Giving Birth in the Early Phases of the COVID-19 Pandemic: The Patient Experience.

OBJECTIVE: Obstetrical patients are at risk of complications from COVID-19 and face increased stress due to the pandemic and changes in hospital birth setting. The objective was to describe the perinatal care experiences of obstetrical patients who gave birth during the early phases of the COVID-19 pandemic. METHODS: A descriptive epidemiological survey was administered to consenting patients who gave birth at The Ottawa Hospital (TOH) between March 16th and June 16th, 2020. The participants reported on prenatal, in-hospital, and postpartum care experiences. COVID-19 pandemic related household stress factors were investigated. Frequencies and percentages are presented for categorical variables and median and interquartile range (IQR) for continuous variables. RESULTS: A total of 216 participants were included in the analyses. Median participants age was 33 years (IQR: 30-36). Collectively, 94 (43.5%) participants felt elevated stress for prenatal appointments and 105 (48.6%) for postpartum appointments because of COVID-19. There were 108 (50.0%) were scared to go to the hospital for delivery, 97 (44.9%) wore a mask during labour and 54 (25.0%) gave birth without a support person. During postpartum care, 125 (57.9%) had phone appointments (not offered prior to COVID-19), and 18 (8.3%) received no postpartum care at all. CONCLUSION: COVID-19 pandemic and public health protocols created a stressful healthcare environment for the obstetrical population where many were fearful of accessing services, experienced changes to standard care, or no care at all. As the pandemic continues, careful attention should be given to the perinatal population to reduce stress and improve continuity of care.

RéSUMé: OBJECTIF: Les patients obstétriques sont à risque de complications de la COVID-19 et font face à un stress accru en raison de la pandémie et des changements dans le cadre de l'accouchement en milieu hospitalier. L'objectif était de décrire les expériences de soins périnataux des patients obstétriques qui ont accouché au cours des premières phases de la pandémie de COVID-19. MéTHODES: Un sondage épidémiologique descriptif a été menée auprès de patients qui ont accouché à L'Hôpital d'Ottawa (TOH) entre le 16 mars et le 16 juin 2020. Les participants ont fait un compte rendu de leurs expériences en matière de soins prénataux, hospitaliers et post-partum. Les facteurs de stress domestique liés à la COVID-19 ont été étudiés. Les fréquences et les pourcentages sont présentés pour les variables catégorielles et la médiane et l'écart interquartile (IQR) sont présentés pour les variables continues. RéSULTATS: Au total, 261 participants ont répondu au sondage. L'âge maternel médian était de 33 ans (IQR: 30­36). Collectivement, 94 participants (43,5%) ressentaient un stress élevé en lien avec les rendez-vous prénataux et 105 (48,6%) pour les rendez-vous post-partum en raison de la COVID-19. Il y avait 108 patients (50,0%) qui avaient peur d'aller à l'hôpital pour accoucher, 97 (44,9%) qui portaient un masque pendant leur travail et 54 (25,0%) qui ont accouché sans personne de soutien. En lien avec les soins post-partum, 125 (57,9%) ont eu des rendez-vous téléphoniques (non offerts avant la pandémie COVID-19) et 18 (8,3%) n'ont reçu aucun soin post-partum. CONCLUSION: La pandémie de COVID-19 et les politiques de santé publique ont créé un environnement de soins de santé stressant pour la population obstétrique où beaucoup avaient peur d'accéder aux services de soins, ont connu des changements dans les soins de base ou n'ont pas eu de soins du tout. Alors que la pandémie se poursuit, une attention particulière doit être accordée à la population périnatale afin de réduire le stress et améliorer la continuité des soins.

Discrepancies among knowledge, practice, and attitudes towards advance care planning among Chinese clinical nurses: A national cross-sectional study.

AIMS AND OBJECTIVES: To explore the Chinese nurses' knowledge and attitudes concerning advance care planning (ACP) and their engagement in ACP practice. BACKGROUND: Nurses' knowledge, attitude, and practice of ACP are important in promoting ACP in patients, but little is known about knowledge, attitudes, and practice of ACP among nurses in countries where there are no national policies or regulations on ACP. DESIGN: A descriptive study with a cross-sectional design. METHODS: An online questionnaire survey was distributed to Chinese nurses who attended a national conference. RESULTS: A total of 531 nurses completed the survey and were included in the final analysis. No nurses answered all questions correctly, while 31 (5.8%) answered all the survey questions wrong. The participants were most knowledgeable about the item "Once ACP is made, the content of advance directives cannot be revoked" and were least knowledgeable about the item "ACP is valid only when the patients are well informed of the medical condition". The implementation of ACP was favored by 92.5% of participants, but only 3.4% of them had actually engaged in all 5 ACP practices listed in the survey. Experience of dealing with death was positively associated with nurses' knowledge concerning ACP. The number of dying patients cared for in the past 6 months, school education of palliative care, knowledge of ACP, and age were related to engagement in the practice of ACP. CONCLUSION: Chinese nurses have supportive attitudes towards ACP, but they have limited knowledge and little practice in ACP.

Racial differences in contribution of prepregnancy obesity and excessive gestational weight gain to large-for-gestational-age neonates.

OBJECTIVES: To examine the racial differences in the population attributable fraction (PAF) of prepregnancy obesity and excessive gestational weight gain to large-for-gestational-age (LGA) neonates. METHODS: We conducted a population-based retrospective cohort study among all women who had prenatal screening and had a singleton live birth in a hospital (1 April 2016-31 March 2017) using data from Ontario birth registry in Canada. We used multivariable log-binomial regression models to estimate the PAF and 95% confidence interval (CI) of LGA neonates due to prepregnancy obesity and excessive gestational weight gain. All models were stratified by race (White, Asian, and Black). RESULTS: Of the 74,402 eligible women, the prevalence of prepregnancy obesity, excessive gestational weight gain, and LGA neonate was 21.1%, 60.0%, and 11.3%, respectively, for Whites; 9.3%, 45.9%, and 5.4%, respectively, for Asians; and 28.6%, 52.4%, and 7.9%, respectively, for Blacks. The association of prepregnancy obesity was greater than that of excessive gestational weight gain on LGA for all racial groups. Excessive gestational weight gain contributed more than prepregnancy obesity in Whites (PAF 32.9%, 95% CI [30.3-35.5%] and 16.6%, 95% CI [15.3-17.9%], respectively, for excessive gestational weight gain and prepregnancy obesity) and in Asians (PAF 32.1%, 95% CI [27.2-36.7%] and 11.8%, 95% CI [9.5-14.1%], respectively, for excessive gestational weight gain and prepregnancy obesity). Prepregnancy obesity (PAF 22.8%, 95% CI [17.1-28.1%]) and excessive gestational weight gain (PAF 20.1%, 95% CI [4.7-33.0%]) contributed to LGA neonates almost the same in Blacks. CONCLUSIONS: Excessive gestational weight gain contributed more to LGA neonates than prepregnancy obesity in Whites and Asians, while there was no difference between excessive gestational weight gain and prepregnancy obesity in their contributions to the LGA neonates in Blacks. The differences are mostly driven by the differential prevalence of the two risk factors across racial groups.

Is abdominal vascular calcification score valuable in predicting the occurrence of colorectal anastomotic leakage? A meta-analysis.

OBJECTIVE: Anastomotic leakage (AL) is a catastrophic surgical complication affecting the prognosis of patients after colorectal surgery. We aimed to determine the value of the arterial calcification (AC) score in predicting AL. METHODS: Medline and Embase were searched through November 2019. The odds ratio (OR) and 95% confidence interval (CI) were used to estimate the association between AC and AL after colorectal surgery. The fixed-effects model or random-effects model was adopted for data pooling. Subgroup analyses were conducted to assess the effect of different aortoiliac trajectories. RESULTS: Four studies involving 496 patients were included. The calcium volume and calcium score measurements of different trajectories revealed a significant difference with regard to the left and right common iliac arteries, the superior mesenteric artery, and the left common iliac artery. Calcification of the internal iliac artery significantly increased the risk of AL compared with no AL (OR = 1.005; 95% CI 1.002-1.009; P = 0.005), as did calcification of the left internal iliac artery (OR = 1.009; 95% CI 1.002-1.016; P = 0.011), but not of the common iliac artery (OR = 1.001; 95% CI 1.000-1.001; P = 0.317) or common and internal iliac artery (OR = 1.000; 95% CI 1.000-1.000; P = 1.000). CONCLUSIONS: AC is associated with increased risk of AL following colorectal surgery. TRIAL REGISTRATION: CRD42019141236.

Surgical Outcomes for Transgender Men Undergoing Hysterectomy.

OBJECTIVE: This study sought to assess surgical outcomes of hysterectomy performed for transgender individuals compared with hysterectomy for individuals with menstrual disorders. METHODS: This retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. Data of transgender individuals who underwent hysterectomy and individuals who underwent hysterectomy for menstrual disorders were extracted from the participant use data file (2015-2016). Transgender individuals were compared with individuals with menstrual disorders for surgical outcomes within 30 days of hysterectomy, by using appropriate statistical tests. A two-sided P value of less than 0.05 was considered statistically significant (Canadian Task Force Classification II-2). RESULTS: The study identified 89 cases of hysterectomy for transgender individuals and 4439 cases of hysterectomy for menstrual disorders. Compared with patients who underwent hysterectomy for menstrual disorders, transgender patients were more likely to be younger (mean ± SD 30.79 ± 9.68 years vs. 42.6 ± 7.04 years), have a normal body mass index (25.84% vs. 17.77%), be classified as American Society of Anesthesiologists class I (34.09% vs. 10.46%), and have outpatient surgery (76.40% vs. 53.55%) (P < 0.05). Overall incidence of postoperative complications was low for both groups. No significant difference in surgical outcomes was observed for re-admission, superficial or deep/organ space infections, wound dehiscence, sepsis, blood transfusion, deep vein thrombosis, pulmonary embolism, or death. Transgender patients who underwent hysterectomy on average required decreased operative time (120.4 ± 79.2 minutes vs. 131.2 ± 64.3 minutes) and decreased lengths of stay (0.82 ± 0.82 days vs. 1.35 ± 2.73 days). CONCLUSION: This study suggests that transgender patients undergoing hysterectomy were younger and healthier than patients undergoing hysterectomy for menstrual disorders. Surgical complications were low for both groups, and significant differences in surgical outcomes were not observed.

The Preconception Period analysis of Risks and Exposures Influencing health and Development (PrePARED) consortium.

BACKGROUND: Preconception health may have intergenerational influences. We have formed the PrePARED (Preconception Period Analysis of Risks and Exposures influencing health and Development) research consortium to address methodological, conceptual, and generalisability gaps in the literature. OBJECTIVES: The consortium will investigate the effects of preconception exposures on four sets of outcomes: (1) fertility and miscarriage; (2) pregnancy-related conditions; (3) perinatal and child health; and (4) adult health outcomes. POPULATION: A study is eligible if it has data measured for at least one preconception time point, has a minimum of selected core data, and is open to collaboration and data harmonisation. DESIGN: The included studies are a mix of studies following women or couples intending to conceive, general-health cohorts that cover the reproductive years, and pregnancy/child cohort studies that have been linked with preconception data. The majority of the participating studies are prospective cohorts, but a few are clinical trials or record linkages. METHODS: Data analysis will begin with harmonisation of data collected across cohorts. Initial areas of interest include nutrition and obesity; tobacco, marijuana, and other substance use; and cardiovascular risk factors. PRELIMINARY RESULTS: Twenty-three cohorts with data on almost 200 000 women have combined to form this consortium, begun in 2018. Twelve studies are of women or couples actively planning pregnancy, and six are general-population cohorts that cover the reproductive years; the remainder have some other design. The primary focus for four was cardiovascular health, eight was fertility, one was environmental exposures, three was child health, and the remainder general women's health. Among other cohorts assessed for inclusion, the most common reason for ineligibility was lack of prospectively collected preconception data. CONCLUSIONS: The consortium will serve as a resource for research in many subject areas related to preconception health, with implications for science, practice, and policy.

Trends in concomitant clopidogrel and proton pump inhibitor treatment among ACS inpatients, 2000-2016.

PURPOSE: The US Food and Drug Administration (FDA) issued three safety announcements between January 2009 and October 2010 warning against concomitant use of clopidogrel and proton pump inhibitors (PPIs) due to a potential drug-drug interaction that may attenuate clopidogrel's antiplatelet activity. This primary objective of this study was to examine trends in concomitant clopidogrel/PPI use among acute coronary syndrome (ACS) inpatients in the US between 2000 and 2016, in relation to the FDA safety communications. METHODS: Adult inpatients with a primary diagnosis of ACS were identified from the Cerner Health Facts® database. The standardized (age, sex, race, and census region) prevalence of clopidogrel use with PPIs was calculated yearly and quarterly. Findings were stratified by PPIs' potential to inhibit clopidogrel's activity and by age. RESULTS: A total of 204,533 inpatients were identified. In 2008, the prevalence of concomitant clopidogrel and PPI treatment was 34.9%, decreasing to 24.4 and 16.4% in 2009 and 2010, respectively, with the decline being similar across age groups. Treatment with inhibiting PPIs (omeprazole and esomeprazole) and clopidogrel has continued to decrease since 2010, with a prevalence of 0.8% in 2016. A similar reduction was not observed with clopidogrel and non-inhibiting PPIs (pantoprazole, lansoprazole, rabeprazole, and dexlansoprazole). During the FDA warning period, the combined treatment with clopidogrel and H2 receptor antagonists, an alternative to PPIs suggested by the FDA, temporarily increased from 7.8% in 2008 to 12.8 and 14.5% in 2009 and 2010, respectively. CONCLUSIONS: Findings suggest that clinical practice recommendations made by the FDA were followed. Further research is needed to determine how changes in drug labels and the availability of new drugs may have influenced the observed trends.

Comparison of peritoneal dialysis with hemodialysis on survival of diabetic patients with end-stage kidney disease: a meta-analysis of cohort studies.

Aim: Renal replacement therapy was primary treatment for end stage kidney (ESRD) patients. Numbers of studies comparing peritoneal dialysis (PD) and hemodialysis (HD) yielded inconsistent results. The aim of this study was to assess the mortality risk between diabetic PD patients and those in HD. Methods: We included cohort studies comparing the risk of death among diabetic ESRD patients who receiving peritoneal dialysis or hemodialysis by searching Medline and Embase. Overall estimates were calculated using the random-effects model. Results: Seventeen studies were included in the meta-analyses. Mortality comparison between PD and HD in the diabetic ESRD patients showed PD significantly increased mortality rate (hazard ratio (HR) 1.20; 95% confidence interval (CI) 1.10-1.30; I2 = 89.1%). The overall HR using an intention-to-treat analysis was 1.23 with 95% CI (1.13 to 1.34). Meta-regression demonstrated PD patients from Asian country were associated with increase in mortality risk (coefficient = 0.270, SE = 0.112, p = .033). Limitation: The high heterogeneity in our meta-analyses undermined the robustness of the findings. Conclusion: ESRD patients with diabetes may benefit more from HD than PD.

Effect of Hexadecyl Azelaoyl Phosphatidylcholine on Cardiomyocyte Apoptosis in Myocardial Ischemia-Reperfusion Injury: A Hypothesis.

Reperfusion after myocardial ischemia can induce cardiomyocyte death, known as myocardial reperfusion injury. The pathophysiology of the process of reperfusion suggests the confluence multiple pathways. Recent studies have focused on the inflammatory response, which is considered to be the main mechanism during the process of myocardial ischemia-reperfusion injury and can cause cardiomyocyte apoptosis. Peroxisome proliferator-activated receptors gamma activated by endogenous ligands and exogenous ligand can decrease the inflammatory response in cardiomyocytes. Thiazolidinediones are synthetic, high-affinity, selective ligands for peroxisome proliferator-activated receptors gamma, and can inhibit the inflammatory response, decrease myocardial infarct size, and protect cardiac function. However, thiazolidinediones, including rosiglitazone and pioglitazone, can also contribute to adverse cardiovascular events such as congestive heart failure. Therefore, there are some limitations to the use of thiazolidinediones. Most endogenous ligands were of low affinity until hexadecyl azelaoyl phosphatidylcholine was identified as a high-affinity ligand and agonist for peroxisome proliferator-activated receptors gamma. Hexadecyl azelaoyl phosphatidylcholine binds recombinant peroxisome proliferator-activated receptors with an affinity (Kd(app) ≈40 nM) which is equivalent to rosiglitazone. Therefore, hexadecyl azelaoyl phosphatidylcholine is a specific peroxisome proliferator-activated receptors gamma agonist. Given these findings, we hypothesized that the use of hexadecyl azelaoyl phosphatidylcholine can activate the peroxisome proliferator-activated receptors gamma signal pathways and prevent the inflammatory response process of myocardial ischemia-reperfusion injury, with reduced cardiomyocyte apoptosis and death.

When east meets west: a qualitative study of barriers and facilitators to evidence-based practice in Hunan China.

BACKGROUND: Research into evidence-based practice has been extensively explored in nursing and there is strong recognition that the organizational context influences implementation. A range of barriers has been identified; however, the research has predominantly taken place in Western cultures, and there is little information about factors that influence evidence-based practice in China. The purpose of this study was to explore barriers and facilitators to evidence-based practice in Hunan province, a less developed region in China. METHODS: A descriptive qualitative methodology was employed. Semi-structured interviews were conducted with staff nurses, head nurses and directors (n = 13). Interviews were translated into English and verified for accuracy by two bilingual researchers. Both Chinese and English data were simultaneously analyzed for themes related to factors related to the evidence to be implemented (Innovation), nurses' attitudes and beliefs (Potential Adopters), and the organizational setting (Practice Environment). RESULTS: Barriers included lack of available evidence in Chinese, nurses' lack of understanding of what evidence-based practice means, and fear that patients will be angry about receiving care that is perceived as non-traditional. Nurses believed evidence-based practice was to be used when clinical problems arose, and not as a routine way to practice. Facilitators included leadership support and the pervasiveness of web based social network services such as Baidu () for easy access to information. CONCLUSION: While several parallels to previous research were found, our study adds to the knowledge base about factors related to evidence-based practice in different contextual settings. Findings are important for international comparisons to develop strategies for nurses to provide evidence-based care.

[Efficacy of sweet solutions in relieving pain caused by vaccination in infants aged 1 to 12 months: a systematic review].

OBJECTIVE: To investigate the efficacy of oral sweet solutions in relieving pain caused by vaccination in infants aged 1 to 12 months. METHODS: Related databases were searched to find related randomized control trails (RCTs). The quality of these RCTs was evaluated. The Meta analysis was performed using RevMan 5.3. RESULTS: A total of 20 RCTs involving 2 376 infants were included, and quality assessment showed that 6 RCTs had grade A quality and 14 had grade B quality. The Meta analysis showed that compared with sterile water, 25%-75% oral sweet solution significantly reduced crying time (WMD=-21.16, 95%CI -39.66 to -2.77, P<0.05) and the proportion of crying time (the duration of crying /3-minute periods after the injection) (WMD=-13.83, 95%CI -20.88 to -6.78, P<0.01), while the crying time showed no significant difference between the group treated with oral administration of 12% sucrose solution and non-intervention group. Co ONCLUSIONS: Oral sweet solution (25%-75%; 2 mL) given 2 minutes before vaccination can effectively relieve the pain caused by vaccination in infants aged 1-12 months.

Sex disparity and perception of obesity/overweight by parents and grandparents.

OBJECTIVE: To explore the factors associated with the sex disparity showing a greater prevalence of obesity/overweight in boys compared with girls in Chinese school children. METHODS: Sampled students and their parents were asked to complete a questionnaire. Perceptions of weight status by the parents, grandparents and children themselves were collected. A logistic regression analysis was used. RESULTS: The sampled students included 327 obese/overweight students and 1078 students with normal body mass index (BMI). The crude OR of obesity/overweight for boys compared with girls was 1.57 (95% CI 1.22 to 2.01). The increased risk of childhood obesity/overweight for boys remained after adjustment for prenatal and infant factors, daily habits and family situation, but disappeared after adjustment for perception of weight status (OR 1.27 [95% CI 0.93 to 1.67]). There were differences in underestimation of children's weight status between boys and girls by their parents and grandparents (OR 1.33 [95% CI 1.08 to 1.64] and OR 1.42 [95% CI 1.15 to 1.75], respectively). CONCLUSIONS: Misconceptions about a child's weight status were prevalent among parents and grandparents, and boys' weight status was more frequently underestimated than girls. The disparity of underestimating weight according to sex may partially contribute to the difference in the prevalence of obesity/overweight between boys and girls among Chinese school children.

OBJECTIF: Explorer les facteurs associés à l'écart entre les sexes qui démontrent une plus grande prévalence d'obésité et d'embonpoint chez les écoliers que chez les écolières en Chine. MÉTHODOLOGIE: Les chercheurs ont invité un échantillon d'élèves et leurs parents à remplir un questionnaire. Ils ont colligé les perceptions des parents, des grands-parents et des enfants. Ils ont utilisé une analyse de régression logistique. RÉSULTATS: L'échantillon se composait de 327 élèves obèses ou faisant de l'embonpoint et de 1 078 élèves à l'indice de masse corporelle (IMC) normal. Par rapport aux filles, le rapport de cotes brut d'obésité et d'embonpoint pour les garçons était de 1,57 (95 % IC 1,22 à 2,01). Le risque accru d'obésité ou d'embonpoint juvénile des garçons était maintenu après rajustement compte tenu de facteurs liés à la prénatalité et au nourrisson, aux habitudes quotidiennes et à la situation familiale, mais disparaissait après rajustement compte tenu de la perception du poids (RC 1,27 [95 % IC 0,93 à 1,67]). Les parents et les grands-parents sous-estimaient le poids des garçons et des filles de manière différente (RC 1,33 [95 % IC 1,08 à 1,64] et RR 1,42 [95 % IC 1,15 à 1,75], respectivement). CONCLUSIONS: L'évaluation erronée du poids d'un enfant est prévalente chez les parents et les grands-parents, le poids des garçons étant plus sous-estimé que celui des filles. L'écart de sous-estimation du poids entre les sexes peut contribuer à la différence de prévalence d'embonpoint ou d'obésité chez les écoliers et écolières en Chine.

Estimating the population size of men who have sex with men: a modified Laska, Meisner and Siegel procedure taking into account internet populations.

OBJECTIVES: Men who have sex with men (MSM) are an at-risk population for HIV/AIDS. Accurately estimating the size of MSM is important to monitor the HIV/AIDS epidemic and to implement HIV/AIDS prevention in the MSM population. None of the current methods for MSM population size estimation is satisfactory, especially for internet samples. We try to use the modified Laska, Meisner and Siegel (LMS) method to estimate the size of MSM in tangible venues and internet virtual venues. METHODS: Laska, Meisner and Siegel developed an unbiased estimator for the size of a population in a single venue based on a single sample (LMS method). In this study, we modified the LMS method for the estimation of population size of MSM (LMS* procedure). Specially, we integrated the MSM size of traditional tangible venue with internet virtual venue. Currently, the latter is an important source of socialisation for MSM population. To do this, we added a few parameters to the original LMS method. Then we applied the LMS* procedure to estimate the size of MSM in Changsha, the capital city of the Chinese Province of Hunan. RESULTS: The LMS* procedure handled the complexity of socialisation among MSM population well. According to the LMS* procedure, the total number of MSM was 65 657 (95% CI 57 922 to 73 388), constituting a proportion of 5.43% (95% CI 4.79% to 6.07%) in the sexually active male population (15-64-year-olds) in Changsha. CONCLUSIONS: We conclude that the LMS* procedure is suitable for the estimation of a hard-to-reach population, such as MSM, in tangible venues and internet virtual venues.

[Pre-conception factors for intrauterine growth retardation].

OBJECTIVE: To analyze the pre-conception factors for intrauterine growth retardation. METHODS: A nested case-control study was conducted in a cohort of 1368 women from 14 Child and Maternity Health Care Departments by cluster sampling method in Liuyang City, Hunan Province. Following-up until delivery, we collected their medical records and maternal health care manual materials. All neonates with intrauterine growth retardation were detected in the follow-up (the case group) and another 186 neonates without intrauterine growth retardation, matched with gender and mother's age, were randomly selected from the cohort as controls. χ2 test and multiple conditional logistic regression were used to investigate the determinants of intrauterine growth retardation. RESULTS: Intrauterine growth retardation was associated with BMI (OR=64.775), waist circumference (OR=0.166), abortion (OR=6.997), level of total cholesterol (OR=0.045), folic acid (OR=0.077), and cortisol (OR=9.164). CONCLUSION: Intrauterine growth retardation is associated with BMI, waist circumference, abortion,level of total cholesterol, folic acid, and cortisol. Effective measures to reduce intrauterine growth retardation in children include strengthening the detection of pre-pregnancy blood biochemical indicators to guide health care during pregnancy, and increasing nutrition during pregnancy according to pre-pregnancy BMI and waist circumference.

[A population based study on incidence and determinants of preterm birth in Liuyang Hunan].

OBJECTIVE: To describe the incidence and to discuss the risk factors of premature birth in rural areas of Liuyang. METHODS: We collected subjects from villages and towns in Liuyang through cluster sampling method. Before enrolling in this cohort, all of them had established health records from January 2010 to December 2011. We followed up the early, middle and late stages of pregnancy until delivery, and collected medical records and maternal health care manual of this cohort as our data materials. We explored the main influence factors of premature delivery by χ2 test and unconditional logistic regression analysis for single factor and multivariate analysis. RESULTS: Among 6270 women who enrolled in our cohort, 259 were diagnosed as premature birth. The incidence (4.13%) was lower than the national average level. Non-conditional logistic regression analysis showed that the risk factors of premature birth were as follows: OR of placental abruption was 7.678 (95% CI: 2.249-26.215), that of premature rupture of fetal membranes (PROM) was 5.177 (95% CI: 3.945-6.793), that of uterine abnormal and deformity was 2.675 (95% CI: 1.007-7.107), that of placenta anomaly was 2.633 (95% CI: 1.666-4.162), that of hypertension in pregnancy was 2.172 (95% CI: 1.044-4.521), that of pregnancy complications was 1.806 (95% CI: 1.033-3.157), that of male fetus was 1.429 (95% CI: 1.086-1.881). Protective factors of preterm birth were too frequent prenatal examination (OR=0.502, 95% CI: 1.033-3.157) and single pregnancy (OR=0.155, 95% CI: 0.075-0.319). CONCLUSION: Preterm delivery is caused by complicated factors, such as placental abruption, PROM and male fetus. Comprehensive measures should be taken to reduce preterm birth.

H1N1 influenza vaccination during pregnancy and fetal and neonatal outcomes.

OBJECTIVES: We evaluated the relationship between maternal H1N1 vaccination and fetal and neonatal outcomes among singleton births during the 2009-2010 H1N1 pandemic. METHODS: We used a population-based perinatal database in Ontario, Canada, to examine preterm birth (PTB), small-for-gestational-age (SGA) births, 5-minute Apgar score below 7, and fetal death via multivariable regression. We compared outcomes between women who did and did not receive an H1N1 vaccination during pregnancy. RESULTS: Of the 55,570 mothers with a singleton birth, 23,340 (42.0%) received an H1N1 vaccination during pregnancy. Vaccinated mothers were less likely to have an SGA infant based on the 10th (adjusted risk ratio [RR]=0.90; 95% confidence interval [CI]=0.85, 0.96) and 3rd (adjusted RR=0.81; 95% CI=0.72, 0.92) growth percentiles; PTB at less than 32 weeks' gestation (adjusted RR=0.73; 95% CI=0.58, 0.91) and fetal death (adjusted RR=0.66; 95% CI=0.47, 0.91) were also less likely among these women. CONCLUSIONS: Our results suggest that second- or third-trimester H1N1 vaccination was associated with improved fetal and neonatal outcomes during the recent pandemic. Our findings need to be confirmed in future studies with designs that can better overcome concerns regarding biased estimates of vaccine efficacy.

Ten-year, thirty-year, and lifetime cardiovascular disease risk estimates following a pregnancy complicated by preeclampsia.

OBJECTIVE: To calculate the cardiovascular disease (CVD) risk estimates for women following a pregnancy with or without preeclampsia. METHODS: We calculated 10-year, 30-year, and lifetime CVD risk estimates at one year postpartum for women recruited into the Pre-Eclampsia New Emerging Team's prospective cohort. RESULTS: Complete CVD risk screening data were obtained from 118 control women and 99 preeclamptic women. A total of 18.2% of preeclamptic women and 1.7% of control women had a high 10-year risk (OR 13.08; 95% CI 3.38 to 85.5), 31.3% of preeclamptic women and 5.1% of control women had a high 30-year risk (OR 8.43; 95% CI 3.48 to 23.23), and 41.4% of preeclamptic women and 17.8% of control women had a high lifetime risk for CVD (OR 3.25; 95% CI 1.76 to 6.11). CONCLUSIONS: The association of preeclampsia with the future development of CVD makes pregnancy an early window of opportunity for the preservation of health and prevention of CVD.

Risk estimation of metabolic syndrome at one and three years after a pregnancy complicated by preeclampsia.

BACKGROUND: Our goal was to determine the prevalence of metabolic syndrome in women following a pregnancy complicated by preeclampsia and to determine whether this changes between one- and three-years postpartum. METHODS: We recruited women into a longitudinal prospective cohort following a pregnancy with or without preeclampsia. The prevalence of cardiometabolic factors were assessed at one- and three-years postpartum. A total of 217 women completed a visit at one year postpartum (n = 99 preeclampsia, n = 118 control subjects) and 120 completed a visit at three-years (n = 73 preeclampsia, n = 47 control subjects). RESULTS: The prevalence of metabolic syndrome at one- and three-years postpartum was significantly greater in women who had preeclampsia (18.18% at one year, 21.92% at three-years) than in control subjects (6.78%, 6.38%) (P < 0.05), but did not change over time. CONCLUSIONS: Given the difficulty in following women long-term, either clinically or as part of study, and because cardiometabolic factors do not change significantly between one- and three-years postpartum, strategies for health preservation and disease prevention should be adopted in the first-year postpartum.

A pre-conception cohort to study preeclampsia in China: Rationale, study design, and preliminary results.

OBJECTIVE: It is uncertain whether preeclampsia (PE) is caused by pre-existing factors or by pregnancy itself. We want to answer this important question in public health by conducting a large pre-conception cohort in China. METHODS: A prospective and pre-conception cohort study with a target recruitment of 5000 couples who plan to have a baby within 6 months was performed and their conception, delivery, and postpartum were followed up in Liuyang county, Hunan Province of P. R. China. RESULTS: A total of 1915 young couples have been recruited into this unique pre-conception cohort till now. In general, both systolic blood pressure and diastolic blood pressure decreased in early second trimester from pre-conception level but increased in third trimester and at delivery. CONCLUSION: The proposed pre-conception cohort study will have important theoretical and practical implications on the prevention of PE and its associated cardiovascular disease risks.

Secular trends in trial of labor and associated neonatal mortality and morbidity in the United States, 1995 to 2002.

OBJECTIVE: A proportion of elective repeated cesarean sections where a trial of labor in a uterus with a previous scar was not attempted is on the increase. This study aimed to assess how reduced the use of trial of labor has impacted on neonatal outcomes in the United States. METHODS: Pregnant women with one previous cesarean delivery and a singleton live birth of the index pregnancy were abstracted from the 1995 to 2002 birth registration data of the United States. Adjusted odds ratios for adverse neonatal outcomes of trial of labor were estimated by multiple logistic regression models, in overall study subjects and in the two periods with high and low rates of trial of labor. RESULTS: A total of 1833407 eligible subjects were included in the analysis. Rate of trial of labor after one previous cesarean section dropped from 38.5% in 1995 to 15.0% in 2002. No significant change was observed in the patient population profile. Successful vaginal birth after cesarean delivery (VBAC) also declined from 76.6% in 1995 to 66.0% in 2002. A trial of labor after one previous cesarean section was correlated with increased risks of asphyxia-related neonatal death and neonatal morbidity. This risk was even more pronounced in low risk women and in the last study years with the lowest rate of trial of labor. CONCLUSION: The reduced use of trial of labor after one cesarean delivery in recent years in the United States has actually resulted in increased risk of adverse neonatal outcomes associated with a trial of labor.