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    Decrease in abundance of bacteria of the genus in gut microbiota may be related to pre-eclampsia progression in women from East China. Food & nutrition research BACKGROUND:Pre-eclampsia (PE) can result in severe damage to maternal and fetal health. It has been reported that gut microbiota (GM) had important roles in regulating the metabolic and inflammatory responses of the mother. However, investigations on GM in PE are rare. OBJECTIVE:The objective of the present study was to investigate the changes of GM in PE and how to alter the GM composition in PE by dietary or dietary supplements. DESIGN:We analyzed the composition changes in GM as well as the relationship between bacteria of different genera and clinical indices by amplifying the V4 region of the 16S ribosomal RNA gene in 12 PE patients and eight healthy pregnant women in East China. RESULTS:In the PE group, the Observed Species Index was lower than that in the control group, indicating that the α-diversity of the microbiome in the PE group decreased. At phylum, family, and genus levels, the relative abundance of different bacteria in PE patients displayed substantial differences to those from healthy women. We noted a decreased abundance of bacteria of the phylum Actinobacteria ( = 0.042), decreased abundance of bacteria of the family Bifidobacteriaceae ( = 0.039), increased abundance of bacteria of the genus ( = 0.026) and ( = 0.048), and decreased abundance of bacteria of the genus ( = 0.038) Among three enriched genera, bacteria of the genus showed a negative correlation with the systolic blood pressure (SBP), diastolic blood pressure (DBP), and dyslipidemia, which involved glucose metabolism, lipid metabolism, and the oxidative-phosphorylation pathway. The increased abundance of bacteria of the genera and was positively correlated with obesity and dyslipidemia, which involved lipid metabolism, glycosyltransferases, biotin metabolism, and the oxidative-phosphorylation pathways. Moreover, women in the PE group ate more than women in the control group, so fetuses were more prone to overnutrition in the PE group. CONCLUSION:There is a potential for GM dysbiosis in PE patients, and they could be prone to suffer from metabolic syndrome. We speculate that alterations in the abundance of bacteria of certain genera (e.g. increased abundance of and , and decreased abundance of ) were associated with PE development to some degree. Our data could help to monitor the health of pregnant women and may be helpful for preventing and assisting treatment of PE by increasing dietary fiber or probiotics supplement. 10.29219/fnr.v65.5781
    Correlations between oligosaccharides in breast milk and the composition of the gut microbiome in breastfed infants. Journal of dairy science The composition of the microbiome in the early stages of life can directly affect the health of developing infants, and prior evidence suggests that human milk oligosaccharides (HMO) are critical regulators in the maintenance of a healthy gut microbiota in infants. Herein, we conducted an analysis of the gut microbiota of 1-mo-old breastfed infants from Jining and Harbin, China, and a corresponding analysis of the HMO profiles in samples of maternal breast milk. Quantification of HMO was conducted via liquid chromatography-mass spectrometry, and bacterial DNA sequencing was employed for characterization of the fecal microbiota. The abundances of total neutral oligosaccharides, lactodifucotetraose, lacto-N-fucopentaose I, and disialyl-lacto-N-tetraose were significantly increased in samples from the Jining group relative to the Harbin group. Bifidobacterium were the predominant microbial species in infants from both Harbin and Jining, with these levels being significantly higher in the former set. Correlation analyses evaluating microbes and 19 different HMO indicated that HMO were beneficial to the development of the gut microbiota in young infants. The predominance of Bifidobacterium in these microbial communities suggests that their ability to efficiently utilize HMO can contribute to the homeostasis of the gut microflora, with breast milk-derived HMO being critical to the shaping of the gut microbiota in breastfed infants. 10.3168/jds.2021-20928
    SARS-CoV-2 and the subsequent development of preeclampsia and preterm birth: evidence of a dose-response relationship supporting causality. Lai Jonathan,Romero Roberto,Tarca Adi L,Iliodromiti Stamatina,Rehal Anoop,Banerjee Anita,Yu Christina,Peeva Gergana,Palaniappan Vadivu,Tan Linda,Mehta Mahishee,Nicolaides Kypros H American journal of obstetrics and gynecology 10.1016/j.ajog.2021.08.020
    Perinatal depressive and anxiety symptoms of pregnant women during the coronavirus disease 2019 outbreak in China. Wu Yanting,Zhang Chen,Liu Han,Duan Chenchi,Li Cheng,Fan Jianxia,Li Hong,Chen Lei,Xu Hualin,Li Xiangjuan,Guo Yi,Wang Yeping,Li Xiufeng,Li Jing,Zhang Ting,You Yiping,Li Hongmei,Yang Shuangqi,Tao Xiaoling,Xu Yajuan,Lao Haihong,Wen Ming,Zhou Yan,Wang Junying,Chen Yuhua,Meng Diyun,Zhai Jingli,Ye Youchun,Zhong Qinwen,Yang Xiuping,Zhang Dan,Zhang Jing,Wu Xifeng,Chen Wei,Dennis Cindy-Lee,Huang He-Feng American journal of obstetrics and gynecology BACKGROUND:On January 20, 2020, a new coronavirus epidemic with human-to-human transmission was officially declared by the Chinese government, which caused significant public panic in China. In light of the coronavirus disease 2019 outbreak, pregnant women may be particularly vulnerable and in special need for preventive mental health strategies. Thus far, no reports exist to investigate the mental health response of pregnant women to the coronavirus disease 2019 outbreak. OBJECTIVE:This study aimed to examine the impact of coronavirus disease 2019 outbreak on the prevalence of depressive and anxiety symptoms and the corresponding risk factors among pregnant women across China. STUDY DESIGN:A multicenter, cross-sectional study was initiated in early December 2019 to identify mental health concerns in pregnancy using the Edinburgh Postnatal Depression Scale. This study provided a unique opportunity to compare the mental status of pregnant women before and after the declaration of the coronavirus disease 2019 epidemic. A total of 4124 pregnant women during their third trimester from 25 hospitals in 10 provinces across China were examined in this cross-sectional study from January 1, 2020, to February 9, 2020. Of these women, 1285 were assessed after January 20, 2020, when the coronavirus epidemic was publicly declared and 2839 were assessed before this pivotal time point. The internationally recommended Edinburgh Postnatal Depression Scale was used to assess maternal depression and anxiety symptoms. Prevalence rates and risk factors were compared between the pre- and poststudy groups. RESULTS:Pregnant women assessed after the declaration of coronavirus disease 2019 epidemic had significantly higher rates of depressive symptoms (26.0% vs 29.6%, P=.02) than women assessed before the epidemic declaration. These women were also more likely to have thoughts of self-harm (P=.005). The depressive rates were positively associated with the number of newly confirmed cases of coronavirus disease 2019 (P=.003), suspected infections (P=.004), and deaths per day (P=.001). Pregnant women who were underweight before pregnancy, primiparous, younger than 35 years, employed full time, in middle income category, and had appropriate living space were at increased risk for developing depressive and anxiety symptoms during the outbreak. CONCLUSION:Major life-threatening public health events such as the coronavirus disease 2019 outbreak may increase the risk for mental illness among pregnant women, including thoughts of self-harm. Strategies targeting maternal stress and isolation such as effective risk communication and the provision of psychological first aid may be particularly useful to prevent negative outcomes for women and their fetuses. 10.1016/j.ajog.2020.05.009
    Minocycline inhibits microglial activation and alleviates depressive-like behaviors in male adolescent mice subjected to maternal separation. Han Yue,Zhang Lijuan,Wang Qiaozhi,Zhang Dingding,Zhao Qiuying,Zhang Jinqiang,Xie Lei,Liu Guangyi,You Zili Psychoneuroendocrinology Exposure to early adversity increases vulnerability to psychiatric disorders in later life. Microglia-mediated inflammation has been linked to psychopathology, so such inflammation may be a target for treating depression. Using a model of depression involving adolescent male C57BL/6J mice subjected to maternal separation, we explored whether using minocycline to mitigate inflammation can alleviate depression-like behaviors. Between postnatal days 1 and 14, male mice were separated from their mothers for 3 h per day. Minocycline (20 mg/kg) was administered intraperitoneally once daily for 2 weeks starting one week after weaning. Then the male mice were subjected to a second stress for 2 weeks. Results from the sucrose preference test, forced swimming test, and open field test showed that maternal separation did not obviously alter behavior of the male mice, but it did increase the risk of depression-like behaviors following a second stress. This increased risk disappeared if minocycline was given preemptively before the second stress. Maternal separation and second stress up-regulated pro-inflammatory markers and down-regulated anti-inflammatory markers in the hippocampus, and they activated microglia and promoted pro-inflammatory transitions in microglia. All these effects were reversed by minocycline. These changes in inflammatory processes correlated with changes in neurogenesis and BDNF expression in the hippocampus. Our results in this mouse model suggest the potential of minocycline for treating psychiatric disorders induced by early adversity. 10.1016/j.psyneuen.2019.04.021
    Mental health of Urban Mothers (MUM) study: a multicentre randomised controlled trial, study protocol. Schwank Simone Eliane,Chung Ho-Fung,Hsu Mandy,Fu Shih-Chien,Du Li,Zhu Liping,Huang Hsuan-Ying,Andersson Ewa,Acharya Ganesh BMJ open INTRODUCTION:Mental health disorders are common during pregnancy and the postnatal period and can have serious adverse effects on women and their children. The consequences for global mental health due to COVID-19 are likely to be significant and may have a long-term impact on the global burden of disease. Besides physical vulnerability, pregnant women are at increased risk of mental health problems such as anxiety, depression and post-traumatic stress disorder due to the consequences of social distancing. It can result in altered healthcare routines, less support from the family and friends, and in some cases, partners not being allowed to be present during prenatal visits, labour and delivery. Higher than expected, rates of perinatal anxiety and depression have been already reported during the pandemic. Pregnant women may also feel insecure and worried about the effects of COVID-19 on their unborn child if they get infected during pregnancy. Today, young urban women are used to using internet services frequently and efficiently. Therefore, providing mental health support to pregnant women via internet may be effective in ameliorating their anxiety/depression, reducing the risk of serious mental health disorders, and lead to improved maternal and perinatal outcomes. OVERARCHING AIM:Our aim is to explore the effectiveness of a web-based psychosocial peer-to-peer support intervention in reducing the risk and severity of perinatal mental health disorders and preventing adverse pregnancy outcomes among pregnant women living in metropolitan urban settings. METHODS AND ANALYSIS:We plan to conduct a multicentre prospective randomised controlled trial, Mental health of Urban Mothers trial. Pregnant women living in large metropolitan cities will be recruited using internet-based application through non-profit organisations' websites. The women who consent will be randomised to receive a web-based peer-to-peer support intervention or usual care. Data will be analysed to identify the effects of intervention on Edinburgh Postnatal Depression Score and Generalised Anxiety Disorder 7 scores as well as pregnancy outcomes. The impact of COVID-19 pandemic on maternal stress will be assesed using Impact Event Scale-R. Any differences in outcomes between cities will be addressed in subgroup analyses. ETHICS AND DISSEMINATION:The study will be conducted according to the principles of Good Clinical Practice and will follow the ethical principles of the Declaration of Helsinki. The study protocol has been approved by the ethical review board of Chinese University of Hong Kong (IRB number 2019-8170) and Shanghai Center for Women's and Children's Health (international review board (IRB) number 2020-F001-12). The results will be disseminated at national and international scientific conferences, published in peer-reviewed medical journals and spread to the public through social media, news outlets and podcasts. TRIAL REGISTRATION NUMBER:NCT04363177; Trial sponsor Karolinska Institute, CLINTEC, Stockholm, Sweden. 10.1136/bmjopen-2020-041133
    Bibliometrics and Visual Analysis of the Research Status and Trends of Postpartum Depression From 2000 to 2020. Bai Xue,Song Zixuan,Zhou Yangzi,Wang Xiaoxue,Wang Yuting,Zhang Dandan Frontiers in psychology The purpose of this study was to evaluate the international scientific output on postpartum depression (PPD) research during 2000-2020 through a bibliometric analysis and to explore research hotspots, frontiers, and trends in the field of postpartum depression. We searched the Web of Science Core Collection for publications on postpartum depression published between 2000 and 2020. CiteSpace, gCluto, and other software applications were used to analyze the data by year, journal, and country. A total of 2,963 publications were retrieved and 96 countries or regions published related papers. The United States had the largest number of published papers and the highest betweenness centrality, which is the dominant position in the field of postpartum depression. A total of 717 journals published papers, with the Archives of Womens Mental Health ranked first in terms of volume and betweenness centrality. In this study, 31 high-frequency main MeSH terms/subheadings were selected. The high-frequency MeSH terms were clustered into six categories: an overview of depression-related research, diagnostic and screening scales for postpartum depression, epidemiological investigation into postpartum depression, treatment and drug selection for postpartum depression, psychological research on postpartum depression, and etiology, physiopathology, complications, genetics of postpartum depression. Finally, we used strategic diagram to analyze research trends in postpartum depression. This study has identified a continuous significant increase in the publication of PPD articles. Currently, the etiology, physiological pathology, intervention and treatment of complications on PPD are immature, which provides reference for the trend of obstetric psychology. 10.3389/fpsyg.2021.665181
    Analysis of the incidence and influencing factors of postpartum depression and anxiety: A cross-sectional study in Xinjiang from 2018 to 2021. Abulaiti Adila,Abudurexiti Maerhaba,Nuermaimaiti Abudulimutailipu,Kelimu Asimuguli Journal of affective disorders BACKGROUND:Postpartum depression(PPD) and anxiety(PPA) have become the one of major public health threats. However, the research evidence on PPD and PPA in Xinjiang is insufficient. This research reports the incidence of PPD and PPA in the past 4 years, and analyzes the impact of sociodemographic and obstetric factors on postpartum mental health. METHODS:The selected research objects are parturients who have undergone postpartum health check-ups in a tertiary hospital in Urumqi from January 2018 to September 2021. The study obtained the socio-demographic and obstetric information of the puerpera through general survey questionnaires, and used the PHQ-9 and GAD-7 scales to screen for PPD and PPA. Furthermore, after univariate analysis of related influencing factors of PPD and PPA, multiple binary logistic regression analysis was used to further explore the relationship between PPD and PPA and various influencing factors. RESULTS:A total of 7,703 parturients were included in this study. The incidence of PPD (PHQ-9 ≥ 10) was 9.7% in 2018, 11.1% in 2019, 13.3% in 2020, and 14.2% in 2021 (χ = 18.386, P < 0001). The incidence of PPA(GAD-7 ≥ 10) was 8.1% in 2018,8.6% in 2019, 11.4% in 2020, and 9.8% in 2021 (χ = 16.895, P = 0.001). The six factors that were statistically different after univariate analysis were included in the multivariate binary logistic regression analysis. The final results suggested that women who delivery in 2020 were 1.405 times (95%CI:1.145-1.723) more likely to suffer from depression than those who delivery in 2018 and 1.688 times (95%CI:1.237-2.303) than that in 2021. Compared with puerpera with formal jobs, the incidence of PPD among puerpera who were self-employed (AOR = 1.372,95%CI:1.085-1.735) or unemployed(AOR = 1.348,95%CI:1.137-1.599) was on the rise. Moreover, studies have shown that mixed feeding (AOR = 1.515,95%CI: 1.296-1.772) or artificial feeding (AOR = 1.736,95%CI: 1.299-2.321) 6 weeks postpartum was associated with a higher risk of depression, and puerpera who delivered female infants (AOR = 0.780, 95%CI: 0.626-0.971) were less likely to report depressive symptoms. Simultaneously, for PPA, women who delivered in 2020 were 1.418 times (95%CI: 1.065-1.887) more likely to suffer from anxiety than those who delivered in 2018. Women aged 18-29 years (AOR = 2.070,95%CI:1.229-3.487) were more likely to report PPA than those over the age of 29. Similarly, women who selected cesarean section delivery (AOR = 1.332,95%CI:1.087-1.632) were more likely to have PPA. Mixed feeding (AOR = 1.436,95%CI: (1.193-1.729) ) or artificial feeding (AOR = 1.742,95%CI: 1.243-2.441) at 6 weeks postpartum was associated with a higher risk of anxiety. While puerpera who delivered female infants (AOR = 0.746,95%CI: 0.567-0.982) were less likely to report anxiety symptoms. CONCLUSION:This study shows that in Xinjiang, the incidence of postpartum depression and anxiety was on the rise from 2018 to 2020, and although there was a slight decline in 2021, it was still higher than in 2019. Simultaneously, the proportion of overweight or obese, cesarean section, and non-breastfeeding women had increased year by year. Factors such as maternal age, occupation, mode of delivery, feeding pattern and neonatal gender may help to identify high-risk patients. Therefore, primary, secondary, and tertiary prevention should be given priority to reduce the incidence of postpartum depression and anxiety in high-risk groups. 10.1016/j.jad.2022.01.069
    Association of COVID-19 Lockdown during the Perinatal Period with Postpartum Depression: Evidence from Rural Areas of Western China. Wu Yuju,Ye Ruixue,Wang Qinagzhi,Sun Chang,Ji Yadong,Zhou Huan,Chang Wei Health communication COVID-19 lockdown has posed unique challenges to postpartum women, but its association with postpartum depression is not well understood in the Global South. This study aims to evaluate the association between COVID-19 lockdown and postpartum depression in rural areas of western China. A multi-stage random cluster sampling method was used to select a cohort of pregnant and postpartum women with infants aged 0-6 months. We conducted an in-person survey before the COVID-19 lockdown and a phone survey right after the lockdown ended. We used multivariate regression models to evaluate the association between lockdown and postpartum depression. Subgroup analysis was performed to explore the role of social support. The overall prevalence of postpartum depression was 13.3%. Postpartum women who experienced the lockdown were less likely to be depressed than those who did not (adjusted odds ratio (aOR) = .43, 95% confidence interval (CI) = [.27, .70]). Lockdown was negatively associated with postpartum depression among postpartum women with low level of social support (aOR = .30, 95% CI = [.18, .51]). COVID-19 lockdown was associated with lower likelihood of postpartum depression, potentially due to increased support from family. Future research is needed to explore targeted interventions to prevent postpartum depression among women from migrant worker families in rural China. 10.1080/10410236.2022.2036425
    Assessing the quality of mobile applications targeting postpartum depression in China. Li Ying,Zhao Qian,Cross Wendy M,Chen Jiarui,Qin Chunxiang,Sun Mei International journal of mental health nursing Postpartum depression is a serious mental illnessdisorder that occurs after delivery and is one of the most common post-partum complications. With the increasing popularity and extensive use of smartphones worldwide and the fact that China has become the country with the largest number of smartphone users, it is necessary to have a deep understanding of the use and influence of smartphones and discuss the role of smartphone applications in postpartum depression. This study evaluated and analysed the contents of all postpartum depression applications available in China, applying the US Preventive Services Task Force Recommendation Statement (Interventions to Prevent Perinatal Depression) and expert consensus on the guidelines for the prevention and treatment of postpartum depression. We used the keywords 'postpartum depression; and 'PPD' to search Android, iOS, and WeChat in the Chinese application market. Two reviewers agreed on the coding guidelines and coded the content and functionality of the application through content analysis to determine its intervention and adherence to the guidelines. In addition, we used the Mobile App Rating Scale (MARS) to evaluate the application for engagement, functionality, aesthetics, and information domains and recorded the features of the postpartum depression application. The current findings suggest that despite the recent expansion of smartphone platforms and increased availability of applications, existing Chinese apps for postpartum depression have low levels of adherence to clinical practice-based guidelines. New apps need to be developed, and existing apps need to be revised following evidence-based principles. 10.1111/inm.12713
    Association between dietary patterns during the third trimester and the risk of postpartum depression in China. Cao Lujia,Liu Yuyan,Liang Xuan,Zheng Yuzhi,Li Wen,Yan Jing,Huang Guowei Journal of affective disorders BACKGROUND:Postpartum depression, which has affected one in six women after giving birth, can exert detrimental effects on maternal, children and family well-being. This study investigated the association between dietary patterns and postpartum depression among Chinese women. METHODS:A total of 1659 participants were recruited and collected between July 2015 and June 2017 in Tianjin, China. The Chinese version of the Self-Rating Depression Scale was used to assess depressive symptoms at 6-12 weeks postpartum. Information about diet was obtained using an 81-item food frequency questionnaire. Logistic regression models were used to assess relationships between dietary patterns and the risk of postpartum depression. RESULTS:Six dietary patterns were identified by principal component analysis, including beverage, vegetable, cereal-meat, nut-fruit, egg and seafood patterns. The highest tertile (T3) of the nut-fruit pattern was significantly associated with a decreased risk of postpartum depression (OR: 0.740, 95% CI: 0.573-0.955, p = =0.020). Moreover, T3 of the seafood pattern was associated with a lower risk of postpartum depression than the lowest tertile (T1) of this pattern (OR: 0.753, 95% CI: 0.580-0.978, p = =0.033). No other associations were found. LIMITATIONS:A retrospective study. CONCLUSIONS:The nut-fruit pattern and seafood pattern were associated with a decreased risk of postpartum depression in Chinese women. The present findings reinforce the importance of an adequate diet of fruit, nuts, and seafood for postpartum women. 10.1016/j.jad.2019.11.054
    Additional evidence on prevalence and predictors of postpartum depression in China: A study of 300,000 puerperal women covered by a community-based routine screening programme. Journal of affective disorders BACKGROUND:Previous studies on the prevalence and predictors of postpartum depression (PPD) in China were mostly hospital-based with relatively small study samples. Basing on a routine screening programme, this study assessed the prevalence and factors associated with PPD at community level. METHODS:A cross-sectional study was conducted with all the women who delivered in a hospital and were screened for depression during routine postpartum home visits in Shenzhen between 2015 August and 2017 April. The Edinburgh Postnatal Depression Scale was used as the screening tool with a cut-off score of 10. Predictors of PPD were determined by Chi-square test and stepwise logistic regression. RESULTS:Approximately 300,000 puerperal women were included in the study with a PPD prevalence of 4.3%. Prenatal anxiety and depression were associated with 4.55 and 3.80 times of PPD risk, respectively. Stressful life events, family history of mental illness, poor economic status, low Apgar scores and birth defects of the infants, bottle and mixed feeding, as well as living with parents-in-low after childbirth were related to moderate risk. Higher gravidity and parity, larger gestation age, prenatal education, and living with the women's own parents were associated with lower risk. LIMITATIONS:The large sample size might have suggested statistically significant differences which were not practical. CONCLUSIONS:The prevalence of PPD at community level is significantly lower than the rates detected within hospitals. Prenatal anxiety and depression are the most important predictors of PPD. Integrating depression screening into routine postpartum home visits facilitates achievement of universal coverage. 10.1016/j.jad.2022.04.011
    Association Between Dietary Quality and Postpartum Depression in Lactating Women: A Cross-Sectional Survey in Urban China. Yang Chenlu,Zhao Ai,Lan Hanglian,Ren Zhongxia,Zhang Jian,Szeto Ignatius Man-Yau,Wang Peiyu,Zhang Yumei Frontiers in nutrition Evidence on the effects of dietary quality on the risk of postpartum depression in the Chinese population is limited. This study aimed to examine the association between dietary quality and postpartum depression in Chinses lactating women. A total of 939 participants from 10 cities were included in this analysis. A one-time 24-h dietary recall was used to obtain the data on food consumption and dietary quality was assessed based on Diet Balance Index. The Edinburgh postnatal depression scale was considered at a cutoff point of 10 to detect postpartum depression. Poisson regression models were used to explore the association of dietary quality with postpartum depression. Depressed women tended to have a more inadequate intake of vegetables and have more insufficient food variety. The median (25th, 75th) of the overall high bound score (HBS), low bound score (LBS), and diet quality distance (DQD) was 9 (5, 14), 30 (25, 37), and 40 (34, 47), respectively. Compared with subjects with the lowest quartile of LBS, those with the highest quartile of LBS had a higher risk of postpartum depression [adjusted prevalence ratio (aPR), 1.08; 95% confidence interval (95% CI), 1.01, 1.15; P for trend, 0.043]. We also observed a significant association between DQD and postpartum depression (Q4 vs. Q1: aPR, 1.07; 95% CI: 1.00, 1.14; P for trend, 0.036). Poor dietary quality was associated with postpartum depression in Chinese lactating women. 10.3389/fnut.2021.705353
    The Relationship Between Images Posted by New Mothers on WeChat Moments and Postpartum Depression: Cohort Study. Zhang Weina,Liu Lu,Cheng Qijin,Chen Yan,Xu Dong,Gong Wenjie Journal of medical Internet research BACKGROUND:As social media posts reflect users' emotions, WeChat Moments, the most popular social media platform in China, may offer a glimpse into postpartum depression in the population. OBJECTIVE:This study aimed to investigate the features of the images that mothers posted on WeChat Moments after childbirth and to explore the correlation between these features and the mothers' risk of postpartum depression. METHODS:We collected the data of 419 mothers after delivery, including their demographics, factors associated with postpartum depression, and images posted on WeChat Moments. Postpartum depression was measured using the Edinburgh Postnatal Depression Scale. Descriptive analyses were performed to assess the following: content of the images, presence of people, the people's facial expressions, and whether or not memes were posted on WeChat Moments. Logistic regression analyses were used to identify the image features associated with postpartum depression. RESULTS:Compared with pictures of other people, we found that pictures of their children comprised the majority (3909/6887, 56.8%) of the pictures posted by the mothers on WeChat Moments. Among the posts showing facial expressions or memes, more positive than negative emotions were expressed. Women who posted selfies during the postpartum period were more likely to have postpartum depression (P=.003; odds ratio 2.27, 95% CI 1.33-3.87). CONCLUSIONS:The vast majority of mothers posted images conveying positive emotions during the postpartum period, but these images may have masked their depression. New mothers who have posted selfies may be at a higher risk of postpartum depression. TRIAL REGISTRATION:International Clinical Trials Registry Platform ChiCTR-ROC-16009255; http://www.chictr.org.cn/showproj.aspx?proj=15699. 10.2196/23575
    Prevalence and risk factors of postpartum depression in China: A hospital-based cross-sectional study. Peng Songxu,Lai Xin,Du Yukai,Meng Liping,Gan Yong,Zhang Xiangyang Journal of affective disorders BACKGROUND:Postpartum depression (PPD) is a major public health problem worldwide, which adversely affects maternal and infant health. The purpose of this study was to determine the prevalence and related factors of postpartum depression in Chinese puerperium women. METHODS:A cross-sectional study was conducted in Baoan Maternal and Child Health Hospital located in the west of Shenzhen, China. The Chinese version of the Edinburgh Postpartum Depression Scale (EPDS) was used to screen PPD. A score of ≥10 was used as the threshold of postpartum depression. RESULTS:A total of 4813 puerperal women were included in this study, 11.5% of whom were considered to have PPD. Multivariate logistic regression analysis found that family history of mental illness (OR = 1.94; 95% CI, 1.05-3.57; P = 0.033), living with parents-in-law (OR = 1.41; 95% CI, 1.16-1.72; P < 0.001), anxiety during pregnancy (OR = 3.66; 95% CI, 2.97-4. 52; P < 0.001), depression during pregnancy (OR = 4.25; 95% CI, 3.28-5.50; P < 0.001), and stressful life events (OR = 1.50; 95% CI, 1.03-2.20; P = 0.036) were associated with the high prevalence of PPD. LIMITATIONS:The cross-sectional survey cannot assess direct causality. EPDS is just a screening tool and not a diagnostic one. CONCLUSION:Postpartum depression is a common disease in Chinese puerperal population. High-risk pregnant women with postpartum depression need routine screening and targeted intervention for PPD. 10.1016/j.jad.2021.01.012
    Associations of COVID-19 related experiences with maternal anxiety and depression: implications for mental health management of pregnant women in the post-pandemic era. Lin Wei,Wu Bo,Chen Bin,Zhong Chuyan,Huang Weikang,Yuan Shixin,Zhao Xiaoshan,Wang Yueyun Psychiatry research Psychological concerns caused by the COVID-19 pandemic become a public health crisis. It is noteworthy that the associations between COVID-19 related experiences and typical mental symptoms among pregnant women remain unclear. A cross-sectional online survey among pregnant women was conducted in Shenzhen, China. Multivariable logistic regression models were applied to explore the associations of COVID-19 related experiences with anxiety and depression symptoms during pregnancy. Totally, 751 pregnant women were enrolled. Lower prevalence of anxiety and depression was observed among older individuals: 17.2%, 12.3%, and 6.7% for anxiety symptom; 40.0%, 35.3%, and 24.6% for depression symptom, respectively in age <30 years, 30 to 34 years, and ≥35 years groups. COVID-19 related experiences that associated with the anxiety and depression symptoms among pregnant women included having confirmed or suspected COVID-19 cases around, subjective moderate or high risk of being infected, subjective severe life impact, subjective moderate or severe psychological impact, and spending more than one hour in COVID-19 related news. In the post-pandemic era, the psychological strain imposed by the COVID-19 pandemic is urgently needed to be alleviated among pregnant women. The long-term impacts of COVID-19 related experiences on maternal and child health should be monitored longitudinally. 10.1016/j.psychres.2021.114115
    Association between prenatal exposure to ambient air pollutants and postpartum depressive symptoms: A multi-city cohort study. Environmental research BACKGROUND:Women are vulnerable to depression during postpartum period. While several studies have shown associations between ambient air pollution exposure and depression in general population, there was few studies focused on the effect of various air pollutants on postpartum depression (PPD). OBJECTIVE:This study is designed to explore the association between prenatal exposure to air pollutants and PPD, and to reveal the potential vulnerable exposure time point. METHODS:The study enrolled 10,209 pregnant women who delivered between October 2019 and February 2021 in 5 participating hospitals from 3 cities in China. Edinburgh Postnatal Depression Scale (EPDS) was administered at 6 weeks postpartum to identify PPD symptoms. Associations between PPD symptoms and exposure levels in PM, PM SO, CO, NO, and O averaged over the whole pregnancy and each trimester were estimated using logistic regression models after adjusting for potential confounding factors. Distributed lag models (DLMs) were used to determine the relevant associations in each gestational week. RESULTS:The risk for developing PPD symptoms was significant following a 10 μg/m increase in PM (aOR = 1.47, 95%CI:1.36-1.59), NO (aOR = 1.63, 95%CI:1.44-1.85), and 0.1 mg/m increase in CO (aOR = 2.31, 95%CI: 1.99-2.69) during the whole pregnancy. Similar results were also found in exposure during each trimester of pregnancy. Besides, SO exposure during the second trimester was a major risk factor for developing PPD symptoms (aOR = 1.10, 95%CI:1.03-1.18). Consistent effects were also observed in DLMs, except for PM and O, which showed no significant sensitive windows throughout pregnancy period. CONCLUSION:Exposure to PM, CO, NO, and SO in pregnancy is associated with increased risks of developing depression at 6 weeks postpartum. Our findings reveal the importance of air pollution control for preventing maternal mental health disorders among the public. 10.1016/j.envres.2022.112786
    Mental health among pregnant women under public health interventions during COVID-19 outbreak in Wuhan, China. Xu Ke,Zhang Ya,Zhang Yuanyuan,Xu Qiao,Lv Lan,Zhang Jianduan Psychiatry research Coronavirus disease 2019 (COVID-19) has become a pandemic. As the first city struck by the COVID-19 outbreak, Wuhan had implemented unprecedented public health interventions. The mental health of pregnant women during these anti-epidemic controls remains unknown. A total of 274 pregnant women living in Wuhan during the COVID-19 outbreak took part in our investigation online. The data on mental health conditions were evaluated using Edinburgh Postnatal Depression Scale (EPDS), Self-Rating Anxiety Scale (SAS), Chinese Perceived Stress Scale (CPSS), and Pittsburgh Sleep Quality Index (PSQI). We also collected the information on physical health status and precautionary measures against COVID-19. The prevalence of depression, anxiety, stress, and poor sleep quality was 16.1%, 13.9%, 42.7%, 37.6%, respectively. Comparing to SAS, PSQI score in pregnant women who participated in the survey after April 8 (date of Wuhan reopening), those data collected before April 8 were significantly higher. High levels of stress, severe health concerns over the fetus, and poor hygienic practices were negatively associated with mental health conditions. In conclusion, a large proportion of pregnant women reported psychological symptoms during the epidemic, which negatively related to the severe health concerns over fetus and poor hygienic practices. More psychological support during the epidemic would promote maternal mental well-being. 10.1016/j.psychres.2021.113977
    Social, Cognitive, and eHealth Mechanisms of COVID-19-Related Lockdown and Mandatory Quarantine That Potentially Affect the Mental Health of Pregnant Women in China: Cross-Sectional Survey Study. Yang Xue,Song Bo,Wu Anise,Mo Phoenix K H,Di Jiangli,Wang Qian,Lau Joseph T F,Wang Linhong Journal of medical Internet research BACKGROUND:Although lockdown and mandatory quarantine measures have played crucial roles in the sharp decrease of the number of newly confirmed/suspected COVID-19 cases, concerns have been raised over the threat that these measures pose to mental health, especially the mental health of vulnerable groups, including pregnant women. Few empirical studies have assessed whether and how these control measures may affect mental health, and no study has investigated the prevalence and impacts of the use of eHealth resources among pregnant women during the COVID-19 outbreak. OBJECTIVE:This study investigated (1) the effects of lockdown and mandatory quarantine on mental health problems (ie, anxiety and depressive symptoms), (2) the potential mediation effects of perceived social support and maladaptive cognition, and (3) the moderation effects of eHealth-related factors (ie, using social media to obtain health information and using prenatal care services during the COVID-19 pandemic) on pregnant women in China. METHODS:An online cross-sectional survey was conducted among 19,515 pregnant women from all 34 Chinese provincial-level administrative regions from February 25 to March 10, 2020. RESULTS:Of the 19,515 participants, 12,209 (62.6%) were subjected to lockdown in their areas of residence, 737 (3.8%) were subjected to mandatory quarantine, 8712 (44.6%) had probable mild to severe depression, 5696 (29.2%) had probable mild to severe anxiety, and 1442 (7.4%) had suicidal ideations. Only 640 (3.3%) participants reported that they used online prenatal care services during the outbreak. Significant sociodemographic/maternal factors of anxiety/depressive symptoms included age, education, occupation, the area of residence, gestational duration, the number of children born, complication during pregnancy, the means of using prenatal care services, and social media use for obtaining health information. Multiple indicators multiple causes modeling (χ=495.21; P<.05; comparative fit index=.99; nonnormed fit index=.98; root mean square error of approximation=.04, 90% CI 0.038-0.045) showed that quarantine was directly and indirectly strongly associated with poor mental health through decreased perceived social support and increased maladaptive cognition (B=.04; β=.02, 95% CI 0.01-0.02; P=.001), while lockdown was indirectly associated with mental health through increased social support and maladaptive cognition among pregnant women (B=.03; β=.03, 95% CI 0.02-0.03; P=.001). Multigroup analyses revealed that the use of social media for obtaining health information and the means of using prenatal care services were significant moderators of the model paths. CONCLUSIONS:Our findings provide epidemiological evidence for the importance of integrating mental health care and eHealth into the planning and implementation of control measure policies. The observed social and cognitive mechanisms and moderators in this study are modifiable, and they can inform the design of evidence-based mental health promotion among pregnant women. 10.2196/24495
    Maternal mental health during the COVID-19 lockdown in China, Italy, and the Netherlands: a cross-validation study. Guo Jing,De Carli Pietro,Lodder Paul,Bakermans-Kranenburg Marian J,Riem Madelon M E Psychological medicine BACKGROUND:The coronavirus disease 2019 (COVID-19) pandemic had brought negative consequences and new stressors to mothers. The current study aims to compare factors predicting maternal mental health during the COVID-19 lockdown in China, Italy, and the Netherlands. METHODS:The sample consisted of 900 Dutch, 641 Italian, and 922 Chinese mothers (age M = 36.74, s.d. = 5.58) who completed an online questionnaire during the lockdown. Ten-fold cross-validation models were applied to explore the predictive performance of related factors for maternal mental health, and also to test similarities and differences between the countries. RESULTS:COVID-19-related stress and family conflict are risk factors and resilience is a protective factor in association with maternal mental health in each country. Despite these shared factors, unique best models were identified for each of the three countries. In Italy, maternal age and poor physical health were related to more mental health symptoms, while in the Netherlands maternal high education and unemployment were associated with mental health symptoms. In China, having more than one child, being married, and grandparental support for mothers were important protective factors lowering the risk for mental health symptoms. Moreover, high SES (mother's high education, high family income) and poor physical health were found to relate to high levels of mental health symptoms among Chinese mothers. CONCLUSIONS:These findings are important for the identification of at-risk mothers and the development of mental health promotion programs during COVID-19 and future pandemics. 10.1017/S0033291720005504
    Maternal Mental Health Status and Approaches for Accessing Antenatal Care Information During the COVID-19 Epidemic in China: Cross-Sectional Study. Jiang Hong,Jin Longmei,Qian Xu,Xiong Xu,La Xuena,Chen Weiyi,Yang Xiaoguang,Yang Fengyun,Zhang Xinwen,Abudukelimu Nazhakaiti,Li Xingying,Xie Zhenyu,Zhu Xiaoling,Zhang Xiaohua,Zhang Lifeng,Wang Li,Li Lingling,Li Mu Journal of medical Internet research BACKGROUND:China was the first country in the world to experience a large-scale COVID-19 outbreak. The rapid spread of the disease and enforcement of public health measures has caused distress among vulnerable populations such as pregnant women. With a limited understanding of the novel, emerging infectious disease, pregnant women have sought ways to access timely and trusted health care information. The mental health status of pregnant women during this public health emergency, as well as how they responded to the situation and where and how they obtained antenatal care information, remain to be understood. OBJECTIVE:This study aimed to evaluate the mental health status of pregnant women during the COVID-19 epidemic in China by measuring their perceived stress, anxiety, and depression levels; explore the approaches used by them to access antenatal health care information; and determine their associations with maternal mental health status. METHODS:We conducted a web-based, cross-sectional survey to assess the mental health status of Chinese pregnant women by using the validated, Chinese version of Perceived Stress Scale, Self-Rating Anxiety Scale, and Edinburgh Depression Scale. We also collected information on the various approaches these women used to access antenatal care information during the early stage of the COVID-19 epidemic, from February 5 to 28, 2020. RESULTS:A total of 1873 pregnant women from 22 provinces or regions of China participated in the survey. The prevalence of perceived stress, anxiety, and depression among these participants was 89.1% (1668/1873; 95% CI 87.6%, 90.4%), 18.1% (339/1873; 95% CI 16.4%, 19.9%), and 45.9% (859/1873; 95% CI 43.6%, 48.1%), respectively. Hospitals' official accounts on the Chinese social media platforms WeChat and Weibo were the most popular channels among these pregnant women to obtain antenatal care information during the COVID-19 outbreak. Access to antenatal care information via the hospitals' official social media accounts was found to be associated with a significantly lower risk of perceived stress (adjusted odds ratio [aOR] 0.46, 95% CI 0.30-0.72; P=.001), anxiety (aOR 0.53, 95% CI 0.41-0.68; P<.001), and depression (aOR 0.73, 95% CI 0.59-0.91; P=.005). Access to health care information via hospital hotlines or SMS was found to be significantly associated with a lower risk of anxiety only (OR 0.77, 95% CI 0.60-0.98; P=.04). CONCLUSIONS:During the COVID-19 outbreak in China, pregnant women experienced high levels of perceived stress, anxiety, and depression. During such public health emergencies, mental health care services should be strengthened to reassure and support pregnant women. Specific information targeted at pregnant women, including information on how to cope in an emergency or major disease outbreak, developed and disseminated by health care institutions via social media platforms could be an effective way to mitigate mental health challenges and ensure epidemic preparedness and response in the future. 10.2196/18722
    Maternal mental health and well-being during the COVID-19 pandemic in Beijing, China. Wei Zhuang,Gao Ming-Yue,Fewtrell Mary,Wells Jonathan,Yu Jin-Yue World journal of pediatrics : WJP BACKGROUND:The aim of this study is to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on breastfeeding women and to identify predictors of maternal mental health and coping. METHODS:Mothers aged ≥ 18 years with a breast-fed infant ≤ 18 months of age during the COVID-19 pandemic in Beijing, China, completed a questionnaire. Descriptive analysis of lockdown consequences was performed and predictors of these outcomes were examined using stepwise linear regression. RESULTS:Of 2233 participants, 29.9%, 20.0% and 34.7% felt down, lonely, and worried, respectively, during the lockdown; however, 85.3% felt able to cope. Poorer maternal mental health was predicted by maternal (younger age, higher education) and infant (older age, lower gestation) characteristics, and social circumstances (husband unemployed or working from home, receiving advice from family, having enough space for the baby, living close to a park or green space). Conversely, better maternal mental health was predicted by higher income, employment requiring higher qualifications, more personal space at home, shopping or walking > once/week and lack of impact of COVID-19 on job or income. Mothers with higher education, more bedrooms, fair division of household chores and attending an online mother and baby group > once/week reported better coping. CONCLUSION:The findings highlight maternal characteristics and circumstances that predict poorer mental health and reduced coping which could be used to target interventions in any future public health emergencies requiring social restrictions. 10.1007/s12519-021-00439-8
    Associations of prenatal exposure to vanadium with early-childhood growth: A prospective prenatal cohort study. Journal of hazardous materials Prenatal vanadium exposure is reported to be associated with restricted fetal growth and adverse birth outcomes. However, trimester-specific vanadium exposure in relation to early-childhood growth still remains unclear. A total of 1873 Chinese mother-infant pairs from whom a complete series of maternal urinary samples were collected over three stages of pregnancy were included from 2014 to 2016. The urinary concentrations of vanadium were analyzed. Children's anthropometric parameters were measured at birth, 6, 12 and 24 months. In boys, each doubling increase in vanadium concentrations at middle pregnancy was inversely associated with weight-for-length [- 9.07% (-17.21%, -0.93%)] and BMI z-score [- 9.66% (-18.05%, -1.28%)] at 24 months. Moreover, vanadium exposure at late pregnancy was negatively associated with weight [- 9.85% (-16.42%, -3.28%)], weight-for-length [- 11.00% (-18.40%, -3.60%)], and BMI z-scores [- 11.05% (-18.67%, -3.42%)] at 24 months in boys. However, the negative associations were not observed in girls, and we found evidence for sex difference (FDR p for interaction=0.01, 0.01 and 0.03 for weight, weight-for-length and BMI z-scores, respectively). Prenatal vanadium exposure may have an adverse effect on early-childhood growth, and the middle and late pregnancy could be windows of vulnerability for the adverse effects of vanadium exposure on growth development. 10.1016/j.jhazmat.2021.125102
    Maternal Protein Intake during Pregnancy Is Not Associated with Offspring Birth Weight in a Multiethnic Asian Population. Chong Mary Foong-Fong,Chia Ai-Ru,Colega Marjorelee,Tint Mya-Thway,Aris Izzuddin M,Chong Yap-Seng,Gluckman Peter,Godfrey Keith M,Kwek Kenneth,Saw Seang-Mei,Yap Fabian,van Dam Rob M,Lee Yung Seng, The Journal of nutrition BACKGROUND:Maternal diet during pregnancy can influence fetal growth. However, the relation between maternal macronutrient intake and birth size outcomes is less clear. OBJECTIVE:We examined the associations between maternal macronutrient intake during pregnancy and infant birth size. METHODS:Pregnant women (n = 835) from the Singapore GUSTO (Growing Up in Singapore Towards healthy Outcomes) mother-offspring cohort were studied. At 26-28 wk of gestation, the macronutrient intake of women was ascertained with the use of 24 h dietary recalls and 3 d food diaries. Weight, length, and ponderal index of their offspring were measured at birth. Associations were assessed by substitution models with the use of multiple linear regressions. RESULTS:Mean ± SD maternal energy intake and percentage energy from protein, fat, and carbohydrates per day were 1903 ± 576 kcal, 15.6% ± 3.9%, 32.7% ± 7.5%, and 51.6% ± 8.7% respectively. With the use of adjusted models, no associations were observed for maternal macronutrient intake and birth weight. In male offspring, higher carbohydrate or fat intake with lower protein intake was associated with longer birth length (β = 0.08 cm per percentage increment in carbohydrate; 95% CI: 0.04, 0.13; β = 0.08 cm per percentage increment in fat; 95% CI: 0.02, 0.13) and lower ponderal index (β = -0.12 kg/m(3) per percentage increment in carbohydrate; 95% CI: -0.19, -0.05; β = -0.08 kg/m(3) per percentage increment in fat; 95% CI: -0.16, -0.003), but this was not observed in female offspring (P-interaction < 0.01). CONCLUSIONS:Maternal macronutrient intake during pregnancy was not associated with infant birth weight. Lower maternal protein intake was significantly associated with longer birth length and lower ponderal index in male but not female offspring. However, this finding warrants further confirmation in independent studies. This trial was registered at clinicaltrials.gov as NCT01174875. 10.3945/jn.114.205948
    Exposure and perception of PM pollution on the mental stress of pregnant women. Li Jie,Huang Lei,Han Bin,van der Kuijp Tsering J,Xia Yankai,Chen Kai Environment international Prenatal exposure to ambient PM has been proved to be related to pregnant women's physical health and birth outcomes. However, the damage from air pollution on pregnant women's mental health has not been fully discussed. A case-control study was conducted to evaluate the effects of PM exposure and risk perception on the mental stress of pregnant women. A total of 605 pregnant women, including 403 high symptoms of stress cases and 202 matched controls, were recruited from January 2018 to December 2018 in Nanjing, among which 313 high symptoms of stress cases and 144 matched controls were included in the analysis. Meaningfully high symptoms of anxiety were defined with a score of 6 points or greater on the phobic anxiety subscale of the Crown-Crisp index. We found that the PM effect perceived by the case group was significantly higher than the control group, and the PM exposure of the case group was also significantly higher than that of the control group. Binary logistic regression showed that for each increase in unit of PM exposure, the risk of pregnant women suffering from high mental stress increased by 13.76% (95 %CI: 8.26-19.53%). Through path analysis modeling, we found that in the case group, perceived indoor attributions not only had a direct impact on mental stress (p < 0.001), but also played a key mediating role in the impact of average daily dose of PM on mental stress (p < 0.001). The high level of mental stress is not only affected by objective exposure, but also by subjective perceptions in the case group. Considering the significant effect of PM exposure on mental stress, pregnant women are recommended to spend appropriate amounts of time outdoors during clean air days. In addition, the mediating role of risk perception cannot be ignored. It is necessary to reassure pregnant women not to become overly concerned about the risk of PM pollution and reduce their psychological burden. 10.1016/j.envint.2021.106686
    Comprehensive maternal serum proteomics identifies the cytoskeletal proteins as non-invasive biomarkers in prenatal diagnosis of congenital heart defects. Chen Lizhu,Gu Hui,Li Jun,Yang Ze-Yu,Sun Xiao,Zhang Li,Shan Liping,Wu Lina,Wei Xiaowei,Zhao Yili,Ma Wei,Zhang Henan,Cao Songying,Huang Tianchu,Miao Jianing,Yuan Zhengwei Scientific reports Congenital heart defects (CHDs) are the most common group of major birth defects. Presently there are no clinically used biomarkers for prenatally detecting CHDs. Here, we performed a comprehensive maternal serum proteomics assessment, combined with immunoassays, for the discovery of non-invasive biomarkers for prenatal diagnosis of CHDs. A total of 370 women were included in this study. An isobaric tagging for relative and absolute quantification (iTRAQ) proteomic approach was used first to compare protein profiles in pooled serum collected from women who had CHD-possessing or normal fetuses, and 47 proteins displayed significant differential expressions. Targeted verifications were performed on 11 proteins using multiple reaction monitoring mass spectrometry (MRM-MS), and the resultant candidate biomarkers were then further validated using ELISA analysis. Finally, we identified a biomarker panel composed of 4 cytoskeletal proteins capable of differentiating CHD-pregnancies from normal ones [with an area under the receiver operating characteristic curve (AUC) of 0.938, P < 0.0001]. The discovery of cytoskeletal protein changes in maternal serum not only could help us in prenatal diagnosis of CHDs, but also may shed new light on CHD embryogenesis studies. 10.1038/srep19248
    The Clinical Values of Afamin, Triglyceride and PLR in Predicting Risk of Gestational Diabetes During Early Pregnancy. Wang Xuechun,Zheng Xiuqiong,Yan Jianying,Xu Rongli,Xu Mu,Zheng Lin,Xu Liangpu,Lin Zhi Frontiers in endocrinology Objective:To establish a model to predict gestational diabetes mellitus (GDM) based on the clinical characteristics, early pregnancy (10-12 weeks gestation) peripheral blood routine, and biochemical indicators, and to explore its predictive efficiencies. Methods:Data from 607 pregnant women with GDM were compared to the data from 833 pregnant women without GDM admitted to the Obstetrics Department of Fujian Maternity and Child Health Hospital (affiliated to Fujian Medical University) from May 2018 to December 2018 were retrospectively included. The ages of the pregnant women, paternal ages, number of pregnancies, number of deliveries, pre-pregnancy heights/weights, and the calculated body mass indexes (BMI) were recorded. In all participants, 10-12 weeks of pregnancy, afamin concentration, routine blood work, prenatal aneuploidy screening, and biochemical testing were performed. At weeks 24-28 of gestation, patients underwent oral glucose tolerance test (OGTT) for GDM screening. Results:Multivariate logistic regression analysis showed that maternal age, early pregnancy afamin level, triglycerides, and platelet/lymphocyte ratio (PLR) were independent risk factors for gestational diabetes. The formula for predicting GDM probability was as follows: = 1/1 + ( - 6.054 + 0.774 × + 0.002 × + 0.155 × - 0.012 × )]. From the established ROC curve, the area under the curve (AUC) was 0.748, indicating that the model has a good degree of discrimination. When the predictive probability cut-off value was set on 0.358, sensitivity, specificity, positive predictive value, and negative predictive value were 69.2%, 68.3%, 42.5%, and 86.2%, respectively, and the accuracy rate was 70.2%. The Hosmer-Lemeshow test results showed that the goodness of the model fit has a good calibration ability (χ2 = 12.269, df=8, P=0.140). Conclusions:Maternal age, early pregnancy afamin level, triglycerides, and PLR are independent risk factors for gestational diabetes. When combined, the above indicators are helpful for prediction, early diagnosis, and intervention of gestational diabetes. 10.3389/fendo.2021.723650
    MicroRNA-351 eases insulin resistance and liver gluconeogenesis via the PI3K/AKT pathway by inhibiting FLOT2 in mice of gestational diabetes mellitus. Chen Shu-Hong,Liu Xiao-Nan,Peng Yan Journal of cellular and molecular medicine Gestational diabetes mellitus (GDM) is known as different degree glucose intolerance that is initially identified during pregnancy. MicroRNAs (miRs) may be a potential candidate for treatment of GDM. Herein, we suggested that miR-351 could be an inhibitor in the progression of GDM via the phosphoinositide 3-kinase/protein kinase B (PI3K/AKT) pathway. Microarray analysis was used to identify differentially expressed genes and predict miRs regulating flotillin 2 (FLOT2). Target relationship between miR-351 and FLOT2 was verified. Gestational diabetes mellitus mice were treated with a series of mimic, inhibitor and small interfering RNA to explore the effect of miR-351 on insulin resistance (IR), cell apoptosis in pancreatic tissues and liver gluconeogenesis through evaluating GDM-related biochemical indexes, as well as expression of miR-351, FLOT2, PI3K/AKT pathway-, IR- and liver gluconeogenesis-related genes. MiR-351 and FLOT2 were reported to be involved in GDM. FLOT2 was the target gene of miR-351. Gestational diabetes mellitus mice exhibited IR and liver gluconeogenesis, up-regulated FLOT2, activated PI3K/AKT pathway and down-regulated miR-351 in liver tissues. Additionally, miR-351 overexpression and FLOT2 silencing decreased the levels of FLOT2, phosphoenolpyruvate carboxykinase, glucose-6-phosphatase, fasting blood glucose, fasting insulin, total cholesterol, triglyceride, glyeosylated haemoglobin and homeostasis model of assessment for IR index (HOMA-IR), extent of PI3K and AKT phosphorylation, yet increased the levels of HOMA for islet β-cell function, HOMA for insulin sensitivity index and glucose transporter 2 expression, indicating reduced cell apoptosis in pancreatic tissues and alleviated IR and liver gluconeogenesis. Our results reveal that up-regulation of miR-351 protects against IR and liver gluconeogenesis by repressing the PI3K/AKT pathway through regulating FLOT2 in GDM mice, which identifies miR-351 as a potential therapeutic target for the clinical management of GDM. 10.1111/jcmm.14079
    Procyanidins and its metabolites by gut microbiome improves insulin resistance in gestational diabetes mellitus mice model via regulating NF-κB and NLRP3 inflammasome pathway. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie Gestational Diabetes Mellitus (GDM) has an effect on the health of pregnant women and fetuses. Procyanidins (PA) is a flavonoid with anti-diabetic activity, but its effects and mechanisms on GDM have not been defined. Herein, we studied further the functions and mechanisms of PA on insulin resistance (IR) in GDM mice, as well as on postpartum and offspring mice. GDM mice model was built by feeding a high-fat-high-sucrose diet, and PA intervention (27.8 mg/kg/d) was performed from 4 weeks before pregnancy to delivery. Intestinal flora deficient (IFD) mice model was established by broad spectrum antibiotics. PA decreased the gestational weight gain, and the levels of fasting blood glucose, insulin, homeostasis model of assessment for IR index, yet increased the levels of HOMA for insulin sensitivity index. Interestingly, in IFD mice the effect of PA on improving IR was significantly weakened. PA inhibited inflammation by decreasing the levels of IL-6, TNF-α, IL-17 and CRP, which also been blocked in the IFD mice. Moreover, PA improved glycometabolism and reduced the secretion of inflammatory factors and hepatic inflammation infiltration of mice at 4 weeks postpartum, but had no significant effect on offspring mice. Mechanistically, PA treatment suppressed the nuclear factor-κB (NF-κB) p65 nuclear translocation and nucleotide-binding domain like receptor protein 3 (NLRP3) inflammasome activation. In vitro studies, 4-hydroxyphenylacetic acid and 3-(4-hydroxyphenyl) propionic acid, main intestinal flora metabolites of PA restrained NF-κB/NLRP3 activation. In conclusions, PA improved IR via NF-κB/NLRP3 pathway in GDM and postpartum mice, which partly through its metabolites by gut microbiome. 10.1016/j.biopha.2022.113078
    Lifestyle intervention modifies the effect of the MC4R genotype on changes in insulin resistance among women with prior gestational diabetes: Tianjin Gestational Diabetes Mellitus Prevention Program. Chen Yuhang,Liu Huikun,Wang Leishen,Zhou Tao,Liang Zhaoxia,Li Weiqin,Shang Xiaoyun,Leng Junhong,Shen Yun,Hu Gang,Qi Lu The American journal of clinical nutrition BACKGROUND:A history of gestational diabetes mellitus (GDM) has been related to an elevated risk of type 2 diabetes. The melanocortin-4 receptor (MC4R) genotype has been related to glycemic changes in women with prior GDM. OBJECTIVE:The objective of this study was to analyze whether lifestyle intervention modified the association between the MC4R genotype and changes in insulin sensitivity among women with prior GDM. METHODS:We genotyped MC4R rs6567160 and measured glucose and insulin in fasting plasma samples at baseline and during the first 2 follow-up visits in 1128 women with prior GDM. They were randomly assigned to either a 4-y lifestyle intervention involving both diet and physical activity or a control group from a randomized clinical trial, the Tianjin Gestational Diabetes Mellitus Prevention Program. We analyzed the interaction between the MC4R genotype and lifestyle intervention on changes in insulin resistance. RESULTS:From baseline to 1.28 y, the MC4R genotype was related to changes in fasting insulin, HOMA-IR, and homeostasis model assessment of β cell function (HOMA-B) in the intervention group. Each risk allele (C) of rs6567160 was associated with a 0.08-unit greater decrease in log(insulin), log(HOMA-IR), and log(HOMA-B) (P = 0.02, 0.04, and 0.04, respectively), whereas in the control group, each C allele tended to be associated with a greater increase in HOMA-IR (P = 0.09). We found significant interactions between the MC4R genotype and lifestyle intervention on 1.28-y changes in fasting insulin and HOMA-IR (P = 0.006 and 0.008, respectively), and such interaction remained significant when we analyzed the trajectory of changes in insulin and HOMA-IR from baseline to 2.55 y (both P = 0.03). CONCLUSIONS:The exploratory results from the first 2 follow-up visits indicate that women with prior GDM carrying a diabetes-increasing MC4R genotype (CC or TC) may obtain better improvement than the TT genotype in insulin resistance through lifestyle intervention. This trial was registered at clinicaltrials.gov as NCT01554358. 10.1093/ajcn/nqz121
    Physical activity before and during pregnancy and maternal mental health: A systematic review and meta-analysis of observational studies. Journal of affective disorders OBJECTIVE:To examine the influence of physical activity before and during pregnancy on maternal mental health outcomes. METHODS:Ten electronic databases were searched up to May 11, 2021. Studies of all observational designs (except case studies and reviews) were included, which contained information on the relevant population (women before and or during pregnancy), exposures (objective or subjective measures of physical activity), comparator (low or no physical activity), and outcomes (diagnosis and symptom severity of depression or anxiety, quality of life scores, stress and emotions). RESULTS:Forty-four observational studies (N = 132,399) were included. 'Low' to 'very low' certainty evidence revealed that compared with low levels of PA during pregnancy, high levels of PA were associated with a reduced odds of developing prenatal depression (odds ratio (OR): 0.68, 95% confidence interval (CI): 0.58 to 0.80) and anxiety (OR: 0.67, 95% CI: 0.54 to 0.83). We also found a reduction in the severity of prenatal depressive symptoms (standardized mean difference (SMD): -0.37, 95% CI -0.57 to -0.17), prenatal anxiety symptoms (SMD: -0.45, 95% CI -0.64 to -0.27), and prenatal stress (SMD: -0.33, 95% CI -0.55 to -0.11), concurrent with improved quality of life (SMD: 0.38, 95% CI 0.23 to 0.54). PA before pregnancy did not impact the outcomes of interest. CONCLUSION:Physical activity during pregnancy is associated with a reduction in the odds and severity of prenatal depression and anxiety, as well as reduced stress and improved quality of life. PROSPERO registration number: CRD42020208469. 10.1016/j.jad.2022.04.143
    Changes in adverse pregnancy outcomes in women with advanced maternal age (AMA) after the enactment of China's universal two-child policy. Scientific reports The universal two-child policy (TCP; 2016) in China has affected many aspects of maternal-neonatal health. A tertiary hospital-based retrospective study (2011-2019) was used to find the association of these policy changes with maternal age and pregnancy outcomes in women with AMA (≥ 35 years) in the Hubei Province, China. The proportion of neonatal births to women with AMA increased by 68.8% from 12.5% in the one-child policy (OCP) period to 21.1% in the universal TCP period [aOR 1.76 (95% CI: 1.60, 1.93)]. In the univariate analysis, the proportion of preterm births (29.4% to 24.1%), low birth weight (LBW) (20.9% to 15.9%), and hypertensive disorders of pregnancy (HDP) (11.5% to 9.2%) significantly (p < 0.05) decreased in women with AMA from the OCP period to universal TCP period. However, the proportion of intrauterine growth restriction (IUGR) (0.2% to 0.7%) and gestational diabetes mellitus (GDM) (1.7% to 15.6%) was significantly (p < 0.05) increased over the policy changes. After adjusting for confounding factors, only the risk of GDM increased [aOR 10.91 (95% CI: 6.05, 19.67)] in women with AMA from the OCP period to the universal TCP period. In conclusion, the risk of GDM increased in women with AMA from the OCP period to the universal TCP period. 10.1038/s41598-022-08396-6
    Assessment of the association between prenatal exposure to multiple ambient pollutants and preterm birth: A prospective cohort study in Jinan, east China. Wang Lifeng,Fang Lei,Fang Zhenya,Zhang Meihua,Zhang Lin Ecotoxicology and environmental safety Air pollution has been documented with a series of adverse pregnancy outcomes, yet their reproductive and developmental toxicity on human beings has not been fully elucidated. Here, we analyzed the geographic distribution of Jinan and examined its contribution to air pollution. After adjusting demographic variables and environmental co-pollutants, we built statistical models based on 424 couples and checked different air pollutants on their pregnancy outcomes. We find that Jinan is tightly surrounded by mountains from 3 of 4 sides, geographically resulting in a typical basin texture that hinders the diffusion of ambient pollutants. Of 424 pregnant women enrolled in this study, 17 subjects were diagnosed with preterm birth. Using air quality index (AQI) as an integrated indicator of PM, PM, SO, NO, CO, and O, we found that each interquartile range (IQR) increase in AQI was associated with 11% increased odds of preterm birth. Also, elevating PM, PM, SO, and O led to different increased risk levels of preterm birth. By running the generalized additive model analyses, the association of AQI and preterm birth was further confirmed. In conclusion, based on samples in Jinan, east China, prenatal exposure to multiple ambient pollutants is associated with reduced gestational age and increased risk of preterm birth. 10.1016/j.ecoenv.2022.113297
    Association of exposure to fine particulate matter wave over the preconception and pregnancy periods with adverse birth outcomes: Results from the project ELEFANT. Chen Juan,Wu Shaowei,Fang Junkai,Liu Ziquan,Shang Xuejun,Guo Xinbiao,Deng Furong,Guo Liqiong Environmental research BACKGROUND:No study has explored the effects of sustained maternal exposure to high-level ambient fine particulate matter (PM) within a short period, i.e., PM wave, on adverse birth outcomes, though increasing epidemiological studies demonstrated that exposure to single days of high ambient PM could increase risks of adverse birth outcomes. In this study, we aim to evaluate associations of maternal PM wave exposure around pregnancy with preterm birth (PTB), small for gestational age (SGA), and large for gestational age (LGA). METHODS:Totally 10,916 singleton pregnant women from all 16 districts in Tianjin, China, and their followed-up birth outcomes were included in this study. We defined PM wave as at least 2 consecutive days with daily average PM concentration exceeding 75 μg/m, and 90th, 92.5th, 95th, 97.5th, 99th percentiles of PM distribution during the study period in Tianjin, respectively. Cox proportional hazard model was applied to evaluate the durational effects of PM wave during each exposure window on PTB, SGA, and LGA after adjusting for potential confounders. RESULTS:Exposure to PM wave over the preconception and pregnancy periods was associated with increased risks of adverse birth outcomes. For PTB, the strongest association was found during the first trimester when PM wave was defined as at least 4 consecutive days with daily average PM concentration >90th (HR, 10.46; 95% CI, 6.23-17.54); and for SGA (HR, 6.23; 95% CI, 3.34-11.64) and LGA (HR, 4.70; 95% CI, 3.35-6.59), the strongest associations both were found when PM wave was defined as at least 2 consecutive days with daily average PM concentration >99th. Additionally, the risks of adverse birth outcomes generally increased at higher PM thresholds or longer durations of PM wave. CONCLUSION:Prolonged exposure to high-level PM over preconception and pregnancy periods was associated with increasing risks of PTB, SGA and LGA. 10.1016/j.envres.2021.112473
    Exposure characteristics of phthalate metabolites among the Zunyi cohort of pregnant women in Southwest China. Liao Juan,Fang Derong,Liu Yijun,Xiong Shimin,Wang Xia,Tian Yingkuan,Zhang Haonan,An Songlin,He Caidie,Chen Wei,Liu Xiang,Wu Nian,Tian Kunming,Wang Linglu,Zhang Ya,Yuan Hongyu,Zhang Li,Li Quan,Shen Xubo,Zhou Yuanzhong Environmental science and pollution research international Reported evidence has increasingly indicated that exposure to phthalates can cause adverse pregnancy outcomes. However, phthalate exposure levels among pregnant women remains unclear. We aimed to evaluate the concentrations and predictors of phthalate metabolites in urine samples of the ongoing Zunyi cohort of pregnant women from Southwest China. The urine samples were collected from 1003 pregnant women during their third trimester of pregnancy. The concentrations of nine phthalate metabolites in urine samples were then determined. Data on socio-demographic profiles of the participants, lifestyle during pregnancy, parity, and sampling season were collected using questionnaires. The detectable rate of phthalate metabolites ranged from 76 to 100%. On average, mono-butyl phthalate exhibited the highest median concentration (62.45 μg/L), while mono-benzyl phthalate exhibited the lowest median concentration (0.04 μg/L). Urine concentrations of phthalate metabolites were significantly higher in older, multiparous, higher body mass index, higher income, and passive smoking during pregnancy participants. The levels of low-molecular-weight phthalate metabolites were highest during the summer. The findings indicate the health of pregnant women and fetuses in Zunyi may be generally harmed by the high exposure of phthalate metabolites, especially by mono-n-butyl phthalate. In addition, phthalate metabolites present a demographic and seasonal differential distribution among the study population. Targeted measures to reduce phthalate exposure for high-risk pregnant women and during high-exposure seasons may have potential benefits for maternal and fetal health protection. 10.1007/s11356-022-19990-6
    An Analysis on the Factors for Cervical Insufficiency Causing Adverse Emotions Among Pregnant Women at Different Gestation Phases. Frontiers in psychiatry Background:To analyze the anxiety, depression, and related factors among pregnant women with cervical insufficiency, so as to provide a reference for clinical psychological intervention as an adjuvant therapy. Methods:A total of 101 cases in China with cervical insufficiency were included in the observation group by a convenience sampling method, and 114 normal healthy women of childbearing age were selected as the control group. Participants were investigated and observed for anxiety and depression by SAS and SDS, respectively, to analyze the emotional state and influencing factors of the patients with cervical insufficiency. Stratified by the first, second and third trimesters, our study used whether depressive or not and whether anxiety or not as the dichotomous variables. A multivariate Logistic regression was adopted to analyze the influencing factors. Relevant influencing factors were screened out by the forward stepwise method in combination with professional knowledge and the number of variables. Results:There were statistical significant differences in SAS and SDS between observation group and control group and the incidence rate of anxiety and depression was higher in pregnant women with CI. Multivariate Logistic regression demonstrated that history of abnormal pregnancy was the main influencing factor for anxiety and depression in the early and middle gestation phases, and cervical insufficiency was the factor influencing the anxiety in early gestation and both anxiety and depression in the late gestation phase. Conclusion:Cervical insufficiency may have a negative impact on the emotions of pregnant women. Individualized and targeted mental care should be added into clinic work to prevent negative outcomes. 10.3389/fpsyt.2022.764345
    Associations between seasonal ambient air pollution and adverse perinatal outcomes: a retrospective cohort study in Wenzhou, China. Environmental science and pollution research international Prenatal exposure to ambient air pollution has been associated with adverse perinatal outcomes in previous studies. However, few studies have examined the interaction between air pollution and the season of conception on term low birth weight (TLBW) or macrosomia. Birth registry data of singleton live births in Wenzhou, China, between January 2015 and December 2016 were accessed from the Wenzhou Maternal and Child Health Information Management platform, and data on the ambient air pollutants in Wenzhou were obtained from the Chinese Air Quality Online Monitoring and Analysis Platform. Single-/two-pollutant binary logistic regression models were used to assess the associations between ambient air pollutants (PM, PM, NO, SO, and O) and TLBW/macrosomia, further exploring whether the season of conception interacts with air pollution to impact birth weight. Finally, 213,959 term newborns were selected, including 2452 (1.1%) infants with TLBW and 13,173 (6.1%) infants with macrosomia. In the single-/two-pollutant models, we observed an increased risk of TLBW associated with maternal exposure to PM, PM, SO, and NO during the entire pregnancy, especially in the 2nd trimester. Maternal exposure to O during the 1st trimester was associated with increased macrosomia risk, and O exposure during the 3rd trimester was associated with increased TLBW risk. Pregnant women who conceive in the warm season may experience a more adverse ambient air environment that is related to the risks of TLBW. These findings add to the evidence suggesting that air pollution and the season of conception may have synergistic effects on adverse perinatal outcomes, especially TLBW. Further prospective cohort studies are needed to validate our results. 10.1007/s11356-022-20084-6
    Effects of household environmental exposure and ventilation in association with adverse birth outcomes: A prospective cohort study in rural China. Pan Dongxiang,Liu Shun,Huang Dongping,Zeng Xiaoyun,Zhang Yuanxiao,Pang Qiang,Wu Huiping,Tan Hui Juan Jennifer,Liang Jun,Sheng Yonghong,Qiu Xiaoqiang The Science of the total environment Prenatal exposure to outdoor air pollution have been associated with birth outcomes. However, there is limited evidence on the adverse effects of household indoor air pollution worldwide, much less in rural areas of China. This study aimed to explore the associations of household environmental factors (primary cooking fuel, housing renovation, and home ventilation) with four adverse birth outcomes (preterm birth (PTB), small for gestational age (SGA), low birth weight (LBW), and term low birth weight (T-LBW)). We conducted a cohort study involving 10,324 pregnancies in women who delivered a live-born infant from 2015 to 2018 in Guangxi, China. Risk ratios and 95% confidence intervals (CI) were estimated with control for reproductive history, lifestyle, home environmental confounders, and other potential confounders. A total of 5.4% of the infants were PTB, 10.7% were SGA, 5.5% had LBW, and 3.0% had T-LBW. Household-use induction cookers as the primary cooking fuel during pregnancy was associated with SGA (RR = 1.31, 95% CI: 1.07-1.60), LBW (1.41, 1.09-1.82), and T-LBW(1.62, 1.16-2.26), as compared with household-use gas as the primary cooking fuel. Housing renovation within one year before pregnancy was associated with PTB (1.45, 1.06-1.98) and LBW (1.56, 1.17-2.09), while housing renovation during pregnancy was associated with a higher risk of SGA only in moderate home ventilation conditions (3.74, 1.69-8.28). Our findings suggested that household-use induction cookers as the primary cooking fuel increased the risks of SGA, LBW, and T-LBW. In addition, housing renovation within one year before pregnancy increased the risks of PTB and LBW. Proper home ventilation may reduce the effect on the association between housing renovation during pregnancy and SGA. 10.1016/j.scitotenv.2022.153519
    The acute effect and lag effect analysis between exposures to ambient air pollutants and spontaneous abortion: a case-crossover study in China, 2017-2019. Environmental science and pollution research international INTRODUCTION:Recent studies demonstrated that living in areas with high ambient air pollution may have adverse effects on pregnancy outcomes, but few studies have investigated its association with spontaneous abortion. Further investigation is needed to explore the acute effect and lag effect of air pollutants exposure on spontaneous abortion. OBJECTIVE:To investigate the acute effect and lag effect between exposure to ambient air pollutants and spontaneous abortion. METHODS:Research data of spontaneous abortion were collected from the Chongqing Health Center for Women and Children (CQHCWC) in China. The daily ambient air pollution exposure measurements were estimated for each woman using inverse distance weighting from monitoring stations. A time-stratified, case-crossover design combined with distributed lag linear models was applied to assess the associations between spontaneous pregnancy loss and exposure to each of the air pollutants over lags 0-7 days, adjusted for temperature and relative humidity. RESULTS:A total of 1399 women who experienced spontaneous pregnancy loss events from November 1, 2016, to September 30, 2019, were selected for this study. Maternal exposure to particulate matter 2.5 (PM), particle matter 10 (PM) nitrogen dioxide (NO), and sulfur dioxide (SO) exhibited a significant association with spontaneous abortion. For every 20 μg/m increase in PM, PM, NO, and SO, the RRs were 1.18 (95% CI: 1.06, 1.34), 1.12 (95% CI, 1.04-1.20), 1.15 (95% CI: 1.02, 1.30), and 1.92 (95% CI: 1.18, 3.11) on lag day 3, lag day 3, lag day 0, and lag day 3, respectively. In two-pollutant model combined with PM and PM, a statistically significant increase in spontaneous abortion incidence of 18.0% (RR = 1.18, 95% CI: 1.06, 1.32) was found for a 20 μg/m increase in PM exposure, and 11.2% (RR = 1.11, 95% CI: 1.03, 1.20) for a 20 μg/m increase in PM exposure on lag day 3, similar to single-pollutant model analysis. CONCLUSION:Maternal exposure to high levels of PM, PM, NO, and SO during pregnancy may increase the risk of spontaneous abortion for acute effects and lag effects. Further research to explore sensitive exposure time windows is needed. 10.1007/s11356-022-20379-8
    Assessing the effect of fine particulate matter on adverse birth outcomes in Huai River Basin, Henan, China, 2013-2018. Environmental pollution (Barking, Essex : 1987) Previous studies have indicated that maternal exposure to particles with aerodynamic diameter <2.5 μm (PM) is associated with adverse birth outcomes. However, the critical exposure windows remain inconsistent. A retrospective cohort study was conducted in Huai River Basin, Henan, China during 2013-2018. Daily PM concentration was collected using Chinese Air Quality Reanalysis datasets. We calculated exposures for each participant based on the residential address during pregnancy. Binary logistic regression was used to examine the trimester-specific association of PM exposure with preterm birth (PTB), low birth weight (LBW) and term LBW (tLBW), and we further estimated monthly and weekly association using distributed lag models. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for each 10 μg/m increase in PM exposure. Stratified analyses were performed by maternal age, infant gender, parity, and socioeconomic status (SES). In total, 196,780 eligible births were identified, including 4257 (2.2%) PTBs, 3483 (1.8%) LBWs and 1770 (0.9%) tLBWs. Maternal PM exposure during the second trimester were associated with the risk of PTB and LBW. At the monthly level, the PTB and LBW risks were associated with PM exposure mainly in the 4th -6th month. By estimating the weekly-specific association, we observed that critical exposure windows of PM exposure and PTB were in the 18th- 27th gestational weeks. Stronger associations were found in younger, multiparous mothers and those with a female baby and in low SES. In conclusion, the results indicate that maternal PM exposure during the second trimester was associated with PTB and LBW. Younger, multiparous mothers and those with female babies and in low SES were susceptible. 10.1016/j.envpol.2022.119357
    Maternal exposure to CeONPs during early pregnancy impairs pregnancy by inducing placental abnormalities. Zhong Hangtian,Geng Yanqing,Chen Jun,Gao Rufei,Yu Chao,Yang Zhangyou,Chen Xuemei,Mu Xinyi,Liu Xueqing,He Junlin Journal of hazardous materials Cerium dioxide nanoparticles (CeONPs) has been widely used in many fields, and also recommended as a promising carrier for cancer targeted drugs in human medicine for its excellent properties. However, its biological safety to human health remains controversial. In this study, we propose a mouse model exposed to CeONPs during early pregnancy, to clarify the effect of maternal CeONPs exposure and related molecular mechanism. Pregnant mice are injected intravenously with CeONPs by once a day on D5, D6, and D7. The effects of CeONPs exposure on pregnancy outcomes are observed on D8, D9, D10 and D12. The results show that CeONPs exposure during early pregnancy would lead to poor pregnancy outcomes. Further study find that low-quality decidualization, including the imbalance of trophoblast invasion regulators secreted by decidual cells and abnormal recruitment and differentiation of uNK cells, leads to subsequent biological negative "ripple effects", including placental dysfunction, fetal loss or growth restriction. This study broadens the understanding of the biological safety of CeONPs, and provide clues for the prevention of its negative biological effects. Improving the function of uNK cells can be used as one of the therapeutic targets to prevent negative effects of CeONPs on pregnancy. 10.1016/j.jhazmat.2019.121830
    Associations between endocrine-disrupting heavy metals in maternal hair and gestational diabetes mellitus: A nested case-control study in China. Jia Xiaoqian,Zhang Le,Zhao Jing,Ren Mengyuan,Li Zewu,Wang Jiamei,Wang Shuo,Liu Yingying,An Hang,Li Yuhuan,Yan Lailai,Li Zhiwen,Liu Xiaohong,Pan Bo,Ye Rongwei Environment international BACKGROUND:Exposure to environmental endocrine disruptors (EDCs) may lead to abnormal glucose metabolism and, potentially, gestational diabetes mellitus (GDM). OBJECTIVE:We investigated the association between five endocrine-disrupting heavy metals (EDHMs), i.e., arsenic (As), cadmium (Cd), lead (Pb), mercury (Hg), and tin (Sn), in maternal hair and the risk of GDM. METHODS:We conducted a nested case-control study including 335 GDM cases and 343 controls without GDM based on a prospective birth cohort established in Beijing, China. Concentrations of EDHMs were analyzed in maternal hair. Log-binomial regression and multiple linear regression were used to estimate the associations between the hair concentrations of single metals and the risk of GDM, while weighted quantile sum (WQS) regression for their mixed effects. RESULTS:The median concentrations of Hg (0.442 vs. 0.403 μg/g) and Sn (0.171 vs. 0.140 μg/g) in the case group were significantly higher than those in the control group. No differences were found between the two groups for the other three metals. After adjusting for confounders, the prevalence ratio (PR; highest vs. lowest tertile) of GDM risk for Hg was 1.27 (95% confidence interval [CI]: 1.05-1.54), while that for Sn was 1.26 (95% CI: 1.04-1.53). Among women with a body mass index < 24 kg/m, the PR (highest vs. lowest tertile) of GDM for Sn was 1.38 (95% CI: 1.09-1.75). The effect of exposure to the five EDHMs on the risk of GDM was estimated by WQS regression: Sn and Hg made the largest contributions to the WQS index (40.9% and 40.3%, respectively). CONCLUSION:High maternal levels of EDHMs, particularly Sn and Hg, may promote the development of GDM. 10.1016/j.envint.2021.106770
    Progress and challenges in maternal health in western China: a Countdown to 2015 national case study. Gao Yanqiu,Zhou Hong,Singh Neha S,Powell-Jackson Timothy,Nash Stephen,Yang Min,Guo Sufang,Fang Hai,Alvarez Melisa Martinez,Liu Xiaoyun,Pan Jay,Wang Yan,Ronsmans Carine The Lancet. Global health BACKGROUND:China is one of the few Countdown countries to have achieved Millennium Development Goal 5 (75% reduction in maternal mortality ratio between 1990 and 2015). We aimed to examine the health systems and contextual factors that might have contributed to the substantial decline in maternal mortality between 1997 and 2014. We chose to focus on western China because poverty, ethnic diversity, and geographical access represent particular challenges to ensuring universal access to maternal care in the region. METHODS:In this systematic assessment, we used data from national census reports, National Statistical Yearbooks, the National Maternal and Child Health Routine Reporting System, the China National Health Accounts report, and National Health Statistical Yearbooks to describe changes in policies, health financing, health workforce, health infrastructure, coverage of maternal care, and maternal mortality by region between 1997 and 2014. We used a multivariate linear regression model to examine which contextual and health systems factors contributed to the regional variation in maternal mortality ratio in the same period. Using data from a cross-sectional survey in 2011, we also examined equity in access to maternity care in 42 poor counties in western China. FINDINGS:Maternal mortality declined by 8·9% per year between 1997 and 2014 (geometric mean ratio for each year 0·91, 95% CI 0·91-0·92). After adjusting for GDP per capita, length of highways, female illiteracy, the number of licensed doctors per 1000 population, and the proportion of ethnic minorities, the maternal mortality ratio was 118% higher in the western region (2·18, 1·44-3·28) and 41% higher in the central region (1·41, 0·99-2·01) than in the eastern region. In the rural western region, the proportion of births in health facilities rose from 41·9% in 1997 to 98·4% in 2014. Underpinning such progress was the Government's strong commitment to long-term strategies to ensure access to delivery care in health facilities-eg, professionalisation of maternity care in large hospitals, effective referral systems for women medically or socially at high risk, and financial subsidies for antenatal and delivery care. However, in the poor western counties, substantial disparity by education level of the mother existed in access to health facility births (44% of illiterate women vs 100% of those with college or higher education), antenatal care (17% vs 69%) had at least four visits), and caesarean section (8% vs 44%). INTERPRETATION:Despite remarkable progress in maternal survival in China, substantial disparities remain, especially for the poor, less educated, and ethnic minority groups in remote areas in western China. Whether China's highly medicalised model of maternity care will be an answer for these populations is uncertain. A strategy modelled after China's immunisation programme, whereby care is provided close to the women's homes, might need to be explored, with township hospitals taking a more prominent role. FUNDING:Government of Canada, UNICEF, and the Bill & Melinda Gates Foundation. 10.1016/S2214-109X(17)30100-6
    Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health. Lancet (London, England) Building upon the successes of Countdown to 2015, Countdown to 2030 aims to support the monitoring and measurement of women's, children's, and adolescents' health in the 81 countries that account for 95% of maternal and 90% of all child deaths worldwide. To achieve the Sustainable Development Goals by 2030, the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than 5 years of age needs to accelerate considerably compared with progress since 2000. Such accelerations are only possible with a rapid scale-up of effective interventions to all population groups within countries (particularly in countries with the highest mortality and in those affected by conflict), supported by improvements in underlying socioeconomic conditions, including women's empowerment. Three main conclusions emerge from our analysis of intervention coverage, equity, and drivers of reproductive, maternal, newborn, and child health (RMNCH) in the 81 Countdown countries. First, even though strong progress was made in the coverage of many essential RMNCH interventions during the past decade, many countries are still a long way from universal coverage for most essential interventions. Furthermore, a growing body of evidence suggests that available services in many countries are of poor quality, limiting the potential effect on RMNCH outcomes. Second, within-country inequalities in intervention coverage are reducing in most countries (and are now almost non-existent in a few countries), but the pace is too slow. Third, health-sector (eg, weak country health systems) and non-health-sector drivers (eg, conflict settings) are major impediments to delivering high-quality services to all populations. Although more data for RMNCH interventions are available now, major data gaps still preclude the use of evidence to drive decision making and accountability. Countdown to 2030 is investing in improvements in measurement in several areas, such as quality of care and effective coverage, nutrition programmes, adolescent health, early childhood development, and evidence for conflict settings, and is prioritising its regional networks to enhance local analytic capacity and evidence for RMNCH. 10.1016/S0140-6736(18)30104-1
    Maternal and child health in Israel: building lives. Rubin Lisa,Belmaker Ilana,Somekh Eli,Urkin Jacob,Rudolf Mary,Honovich Mira,Bilenko Natalya,Grossman Zachi Lancet (London, England) Israel is home to a child-oriented society that values strong family ties, universal child benefits, and free education for all children from 3 years of age to school grade 12. Alongside the universal health-care services that are guaranteed by the National Health Insurance Law and strong, community-based primary and preventive care services, these values have resulted in good maternal and child health. In 2015, infant and maternal mortality (3·1 deaths per 1000 livebirths and 2·0 deaths per 100 000 livebirths, respectively) were lower than the mean infant and maternal mortality of countries within the Organisation for Economic Co-operation and Development. Israel has already exceeded the developed regions' Sustainable Development Goal 2030 targets for maternal mortality, neonatal mortality, and mortality in children younger than 5 years in all population groups. Yet these accomplishments are marred by Israel's high prevalence of child poverty (more than 30%), particularly among Arabs (63%) and ultra-Orthodox Jews (67%). Although infant mortality has improved in all subpopulations since Israel was founded in 1948, infant mortality among Arabs is still more than twice as high as among Jews. To address these disparities in health, the Israeli Ministry of Health has created a special division and has funded an intervention programme to reduce the infant mortality among Bedouin Arabs. Other interventions include targeted and culturally appropriate health-care programmes and services for communities with a high number of at-risk children and young adults, dental health service for all children up to 15 years, and improved collaboration between health, education, and welfare services. The challenges faced by the Israeli health-care system include a growing trend towards medicalisation of prenatal care, ensuring staff are trained to treat developmental, behavioural, and psychosocial issues in children and their families, securing sustainable funding for health promotion and injury prevention programmes, expanding and improving the coordination of services for children with special needs or who are at risk, and programme assessment. Ensuring adequate funding for dedicated, preventive paediatric care and taking action on a nationwide scale to reduce child poverty are essential for maintaining health gains in children. In this Series paper, we describe the health indices, highlight disparities, and discuss the challenges in delivering and maintaining maternal and child health care in Israel. 10.1016/S0140-6736(17)30929-7
    Ethnicity and maternal and child health outcomes and service coverage in western China: a systematic review and meta-analysis. Huang Yuan,Shallcross David,Pi Li,Tian Fan,Pan Jay,Ronsmans Carine The Lancet. Global health BACKGROUND:There is a dearth of accurate information about health outcomes and health service coverage among ethnic minorities in China. We assessed maternal and child health (MCH) outcomes and service coverage among ethnic minorities compared with Han populations in western China. METHODS:We did a systematic review searching English (Embase, MEDLINE, Web of Science) and Chinese (China National Knowledge Infrastructure [CNKI], VIP, Wanfang) databases for population-based studies comparing MCH indicators between ethnic minorities between Jan 1, 1990, and Nov 9, 2016, in any language. For studies making individual comparisons we used the odds ratio (OR) and corresponding 95% CIs as the primary measure to assess the association between MCH indicators and ethnicity. We used a random-effects model to pool odds ratios. FINDINGS:We included 29 Chinese and 16 English language studies, providing 31 individual comparisons and 15 ecological comparisons. Ethnic minority women had lower odds of antenatal care use (pooled crude OR 0·60 [95% CI 0·48-0·75]) and birth in health facilities (0·50 [0·39-0·64]) than did Han women; and their children had higher odds of mortality (2·02 [1·23-3·32]) and lower immunisation (0·34 [0·24-0·47]) than did Han children. After taking account of the potential confounding effects of socioeconomic factors, ethnic minority women were less likely to use antenatal care (pooled adjusted OR 0·54 [0·42-0·71]) or to immunise their children (0·57 [0·44-0·74]) compared with Han women. INTERPRETATION:China has a wealth of primary data that could further our understanding of why ethnic minority populations are lagging behind. As MCH outcomes continue to improve nationally, ethnic minorities will take a greater share of the overall burden of adverse outcomes, requiring strategic investments to address the specific challenges faced by people living in remote areas. FUNDING:China Medical Board. 10.1016/S2214-109X(17)30445-X
    Initiatives to Reduce Maternal Mortality and Severe Maternal Morbidity in the United States : A Narrative Review. Ahn Roy,Gonzalez Grace P,Anderson Britta,Vladutiu Catherine J,Fowler Erin R,Manning Leticia Annals of internal medicine Maternal mortality and severe maternal morbidity are critical health issues in the United States, with unacceptably high rates and racial, ethnic, and geographic disparities. Various factors contribute to these adverse maternal health outcomes, ranging from patient-level to health system-level factors. Furthermore, a majority of pregnancy-related deaths are preventable. This review briefly describes the epidemiology of maternal mortality and severe maternal morbidity in the United States and discusses selected initiatives to reduce maternal mortality and severe maternal morbidity in the areas of data and surveillance; clinical workforce training and patient education; telehealth; comprehensive models and strategies; and clinical guidelines, protocols, and bundles. Related Health Resources and Services Administration initiatives are also described. 10.7326/M19-3258
    Gestational diabetes: opportunities for improving maternal and child health. Saravanan Ponnusamy, , , The lancet. Diabetes & endocrinology Gestational diabetes, the most common medical disorder in pregnancy, is defined as glucose intolerance resulting in hyperglycaemia that begins or is first diagnosed in pregnancy. Gestational diabetes is associated with increased pregnancy complications and long-term metabolic risks for the woman and the offspring. However, the current diagnostic and management strategies recommended by national and international guidelines are mainly focused on short-term risks during pregnancy and delivery, except the Carpenter-Coustan criteria, which were based on the risk of future incidence of type 2 diabetes post-gestational diabetes. In this Personal View, first, we summarise the evidence for long-term risk in women with gestational diabetes and their offspring. Second, we suggest that a shift is needed in the thinking about gestational diabetes; moving from the perception of a short-term condition that confers increased risks of large babies to a potentially modifiable long-term condition that contributes to the growing burden of childhood obesity and cardiometabolic disorders in women and the future generation. Third, we propose how the current clinical practice might be improved. Finally, we outline and justify priorities for future research. 10.1016/S2213-8587(20)30161-3
    Effective coverage measurement in maternal, newborn, child, and adolescent health and nutrition: progress, future prospects, and implications for quality health systems. Marsh Andrew D,Muzigaba Moise,Diaz Theresa,Requejo Jennifer,Jackson Debra,Chou Doris,Cresswell Jenny A,Guthold Regina,Moran Allisyn C,Strong Kathleen L,Banerjee Anshu,Soucat Agnès, The Lancet. Global health Intervention coverage-the proportion of the population with a health-care need who receive care-does not account for intervention quality and potentially overestimates health benefits of services provided to populations. Effective coverage introduces the dimension of quality of care to the measurement of intervention coverage. Many definitions and methodological approaches to measuring effective coverage have been developed, resulting in confusion over definition, calculation, interpretation, and monitoring of these measures. To develop a consensus on the definition and measurement of effective coverage for maternal, newborn, child, and adolescent health and nutrition (MNCAHN), WHO and UNICEF convened a group of experts, the Effective Coverage Think Tank Group, to make recommendations for standardising the definition of effective coverage, measurement approaches for effective coverage, indicators of effective coverage in MNCAHN, and to develop future effective coverage research priorities. Via a series of consultations, the group recommended that effective coverage be defined as the proportion of a population in need of a service that resulted in a positive health outcome from the service. The proposed effective coverage measures and care cascade steps can be applied to further develop effective coverage measures across a broad range of MNCAHN services. Furthermore, advances in measurement of effective coverage could improve monitoring efforts towards the achievement of universal health coverage. 10.1016/S2214-109X(20)30104-2
    Building resilient societies after COVID-19: the case for investing in maternal, neonatal, and child health. Jacob Chandni Maria,Briana Despina D,Di Renzo Gian Carlo,Modi Neena,Bustreo Flavia,Conti Gabriella,Malamitsi-Puchner Ariadne,Hanson Mark The Lancet. Public health Resilient societies respond rapidly and effectively to health challenges and the associated economic consequences, and adapt to be more responsive to future challenges. Although it is only possible to recognise resilience retrospectively, the COVID-19 pandemic has occurred at a point in human history when, uniquely, sufficient knowledge is available on the early-life determinants of health to indicate clearly that a focus on maternal, neonatal, and child health (MNCH) will promote later resilience. This knowledge offers an unprecedented opportunity to disrupt entrenched strategies and to reinvest in MNCH in the post-COVID-19 so-called new normal. Furthermore, analysis of the short-term, medium-term, and longer-term consequences of previous socioeconomic shocks provides important insights into those domains of MNCH, such as neurocognitive development and nutrition, for which investment will generate the greatest benefit. Such considerations apply to high-income countries (HICs) and low-income and middle-income countries (LMICs). However, implementing appropriate policies in the post-COVID-19 recovery period will be challenging and requires political commitment and public engagement. 10.1016/S2468-2667(20)30200-0
    Targeted drug delivery for maternal and perinatal health: Challenges and opportunities. Sharma Anjali,Sah Nirnath,Kannan Sujatha,Kannan Rangaramanujam M Advanced drug delivery reviews Pre-existing conditions at reproductive age, and complications arising during pregnancy can be detrimental to maternal and fetal health. Current therapies to combat obstetric disorders are limited due to the inherent complexity of pregnancy, and can have harmful effects on developing fetus. Emerging research shows intricate signaling between the cells from mother and fetus at maternal-fetal interface, providing unique opportunities for interventions specifically targeted to the mother, fetus, or placenta. Advancements in nanotechnology, stem-cell biology and gene therapy have resulted in target-specific treatments with promising results in pre-clinical maternal and fetal disorder models. Comprehensive understanding of the effect of physicochemical properties of delivery systems on their uptake, retention and accumulation across placenta will help in the better diagnosis and treatment of perinatal disorders. This review describes the factors leading to obstetric complications along with their effect on pregnancy outcomes, and discusses key targeted therapeutic strategies for addressing conditions related to maternal and fetal health. 10.1016/j.addr.2021.113950
    Next generation maternal health: external shocks and health-system innovations. Kruk Margaret E,Kujawski Stephanie,Moyer Cheryl A,Adanu Richard M,Afsana Kaosar,Cohen Jessica,Glassman Amanda,Labrique Alain,Reddy K Srinath,Yamey Gavin Lancet (London, England) In this Series we document the substantial progress in the reduction of maternal mortality and discuss the current state of science in reducing maternal mortality. However, maternal health is also powerfully influenced by the structures and resources of societies, communities, and health systems. We discuss the shocks from outside of the field of maternal health that will influence maternal survival including economic growth in low-income and middle-income countries, urbanisation, and health crises due to disease outbreaks, extreme weather, and conflict. Policy and technological innovations, such as universal health coverage, behavioural economics, mobile health, and the data revolution, are changing health systems and ushering in new approaches to affect the health of mothers. Research and policy will need to reflect the changing maternal health landscape. 10.1016/S0140-6736(16)31395-2
    Secretory IgA: Linking microbes, maternal health, and infant health through human milk. Cell host & microbe Secretory immunoglobulin A (SIgA) in human milk plays a central role in complex maternal-infant interactions that influence long-term health outcomes. Governed by genetics and maternal microbial exposure, human milk SIgA shapes both the microbiota and immune system of infants. Historically, SIgA-microbe interactions have been challenging to unravel due to their dynamic and personalized nature, particularly during early life. Recent advances have helped to clarify how SIgA acts beyond simple pathogen clearance to help guide and constrain a healthy microbiota, promote tolerance, and influence immune system development. In this review, we highlight these new findings in the context of the critical early-life window and propose outstanding areas of study that will be key to harnessing the benefits of SIgA to support healthy immune development during infancy. 10.1016/j.chom.2022.02.005
    Diversity and divergence: the dynamic burden of poor maternal health. Graham Wendy,Woodd Susannah,Byass Peter,Filippi Veronique,Gon Giorgia,Virgo Sandra,Chou Doris,Hounton Sennen,Lozano Rafael,Pattinson Robert,Singh Susheela Lancet (London, England) Maternal health is a big issue and is central to sustainable development. Each year, about 210 million women become pregnant and about 140 million newborn babies are delivered-the sheer scale of maternal health alone makes maternal well being and survival vital concerns. In this Series paper, we adopt primarily a numerical lens to illuminate patterns and trends in outcomes, but recognise that understanding of poor maternal health also warrants other perspectives, such as human rights. Our use of the best available evidence highlights the dynamic burden of maternal health problems. Increased diversity in the magnitude and causes of maternal mortality and morbidity between and within populations presents a major challenge to policies and programmes aiming to match varying needs with diverse types of care across different settings. This diversity, in turn, contributes to a widening gap or differences in levels of maternal mortality, seen most acutely in vulnerable populations, predominantly in sub-Saharan Africa. Strong political and technical commitment to improve equity-sensitive information systems is required to monitor the gap in maternal mortality, and robust research is needed to elucidate major interactions between the broad range of health problems. Diversity and divergence are defining characteristics of poor maternal health in the 21st century. Progress on this issue will be an ultimate judge of sustainable development. 10.1016/S0140-6736(16)31533-1
    Call to Action: Maternal Health and Saving Mothers: A Policy Statement From the American Heart Association. Mehta Laxmi S,Sharma Garima,Creanga Andreea A,Hameed Afshan B,Hollier Lisa M,Johnson Janay C,Leffert Lisa,McCullough Louise D,Mujahid Mahasin S,Watson Karol,White Courtney J, Circulation The United States has the highest maternal mortality rates among developed countries, and cardiovascular disease is the leading cause. Therefore, the American Heart Association has a unique role in advocating for efforts to improve maternal health and to enhance access to and delivery of care before, during, and after pregnancy. Several initiatives have shaped the time course of major milestones in advancing maternal and reproductive health equity in the United States. There have been significant strides in improving the timeliness of data reporting in maternal mortality surveillance and epidemiological programs in maternal and child health, yet more policy reforms are necessary. To make a sustainable and systemic impact on maternal health, further efforts are necessary at the societal, institutional, stakeholder, and regulatory levels to address the racial and ethnic disparities in maternal health, to effectively reduce inequities in care, and to mitigate maternal morbidity and mortality. In alignment with American Heart Association's mission "to be a relentless force for longer, healthier lives," this policy statement outlines the inequities that influence disparities in maternal outcomes and current policy approaches to improving maternal health and suggests additional potentially impactful actions to improve maternal outcomes and ultimately save mothers' lives. 10.1161/CIR.0000000000001000