Association between fetal macrosomia and risk of obesity in children under 3 years in Western China: a cohort study.
Pan Xiong-Fei,Tang Li,Lee Andy H,Binns Colin,Yang Chun-Xia,Xu Zhu-Ping,Zhang Jian-Li,Yang Yong,Wang Hong,Sun Xin
World journal of pediatrics : WJP
BACKGROUND:Fetal macrosomia, defined as birth weight equal or over 4000 g, is a major concern for both neonatal and maternal health. A rapid increasing trend in fetal macrosomia is observed in different regions of China. We aimed to examine the association between fetal macrosomia and risk of childhood obesity in Western China. METHODS:All macrosomic live singletons (≥ 4000 g), and a random sample of singletons with normal birth weight (2500-3999 g) born in four districts of Chengdu, Western China, in 2011 were included in the cohort study. Maternal demographics, obstetric factors, labor and delivery summary at baseline were extracted from the Chengdu Maternal and Child Health Management System. Anthropometric measurements before 3 years and infant feeding information at around 6 months were also collected. Childhood obesity under 3 years was primarily defined as a weight-for-length/height z score ≥ 1.645 using the WHO growth reference. Secondary definitions were based on weight-for-age and body mass index (BMI)-for-age over the same cut-offs. RESULTS:A total of 1767 infants were included in the analyses, of whom 714 were macrosomic. After controlling for maternal age, parity, gestational age and anemia at the first antenatal visit, pre-pregnancy BMI, gestational weight gain, gestational age at birth, baby age and sex, and breastfeeding practices at 6 months, the risk of childhood obesity defined according to weight-for-length/height among macrosomic babies was 1.90 (95% confidence interval 1.04-3.49) times that of babies with normal birth weight. The risk of childhood obesity for macrosomic babies was 3.74 (1.96-7.14) and 1.64 (0.89-3.00) times higher based on weight-for-age and BMI-for-age, respectively. CONCLUSION:Fetal macrosomia is associated with increased risk of obesity in children under 3 years in Western China.
Associations of Maternal Diabetes and Body Mass Index With Offspring Birth Weight and Prematurity.
Kong Linghua,Nilsson Ida A K,Gissler Mika,Lavebratt Catharina
Importance:Maternal obesity, pregestational type 1 diabetes, and gestational diabetes have been reported to increase the risks for large birth weight and preterm birth in offspring. However, the associations for insulin-treated diabetes and non-insulin-treated type 2 diabetes, as well as the associations for joint diabetes disorders and maternal body mass index, with these outcomes are less well documented. Objective:To examine associations of maternal diabetes disorders, separately and together with maternal underweight or obesity, with the offspring being large for gestational age and/or preterm at birth. Design, Setting, and Participants:This population-based cohort study used nationwide registries to examine all live births (n = 649 043) between January 1, 2004, and December 31, 2014, in Finland. The study and data analysis were conducted from April 1, 2018, to October 10, 2018. Exposures:Maternal prepregnancy body mass index, pregestational diabetes with insulin treatment, pregestational type 2 diabetes without insulin treatment, and gestational diabetes. Main Outcomes and Measures:Offspring large for gestational age (LGA) at birth and preterm delivery. Logistic regression models were adjusted for offspring birth year; parity; and maternal age, country of birth, and smoking status. Results:Of the 649 043 births, 4000 (0.62%) were delivered by mothers who had insulin-treated diabetes, 3740 (0.57%) by mothers who had type 2 diabetes, and 98 568 (15.2%) by mothers who had gestational diabetes. The mean (SD) age of mothers was 30.15 (5.37) years, and 588 100 mothers (90.6%) were born in Finland. Statistically significant interactions existed between maternal body mass index and diabetes on offspring LGA and prematurity (insulin-treated diabetes: LGA F = 3489.0 and prematurity F = 1316.4 [P < .001]; type 2 diabetes: LGA F = 147.3 and prematurity F = 21.9 [P < .001]; gestational diabetes: LGA F = 1374.6 and prematurity F = 434.3 [P < .001]). Maternal moderate obesity, compared with normal-weight mothers with no diabetes, was associated with a mildly increased risk of having an offspring LGA (1069 [3.5%] vs 5151 [1.5%]; adjusted odds ratio [aOR], 2.45; 95% CI, 2.29-2.62), and mothers with insulin-treated diabetes had markedly elevated risks of having an offspring LGA (1585 [39.6%] vs 5151 [1.5%]; aOR, 43.80; 95% CI, 40.88-46.93) and a preterm birth (1483 [37.1%] vs 17 481 [5.0%]; aOR, 11.17; 95% CI, 10.46-11.93). Mothers who were moderately obese with type 2 diabetes were at increased risks of LGA (132 [16.4%] vs 5151 [1.5%]; aOR, 12.44; 95% CI, 10.29-15.03) and prematurity (83 [10.3%] vs 17 481 [5.0%]; aOR, 2.14; 95% CI, 1.70-2.69). Mothers who were moderately obese with gestational diabetes had a milder risk of LGA (1195 [6.7%] vs 5151 [1.5%]; aOR, 4.72; 95% CI, 4.42-5.04). Among spontaneous deliveries, the risks were strongest for moderately preterm births, but insulin-treated diabetes was associated with an increased risk also for very and extremely preterm births. Conclusions and Relevance:Maternal insulin-treated diabetes appeared to be associated with markedly increased risks for LGA and preterm births, whereas obesity in mothers with type 2 diabetes had mild to moderately increased risks; these findings may have implications for counseling and managing pregnancies.
Maternal exposure to different sizes of polystyrene microplastics during gestation causes metabolic disorders in their offspring.
Luo Ting,Zhang Yi,Wang Caiyun,Wang Xiaoyu,Zhou Jiajie,Shen Manlu,Zhao Yao,Fu Zhengwei,Jin Yuanxiang
Environmental pollution (Barking, Essex : 1987)
Microplastics (MPs) are highly concerned environmental pollutants that are ubiquitous in the environmental and might affect human and animal health. In this study, we exposed pregnant mice to 0.5 and 5 μm with 100 and 1000 μg/L polystyrene MPs, then investigated maternal MPs exposure during gestation and evaluated the potential effects on the mice offspring (PND42). In the F1 offspring, the serum triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels and hepatic TC, TG levels were altered, while some of them were only significant in 5 μm MPs-treated group. Various serum metabolites including amino acids and acyl-carnitines were carried out by nonderivatized tandem mass spectrometry, there were 11 and 15 kinds of metabolites changes significantly in 0.5 and 5 μm MPs-treated groups, respectively. Furthermore, the changes of C0 and C0/(C16 + 18) indicators suggested the potential risk of fatty acid metabolism disorder, which was verified by hepatic genes expression. These results indicated that maternal exposure of two different sizes of polystyrene MPs increased risks of metabolic disorder in their offspring, and greater effects were observed in 5 μm MPs-treated groups. The data provides a preliminary exploration of the potential relationship between MPs and the risk metabolic disorder even in the next generation, which might offer new insights into the health risk assessment of MPs.
Association between Ambient Air Pollution and Pregnancy Outcomes in Patients Undergoing In Vitro Fertilization in Chengdu, China: A retrospective study.
Zeng Xun,Jin Song,Chen Xiaolan,Qiu Yang
Ambient air pollution has been a major concern in China due to its effect on population health. Exposure to ambient air pollution has negative impact on animal reproduction and fertility, however, its effect on human reproduction has been inconclusive. We conducted a retrospective study on in vitro fertilization (IVF) patients from Chengdu, Sichuan Province in western China, a city with persistent ambient air pollution. We analyzed the medical records of 1139 patients who underwent first conventional IVF cycles during 2014-2019. The relationship between six atmospheric pollutants (PM, PM, O, NO, SO, CO) and IVF pregnancy outcomes were assessed by 1) stratification of maternal age into three groups (<35, 35-39, ≥40 years), and by 2) averaging pollutant concentration during different exposure windows. The results indicate that the association between ambient air pollution and IVF pregnancy outcomes (biochemical pregnancy and clinical pregnancy) is more significant for women in <35 years age group. Concentrations of PM, PM, NO, SO and CO are negatively associated with the odds of biochemical pregnancy and clinical pregnancy, and concentration of CO in particular is associated with the largest reduction in odds. Conversely, O concentration is positively associated with biochemical pregnancy and clinical pregnancy. Moreover, pollutant concentration during long-term exposure window is associated with larger magnitude of change in the odds of biochemical pregnancy and clinical pregnancy. Findings from this study suggest that exposure to ambient air pollution during any period within the IVF treatment timeline would influence IVF pregnancy outcomes, and such influence is more pronounced in younger women (<35 years).
Maternal air pollution exposure and neonatal congenital heart disease: A multi-city cross-sectional study in eastern China.
Li Die,Xu Weize,Qiu Yunxiang,Pan Feixia,Lou Hongliang,Li Jing,Jin Yueqin,Wu Ting,Pan Lulu,An Jing,Xu Junqiu,Cheng Wei,Tao Linghua,Lei Yongliang,Huang Chengyin,Yin Fei,Shu Qiang
International journal of hygiene and environmental health
OBJECTIVE:To examine the association between air pollution and neonatal congenital heart disease (CHD), and evaluate the cumulative burden of CHD attributed to above certain level for ambient air pollution exposure. METHODS:We identified newborns who were diagnosed as CHD by echocardiography in Network Platform for Congenital Heart Disease (NPCHD) from January 2019 to December 2020 in 11 cities eastern China. The exposure lag response relationship between air pollutants (PM, PM, SO, NO, CO, and O) concentration and CHDs was calculated by the distributed lag nonlinear model (DLNM). We further calculated the cumulative risk ratios (CRRs) of each air pollutant above reference concentrations on CHDs. RESULTS:A total of 5904 CHDs from 983, 523 newborns were enrolled in this study. A 10 μg/m increase in PM, PM, SO, NO, CO and O exposure was associated with an increased risk of higher CHD incident RR = 1.025, 95% CI: 1.016-1.038 for PM in the third trimester, RR = 1.001, 95% CI: 1.000-1.002 for PM in the third trimester, 1.020, 95%CI: 1.004-1.036 for NO in the third trimester, RR = 1.001, 95%CI: 1.000-1.002 for O in the first trimester, all P value < 0.05). Cumulative effect curves of PM, PM, SO, NO, CO, and O were observed as sub-linear with a maximum of 1.876 (95%CI:1.220-2.886), 1.973 (95%CI:1.477,2.637), 2.169 (95%CI:1.347-3.493), 2.902 (95%CI:1.859-4.530), 1.398 (95%CI:1.080-1.809), 2.691 (95%CI:1.705-4.248), respectively. Significant associations were observed for air pollutants and CHDs in cities with higher average education years and babies concepted in cold season. CONCLUSIONS:Our findings could provide growing evidence regarding the adverse health effects of air pollution on CHD, thereby strengthening the hypothesis that air pollutants have harmful impacts on cardiac development. Further studies are needed to verify the associations.
Polymorphisms in oxidative stress, metabolic detoxification, and immune function genes, maternal exposure to ambient air pollution, and risk of preterm birth in Taiyuan, China.
Zhao Nan,Wu Weiwei,Feng Yongliang,Yang Feifei,Han Tianbi,Guo Mengzhu,Ren Qingwen,Li Wangjun,Li Jinbo,Wang Suping,Zhang Yawei
Exposure to air pollutants may be associated with preterm birth (PB) through oxidative stress, metabolic detoxification, and immune system processes. However, no study has investigated the interactive effects of maternal air pollution and genetic polymorphisms in these pathways on risk of PB. The study included 126 PB and 310 term births. A total of 177 single nucleotide polymorphisms (SNPs) in oxidative stress, immune function, and metabolic detoxification-related genes were examined and analyzed. The China air quality index (AQI) was used as an overall estimation of ambient air pollutants. Among 177 SNPs, four SNPs (GPX4-rs376102, GLRX-rs889224, VEGFA-rs3025039, and IL1A-rs3783550) were found to have significant interactions with AQI on the risk of PB (P were 0.001, 0.003, 0.03, and 0.04, respectively). After being stratified by the maternal genotypes in these four SNPs, 1.38 to 1.76 times of the risk of PB were observed as per interquartile range increase in maternal AQI among women who carried the GPX4-rs376102 AC/CC genotypes, the GLRX-rs889224 TT genotype, the VEGFA-rs3025039 CC genotype, or the IL1A-rs3783550 GT/TT genotypes. After adjustment for multiple comparisons, only GPX4-rs376102 and AQI interaction remained statistically significant (false discovery rate (FDR)=0.17). After additional stratification by preeclampsia (PE) status, a strongest association was observed in women who carried the GPX4-rs376102 AC/CC genotypes (OR, 2.26; 95% CI, 1.41-3.65, P=0.0002, FDR=0.035) in the PE group. Our study provided the first evidence that association between maternal air pollution and PB risk may be modified by the genetic polymorphisms in oxidative stress and immune function genes. Future large studies are necessary to replicate and confirm the observed associations.
High Maternal Triglyceride Levels Mediate the Association between Pre-Pregnancy Overweight/Obesity and Macrosomia among Singleton Term Non-Diabetic Pregnancies: A Prospective Cohort Study in Central China.
This study aimed at examining the risk of macrosomia, in relation to maternal pre-pregnancy overweight/obesity mediated via high maternal triglyceride (mTG) levels. In this prospective study, 24,730 singleton term non-diabetic pregnancies were finally included. Serum mTG levels were measured using fasting blood samples that were collected after 28 weeks of gestation. High mTG levels were defined as values ≥ the 90th percentile. The outcome of interest was macrosomia (≥4000 g). Log-binomial regression was used to assess the mediation path between overweight/obesity, high mTG levels, and macrosomia. The mediation analysis found a total effect of overweight on macrosomia of 0.006 (95% CI, 0.001-0.010), including a direct effect of 0.005 (95% CI, 0.001, 0.009) and indirect effect of 0.001 (95% CI, 0.000-0.001), with an estimated proportion of 11.1% mediated by high mTG levels. Additionally, we also found a total effect of obesity on macrosomia of 0.026 (95% CI, 0.018-0.036), including a direct effect of 0.025 (95% CI, 0.017-0.036) and indirect effect of 0.001 (95% CI, 0.000-0.001), with an estimated proportion of 3.8% mediated by high mTG levels. In conclusion, non-diabetic women with overweight or obesity had an increased risk of macrosomia, and this positive association was partly mediated by high mTG levels.
Joint Associations of Maternal Gestational Diabetes and Hypertensive Disorders of Pregnancy With Overweight in Offspring.
Gu Yuying,Lu Jun,Li Weiqin,Liu Huikun,Wang Leishen,Leng Junhong,Li Wei,Zhang Shuang,Wang Shuting,Tuomilehto Jaakko,Yu Zhijie,Yang Xilin,Baccarelli Andrea A,Hou Lifang,Hu Gang
Frontiers in endocrinology
Either maternal gestational diabetes mellitus (GDM) or hypertensive disorder of pregnancy (HDP) is associated with an increased risk of obesity in the offspring. However, their joint associations with obesity in offspring remain unclear. We investigated the joint associations of maternal GDM and HDP with childhood overweight in offspring. We performed a large study in 1967 mother-child pairs. Maternal GDM was diagnosed according to the 1999 World Health Organization (WHO) criteria. HDP was defined as self-reported doctor-diagnosed hypertension or treatment of hypertension (including gestational hypertension, preeclampsia, sever preeclampsia or eclampsia) after 20 weeks of gestation on the questionnaire. Body mass index (BMI) for age Z-score and childhood overweight were evaluated according to WHO growth reference. We used the general linear models to compare children's Z score for BMI and logistic regression models to estimate odds ratios of childhood overweight according to maternal different status of GDM and HDP. Offspring of mothers with both GDM and HDP had a higher BMI for age Z-score (0.63 vs. 0.03, < 0.001) than children born to normotensive and normoglycemic pregnancy. After adjustment for maternal and children's major confounding factors, joint GDM and HDP were associated with increased odds ratios of offspring's overweight compared with normotensive and normoglycemic pregnancy (2.97, 95% confidence intervals [CIs] 1.65-5.34) and GDM alone (2.06, 95% CIs 1.20-3.54), respectively. After additional adjustment for maternal pre-pregnancy BMI and gestational weight gain, joint maternal GDM, and HDP was still associated with an increased risk of offspring's overweight compared with the maternal normotensive, and normoglycemic group but became to have a borderline increased risk compared with the maternal GDM alone group. Maternal GDM alone or joint GDM and HDP were associated with increased ratios of offspring's overweight.
Effects of PM exposure during gestation on maternal gut microbiota and pregnancy outcomes.
Liu Wei,Zhou Yalin,Yong Li ,Qin Yong,Yu Lanlan,Li Ruijun,Chen Yuhan,Xu Yajun
A number of studies have reported that fine particulate matter (PM) exposure is associated with adverse pregnancy outcomes. Moreover, PM exposure contributes to changes of gut microbiota. However, influences of PM exposure during gestation on maternal gut microbiota and pregnancy outcomes were not well understood. Here we performed a study using mice models. Dams were exposed to PM suspension by intratracheal instillation on gestational day (GD) 3, 6, 9, 12 and 15. Pregnancy outcomes, maternal gut microbiota and short chain fatty acids on GD 18 were all measured. The fetal body weight of PM group was significantly lower than that of control group (p < 0.05). Meanwhile, the fetal body length of PM group was significantly shorter than that of control group (p < 0.05). The Shannon or Simpson index of PM group were higher than that of control group (p < 0.05). At the phyla level, compared to dams in control group, mice in the PM group had higher ratio of phyla Proteobacteria, Candidatus Saccharibacteria and Fusobacteria and lower ratio of phyla Acidobacteria, Gemmatimonadetes and Deferribacteres in the gut. Compared with control group, the concentration of isobutyric acid was higher in PM group, but butyric acid concentration was lower in PM group (p < 0.05). These findings suggested that prenatal exposure to PM had an effect on birth weight of fetus. Meanwhile, PM tracheal exposure during gestation caused changes in the distribution and structure of gut microbiota of dams.
Maternal consumption of a fermented diet protects offspring against intestinal inflammation by regulating the gut microbiota.
The neonatal intestinal tract is immature and can be easily infected by pathogens causing inflammation. Maternal diet manipulation is a promising nutritional strategy to enhance the gut health of offspring. A fermented diet is a gut microbiota targeting diet containing live probiotics and their metabolites, which benefit the gut and overall health host. However, it remains unclear how a maternal fermented diet (MFD) affects neonatal intestinal inflammation. Here, and models together with multi-omics analysis were applied to investigate the impacts and the underlying mechanism through which an MFD prevents from gut inflammation in neonates. An MFD remarkably improved the performance of both sows and piglets and significantly altered the gut microbiome and milk metabolome of sows. In addition, the MFD significantly accelerated the maturation of the gut microbiota of neonates and increased the abundance of gut and the microbial functions of amino acid-related enzymes and glucose metabolism on the weaning day. Notably, the MFD reduced susceptibility to colonic inflammation in offspring. The fecal microbiota of sows was then transplanted into mouse dams and it was found that the mouse dams and pups in the MFD group alleviated the LPS-induced decrease in gut abundance and barrier injury. Milk L-glutamine (GLN) and gut (LR) were found as two of the main MFD-induced sow effectors that contributed to the gut health of piglets. The properties of LR and GLN in modulating gut microbiota and alleviating colonic inflammation by inhibiting the phosphorylation of p38 and JNK and activation of Caspase 3 were further verified. These findings provide the first data revealing that an MFD drives neonate gut microbiota development and ameliorates the colonic inflammation by regulating the gut microbiota. This fundamental evidence might provide references for modulating maternal nutrition to enhance early-life gut health and prevent gut inflammation.
The relationship between maternal vitamin D deficiency and glycolipid metabolism and adverse pregnancy outcome.
Chen Hai-Ying,Zhang Hong-Ping,Yang Jie,Huang Zhi-Qiong,Xu Hai-Xia,Jin Jiang,Xu Kai,Tong Yu,Dong Qian-Qian,Zheng Jian-Qiong
OBJECTIVE:Maternal vitamin D deficiency is associated with glucose and lipid metabolism in the mother and offspring. Meanwhile, it can also lead to adverse pregnancy outcomes. The aim of this case-control study was to document maternal, umbilical arterial glucose and lipid metabolic levels and correlations in pregnancies with or without vitamin D deficiency, while also investigating adverse pregnancy outcomes. DESIGN/PARTICIPANTS/MEASUREMENTS:A total of 425 pregnant women who received antenatal care and delivered at Wenzhou People's Hospital were enrolled. According to their serum 25-hydroxyvitamin D [25(OH)D] level, the pregnant women were divided into the vitamin D deficiency group [25(OH)D < 20 ng/mL, 185 participants] and the control group [25(OH)D ≥ 20 ng/mL, 240 participants]. Maternal blood samples were collected at 24-28 weeks of gestation and delivery for 75-g oral glucose tolerance test (OGTT), and measurements of glucose and lipid metabolite levels and 25(OH)D levels. Umbilical arterial samples were collected during delivery (33.57-41.43 gestational weeks). RESULTS:Compared with control participants, vitamin D deficiency women had significantly higher concentrations of fasting blood-glucose (P < .01), 1-h OGTT plasma glucose (P < .01), 2-h OGTT plasma glucose (P < .01), insulin (P < .01), HOMA-IR (P < .01), LDL (P < .01) and triglycerides (P = .02) and lower concentrations of HOMA-S (P < .01). Compared with the control group, vitamin D deficiency women had higher concentrations of triglycerides (P < .01) and lower concentrations of HDL-C (P < .01) and HOMA-β (P = .01) in infant umbilical arterial blood. Pearson's correlation analysis demonstrated that the maternal 25(OH)D level was negatively correlated with maternal plasma glucose, insulin, LDL-C, cholesterol, triglyceride and HOMA-IR (r = -.38, -.27, -.2, -.11, -.11, -.33 and .11; P < .01, <.01, <.01, <.05, <.05 and <.01, respectively), while there was a positive correlation between maternal serum 25(OH)D and HOMA-S (r = .11, P < .05). The triglyceride level in the umbilical artery was negatively correlated with maternal serum 25(OH)D concentration (r = -.286, P < .01), while the HDL-C and HOMA-β in umbilical artery were positively related (r = .154, .103, P < .01). Compared with the control group, the incidences of pre-eclampsia [4.8% (9/185) vs 1.25% (3/240), P = .03], gestational diabetes mellitus [19.45% (36/185) vs 12.08% (29/240), P = .04] and premature rupture of membranes [15.68% (29/185) vs 5.42% (13/240), P < .01] were higher in the vitamin D deficiency group. CONCLUSION:Vitamin D deficiency during pregnancy is associated with maternal glucose and lipid metabolism and pregnancy outcomes. Therefore, it is worth recommending to maintain vitamin D status at an optimal level in pregnant women to prevent metabolic disorders and pregnancy complications.
The Association of Gene Variants in the Vitamin D Metabolic Pathway and Its Interaction with Vitamin D on Gestational Diabetes Mellitus: A Prospective Cohort Study.
Mo Minjia,Shao Bule,Xin Xing,Luo Wenliang,Si Shuting,Jiang Wen,Wang Shuojia,Shen Yu,Wu Jinhua,Yu Yunxian
The present prospective study included 2156 women and investigated the effect of gene variants in the vitamin D (VitD) metabolic and glucose pathways and their interaction with VitD levels during pregnancy on gestational diabetes mellitus (GDM). Plasma 25(OH)D concentrations were measured at the first and second trimesters. GDM subtype 1 was defined as those with isolated elevated fasting plasma glucose; GDM subtype 2 were those with isolated elevated postprandial glucose at 1 h and/or 2 h; and GDM subtype 3 were those with both elevated fasting plasma glucose and postprandial glucose. Six Gc isoforms were categorized based on two gene variants rs4588 and rs7041, including 1s/1s, 1s/2, 1s/1f, 2/2, 1f/2 and 1f/1f. -rs10783219 and -rs10830962 were associated with increased risks of GDM and GDM subtype 2; interactions between each other as well as with -rs7754840 were observed ( < 0.05). Compared with the 1f/1f isoform, the risk of GDM subtype 2 among women with 1f/2, 2/2, 1s/1f, 1s/2 and 1s/1s isoforms and with prepregnancy body mass index ≥24 kg/m increased by 5.11, 10.01, 10, 14.23, 19.45 times, respectively. Gene variants in VitD pathway interacts with VitD deficiency at the first trimester on the risk of GDM and GDM subtype 2.
Reducing maternal mortality in China in the era of the two-child policy.
Liu Jue,Song Li,Qiu Jie,Jing Wenzhan,Wang Liang,Dai Yue,Qin Geng,Liu Min
BMJ global health
Reducing maternal mortality ratio (MMR) is of great concern worldwide. After the implementation of the two-child policy in 2013, the number of live births and the proportion of high-risk pregnancies both increased, and these bring new challenges to the reduction of MMR. China implemented a package of nationwide strategies in April 2016, the Five Strategies for Maternal and Newborn Safety (FSMNS). The FSMNS consists of five components: (1) pregnancy risk screening and assessment strategy, (2) case-by-case management strategy for high-risk pregnancies, (3) referral and treatment strategy for critically ill pregnant women and newborns, (4) reporting strategy for maternal deaths (and 5) accountability strategy. To better implement the FSMNS, China formulated a unified pregnancy risk screening form. After risk assessment and classification, medical records of all the pregnant women are labelled with green (low risk), yellow (moderate risk), orange (high risk), red (highest risk) or purple (infectious disease) for tailored management. By the implementation of FSMNS, China has already kept the MMR stable and cause it to enter a controlled decline. MMR in China has declined by 21.1%, from 23.2 per 100 000 live births in 2013 to 18.3 per 100 000 live births in 2018. The country's challenges and experience in reducing the MMR could provide useful lessons for other countries.
Hospital bed supply and inequality as determinants of maternal mortality in China between 2004 and 2016.
Tian Fan,Pan Jay
International journal for equity in health
BACKGROUND:Driven by the government's firm commitment to promoting maternal health, maternal mortality ratio (MMR) in China has achieved a remarkable reduction over the past 25 years. Paralleled with the decline of MMR has been the expansion of hospital bed supply as well as substantial reduction in hospital bed distribution inequalities, which were thought to be significant contributors to the reduction in MMR. However, evidences on the impact of hospital bed supply as well as how its distribution inequality has affected MMR remains scarce in China. Addressing this uncertainty is essential to understand whether efforts made on the expansion of healthcare resource supply as well as on improving its distribution inequality from a geographical perspective has the potential to produce measurable population health improvements. METHODS:Panel data of 31 provinces in China between 2004 and 2016 were extracted from the national statistical data, including China Statistical Yearbooks, China Health Statistical Yearbooks and other national publications. We firstly described the changes in hospital bed density as well as its distribution inequality from a geographical perspective. Then, a linear mixed model was employed to evaluate the impact of hospital bed supply as well as its distribution inequality on MMR at the provincial level. RESULTS:The MMR decreased substantially from 48.3 to 19.9 deaths per 100,000 live births between 2004 and 2016. The average hospital bed density increased from 2.28 per 1000 population in 2004 to 4.54 per 1000 population in 2016, with the average Gini coefficient reducing from 0.32 to 0.25. As indicated by the adjusted mixed-effects regressions, hospital bed density had a negative association with MMR (β = - 0.112, 95% CI: - 0.210--0.013) while every 0.1-unit reduction of Gini coefficient suggested 14.50% decline in MMR on average (β = 1.354, 95% CI: 0.123-2.584). Based on the mediation analysis, the association between hospital bed density or Gini coefficient with MMR was found to be significantly mediated by facility birth rate, especially during the period from 2004 to 2009. CONCLUSIONS:This study provided empirical evidences on China's impressive success in the aspect of reducing MMR which could be attributed to the expansion of hospital beds as well as the improvement in its distribution inequality from a geographical perspective. Such findings were expected to provide evidence-based implications for long-term policy-making procedures in order to achieve rational healthcare resource allocations as well as promoting the equity and accessibility to obtaining health care from a holistic perspective. Constant efforts should be made on improving the equity in healthcare resource allocations in order to achieve the penetration of universal healthcare coverage.
Spatiotemporal trends and ecological determinants in maternal mortality ratios in 2,205 Chinese counties, 2010-2013: A Bayesian modelling analysis.
Li Junming,Liang Juan,Wang Jinfeng,Ren Zhoupeng,Yang Dian,Wang Yanping,Mu Yi,Li Xiaohong,Li Mingrong,Guo Yuming,Zhu Jun
BACKGROUND:As one of its Millennium Development Goals (MDGs), China has achieved a dramatic reduction in the maternal mortality ratio (MMR), although a distinct spatial heterogeneity still persists. Evidence of the quantitative effects of determinants on MMR in China is limited. A better understanding of the spatiotemporal heterogeneity and quantifying determinants of the MMR would support evidence-based policymaking to sustainably reduce the MMR in China and other developing areas worldwide. METHODS AND FINDINGS:We used data on MMR collected by the National Maternal and Child Health Surveillance System (NMCHSS) at the county level in China from 2010 to 2013. We employed a Bayesian space-time model to investigate the spatiotemporal trends in the MMR from 2010 to 2013. We used Bayesian multivariable regression and GeoDetector models to address 3 main ecological determinants of the MMR, including per capita income (PCI), the proportion of pregnant women who delivered in hospitals (PPWDH), and the proportion of pregnant women who had at least 5 check-ups (PPWFC). Among the 2,205 counties, there were 925 (42.0%) hotspot counties, located mostly in China's western and southwestern regions, with a higher MMR, and 764 (34.6%) coldspot counties with a lower MMR than the national level. China's westernmost regions, including Tibet and western Xinjiang, experienced a weak downward trend over the study period. Nationwide, medical intervention was the major determinant of the change in MMR. The MMR decreased by 1.787 (95% confidence interval [CI]: 1.424-2.142, p < 0.001) per 100,000 live births when PPWDH increased by 1% and decreased by 0.623 (95% CI 0.436-0.798, p < 0.001) per 100,000 live births when PPWFC increased by 1%. The major determinants for the MMR in China's western and southwestern regions were PCI and PPWFC, while that in China's eastern and southern coastlands was PCI. The MMR in western and southwestern regions decreased nonsignificantly by 1.111 (95% CI -1.485-3.655, p = 0.20) per 100,000 live births when PCI in these regions increased by 1,000 Chinese Yuan and decreased by 1.686 (95% CI 1.275-2.090, p < 0.001) when PPWFC increased by 1%. Additionally, the western and southwestern regions showed the strongest interactive effects between different factors, in which the corresponding explanatory power of any 2 interacting factors reached up to greater than 80.0% (p < 0.001) for the MMR. Limitations of this study include a relatively short study period and lack of full coverage of eastern coastlands with especially low MMR. CONCLUSIONS:Although China has accomplished a 75% reduction in the MMR, spatial heterogeneity still exists. In this study, we have identified 925 (hotspot) high-risk counties, mostly located in western and southwestern regions, and among which 332 counties are experiencing a slower pace of decrease than the national downward trend. Nationally, medical intervention is the major determinant. The major determinants for the MMR in western and southwestern regions, which are developing areas, are PCI and PPWFC, while that in China's developed areas is PCI. The interactive influence of any two of the three factors, PCI, PPWDH, and PPWFC, in western and southwestern regions was up to and in excess of 80% (p < 0.001).
Associations between Maternal and Infant Illness and the Risk of Postpartum Depression in Rural China: A Cross-Sectional Observational Study.
Min Wenbin,Nie Wei,Song Shuyi,Wang Nan,Nie Weiqi,Peng Lanxi,Liu Zhuo,Nie Jingchun,Yang Jie,Ma Yonghong,Shi Yaojiang
International journal of environmental research and public health
This study explored how maternal and infant illness correlated with the risk of postpartum depression in the Chinese Qinba Mountains region. In total, 131 villages comprising 435 families with infants (≤6 months old) were randomly sampled. We collected data on maternal and infant illnesses and maternal health knowledge level. The Depression, Anxiety, and Stress Scale-21 was used to measure the risk of postpartum depression. We used descriptive statistics and multivariate logistic regression for the analysis. Infant overall health status was a risk factor for postpartum depression (odds ratio (OR) = 1.90, 95% Confidence Interval (95% CI) = 1.10~3.28), whereas maternal overall health status was not correlated with postpartum depression (OR = 1.36, 95% CI = 0.55~3.39). For specific illnesses, infants experiencing over two common illnesses in the past two weeks (OR = 1.98, 95% CI = 1.13~3.45) and mothers experiencing over two common pains within two weeks after delivery (OR = 1.77, 95% CI = 1.02~3.08) were risk factors for postpartum depression, whereas infants with mild and severe stunted growth, maternal C-section, and postpartum body mass index (normal or overweight) were not correlated with it (all > 0.050). Maternal health knowledge was an important moderator of maternal and infant illnesses on the risk of postpartum depression. In conclusion, maternal and infant illness were essential factors for the risk of postpartum depression in a poor rural region in western China, which may be mainly affected by the feeling of uncertainty of illness. Improved maternal and infant health and enhanced maternal health knowledge might alleviate the risk of postpartum depression.
Effect of China's maternal health policy on improving rural hospital delivery: Evidence from two cross-sectional surveys.
Fan Xiaojing,Xu Yongjian,Stewart Martyn,Zhou Zhongliang,Dang Shaonong,Wang Duolao,Gao Jianmin
This population-based cross-sectional study aims to explore the effect of China's Rural Hospital Delivery Subsidy (RHDS) policy on the utilization of women's hospital delivery between rural and urban areas. A total of 2398 women were drawn from the Fourth and Fifth National Health Service Surveys, from the Shaanxi province. A generalized linear mixed model was used to analyze the influence of the RHDS policy on the hospital delivery rate. Concentration index and decomposition methods were used to explore the equity of hospital delivery utilization. Prior to introduction of the RHDS policy, the difference in hospital delivery rates was -0.09 (95% CL: -0.16, -0.01) between rural and urban women when adjusting the influence of socioeconomic factors on hospital delivery; after implementation of the policy, the difference was reduced to 0.02 (95% CL: -0.01, 0.06). The horizontal inequity index was reduced from 0.084 to 0.009 for rural women and from 0.070 to 0.011 for urban women. China's Rural Hospital Delivery Subsidy policy had some positive effect on reducing the gap between rural and urban women's hospital delivery rate and inequity. However, there is still a pro-rich inequity of hospital delivery utilization for both rural and urban women.
Sociodemographic determinants of maternal health service use in rural China: a cross-sectional study.
Jiang Kexin,Liang Libo,Wang Haifeng,Li Jingqun,Li Yuze,Jiao Mingli,Mao Jingfu,Wu Qunhong
Health and quality of life outcomes
OBJECTIVE:This study examined the relationship between sociodemographic characteristics and maternal health use from a policy perspective. It aimed to provide an overview of maternal health in Heilongjiang's rural provinces and its implications on rural areas in countries with low and middle income gross domestic products. DESIGN, SETTING, AND PARTICIPANTS:This cross-sectional study used data from the Fifth Health Service Survey of Heilongjiang Province. Participants included 481 mothers who delivered a baby after August 15, 2008. Trained investigators collected data on their family and sociodemographic characteristics, antenatal care, delivery at specialised obstetric institutions (e.g. hospitals, clinics, other medical institutions), and postnatal care services. RESULTS:The number of women with more than five antenatal care visits and the delivery rate at specialised obstetric institutions were high. Approximately 50% of the participants had three or more postnatal care visits. Maternal healthcare use among women less than 20 years old and those with natural deliveries were higher. There were fewer antenatal care visits among women who had been pregnant once or twice before. CONCLUSIONS:Delivery rates at specialised obstetric institutions and the number of antenatal care visits were higher than the World Health Organization requirements, while the frequency of postnatal care visits were better than most countries. This study identified several demographic characteristics that influenced maternal health service use. Policymakers should consider these findings when developing maternal health policies that protect women's interests and expand free services. Additional resources should be given to increase the postnatal care capacity and quality of maternal healthcare.
Progress and challenges in maternal health in western China: a Countdown to 2015 national case study.
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.
Risk management of pregnant women and the associated low maternal mortality from 2008-2017 in China: a national longitude study.
Liu Jue,Jing Wenzhan,Liu Min
BMC health services research
BACKGROUND:Reducing maternal mortality is one of the key targets of the Sustainable Development Goals (SDGs). In response to the impact of increased birth rate on maternal and child safety following the implementation of the two-child policy in 2013, the Chinese government implemented the risk management strategy (namely Five Strategies for Maternal and Newborn Safety, FSMNS) to reduce maternal mortality ratio (MMR). We aimed to analyze the changes in the proportion of pregnant women at high risk screened before and after the implementation of the risk management strategy and the association with maternal mortality during the two-child policy era in China. METHODS:We conducted a nationwide longitudinal study using data obtained from the National Statistical Yearbook and the National Health Statistics Yearbook for all 31 provinces from 2008-2017 to assess and analyze the changes in the proportion of pregnant women at high risk screened before (2008-2013) and after (2014-2017) the implementation of the risk management strategy during the two-child policy era. We used generalized estimating equation (GEE) models to analyze the relationship between the proportion of pregnant women at high risk and MMR after controlling for sociodemographic factors, health resources, and other maternal healthcare factors. RESULTS:In the past decade, the number of livebirths in China increased by 32.3%, from 13.3 million in 2008 to 17.6 million in 2017. The median proportion of pregnant women at high risk in 31 provinces increased by 64.8%, from 14.87% in 2008 to 24.50% in 2017. The annual rate of increase in the median proportion of pregnant women at high risk after the implementation of risk management (1.33%) was higher than that before the implementation (0.74%). The median MMR in China decreased by 39.6%, from 21.7 per 100,000 livebirths in 2008 to 13.1 per 100,000 livebirths in 2017. The univariate GEE models showed that MMR decreased by 7.9% per year from 2008-2017 (cRR 0.92, 95% CI 0.91-0.93), and the proportion of pregnant women at high risk was negatively correlated with MMR (cRR 0.97, 95%CI 0.94-0.99; p = 0.001). In the multivariate GEE models, after adjusting for confounders, the proportion of pregnant women at high risk remained negatively correlated with MMR. In the subgroup analysis, the association of MMR with GDP per capita and government health expenditure per capita existed only prior to the implementation of risk management; while high MMR was associated with a low proportion of pregnant women at high risk after the implementation of risk management. CONCLUSION:The national risk management strategy contributed to the stable decline of MMR in China during the two-child policy era. Further attention should be focused on pregnant women in China's central and western regions to ensure reaching SDGs targets and the 'Healthy China Plan' by 2030.
Changes in adverse pregnancy outcomes in women with advanced maternal age (AMA) after the enactment of China's universal two-child policy.
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.
Changes in maternal age and prevalence of congenital anomalies during the enactment of China's universal two-child policy (2013-2017) in Zhejiang Province, China: An observational study.
Zhang Xiaohui,Chen Lijin,Wang Xuemiao,Wang Xiaoyan,Jia Menghan,Ni Saili,He Wei,Zhu Shankuan
BACKGROUND:China implemented a partial two-child policy (2013) followed by a universal two-child policy (2015), replacing the former one-child policy mandated by the government. The changes affect many aspects of China's population as well as maternal and infant health, but their potential impact on birth defects (BDs) remains unknown. In this study, we investigated the associations of these policy changes with BDs in Zhejiang Province, China. METHODS AND FINDINGS:We used data from the BD surveillance system in Zhejiang Province, China, which covers 90 hospitals in 30 urban districts and rural counties, capturing one-third of the total births in this province. To fully consider the time interval between conception and delivery, we defined the one-child policy period as data from 2013 (births from October 2012 to September 2013), the partial two-child policy period as data from 2015 (births from October 2014 to September 2015), and the universal two-child policy period as data from 2017 (births from October 2016 to September 2017). Data from 2009 and 2011 were also used to show the changes in the proportion of births to women with advanced maternal age (35 years and older) prior to the policy changes. Main outcome measures were changes in the proportion of mothers with advanced maternal age, prevalence of BDs, rankings of BD subtypes by prevalence, prenatal diagnosis rate, and live birth rate of BDs over time. A total of 1,260,684 births (including live births, early fetal losses, stillbirths, and early neonatal deaths) were included in the analyses. Of these, 644,973 (51.16%) births were to women from urban areas, and 615,711 (48.84%) births were to women from rural areas. In total, 135,543 (10.75%) births were to women with advanced maternal age. The proportion increased by 85.68%, from 8.52% in 2013 to 15.82% in 2017. However, it had remained stable prior to policy changes. Overall, 23,095 BDs were identified over the policy changes (2013-2017). The prevalence of BDs during 2013, 2015, and 2017 was 245.95, 264.86, and 304.36 per 10,000 births, respectively. Trisomy 21 and other chromosomal defects increased in both risk and ranking from 2013 to 2017 (crude odds ratio [95% confidence interval] 2.13 [1.75-2.60], from ranking 10th to 5th, and 3.63 [2.84-4.69], from ranking 16th to 6th, respectively). The prenatal diagnosis rate increased by 3.63 (2.2-5.1) percentage points (P < 0.001), from 31.10% to 34.72%, and identification of BDs occurred 1.88 (1.81-1.95) weeks earlier (P < 0.001). The live birth rate for infants with BDs born before 28 gestational weeks increased from 1.29% to 11.45%. The major limitations of this observational study include an inability to establish causality and the possible existence of unknown confounding factors, some of which could contribute to BDs. CONCLUSIONS:In this study, we observed significant increases in maternal age and the prevalence of total and age-related anomalies following China's new two-child policy. Increases in live birth rate for infants with BDs born before 28 gestational weeks suggest that healthcare for very preterm births with BDs may be warranted in the future, as well as updating the definition of perinatal period.
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.
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.
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.
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
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.
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
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.
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.
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.
Association of COVID-19 Lockdown during the Perinatal Period with Postpartum Depression: Evidence from Rural Areas of Western China.
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.
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.
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.
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.
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.
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.
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.
Associations of COVID-19 related experiences with maternal anxiety and depression: implications for mental health management of pregnant women in the post-pandemic era.
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.
Association between prenatal exposure to ambient air pollutants and postpartum depressive symptoms: A multi-city cohort study.
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.
Mental health among pregnant women under public health interventions during COVID-19 outbreak in Wuhan, China.
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.
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.
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
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.
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.
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.
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.
Maternal Protein Intake during Pregnancy Is Not Associated with Offspring Birth Weight in a Multiethnic Asian Population.
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.
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
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
Exposure characteristics of phthalate metabolites among the Zunyi cohort of pregnant women in Southwest China.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
Gestational diabetes: opportunities for improving maternal and child health.
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.
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.
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.
Targeted drug delivery for maternal and perinatal health: Challenges and opportunities.
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.
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.
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.
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.
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,
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.