Letter to a genetic counselor

The author describes her personal experience terminating a pregnancy after receiving an abnormal amniocentesis result: While still waiting for the results, she and her husband attempted to deny the importance of the pregnancy, an approach which they subsequently regretted. When they received the abnormal result, they found themselves able to make necessary decisions quickly, despite being in shock. It then took some time before they realized what a major loss they had actually suffered. The painful aftermath included accepting emotional responsibility for their decision to abort, as well as explaining that difficult decision to their older children. Thoughts of a possible subsequent pregnancy could not be faced at once. Over time, the author found the support of friends and colleagues, and even of a support group, to be invaluable. All in all, the entire experience was more painful than she would have predicted, and she hopes that this account will prove helpful both to genetic counselors and to other patients who receive abnormal results from prenatal diagnosis. A list of suggested readings is appended.Rose Green is a pseudonym.     

Solidarity in Perinatal Medicine

In this paper it is argued that questions in perinatal medicine concerning treatment or non-treatment of severely handicapped children, after or before birth, cannot be answered solely by referring to the general aims and objectives of medical treatment and its specific deontology. Justifications of decisions about treatment and non-treatment need to be placed in a broader context of discussions about social justice and the social significance of medical practice as a whole.     

Associations between prenatal maternal mental health indices and mother–infant relationship quality 6 to 18 months’ postpartum: A systematic review

Maternal mental disorders can significantly impact on children's psychosocial and psychological development, incurring substantial ongoing economic and personal costs. A key mediating mechanism is mother–infant relationship quality (MIRQ). Research studies and perinatal mental health screening initiatives have predominantly focused on depressive symptoms and perinatal depression as predictors of MIRQ. While maternal depression is associated with suboptimal MIRQ, the findings have not been consistent. Personality characteristics are associated with parenting and proneness to depression, presenting a potential addition to prenatal mental health assessment. We conducted a systematic review of studies that have examined the link between prenatal depressive symptoms and/or personality characteristics with postnatal MIRQ. Our findings suggest that both maternal personality traits and depressive symptoms measured in early pregnancy are associated with postnatal MIRQ. A measure of personality characteristics may enhance prenatal mental health assessment, affording opportunities for targeted intervention commencing in pregnancy to improve MIRQ, parenting, maternal mental health outcomes, and infant psychosocial and psychological development, and thereby contributing to the reduction of human and economic cost burdens.     

Mother's prenatal and postpartum depression symptoms and infant's sleep problems at 6 months

Mother's prenatal and postpartum depression have been associated with infant's sleep problems. This study aimed to analyze (a) the effects of mother's prenatal and postpartum depression symptoms, including the effects of prenatal and postpartum anxiety and depression scores of the Edinburgh Postnatal Depression Scale (EPDS), on infant's sleep problems at 6 months, and (b) the interaction effect between mother's prenatal and postpartum depression symptoms and infant's sex on infant's sleep problems at 6 months. The sample was comprised of 164 mother–infant dyads whose mothers completed measures of depression at the third trimester of pregnancy, 2 weeks, 3 and 6 months postpartum and a measure of infant's sleep problems at 6 months (CSHQ-I). Mother's prenatal depression symptoms, specifically depression scores of the EPDS, predicted more infant's sleep anxiety and daytime sleepiness, while mother's depression symptoms at 2 weeks postpartum, specifically anxiety scores of the EPDS, predicted more bedtime resistance and CSHQ-I total scores at 6 months. Boys of mothers with more prenatal depression symptoms presented more sleep anxiety at 6 months. Both mother's prenatal and early postpartum depression symptoms have a negative effect on the emergence of infant's sleep problems. Additionally, boys seem more vulnerable to mother's prenatal depression symptoms.     

ALI/ARDS患者糖皮质激素的治疗效果和时机

急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)是临床各科经常遇到的急症,其发病机制主要是中性粒细胞向炎症部位的移动,释放出大量的炎性介质和细胞因子,引起肺泡毛细血管膜通透性增高,弥漫性肺损伤和蛋白性肺泡水肿液聚集等病理生理改变。临床表现为呼吸困难、呼吸窘迫、顽固的低氧血症,虽然使用机械通气和呼气末正压通气(PEEP)后,其病死率有所下降,但仍然维持在50%左右。就糖皮质激素的作用机制,对不同原因引起的ALI/ARDS治疗效果,使用时机作一综述,期望对ALI/ARDS治疗过程中糖皮质激素的使用予以规范。     

Prenatal attachment in future parents of twins

The present study aims at contributing to a better understanding of prenatal attachment in parents expecting twins. In particular, the relationship between prenatal attachment (measured with the Questionnaire for Antenatal Emotional Attachment) and three other psychosocial factors—the parents' psychosocial well-being and the quality of the marital relationship (respectively assessed with the General Health Questionnaire and the Relational Interactional Satisfaction Scale) and the presence of older children in the family—was investigated in both future mothers and fathers at 27 weeks of gestation. Multiple regression analysis revealed no significant relationship between the intensity of prenatal attachment and either of the three variables. For the mothers, a significant positive relationship was found between the quality of attachment on the one hand and psychosocial well-being and quality of the marital relationship on the other hand. For the fathers, the quality of attachment was only significantly predicted by the quality of the marital relationship. © 1998 John Wiley & Sons, Ltd.     

Effects of prenatal cocaine and genotype on intermale agonistic behavior in Mus musculus

We exposed the pups of three F₁ genotypes of mice to a daily regime of cocaine by injecting their mothers (all C57BL/10J strain) on days 7–18 of gestation with 20 mg/kg subcutaneously. Pups of the cocaine and control groups did not differ on measures of maternal and pup health or size. Male pups were weaned and isolated at 21 days of age and their behaviors measured in an intermale aggression situation at about 80 days of age. Treated and untreated males of each F₁ genotype were paired in dyads with either a C3H/HeJ (hawk-like) or AKR/J (retaliator-like) standard tester male. Standard tester males were not exposed to cocaine. Cocaine treatment alone reduced the overall level of aggression in dyads, and in interaction with genotype or the standard tester it altered the behavior of dyads in all phases of social interaction: the initiation, content, and outcome. Standard testers used as behavioral probes, differentiated cocaine and control males with respect to their stimulus and behavioral qualities. Aggr. Behav. 23:183–196, 1997.© 1997 Wiley-Liss, Inc.     

Posttraumatic Stress Disorder and Associated Functional Impairments During Pregnancy: Some Consequences of Violence Against Women

Despite the high prevalence of violence in the lives of women of reproductive age, and the adverse consequences posed to pregnant women suffering from PTSD, few studies have examined violence-related trauma and PTSD among pregnant women. A structured research interview was administered to a convenience sample of 85 prenatal care women to collect information regarding their experiences of violence victimization, PTSD symptoms related to violence-related traumatic events, and whether these symptoms impaired various aspects of the women's daily functioning. Results indicated that 69% of the women experienced a violent traumatic event, with the majority of events occurring before the current pregnancy and being perpetrated by the women's intimate partners. The traumatized women evidenced high levels of PTSD symptoms during pregnancy, with 58% of the women meeting criteria for a PTSD diagnosis. Moreover, many of the women with PTSD symptoms reported that the symptoms adversely affected aspects of their daily functioning.     

论遗传咨询和保健服务的科技保障与伦理优先

就遗传咨询服务及相关保健服务过程中涉及到的科技保障与伦理优先的问题进行了讨论。对在遗传咨询服务和产前诊断技术服务中的有关伦理问题提出了一些见解。认为,科技保障是遗传咨询和相关保健服务的基础,而伦理优先则是传咨询和相关保健服务的道德规范。只有在符合道德规范前提下的技术服务,才是真正科学的技术服务。     

当代感染性休克糖皮质激素治疗的若干问题探讨

糖皮质激素替代治疗目前是全身性感染和感染性休克治疗的主要手段之一。尽管理论上存在着相对性肾上腺功能不足和糖皮质激素抵抗,但是其具体机制和诊断手段并未充分廓清;同时感染性休克小剂量激素替代治疗也未能被最新的临床研究证实。有鉴于此,有必要针对激素替代治疗对预后影响进行更深入的基础与临床研究。