Small-for-dates baby

近日，中华医学会第十七次全国围产医学学术会议在羊城广州拉开帷幕。全球围产医学界知名专家学者汇聚一堂，研讨医学最新进展。会上，拜耳邀请了国际儿科肠胃、肝病和营养学会联合会前主席，德国慕尼黑大学医学中心资深教授Berthold Koletzko，美国丙型肝炎导师支持小组顾问，纽约西奈山医院肝病、妇产和生殖科副教授Tatyana Kushner围绕“孕期营养管理与肝脏健康”做主题分享，并就这个主题与广州医科大学附属第三医院陈敦金教授、北京大学第三医院赵扬玉教授、南方医科大学南方医院刘志华教授等国内围产专家展开学术讨论，贡献真知灼见。“国际大咖会谈 - 孕期营养管理与肝脏健康”专题讨论现场通过此次学术上的主题分享和专题讨论，中外大咖们对于广大孕期妇女普遍关注的营养摄入和肝脏生理变化等问题，给出了一些专业的答案。科学应对肝脏生理变化，守护孕期肝脏健康美国丙型肝炎导师支持小组顾问，纽约西奈山医院肝病、妇产和生殖科副教授Tatyana Kushner表示：妊娠期肝脏检测指标异常可能与多种因素相关，包括慢性肝病、妊娠期特发性疾病和妊娠期合并疾病，其中孕期胆汁淤积症（ICP）是最常见的一类妊娠期特发性肝病、脂肪肝（代谢功能障碍相关脂肪性肝病，MASLD）是最为常见的慢性肝病，而妊娠期因药物诱导的肝损伤则较为罕见。妊娠期是识别患者肝脏疾病的大好机会。根据孕期肝功能异常情况，分为胆汁淤积型和肝细胞型，不同分型后续的进一步检查和病因诊断会有所不同。纽约西奈山医院肝病、妇产和生殖科副教授Tatyana Kushner发言南方医科大学南方医院刘志华教授建议：在整个妊娠期间，尤其在分娩前后，我国很多孕妇都会出现转氨酶升高，这种情况是比较常见的。临床医生需要结合其他肝脏检查指标的变化来综合判断，例如单纯的转氨酶升高而不伴其他肝脏指标的变化，可以密切随访患者情况，根据观察结果适时采取合适的干预措施。对于中国医生来说，最需关注乙肝感染的问题。乙肝在中国孕妇这个群体中的发病率达到了6%，值得每一个产科医生去关注。南方医科大学南方医院刘志华教授发言合理摄入孕期营养，改善妊娠结局国际儿科肠胃、肝病和营养学会联合会前主席，德国慕尼黑大学医学中心资深教授Berthold Koletzko指出：根据FIGO（国际妇产科联盟）的研究，妊娠期和哺乳期阶段，一些关键营养元素如B族维生素、叶酸、铁、Omega-3 DHA、维生素D等尚未达到理想水平，这些关键营养素对母婴健康均有显著的影响。一项针对哺乳期多种维生素、DHA和叶黄素补充的双盲随机对照试验研究表明，在孕前、孕早、中、晚期和哺乳期，多种营养素联合补充有助于改善孕妇和胎儿的营养状况和母婴健康状况，减少先天性畸形、SGA、早产和其他不良妊娠结局的发生风险。更早、更高（0.8mg）的叶酸补充，能够让胎儿生长获益，显著减少胎儿畸形和先天性心脏病的发生率，使用复合维生素要比单独使用叶酸获益更大。过多的能量摄入（碳水化合物、果糖等）是不合理的，因为可能导致脂肪沉积过多和过重或肥胖，甚至引起脂肪肝，影响肝脏健康，导致不良的妊娠结局。针对孕期饮食，需要考虑到多种营养素摄入的合理性和平衡性，包括不饱和脂肪酸、Omega-3脂肪酸等，并且从微量营养素的角度来说（比如抗氧化的效果等），能够在一定程度上帮助减少脂肪肝发生风险，更好地保护肝脏免受进一步的损伤。德国慕尼黑大学医学中心资深教授Berthold Koletzko发言广州医科大学附属第三医院陈敦金教授表示：怀孕之后肝脏功能是会发生变化的，医生可以采用影像和检测去发现一些问题。目前看来，我们在补充微量元素的过程当中，没有发现对肝功能产生影响的证据。广州医科大学附属第三医院陈敦金教授发言北京大学第三医院赵扬玉教授指出：对于产科医生来说，孕期营养关注较多的是元素铁、钙和叶酸的补充。虽然目前国内外有循证医学的证据表明在妊娠期间补充叶酸等多种营养物质对于妊娠结局有积极意义，但同样应根据相应的标准和推荐进行补充，不宜过量或过度补充，以免增加孕期的身体负担，造成不良后果。“国际大咖会谈 - 孕期营养管理与肝脏健康”专题讨论现场

Women are taught from a young age to be ashamed of our bodies. We’re conditioned to stay small, look pretty, and have no flaws - and if we do, we must certainly never admit them. This is maybe why so many areas of women’s health - from periods to fertility to menopause - are shrouded in taboo. We’ve been taught that anything less than physical perfection is something to be ashamed of. Taboo and shame are incredibly powerful. They stop us from sharing our experience, from finding out we aren’t the ‘only one’ going through something and seeking help when we need it. We don’t realise that conditions we assume impact a minority are actually affecting more people than we realise - even those closest to us. So often we hear stories of someone opening up about a miscarriage or fertility struggle, only to find out that their best friends or family members have been going through the exact same thing in secret. This unnecessary stigma and isolation can have a domino effect on our mental wellbeing and physical health. It causes us to withdraw from our support networks even more and not feel comfortable to share with our health providers. It’s a vicious cycle. The only way to end it is to open up the conversation and break the taboo. The physical and mental impact of shame The taboo and shame cycle doesn’t only impact our emotions - it can also have an effect on our physical health. Research has shown that when a woman experiences taboo or shame, they are less likely to reach out for professional help and medical advice. This can delay diagnosis time and potentially lead to a more serious condition. However, the sad fact is that even if you make it to a doctor, you may not get the level of care you deserve. Many women’s health conditions are under-researched and under-funded - as taboo has kept them at the bottom of the priority list. This means that even the most well-meaning medical professionals can find themselves under-informed and ill-prepared to offer effective solutions and support. Endometriosis famously has an average diagnosis time of eight years. Finally, not speaking about our negative emotions can worsen our health as issues are exacerbated by stress. Having the confidence to talk about our feelings and experiences can transform our overall health and wellbeing. Miscarriage and baby loss One of the biggest taboos in reproductive health - and a personal one to me - is pregnancy loss. Whilst losing a baby can be an incredibly isolating experience, it is sadly not an uncommon one. 1 in 4 pregnancies will end in miscarriage and yet it is still a subject full of shame. Society tells us to wait three months to announce a pregnancy. And why? So that if we lose it we can do so quietly and privately. Whilst this might sound like a tactic for protecting our wellbeing, it actually cuts us off from our support networks when we need them the most. Unfortunately ‘miscarriage’ finds itself at the intersection of two taboo topics - reproductive health and mental health. Losing a baby can have a long and devastating effect on your mental health. A recent study showed that 70% of women who experience miscarriage will go on to have some symptoms of PTSD. But this is an uncomfortable fact that no one wants to talk about - and certainly isn’t something a lot of medical professionals are prepared to deal with. Many women in our community report feeling unsupported and unsure how - and where - they can get advice around pregnancy loss. Routine mental health care is not given to women following miscarriage and GPs - who often don’t specialise in women’s health - can be ill-prepared gatekeepers, unsure how to even talk to a woman going through baby loss - let alone treat them. Dr Ines de Santiago, data scientist and researcher from Cambridge believes that ending the stigma around miscarriage is essential if women are to get the right support. ‘Pregnancy loss can have a serious psychological impact, yet it’s not widely talked about and it is often linked to a sense of humiliation and personal failure,” she says. “Breaking the taboo around miscarriage will break the stigma and shame that many women experience, which will, in turn, improve their chances of receiving appropriate and respectful care during such a difficult time." The rise of boundary-breaking femtech brands But it’s not only pregnancy loss that suffers from being put in a box labelled ‘taboo’. Female pleasure, period health, infertility, postnatal depression, incontinence and menopause all fall under this umbrella - and in turn end up falling through the cracks of healthcare. Women’s health as always, has been sidelined, by business and medicine alike - two areas historically dominated by men. And that’s no coincidence. If women find it uncomfortable to discuss issues around their own bodies, it’s unsurprising that men have shied away from these ‘taboo’ topics as well. But the growing femtech sector is here to change that. This incredible growth of femtech over the last decade can actually be linked to a collective desire to end shame around women’s health. Many of the businesses at the forefront of this movement are founded by women who have felt under-served by a traditional approach to healthcare. They are demanding more and are creating the products and services they couldn’t access themselves, putting women’s needs at the core. Investors have started to recognise the importance of this sector and - slowly but surely - these companies are getting the financial backing they need to help more women. Brands like Elvie - who cater for pelvic floor dysfunction and breastfeeding - have closed one of the biggest femtech investment rounds ($42 million to be exact) in recent years. Menstrual cycle tracker Clue has raised €27.4 million to date and last year global healthcare giant Bayer acquired KaNDy Therapeutics - a biotech company specialising in menopause - for more than $1 billion. It’s clear that breaking taboos in women’s health is big business. Technology tackling taboos But femtech is not only driven by breaking taboo - it’s helping to close the care gap caused by shame. Technology makes it easier than ever to connect with healthcare professionals from the comfort of home. It also means that it can be done anonymously, encouraging women to deal with conditions they may have previously avoided. It also creates a safe and engaged community where women can share their experiences and feel less isolated on their personal health journey. A common thread amongst female-founded femtech businesses is that they not only develop products that solve a problem - they create brands that start a conversation. They also involve the women affected in the design process to ensure they are building something that caters to their needs and is sensitive to their feelings. At Parla, we are dedicated to breaking the taboo around infertility and miscarriage and providing access and support for women at every stage of their fertility journey. We are proud to be part of the femtech movement that is working to end the shame and close this health gap, ultimately ensuring women live healthier, happier lives - shame free. About the author: Lina Chan is the founder and CEO of women's fertility platform, Parla: "Parla was inspired by my own experience with fertility. I always felt on the back foot. Like many women, I found it difficult to understand what was going on with my body, get trusted support, and take care of my emotional health. Parla means to speak, and we believe it’s time to make women’s health an ongoing informed conversation. We’re breaking taboos and making misinformation a thing of the past by creating a space that empowers women as they become the authority of their health, body and choices."