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Converging evidence has revealed disturbances in the corticostriatolimic system are associated with suicidal behaviors in adults with major depressive disorder. However, the neurobiological mechanism that confers suicidal vulnerability in depressed adolescents is largely unknown. A total of 86 depressed adolescents with and without prior suicide attempts (SA) and 47 healthy controls underwent resting-state functional imaging (R-fMRI) scans. The dynamic amplitude of low-frequency fluctuations (dALFF) was measured using sliding window approach. We identified SA-related alterations in dALFF variability primarily in the left middle temporal gyrus, inferior frontal gyrus, middle frontal gyrus (MFG), superior frontal gyrus (SFG), right SFG, supplementary motor area (SMA) and insula in depressed adolescents. Notably, dALFF variability in the left MFG and SMA was higher in depressed adolescents with recurrent suicide attempts than in those with a single suicide attempt. Moreover, dALFF variability was capable of generating better diagnostic and prediction models for suicidality than static ALFF. Our findings suggest that alterations in brain dynamics in regions involved in emotional processing, decision-making and response inhibition are associated with an increased risk of suicidal behaviors in depressed adolescents. Furthermore, dALFF variability could serve as a sensitive biomarker for revealing the neurobiological mechanisms underlying suicidal vulnerability.
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BACKGROUND: Few studies in China have examined personal ultraviolet radiation (UVR) exposure using polysulfone dosimetry. METHODS: In this study, 93 mother and adolescent child pairs (N = 186) from two locations in China, one rural (higher latitude) and one urban (lower latitude), completed 3 days of personal UVR dosimetry and a sun/clothing diary, as part of a larger pilot study. RESULTS: The average daily ambient UVR in each location as measured by dosimetry was 20.24 Minimal Erythemal Doses (MED) in the rural location and 20.53 MED in the urban location. Rural mothers had more average daily time outdoors than urban mothers (5.5 h, compared with 1.5 h, in urban mothers) and a much higher daily average personal UVR exposure (4.50 MED, compared with 0.78 MED in urban mothers). Amongst adolescents, rural males had the highest average daily personal UVR exposure, followed by rural females, urban females and urban males (average 2.16, 1.05, 0.81, and 0.48 MED, respectively). CONCLUSIONS: Although based on small numbers, our findings show the importance of geographic location, age, work/school responsibilities, and sex of the adolescents in determining personal UVR exposure in China. These results suggest that latitude of residence may not be a good proxy for personal UVR exposure in all circumstances.
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Exposição Ambiental/estatística & dados numéricos , Exposição à Radiação/estatística & dados numéricos , Raios Ultravioleta , Adolescente , Criança , China , Estudos de Coortes , Feminino , Humanos , Masculino , Mães , Projetos Piloto , Radiometria , População RuralRESUMO
Background: Mood disorders are very common among adolescents and include mainly bipolar disorder (BD) and major depressive disorder (MDD), with overlapping depressive symptoms that pose a significant challenge to realizing a rapid and accurate differential diagnosis in clinical practice. Misdiagnosis of BD as MDD can lead to inappropriate treatment and detrimental outcomes, including a poorer ultimate clinical and functional prognosis and even an increased risk of suicide. Therefore, it is of great significance for clinical management to identify clinical symptoms or features and biological markers that can accurately distinguish BD from MDD. With the aid of bibliometric analysis, we explore, visualize, and conclude the important directions of differential diagnostic studies of BD and MDD in adolescents. Materials and methods: A literature search was performed for studies on differential diagnostic studies of BD and MDD among adolescents in the Web of Science Core Collection database. All studies considered for this article were published between 2004 and 2023. Bibliometric analysis and visualization were performed using the VOSviewer and CiteSpace software. Results: In total, 148 publications were retrieved. The number of publications on differential diagnostic studies of BD and MDD among adolescents has been generally increasing since 2012, with the United States being an emerging hub with a growing influence in the field. Boris Birmaher is the top author in terms of the number of publications, and the Journal of Affective Disorders is the most published journal in the field. Co-occurrence analysis of keywords showed that clinical characteristics, genetic factors, and neuroimaging are current research hotspots. Ultimately, we comprehensively sorted out the current state of research in this area and proposed possible research directions in future. Conclusion: This is the first-ever study of bibliometric and visual analyses of differential diagnostic studies of BD and MDD in adolescents to reveal the current research status and important directions in the field. Our research and analysis results might provide some practical sources for academic scholars and clinical practice.
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Background: Depression in adolescents is recognised as a global public health concern, but little is known about the trajectory of its clinical symptoms and pathogenesis. Understanding the nature of adolescents with depression and identifying early biomarkers can facilitate personalised intervention and reduce disease burden. Aims: To track multidimensional outcomes of adolescents with depression and develop objective biomarkers for diagnosis, as well as response to treatment, prognosis and guidance for early identification and intervention. Methods: This is a multidimensional cohort study on the Symptomatic trajectory and Biomarkers of Early Adolescent Depression (sBEAD). We planned to recruit more than 1000 adolescents with depression and 300 healthy controls within 5 years. Multidimensional clinical presentations and objective indicators are collected at baseline, weeks 4, 8, 12 and 24, and years 1, 2, 3, 4 and 5. Conclusions: To the best of our knowledge, this is the first longitudinal cohort study that examines multidimensional clinical manifestations and multilevel objective markers in Chinese adolescents with depression. This study aims at providing early individualised interventions for young, depressed patients to reduce the burden of disease. Trial registration number: Chinese Clinical Trial Registry ID ChiCTR2100049066.
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Phosphate-solubilizing bacteria (PSB) can accelerate phytoremediation, especially in those fertilized soils. However, PSB function in oligotrophic growth substrates remains poorly studied. In this study, we isolated lead (Pb)- and cadmium (Cd)-resistant PSB from contaminated sandy soil at an abandoned lubricant plant. The isolated Pantoea sp. PP4 (PP4 hereafter) can produce organic acid and IAA (Indole-3-acetic acid) and dissolve up to 238 mg/L of inorganic phosphate Ca2(PO4)3, exhibiting biosorption capability for Pb and bioprecipitation for Pb and Cd. In the sand pot experiment, inoculation of PP4 increased the accumulation of Pb and Cd in Lolium multiflorum Lam. by 28.9% and 95.5%, respectively, and increased the available phosphorous in oligotrophic river sand by 30.8% (P < 0.05). Meanwhile, the growth of Lolium multiflorum Lam. was also stimulated, resulting in 89.2%, 57.1%, 184.6%, and 28.5% increase in fresh weight, dry weight, root length, and shoot length, respectively. NMDS analysis showed that the bacterial communities in river sand were more clustered after inoculation with PP4. These results indicated that the application of Pantoea sp. PP4 can facilitate the phytoremediation of Pb and Cd in oligotrophic growth substrates, forming a convergent bacterial community. Our findings highlighted the importance of identifying ideal PSB to improve phytoremediation efficiency in oligotrophic environments.
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Lolium , Metais Pesados , Pantoea , Poluentes do Solo , Biodegradação Ambiental , Cádmio/análise , Chumbo , Metais Pesados/análise , Fosfatos , Areia , Solo , Poluentes do Solo/análiseRESUMO
The phospholipase pl-S.t gene of Sphingobacterium thalpophilum 2015 was cloned and the gene sequence was submitted to NCBI with Accession Number KX674735.1. The phylogenetic analysis showed that this PL-S.t was clustered to phospholipase D (PLD). As far as we know, the PL-S.t with a molecular mass of 22.5 kDa is the lowest of the currently purified bacterial PLDs, which belongs to a non-HKD PLD enzyme. This PL-S.t was resistant to a wide range of alkali pHs (7.5-9.0) after 1 h incubation, retaining more than 90% of its maximum activity. The PL-S.t activity can be enhanced by Ni2+, Co2+ and Mn2+. This PL-S.t has only one cysteine residue and fewer negatively-charged amino acids (AAs). The hydrogen bonds network was found around the cystein108, which may be beneficial to the stability and activity of PL-S.t in Ni2+ solution. This study has laid the foundation for further research on the molecular mechanism of the catalytic characteristics of low molecular weight alkalic PLD from S. thalpophilum 2015.
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Álcalis/metabolismo , Clonagem Molecular , Regulação Bacteriana da Expressão Gênica , Fosfolipase D/metabolismo , Sphingobacterium/genética , Sphingobacterium/metabolismo , Sequência de Aminoácidos , Cobalto , Genes Bacterianos , Concentração de Íons de Hidrogênio , Manganês , Níquel , Filogenia , Sphingobacterium/classificaçãoRESUMO
Oligotrophic nitrifiers and denitrifiers play important roles in the removal of nitrogen from wastewater. Here, we studied the dominant bacterial populations of the sewage treatment ecosystem (STE) water from different processes and those of culture on oligotrophic heterotrophic nitrification (OHN) medium and oligotrophic aerobic denitrification (OAD) medium, using co-analysis of Illumina HiSeq DNA sequencing and traditional culture methods. The results showed that the STE water had no dominant population of oligotrophic nitrifiers or oligotrophic denitrifiers. However, after culturing on OHN medium and OAD medium, the core genera Pseudomonas, Aeromonas, and Acinetobacter that have the nitrogen removal capacity in oligotrophic environments, dominated in the bacterial community. The principal component analysis (PCA) showed that the bacterial community in the constructed rapid infiltration (CRI) effluent water of STE had high similarity with those of cultures on OHN medium and OAD medium, which prompt the special purification role of nitrogen in the CRI system. The sodium alginate immobilized OAD bacteria strain Delftia tsuruhatensis NF4 was isolated from the CRI system, with total nitrogen (TN) removal efficiency of 43.3% in sterilized STE influent water, and 60.1% in OAD medium on day three. The immobilization significantly influenced the TN and nitrate removal efficiency in OAD medium (p < 0.05), but not in sterilized STE influent water (p > 0.05). This study would lay the foundation for resource discovery of oligotrophic heterotrophic nitrifiers and aerobic denitrifiers in STE and further functional application of them on the bioremediation of wastewater.Oligotrophic nitrifiers and denitrifiers play important roles in the removal of nitrogen from wastewater. Here, we studied the dominant bacterial populations of the sewage treatment ecosystem (STE) water from different processes and those of culture on oligotrophic heterotrophic nitrification (OHN) medium and oligotrophic aerobic denitrification (OAD) medium, using co-analysis of Illumina HiSeq DNA sequencing and traditional culture methods. The results showed that the STE water had no dominant population of oligotrophic nitrifiers or oligotrophic denitrifiers. However, after culturing on OHN medium and OAD medium, the core genera Pseudomonas, Aeromonas, and Acinetobacter that have the nitrogen removal capacity in oligotrophic environments, dominated in the bacterial community. The principal component analysis (PCA) showed that the bacterial community in the constructed rapid infiltration (CRI) effluent water of STE had high similarity with those of cultures on OHN medium and OAD medium, which prompt the special purification role of nitrogen in the CRI system. The sodium alginate immobilized OAD bacteria strain Delftia tsuruhatensis NF4 was isolated from the CRI system, with total nitrogen (TN) removal efficiency of 43.3% in sterilized STE influent water, and 60.1% in OAD medium on day three. The immobilization significantly influenced the TN and nitrate removal efficiency in OAD medium (p < 0.05), but not in sterilized STE influent water (p > 0.05). This study would lay the foundation for resource discovery of oligotrophic heterotrophic nitrifiers and aerobic denitrifiers in STE and further functional application of them on the bioremediation of wastewater.
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Bactérias/metabolismo , Delftia/metabolismo , Desnitrificação , Microbiota , Nitrificação , Esgotos/microbiologia , Aerobiose , Bactérias/classificação , Biodegradação Ambiental , Processos Heterotróficos , Eliminação de Resíduos Líquidos/métodosRESUMO
OBJECTIVE: To determine the feasibility of long-term prospective follow-up and ascertainment of cancer in offspring and mothers from the 1993-1995 Chinese Community Intervention Program that provided folic acid supplements before and during early pregnancy to reduce neural tube defects. DESIGN: Feasibility pilot study for a prospective cohort study. SETTING: Families residing during 2012-2013 in one rural and one urban county from 21 counties in 3 provinces in China included in the Community Intervention Program campaign. PARTICIPANTS: The feasibility study targeted 560 families, including 280 from the rural and 280 from the urban county included in the large original study; about half of mothers in each group had taken and half had not taken folic acid supplements. INTERVENTION: The planned new study is observational. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary: incidence of paediatric cancers in offspring; secondary: other chronic diseases in offspring and chronic diseases in mothers RESULTS: Only 3.4% of pilot study families could not be found, 3.9% had moved out of the study area and 8.8% refused to participate. Interviews were completed by 82% of mothers, 79% of fathers and 83% of offspring in the 560 families. Almost all mothers and offspring who were interviewed also participated in anthropometric measurements. We found notable urban-rural differences in sociodemographic and lifestyle characteristics of the parents, but fewer differences among the offspring. In eight catchment area hospitals, we identified a broad range of paediatric cancers diagnosed during 1994-2013, although paediatric brain tumours, lymphomas and rarer cancers were likely under-represented. CONCLUSIONS: Overall, 20 years after the original Community Intervention Program, the pilot study achieved high levels of follow-up and family member interview participation, and identified substantial numbers of paediatric malignancies during 1994-2013 in catchment area hospitals. Next steps and strategies for overcoming limitations are described.
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Ácido Fólico/uso terapêutico , Neoplasias/epidemiologia , Defeitos do Tubo Neural/prevenção & controle , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Complexo Vitamínico B/uso terapêutico , Adolescente , Adulto , Criança , China/epidemiologia , Estudos de Coortes , Suplementos Nutricionais , Estudos de Viabilidade , Feminino , Humanos , Incidência , Masculino , Projetos Piloto , Gravidez , Estudos Prospectivos , População Rural , População Urbana , Adulto JovemRESUMO
This article reports the study design, methodological issues and early results of a pilot study testing methods for collecting nutrition, physical activity, and ultraviolet (UV) radiation exposure data in a groundbreaking study in China. Epidemiological studies suggest that exposures across the entire life course, including in utero, early childhood, and adolescence, may be important in the etiology of adult cancers and other chronic diseases. The Chinese Children and Families Cohort Study intends to follow-up subjects from the 1993 to 1995 Community Intervention Program of folic acid supplementation for the prevention of neural tube defects. This cohort is unique in that only folic acid exposure during pregnancy varies between groups as other supplements were not available, and there were nutrient deficiencies in the populations. Prior to launching a large-scale follow-up effort, a pilot study was conducted to assess the feasibility of recontacting original study participants to collect extensive diet, physical activity, and UV radiation exposure data in this population. The pilot study included 92 mothers and 184 adolescent children aged 14 to 17 years from 1 urban and 1 rural Community Intervention Program site. Subjects completed a Food Frequency Questionnaire, a 3-day food record, a physical activity questionnaire, a 3-day sun exposure diary together with 3 days of personal UV dosimetry, and 7 days of pedometry measurements and provided blood, saliva, and toenail samples. Grip strength and body composition measurements were taken, and ambient solar UV radiation was monitored in both study sites. While most of the assessments were successful, future studies would likely require different dietary intake instruments. The purpose of this report is to describe the study design and methodological issues emerging from this pilot work relevant for the follow-up of this large birth cohort.
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A bienzymatic glucose biosensor was proposed for selective and sensitive detection of glucose. This mediatorless biosensor was made by simultaneous immobilization of glucose oxidase (GOD) and horseradish peroxidase (HRP) in an electropolymerized pyrrole (PPy) film on a single-wall carbon nanotubes (SWNT) coated electrode. The amperometric detection of glucose was assayed by potentiostating the bienzymatic electrode at -0.1 versus Ag/AgCl to reduce the enzymatically produced H(2)O(2) with minimal interference from the coexisting electroactive compounds. The single-wall carbon nanotubes, sandwiched between the enzyme loading polypyrrole (PPy) layer and the conducting substrate (gold electrode), could efficiently promote the direct electron transfer of HRP. Operational characteristics of the bienzymatic sensor, in terms of linear range, detection limit, sensitivity, selectivity and stability, were presented in detail.
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Técnicas Biossensoriais/métodos , Enzimas Imobilizadas/metabolismo , Glucose Oxidase/metabolismo , Glucose/análise , Peroxidase do Rábano Silvestre/metabolismo , Nanotubos de Carbono/química , Técnicas Biossensoriais/instrumentação , Enzimas Imobilizadas/química , Glucose/metabolismo , Glucose Oxidase/química , Peroxidase do Rábano Silvestre/química , Microscopia Eletrônica de Varredura , Nanotubos de Carbono/ultraestruturaRESUMO
Meldola's blue (MB) functionalized carbon nanotubes (CNT) nanocomposite film (MB/CNT) electrode was prepared by non-covalent adsorbing MB on the surface of a carbon nanotubes modified glassy carbon electrode (CNT/GCE). Electrochemical behaviors of the resulting electrode were investigated thoroughly with cyclic voltammetry in the potential range of -0.6 to 0.2V, and two well-defined redox couples were clearly visualized. We also studied the electron transfer kinetics of MB loaded on CNT (MB/CNT) in comparison with that of MB on conventional graphite powder (MB/GP). The heterogeneous electron transfer rate constant (k(s)) of MB/CNT was calculated to be about three times larger than that of MB/GP. The accelerated electron transfer kinetics was attributed to the unique electrical and nanostructural properties of CNT supports as well as the interaction between MB and CNT. In connection with the oxidation of nicotinamide adenine dinucleotide (NADH), excellent electrocatalytic activities were observed at MB/CNT/GCE compared with MB/GP modified glassy carbon electrode (MB/GP/GCE). Based on the results, a new NADH sensor was successfully established using the MB/CNT/GCE. Under a lower operation potential of -0.1V, NADH could be detected linearly up to a concentration of 500 microM with an extremely lower detection limit of 0.048+/-0.02 microM estimated at a signal-to-noise ratio of 3. Sensitivity, selectivity, reproducibility and stability of the NADH sensor were also investigated and the main analytical data were also compared with those obtained with the MB/GP/GCE.
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Técnicas Biossensoriais/instrumentação , Eletroquímica/instrumentação , Microeletrodos , NAD/análise , NAD/química , Nanotubos de Carbono/química , Oxazinas/química , Técnicas Biossensoriais/métodos , Catálise , Materiais Revestidos Biocompatíveis/química , Eletroquímica/métodos , Desenho de Equipamento , Análise de Falha de Equipamento , Nanotubos de Carbono/ultraestrutura , Oxirredução , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To describe the prevalence of anemia and yearly trends (1993-2003) among women who came to the hospitals or maternal and child health units for premarital examinations in 6 counties of Jiangsu and Zhejiang provinces. METHODS: Data were obtained from the records of the premarital examinations in perinatal health care surveillance system that had been established since 1992 in these areas. We reviewed hemoglobin levels of those women who were enrolled in the perinatal health care surveillance system from 1993 to 2003. Anemia was defined according to the WHO (2001) criterion. We calculated the prevalence of anemia and analyzed the yearly trends based on the data of hemoglobin concentration. RESULTS: In the period of 1993-2003, there were 82 995 anemia cases identified among 193,434 women with an overall anemia rate as 42.9%. The rates of anemia were high (65.5%) in 1993 but low (25.8%) in 2003. 99.7% of the anemic women whose hemoglobin concentration were between 80-119.9 g/L. Time trend analysis indicated a significant decline on anemia rate while monthly analysis showed that the prevalence rates were high (48.2%) in September and low in March (39.5%). The results also showed that the prevalence rates of anemia were relatively higher in farmers and workers in rural enterprises, and lower in Han ethnicity than minorities. The higher prevalence rates of anemia were presented among the women with less education, lower body mass index, or at older age. CONCLUSION: For those premarital women in 6 counties of Jiangsu and Zhejiang provinces, the overall anemic rate presented a significant downward trend between 1993 and 2003 while the prevalence of anemia remained high, especially for the women with less education, lower body mass index or older ages.
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Anemia/epidemiologia , Adolescente , Adulto , China/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Exames Pré-Nupciais , Adulto JovemRESUMO
OBJECTIVE: To examine the association between pregnancy-induced hypertension (PIH) and small-for-gestational-age babies (SGA) in a Chinese population. METHODS: Subjects were women who delivered a singleton baby (gestational weeks: equal to or greater than 28, and less than 42) in four cities or counties in Jiangsu and Zhejiang provinces, China, during the period of 1995 - 2000. A total number of 93 743 women were included. Incidence of SGA was calculated and compared between women with or without PIH and between groups with different severities of PIH. Multiple logistic regression was used to address the relationship between PIH and SGA while controlling for maternal age, occupation, education, parity, BMI, anemia, premature rupture of membranes and fetal sex. The association between PIH and SGA was also examined according to preterm or term delivery. RESULTS: The incidence of SGA in women with PIH (6.0%) was higher than women without (4.5%), and the incidence increased with severities of PIH. The adjusted relative risk rates (95% CI) of SGA in women with mild,moderate and severe PIH were 1.17 (1.01-1.34), 1.69 (1.33-2.14), and 3.50 (2.57-4.77), respectively, when confounders were controlled for. The risk ratios of SGA in women with PIH among women who delivered a preterm baby were higher than those among women who delivered a term baby. CONCLUSION: There seemed a statistical association between PIH and SGA and women with PIH having higher incidence of SGA than those without PIH.
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Hipertensão Induzida pela Gravidez/fisiopatologia , Recém-Nascido Pequeno para a Idade Gestacional , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Fatores de Risco , Adulto JovemRESUMO
This paper describes a new method for the determination of total flavonoids in Platycladus orientalis (L.) Franco. The method was based on dynamic microwave-assisted extraction (DMAE) coupled with on-line derivatization and ultraviolet-visible (UV-vis) detection. The influence of the experimental conditions was tested. Maximum extraction yield was achieved using 80% aqueous methanol of extraction solvent; 80 W of microwave output power; 5 min of extraction time; 1.0 mL min(-1) of extraction solvent flow rate. The derivatization reaction between aluminium chloride and flavonoid is one of the most sensitive and selective reactions for total flavonoids determination. The optimized derivatization conditions are as follows: derivatization reagent 1.5% aluminium chloride methanol solution; reaction coil length 100 cm; derivatization reagent flow rate 1.5 mL min(-1). The detection and quantification limits obtained are 0.28 and 0.92 mg g(-1), respectively. The intra-day and inter-day precisions (R.S.D.) obtained are 1.5% and 4.6%, respectively. Mean recovery is 98.5%. This method was successfully applied to the determination of total flavonoids in P. orientalis (L.) Franco and compared with heat reflux extraction. The results showed that the higher extraction yield of total flavonoids was obtained by DMAE with shorter extraction time (5 min) and small quantity of extraction solvent (5 mL).
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Cupressaceae/química , Flavonoides/análise , Micro-Ondas , Sistemas On-Line , Espectrofotometria Ultravioleta/métodos , Cloreto de Alumínio , Compostos de Alumínio/química , Cloretos/química , Metanol/química , Estrutura Molecular , Extratos Vegetais/química , Sensibilidade e Especificidade , Soluções/químicaRESUMO
OBJECTIVE: To investigate the association between third trimester hemoglobin (Hb) concentrations and the risk of low birth weight and preterm delivery in a Chinese population. METHODS: Subjects were women who delivered in four cities/counties in Jiangsu and Zhejiang provinces, China, during the period of 1995 - 2000. Incidence of low birth weight and preterm delivery was calculated and compared among groups of women with different levels of Hb during the third trimester. Multiple logistic regression was used to address relationships between Hb levels and the risk of preterm delivery and low birth weight while controlling for potential confounding factors. RESULTS: The overall prevalence of anemia during third trimester of pregnancy was 48.2% , mainly consisting of mild and moderate anemia. Mild and moderate anemia did not increase the risk of preterm delivery and low birth weight statistically. The lowest incidence of preterm delivery and low birth weight was found among pregnant women with Hb levels at 90-99 g/L. The risk for preterm delivery and low birth weight increased with either increasing or decreasing hemoglobin concentrations. However,there was no remarkable elevation of the risk when Hb was in the range of 70-119 g/L. Women with severe anemia (Hb< 70 g/L) had 80% higher risk (95% CI:1.0-3.3) of preterm delivery and a 4.0-fold higher risk (95 % CI :2. 1-7.5) of low birth weight compared with women with an Hb value of 90-99 g/L. In addition, women with a high Hb concentration (Hb> 130 g/L) had 20% higher risk (95 % CI: 1..0-1.4) of preterm delivery and 50 % higher risk (95 % CI: 1.2-1.9) of low birth weight. CONCLUSION: A U-shape relationship was found between Hb concentration and the risk of preterm delivery and low birth weight. Severe anemia and high hemoglobin concentration were both associated with increased risk of preterm deliveries and low birth weight.