Maternal cardiovascular health in early pregnancy and the risk of congenital heart defects in offspring.

BACKGROUND: Congenital heart disease (CHD) is the predominant birth defect. This study aimed to explore the association between maternal cardiovascular health (CVH) and the CHD risk in offspring. METHODS: We used the prospective data from the Fujian Birth Cohort Study, collected from March 2019 to December 2022 on pregnant women within 14 weeks of gestation. Overall maternal CVH was assessed by seven CVH metrics (including physical activity, smoking, sleep duration, body mass index, blood pressure, total cholesterol, and fasting plasma glucose), with each metric classified as ideal, intermediate or poor with specific points. Participants were further allocated into high, moderate and low CVH categories based on the cumulative CVH score. The association with offspring CHD was determined with log-binominal regression models. RESULTS: A total of 19810 participants aged 29.7 (SD: 3.9) years were included, with 7846 (39.6%) classified as having high CVH, 10949 (55.3%) as having moderate CVH, and 1015 (5.1%) as having low CVH. The average offspring CHD rate was 2.52%, with rates of 2.35%, 2.52% and 3.84% across the high, moderate and low CVH categories, respectively (P = 0.02). Adjusted relative risks (RRs) of having offspring CHD were 0.64 (95% CI: 0.45-0.90, P = 0.001) for high CVH and 0.67 (95% CI: 0.48-0.93, P = 0.02) for moderate CVH compared to low CVH. For individual metrics, only ideal total cholesterol was significantly associated with lower offspring CHD (RR: 0.73, 95% CI: 0.59-0.83, P = 0.002). CONCLUSIONS: Pregnant women of high or moderate CVH categories in early pregnancy had reduced risks of CHD in offspring, compared to those of low CVH. It is important to monitor and improve CVH during pre-pregnancy counseling and early prenatal care.

Association of sleep duration and sleep quality with gestational diabetes mellitus in pregnant women after treatment with assisted reproductive technology: A birth cohort study.

Maternal sleep is closely related to subsequent gestational diabetes mellitus (GDM) in natural pregnancies. However, whether this connection exists in pregnant women conceiving with the help of assisted reproductive technology (ART) has not been confirmed. Hence, in this study, we evaluated whether early pregnancy sleep duration or sleep quality is associated with gestational diabetes mellitus in ART-pregnant women, as well as the influence of maternal age on this association. This prospective birth cohort study included 856 pregnant women who successfully conceived with the help of ART treatment. The sleep parameters of ART-pregnant women were assessed using the Pittsburgh Sleep Quality Index (PSQI) in early pregnancy. We explored the association between sleep and the risk of gestational diabetes mellitus using an unconditional binary logistic regression model. Different models were constructed to examine the robustness of the estimation by incorporating different confounding factors. Multivariable logistic regression revealed that sleep duration of more than 10 h among ART-pregnant women was significantly associated with the risk of GDM, and the association between sleep duration and gestational diabetes mellitus varied by maternal age. We found an increased risk of subsequent gestational diabetes mellitus with increasing sleep duration only in pregnant women aged <35 years. Additionally, no statistically significant association between sleep quality and gestational diabetes mellitus was found in this study. In conclusion, excessive sleep duration (≥10 h) is associated with a high risk of gestational diabetes mellitus in pregnant women who conceived with the help of assisted reproductive technology, and maternal age may modify this effect.

Association between lipid profile in early pregnancy and the risk of congenital heart disease in offspring: a prospective cohort study.

This study aimed to investigate the association of lipid profile in early pregnancy and the risk of congenital heart disease (CHD) in offspring. This study was a prospective cohort design based on the Fujian Birth Cohort Study in China. We recruited pregnant women at ≤ 14 weeks of gestation between 2019 and 2022, and all participants in this study filled out the questionnaire about periconceptional exposure. Simultaneously, we collected participants' fasting blood samples to measure their lipid profile by automatic biochemical analyzer. The outcome was defined as offspring with CHD. A multivariable logistic regression model was used to calculate adjusted odds ratio (AOR) risk estimates, which indicate the associations between maternal lipid profiles and CHD in offspring. Restricted cubic splines were used to estimate their nonlinear relationship. A total of 21,425 pregnant women with an average gestational age of 11.3 (± 1.40) weeks were included in the analysis. The higher triglyceride (AOR 1.201, 95% CI [1.036, 1.394]), low-density lipoprotein (AOR 1.216, 95% CI [1.048, 1.410]), apolipoprotein B (Apo B) (AOR 2.107, 95% CI [1.179, 3.763]) levels were correlated with increased odds of CHD in offspring, while high-density lipoprotein (OR 0.672, 95% CI [0.490, 0.920]) related with decreased odds of CHD in offspring. The restricted cubic spline suggested a nonlinear relationship between total cholesterol (TC) levels and the risk of CHD in offspring (P = 0.0048), but no significant nonlinear relationships were found in other lipid profile. Apolipoprotein A was not related to the risk of CHD in offspring as either a continuous variable or a hierarchical variable. Elevated lipid profile in early pregnancy levels are associated with an increased risk of CHD in offspring. Additionally, there is a non-linear relationship between TC levels and the risk of CHD in offspring.

Trajectories of maternal D-dimer are associated with the risk of developing adverse maternal and perinatal outcomes: A prospective birth cohort study.

OBJECTIVE: To assess the relationships of maternal D-dimer trajectories with the risk of developing adverse maternal and perinatal outcomes (AMPOs). METHODS: A prospective birth cohort study was conducted in China, and 7,095 women who had singleton birth were included. The latent class growth model was used to determine the maternal D-dimer trajectory. RESULTS: Three maternal D-dimer trajectories were identified: (1) slight increase (43.6%), (2) rapid rise (51.3%), (3) sustained high (5.1%). Compared to pregnant women with a slight increase in D-dimer trajectory, the risk of gestational diabetes mellitus, placenta previa, macrosomia, large for gestational age (LGA), and increased postpartum bleeding was significantly increased in those with a rapid rise trajectory (adjusted OR = 1.22, 2.00, 1.80, and 1.56, adjusted ß = 15.92 âˆ¼ 25.1 ml, respectively, P < 0.05), and women with a sustained high trajectory also demonstrated a relatively elevated risk of macrosomia and LGA (adjusted OR = 2.11 and 1.82, respectively, P < 0.05). While the odds of pregnancy-induced hypertension, low birth weight, and small for gestational age in pregnant women with the rapid rise D-dimer trajectory and fetal distress in those with sustained high trajectory exhibited a reduction (adjusted OR = 0.62, 0.38, 0.54, and 0.64, respectively, P < 0.05). CONCLUSION: This study highlights the influence of inappropriate maternal D-dimer trajectories on the risk of AMPOs.

First-Trimester Triglyceride-Glucose Index and Risk of Pregnancy-Related Complications: A Prospective Birth Cohort Study in Southeast China.

Purpose: To evaluate the relationships of the triglyceride-glucose (TyG) index with pregnancy-related complications (PRCs) and to clarify the predictability of the TyG index for PRCs. Patients and Methods: Totally of 11,387 women with a singleton pregnancy were prospectively followed until after delivery. Maternal fasting lipids and glucose concentration were measured in the first trimester (11 weeks gestation on average). The TyG index was calculated as ln [triglyceride (mg/dL) × fasting plasma glucose (mg/dL)/2]. We used generalized linear models to calculate the relative risks and 95% confidence intervals. Receiver-operating characteristic curve analysis was employed to assess the ability of the TyG index to predict the risks of PRCs. Results: Smooth spline reveals that the probability of gestational diabetes mellitus (GDM) is intensified with the increasing TyG index. Multivariate logistic regression adjusted for risk factors demonstrates a 1-unit and a 1-SD increment in the TyG index raises the risk of GDM by 3.63 and 1.57 times, respectively. Identically, the risk of GDM maximizes in the TyG quintile 5 (OR: 3.14; 95% CI: 2.55~3.85) relative to the lowest TyG index group. However, no association between TyG index and the risk of other PRCs was observed after full adjustment. The area under receiver operating characteristic curves is 0.647 (95% CI: 0.632-0.66) for GDM, and the optimal predictive cut-off is 8.55, with a specificity of 0.679 and sensitivity of 0.535. Conclusion: The first-trimester TyG index is significantly associated with the risk of incident GDM, while the relationships between the TyG index and other PRCs need further exploration.

The lag-effects of meteorological factors and air pollutants on child respiratory diseases in Fuzhou, China.

Background: The effects of meteorological factors and air pollutants on respiratory diseases (RDs) were various in different populations according to the demographic characteristics, and children were considered a vulnerable population. Previous studies were mainly based in cities with serious air pollution. This study aimed to qualify the lag effects of meteorological factors and air pollution on respiratory diseases among children under 18 years old in Fuzhou. Methods: Meteorological data, air pollutants concentrations and hospital admission data of Fujian Maternity and Child Health Hospital between 2015 and 2019 were collected. A Distributed Lag Nonlinear Model (DLNM) was used to evaluate the nonlinear and lagged effect of meteorological factors and air pollutants on daily RDs number. A subgroup analysis was also conducted to evaluate the effect on different sex groups and age groups. Results: A total number of 796 125 RDs visits was included during the study period. For meteorological factors, lower mean temperature and relative humidity were significantly associated with daily RDs number (peak relative risk (RR) = 1.032 (95% confidence interval (CI) = 1.011-1.053) and 1.021 (95% CI = 1.013-1.029)), while lower wind speed showed a significant association at low range (peak RR = 0.995 (95% CI = 0.992-0.999)). Temperature warming was a significant protective factor for RDs (peak RR = 0.989 (95% CI = 0.986-0.993)). For air pollutants, SO2, NO2, PM10 and PM2.5 were all significantly associated with RDs (peak RR = 1.028 (95% CI = 1.022-1.035), 1.024 (95% CI = 1.013-1.034), 1.036 (95% CI = 1.025-1.047), 1.028 (95% CI = 1.019-1.037)), and the relationship had no threshold. The estimated RR and peak lag day did not change extremely between subgroups. Conclusions: The findings provide statistical evidence for the prevention of child RDs. In addition, our findings suggested that even at low concentrations, air pollutants still have negative effects on the respiratory system.

Drought stress drives sex-specific differences in plant resistance against herbivores between male and female poplars through changes in transcriptional and metabolic profiles.

Drought stress poses adverse influence on plant growth and further alters plant-herbivore interactions. Such effect is enhanced as drought occurrence is reported to increase due to global warming. Although dioecious plant species have shown sex-specific response to drought stress through the changes in growth performance and stress tolerance, whether such changes will drive sex-specific differences in defense against herbivores between male and female plant conspecifics is barely studied. In the current study, female and male poplar full-siblings were submitted to moderate (75 % field water capacity) and severe drought (50 % field water capacity) stresses, followed by herbivore growth and feeding bioassays to test the effect of plant gender on herbivore growth and feeding performance of two specialist and two generalist leaf herbivores. The results showed that although the growth of both plant sexes was inhibited by the two drought levels, male plants performed better than female conspecifics. In the paired-choice bioassays, the specialist herbivores preferred female plants while the generalist herbivores fed more on the male plants without drought stress. Both the moderate and severe drought stresses reversed such preferences. In the triple-choice bioassays, the specialist herbivores preferred female control plants while the generalist herbivores fed more on female plants under severe drought. In addition, the specialist herbivores fed on female plants from severe drought stress grew the worst while the generalist herbivores gained the highest fresh weight. The transcriptomic and metabolomic profiling revealed that female plant leaves contained higher levels of flavonoids than males under control condition while severe drought stress remarkably reduced the levels of defensive metabolites such as flavonoids, isoflavonoids, neoflavonoids and alkaloids in female but not in male plant leaves.

Maternal pre-pregnancy body mass index, gestational weight gain trajectory, and risk of adverse perinatal outcomes.

OBJECTIVE: To evaluate the relationships of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) trajectory with adverse perinatal outcomes (APOs). METHODS: A retrospective cohort study was conducted in China, and 12 855 women who had a singleton birth were included. The WHO classification categorized pre-pregnancy BMI, and five GWG trajectories were identified using the latent class growth model. RESULTS: The adjusted odds ratios for the risks of cesarean delivery, preterm birth, and large-for-gestational-age (LGA) infant were significantly higher in women with whoe were overweight or obese pre-pregnancy, but were lower in underweight (except preterm birth) than in normal weight women. Five GWG trajectories were identified: (1) retaining GWG (6.6 kg), (2) moderately slow GWG (10.5 kg), (3) moderate GWG (13.7 kg), (4) moderately fast GWG (16.3 kg), and (5) rapid GWG (19.8 kg). Compared with women in trajectory 3, the risks of cesarean delivery and LGA increase by about 35%-96% for the women in trajectory 4 or 5, whereas the women in trajectory 1 or 2 are inclined to have a higher risk of small for gestational age, but lower risk of LGA. Association of GWG trajectory with APOs varies across pre-pregnancy BMI subgroups. CONCLUSION: This study highlights the influence of inappropriate pre-pregnancy maternal weight and GWG trajectories on the risk of APOs.

The effects of different parity and delivery mode on wheezing disorders in the children-a retrospective cohort study in Fujian, China.

BACKGROUND: The relationship between childbirth delivery methods and the risk of wheezing in children remains controversial. Few studies have explored it under different maternal conditions. OBJECTIVE: To explore the influence of childbirth delivery method on the onset of wheezing in children of different parity. METHODS: A total of 21716 patients were included in this retrospective observational study. Multivariable logistic regression was used to analyze the relationship between childbirth delivery method and wheezing in children under 18 years of age in Fujian Province. RESULTS: Wheezing differed statistically based on the child's sex, age, season of onset, parity, jaundice history, and feeding patterns (P < 0.05). After adjusting for confounding factors, in cases of parity greater than two, the risk of wheezing in cesarean section deliveries was higher than that in vaginal deliveries (OR: 1.107; 95% CI 1.010-1.214). In girls with parity greater than two (OR: 1.179; 95% CI 1.003-1.387) and normal-weight infants with parity greater than two (OR: 1.106; 95% CI 1.003-1.220), the risk of wheezing in cesarean section deliveries was higher. The interaction term between the mode of childbirth and parity was significant in girls (P = 0.014). CONCLUSION: The method of childbirth delivery and parity are related to the risk of wheezing and may be relevant to gender and birth weight. Parity and gender have synergistic effects on wheezing.

Effects of exogenous spermidine on poplar resistance to leaf and root herbivory as affected by soil cadmium stress.

Elemental defense hypothesis (EDH) proposed that metal accumulation in plants could increase plant resistance to herbivores. However, the over-accumulation of metals in low-accumulators such as woody plants will cause adverse effects on plant health. Thus, the application of EDH on low-accumulators in metal contaminated areas is strongly limited. Since the supplement of exogenous spermidine (Spd) was reported to alleviate metal-induced toxicity in plants while stimulating metal accumulation in plant tissues, we hypothesized that such application will further improve plant resistance to herbivores. In this study, we employed a woody plant species, Populus yunnanensis, to test this hypothesis. We first tested a Spd concentration series applied on plants subjected to soil cadmium (Cd) stress and found that the 1 mM Spd strongly promoted plant growth while stimulated Cd accumulation in plant leaves and roots. We further conducted herbivore bioassays to test the growth performance and feeding preference of two leaf herbivore species and a root herbivore species that fed on plants from different treatments. The results showed that the inhibition effect of Cd stressed-plants on herbivore growth was significantly magnified by the addition of Spd. The growth weight of all the three tested herbivores were negatively correlated with increased Cd concentrations in plant tissues. In addition, the feeding preferences of the two leaf herbivore species were strongly repelled by leaf discs from Cd-treated plants with Spd supplement. The results suggested that the application of exogenous Spd at a certain dose could enhance elemental defense of plants against herbivory.