Our objective was to examine whether high blood pressure in the preconception period was associated with gestational hypertension and preeclampsia in Chinese women. Data were obtained from the ...China-US Collaborative Project for Neural Tube Defects Prevention, a large population-based cohort study. We included 45,628 women who were registered before pregnancy in seven counties in South China. Blood pressure was measured during registration by trained health care workers, and other health-related information was recorded prospectively. We used logistic regression to evaluate the associations between preconception blood pressure and the risk of gestational hypertension and preeclampsia, adjusting for potential confounders. The prevalence of hypertension in the preconception study population was 4.57% (2083/45,628). The incidences of gestational hypertension and preeclampsia were 11.95% and 4.08%, respectively, in the hypertension group and 8.60% and 2.28%, respectively, in the nonhypertension group. Compared with the nonhypertension group, the hypertension group showed a significantly increased risk for gestational hypertension adjusted risk ratio (RR) = 1.40, 95% confidence interval (CI): 1.22-1.60 and preeclampsia adjusted RR = 1.75, 95% CI: 1.39-2.19. When participants with normal blood pressure were used as the reference, the adjusted ORs for gestational hypertension were 1.48 (95% CI: 1.37-1.59), 1.70 (95% CI: 1.44-2.01), and 1.29 (95% CI: 1.02-1.64), and for preeclampsia, the adjusted ORs were 1.55 (95% CI: 1.35-1.78), 1.95 (95% CI: 1.46-2.60), and 1.99 (95% CI: 1.39-2.85) for the participants with prehypertension, stage 1 hypertension, and stage 2 hypertension, respectively. Our results support an association between hypertension or higher blood pressure prior to pregnancy and an increased risk of gestational hypertension and preeclampsia.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Cesarean has been suggested to decrease neonatal iron stores at birth. However, few studies have differentiated the effect induced by cesarean operation from that related to medical indications.
We ...aimed to estimate the association of cesarean delivery on maternal request (CDMR), a subtype of cesarean without any medical indications, with a spectrum of indicators reflecting iron stores at birth.
This prospective cohort study involved 288 term singleton neonates born to women without any complications by CDMR or spontaneous vaginal delivery (SVD). Measured hematological iron-related indicators in cord blood included serum ferritin (SF), hemoglobin (Hb), red blood cell (RBC), and hematocrit (Hct). Blood flow volume (BFV) of cord vein when clamping was measured to reflect placental transfusion status during birth. Quantile regression was used to assess the association between delivery mode and the iron store indicators.
CDMR (n = 154) versus SVD group (n = 134) had lower conditional median cord blood SF (-34.80; 95% CI -64.70, -4.90 μg/L; P = 0.02), Hb (-10.67; 95% CI -18.87, -2.47 g/L; P = 0.01), RBC (-0.30; 95% CI -0.48, -0.12 ×10
/L; P = 0.002), and Hct (-3.06; 95% CI -6.08, -0.04 %; P = 0.047). The BFV was higher in CDMR than SVD group at the 25th centile (0.51; 95% CI 0.19, 0.82 ml/cm
; P = 0.002), median (0.49; 95% CI 0.04, 0.95 ml/cm
; P = 0.03) and the 75th centile (0.54; 95% CI 0.06, 1.03 ml/cm
; P = 0.03).
The cesarean operation per se likely hampered placental transfusion from mother to neonate and decreased iron stores at birth.
Full text
Available for:
DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Background: Breastfeeding could improve a child’s health early on, but its long-term effects on childhood behavioral and emotional development remain inconclusive. We aimed to estimate the ...associations of feeding practice with childhood behavioral and emotional development. Methods: In this population-based birth cohort study, data on feeding patterns for the first 6 mo of life, the duration of breastfeeding, and children’s emotional and behavioral outcomes were prospectively collected from 2489 mother–child dyads. Feeding patterns for the first 6 mo included exclusive breastfeeding (EBF) and non-exclusive breastfeeding (non-EBF, including mixed feeding or formula feeding), and the duration of breastfeeding (EBF or mixed feeding) was categorized into ≤6 mo, 7–12 mo, 13–18 mo, and >18 mo. Externalizing problems and internalizing problems were assessed with the Child Behavior Checklist (CBCL) and operationalized according to recommended clinical cutoffs, corresponding to T scores ≥64. Multivariable linear regression and logistic regression were used to evaluate the association of feeding practice with CBCL outcomes. Results: The median (interquartile range) age of children at the outcome measurement was 32.0 (17.0) mo. Compared with non-EBF for the first 6 mo, EBF was associated with a lower T score of internalizing problems adjusted mean difference (aMD): −1.31; 95% confidence interval (95% CI): −2.53, −0.10, and it was marginally associated with T scores of externalizing problems (aMD: −0.88; 95% CI: −1.92, 0.15). When dichotomized, EBF versus non-EBF was associated with a lower risk of externalizing problems (aOR: 0.54, 95% CI: 0.34, 0.87), and it was marginally associated with internalizing problems (aOR: 0.75, 95% CI: 0.54, 1.06). Regarding the duration of breastfeeding, breastfeeding for 13–18 mo versus ≤6 mo was associated with lower T scores of internalizing problems (aMD: −2.50; 95% CI: −4.43, −0.56) and externalizing problems (aMD: −2.75; 95% CI: −4.40, −1.10), and breastfeeding for >18 mo versus ≤6 mo was associated with lower T scores of externalizing problems (aMD: −1.88; 95% CI: −3.68, −0.08). When dichotomized, breastfeeding for periods of 7–12 mo, 13–18 mo, and >18 mo was associated with lower risks of externalizing problems aOR (95% CI): 0.96 (0.92, 0.99), 0.94 (0.91, 0.98), 0.96 (0.92, 0.99), respectively. Conclusions: Exclusive breastfeeding for the first 6 mo and a longer duration of breastfeeding, exclusively or partially, are beneficial for childhood behavioral and emotional development.
Folic acid (FA) supplementation is known to prevent neural tube defects (NTDs). We examined whether this preventive effect differs by the sex of the infant.
Data were gathered from a large ...population-based cohort study in China that evaluated the effects of FA supplementation on NTDs. All births at 20 complete gestational weeks, including live births, stillbirths, and pregnancy terminations, and all NTDs, regardless of gestational age, were recorded. In a northern China province, a total of 30,801 singleton live births to women whose use of FA supplements during the first trimester was known at the time were included in the study. The birth prevalence of NTDs was classified by sex, subtype, and maternal FA supplementation. Male to female rate ratios RR and their 95% confidence intervals CI were calculated.
A total of 106 NTDs cases were recorded. The overall prevalence of NTDs was 2.5‰ among males and 4.4‰ among females; NTDs were less prevalent among males than among females (RR, 0.58; 95% CI, 0.54-0.63). There was a higher prevalence of anencephaly (RR, 0.34; 95% CI, 0.27-0.43) and spina bifida (RR, 0.73; 95% CI, 0.63-0.84) among females. However, FA supplementation led to significantly greater decreases in the rates of anencephaly (4.8‰) and total NTDs (7.6‰) in females than in males (1.6‰ and 2.8‰, respectively).
FA supplementation successfully reduces the prevalence of NTDs in both male and female infants, although we found a significantly greater decrease in anencephaly and total NTDs in females than in males. How the protective effects of FA supplementation affect the sexes differently needs to be studied further.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Emerging evidence has suggested that folic acid–containing multivitamins may markedly reduce the risk of gestational hypertension or preeclampsia. We examined whether maternal supplementation with ...folic acid alone during early pregnancy can prevent the occurrence of gestational hypertension and preeclampsia. The data are from a large population-based cohort study established to evaluate the effectiveness of the campaign to prevent neural tube defects with folic acid supplementation in China. We selected participants who were registered in 2 southern provinces, had exact information on folic acid use, and were not affected by chronic hypertension or diabetes mellitus before 20 weeks gestation. A logistic regression model was used to adjust for the effects of the main potential confounders, including age, body mass index, education, occupation, parity, and multiple births. The study size had 99.9% power (α=0.05) to detect a decrease of 10% over the unexposed rate of 9.4% for gestational hypertension. Among the 193 554 women (47.9% took folic acid, 52.1% did not), the overall incidence of gestational hypertension and preeclampsia was 9.5% and 2.5%, respectively. The incidence of gestational hypertension and preeclampsia was 9.7% and 2.5% for women who took folic acid, and 9.4% and 2.4% for women who did not use it. The adjusted risk ratio associated with folic acid use was 1.08 (95% confidence interval, 1.04–1.11) for gestational hypertension and 1.11 (95% confidence interval, 1.04–1.18) for preeclampsia. Our findings suggest that daily consumption of 400 μg folic acid alone during early pregnancy cannot prevent the occurrence of gestational hypertension and preeclampsia.
Infant birth sizes are vital clinical parameters to predict poor growth and micronutrient deficiency in early life. However, their effects on childhood anemia remain unclear. We aimed to explore the ...associations between birth weight, crown–heel length, and head circumference with anemia in early childhood, as well as potential modification factors. This population-based prospective cohort study included 204,556 participants with singleton live births delivered at gestational ages of 28–42 weeks. A logistic regression model was used to estimate the associations of the measures of infant birth size and their Z-score with anemia under five years old. There were 26,802 (13.10%) children under five years old who were diagnosed has having anemia. Compared with children who did not have anemia, children who had anemia had a lower birth weight and smaller head circumference and a longer crown–heel length (all p-values < 0.05). After adjusting for confounders, not only birth weight (β coefficient, −0.008; 95% CI, −0.011–−0.004; p < 0.001) and head circumference (β coefficient, −0.004; 95% CI, −0.007–−0.001; p = 0.009), but also the related Z-scores were negatively associated with childhood anemia, while the trends for crown–heel length were the opposite. We further found significant interactions of folic acid use and maternal occupation with infant birth sizes. In conclusion, infants having abnormal sizes at birth are significantly associated with the risk for childhood anemia, which can be modified by folic acid use during pregnancy and maternal occupation.
To determine whether gestational weight gain (GWG) was associated with increased odds of childhood overweight after accounting for pre-pregnancy BMI.
In a prospective cohort study based on a ...premarital and perinatal health care system in China, data of 100 612 mother-child pairs were obtained. The main exposure was GWG as both a continuous and categorical variable. The outcome measure was overweight, defined by age- and sex-specific cutoff values for body mass index (BMI) in children aged 3-6 years.
A 1-kg increase in maternal GWG was associated with an increase of 0.009 (95% confidence interval CI: 0.007-0.010, P < 0.001) in children's mean BMI; in the subgroup of pre-pregnancy overweight/obese mothers, the increase in children's BMI was 0.028 (95% CI, 0.017-0.039, P < 0.001). Excessive GWG played an important role in childhood overweight when adequate GWG was used as the reference, with an odds ratio (OR) of 1.21 (95% CI, 1.12-1.29). The risk was highest (OR 2.22; 95% CI, 1.79-2.76) in the children of mothers who were overweight/obese before pregnancy and gained excessive weight during pregnancy.
Greater maternal GWG was associated with greater offspring BMI, and the risk of overweight was doubled in children whose mothers were overweight/obese before pregnancy and gained excessive weight during pregnancy. As a result, maintenance of appropriate weight gain during pregnancy and prophylaxis of maternal overweight/obesity before pregnancy should be a strategy for preventing childhood overweight/obesity.
Full text
Available for:
FFLJ, NUK, ODKLJ, UL, UM, UPUK
Purpose
To examine plasma retinol status and its determinants in Chinese pregnant or lactating women.
Methods
A cross-sectional study involving 1211 healthy women in mid-pregnancy, late pregnancy, or ...lactation was conducted in northern, central, and southern China. Plasma retinol concentration was determined by high-performance liquid chromatography. Multivariate quantile regression or modified Poisson regression was used to estimate adjusted medians, or to examine the associations of suboptimal retinol concentration (< 1.05 µmol/L) with various factors.
Results
The overall median (interquartile range) retinol concentration was 1.25 (1.06–1.46) µmol/L. The adjusted concentration was higher in women at lactation (1.39 1.20–1.63 µmol/L) and mid-pregnancy (1.26 1.10–1.44 µmol/L) than late pregnancy (1.07 0.92–1.28 µmol/L), and higher in women in the central area (1.34 1.18–1.49 µmol/L) and the north (1.26 1.10–1.43 µmol/L) than the south (1.19 1.07–1.31 µmol/L). The retinol concentration was more likely to be low in women with lower pre-pregnancy BMI, younger age, less education, and in lactating women who had a caesarean birth or were breastfeeding exclusively. A total of 290 (24.0%) women had a suboptimal retinol concentration, and the prevalence was higher in women at late pregnancy, residing in the south, with younger age, and having underweight pre-pregnancy.
Conclusion
About one-fourth of pregnant or lactating women in China had suboptimal retinol concentrations that varied with phases of pregnancy and lactation, region of residence, and socio-demographic characteristics, indicating a need for population-specific public health strategies to optimize vitamin A status.
Full text
Available for:
DOBA, EMUNI, FIS, FSPLJ, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
This study explored the potential association between age at menarche and the risks of gestational hypertension and preeclampsia in Chinese women. Data were sourced from the China-US Collaborative ...Project for Neural Tube Defects Prevention, a large population-based cohort study. Our study consisted of 209 411 women pre-registered for pregnancy in two provinces in South China. Trained healthcare workers measured blood pressure at registration and recorded other pertinent health information. Using logistic regression, we assessed the correlations between age at menarche and the likelihood of developing gestational hypertension and preeclampsia, considering confounders such as maternal age, body mass index, ethnicity, parity, folic acid supplementation, education level, and occupation. The observed incidences for gestational hypertension and preeclampsia were 9.65% and 2.54%, respectively. The adjusted odds ratios (ORs) for gestational hypertension, based on age at menarche, were as follows: ≤13 years, 1.18 (95% confidence interval: 1.11-1.26); 14 years, 1.09 (1.04-1.15); 15 years, 1.11 (1.06-1.16); 16 years, 1.06 (1.01-1.12); and ≥17 years, 1.00 (reference; P for trend < .001). The correlation between age at menarche and preeclampsia varied across age groups, with the following respective ORs: 1.35 (1.20-1.52), 1.21 (1.09-1.34), 1.27 (1.15-1.39), 1.14 (1.03-1.26), and 1.00 (reference; P for trend < .001). This association appeared to be more pronounced in women with no folic acid supplementation and those with a lower education level. In conclusion, an earlier age at menarche seems to be linked to increased risks of gestational hypertension and preeclampsia.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
PDF
