| Objectives To describe the mental and physical health status in pregnant women and estimate whether there is an association between psychosocial stress and fetal growth restriction. To analyze the possible influencing factors of fetal growth restriction, and after adjusting other influencing factors, explore whether there still exists relationship between insulin-like growth factor system-related indicators in cord blood and idiopathic fetal growth restriction.Methods A voluntary sample of pregnant women was selected in maternal and child health care hospital in Hefei, Anhui Province from January 1st, 2008 to September 30th, 2008. All participants could response clearly and didn't have any psychological disorders. Their socio-demographic data, physical and psychological health information were assessed by a questionnaire and were compared between women who delivered SGA neonates and women who delivered AGA neonates. Their deliveries were observed and recorded, and umbilical cord blood serum samples were reserved from placenta for longtime in ultra-low temperature refrigerator. A total of 42 idiopathic FGR cases, each matched with 1 control were selected from preservation of specimens by nested case-control study design. GH, IGF-I and IGF-BP-3 level of umbilical cord blood serum among two groups was detected by radio immunoassay. The general state of health and socio-demographic information, the reporting rate of anxiety and depression, the state of coping style and social support of participants were described. Relationship between fetal growth restriction and various socio-demographic information, mental health variables, complication variables or newborn gender were analyzed by using Chi square test. Main influencing factor of fetal growth restriction were explored by means of non-conditional Logistic regression model. The concentrations of GH, IGF-I, IGF-BP-3 were measured and the results were analyzed and compared by paired-samples t test, nonparametric test and Pearson correlation analysis.Results A total of 108 FGR cases were found among participants and the reporting rate was 4.5%. Number of AGA and LGA was 1 698 and 581, respectively, with the reporting rate of 71.1% and 24.3%, respectively. The reporting rate of anxiety and depression among pregnant women was 16.8% and 4.0%, respectively. Almost half pregnant women were with complications, and pregnancy-associated complications and diseases were in order: premature rupture of membranes (17.4%), oligohydramnios (8.6%), and umbilical cord around the neck not less than two rounds (6.5%), abnormal fetal position (6.4%), ICP (6.3%) and so on. The rate of FGR among rural registration of pregnant women was 8.0%, higher than that in urban areas which was 5.3%, and the difference was statistically significant (χ~2=4.35, P=0.037). FGR rates were different in various maternal educational levels, and the difference was of significance (χ~2=9.57, P=0.023). There were no association between maternal anxiety and FGR (χ~2=0.56, P=0.454), but the different rate of FGR between pregnant women who had suspect of depressive symptoms and pregnant women who had no depressive symptoms was of significance (χ~2=4.02, P=0.045). The rate of FGR among pregnant women who had moderate or severe, mild, and no life events occurring in early pregnancy was 19.3%, 6.0%, 5.3%, respectively, and the difference was of statistically significance (χ~2=27.51, P=0.000). But life events occurring in the second or third trimester of pregnancy had no relationship with FGR (P > 0.05 for all comparisons). The rate of FGR was 8.2% in female infant, higher than that in male infant (3.8%). Significant difference was observed (χ~2=15.79, P=0.000). Women with hypertensive disorder complicating pregnancy had higher rate of FGR than women without it, and the difference was of significance (χ~2=17.97, P=0.000). The rate of FGR in pregnant women with oligohydramnios or polyhydramnios, normal amniotic fluid, and those whose amount can not be estimated, was 12.4%, 4.6%, 8.9%, respectively and the difference was of significance (χ~2=20.99, P=0.000). Other complications were not found association with FGR (P>0.05 for all comparisons).By unconditional multivariate logistic regression model, it demonstrated that female newborn, hypertensive disorder complicating pregnancy, oligohydramnios or polyhydramnios and amniotic fluid not being estimated, life events in early pregnancy were risk factors of FGR (OR=2.29, 95%CI=1.50～3.49; OR=3.81, 95%CI=1.86～7.82; OR=2.70, 95%CI=1.61～4.54; OR=1.97, 95%CI=1.16～3.32; OR=4.21, 95%CI=2.28～7.77).The results of paired-samples t test and nonparametric test both showed that the level of cord blood GH in case group was higher than control group, the level of cord blood IGF-I and IGF-BP-3 in case group both was lower than control group, and the ratio of IGF-I to IGF-BP-3 was also higher in case group. These differences were all of statistical significance (P<0.05 for all comparisons). Pearson correlation analysis for the merge of two groups manifested that the level of cord blood GH negatively correlated with birth weight (r=-0.446,P=0.000 ), the level of cord blood IGF-I and IGF-BP-3 both positively correlated with birth weight (r=0.497,P=0.000;r=0.331,P=0.000 ), and the level of cord blood IGF-I negatively correlated with GH (r=-0.245,P=0.024), the level of cord blood IGF-I positively correlated with IGF-BP-3 (r=0.527,P=0.000). Pearson correlation analysis for each group manifested that the GH level in cord blood of case group negatively correlated with birth weight (r=-0.334,P=0.031 ), the IGF-I level in cord blood of case group positively correlated with IGF-BP-3 (r=0.593,P=0.000).Conclusions There are general social-psychological stresses during pregnancy. Moderate or severe psychosocial life event in early pregnancy may have adverse effect on fetal growth. GH, IGF-I and IGF-BP-3 in cord blood are possibly involved in intrauterine fetal growth. It is important to pay attention to physiological health care as well as psychologically health promotion to pregnant women.
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