ????,?????? ??????,?????A???????????? ???????,??????????????? ????????????????,???????? ???????,?????????? ????,???????
?? ??????? ?????????????????????
?? ?????????? ????????? ??????
?? ??????????????? ?????,???????
?? ??????? ?????? ?????? ????,????????
61
? ?!