ABSTRACT
Maternal obesity is associated with an increased risk of a range of congenital malformations in offspring, including neurological malformations, congenital heart disease, congenital kidney and urinary system abnormalities, cleft lip and palate, anorectal atresia, etc. This may be related to existing metabolic abnormalities, including increased insulin resistance, chronic inflammation, and oxidative stress caused by excessive accumulation of fat, as well as the relative deficiency of nutrients such as folic acid in obese pregnant women. Therefore, it is recommended that obese women have a planned pregnancy, address folate and micronutrient supplementation and optimize their health status prior to conception.
ABSTRACT
Overweight or obese women have a significantly increased risk of gestational diabetes mellitus (GDM). With the increasing prevalence of obesity among women of reproductive age, the prevalence of GDM has also risen. The prevention of GDM during pregnancy is particularly important in reducing the adverse pregnancy outcomes for both mothers and their offspring and decreasing the economic burden of the society. Lifestyle interventions (exercises, dietary), dietary supplementation, and pharmacological approaches are the main preventive measures. Exercise intervention and myo-inositol supplementation are effective in preventing GDM; dietary intervention and combined lifestyle intervention have some benefits, but the results remain controversial; probiotic supplementation and prophylactic use of metformin seem to be ineffective; the effectiveness of vitamin D supplementation is unclear.
ABSTRACT
Objective To investigate the incidence and major risk factors of preterm birth in urban hospitals in China so as to provide evidence for effective interventions to reduce preterm birth.Methods Postpartum women delivered between 22 and 37 weeks of gestation were selected from 15 urban hospitals in Beijing,and Guangdong,Hu'nan,Hubei,Sichuan and Shaan'xi Province.Between April 2012 and March 2013,data of 10 days were collected every 3 months.Questionnaire was obtained under informed consent from 9 143 cases,including 958 cases of preterm birth and 8 185 cases of term birth.Demographics,history of pregnancy,prenatal care,and incidences of complication and/or comorbidities,lifestyle and dietary habit during pregnancy were included in the questionnaire.Chi-square test for univariate analysis and logistic regression multivariate analysis were used for statistics.Results The incidence ofpreterm birth was 9.9％(10 986/111 095) in the 15 hospitals.Among the 958 preterm birth cases,2.3％(22/958) were in gestational weeks ＜28,22.7％(217/958) in ≥ 28-＜34 gestational weeks,and 75.1％(719/958) in ≥ 34-＜37 gestational weeks.Univariate analysis showed that the influencing factors related to preterm birth included(preterm birth groups vs term birth group):maternal age ＞40 years or ＜18 years[1.6％(15/958) vs 1.2％(100/8 185),0.6％(6/958) vs 0.1％(7/8 185),22=18.515,P=0.000],ethnic Han [97.7％(919/941) vs 96.3％(7 811/8 115),22=4.819,P=0.028],less educated (lower than junior middle school) [27.1％(257/950) vs 14.9％(1 215/8 132),22=91.879,P=0.000],unmarried status[2.8％(27/955) vs 1.3％(110/8 154),22=12.609,P=0.000],family income ＜5 000 yuan(RMB)/ month [40.5％(380/939) vs 30.8％(2 479/8 060),22=40.457,P=0.000],being preterm born [14.2％(134/942) vs 2.6％(211/8 099),22=349.801,P=0.000],adverse obstetric history [12.9％(72/958) vs 8.5％(346/8 185),22=12.009,P=0.001],previous preterm delivery [50.0％(36/72) vs 17.1％(59/346),x2=36.840,P=0.000],fetal malformation history[4.2％(3/72) vs 18.8％(65/346),22=9.351,P=0.002],reproductive technology assisted conception [7.7％(72/930) vs 2.1％(172/8 037),x22=98.816,P=0.000],antenatal visits ＜5 times [21.0％(195/930) vs 12.0％(966/8 037),22=68.634,P=0.000],second hand smoking [24.5％(235/958) vs 19.6％(1 603/8 185),x2=13.573,P=0.000],unpleasant events during pregnancy [27.6％(264/958) vs 22.0％(1 802/8 185),x2=15.213,P=0.000],folic acid supplementation before and during pregnancy [before pregnancy:39.1％(375/958) vs 49.0％(4 007/8 185);during pregnancy:61.2％(586/958) vs 67.0％(5 485/8 185),x2=31.842,11.667,P=0.000,0.001],multivitamin supplementation during pregnancy [43.4％(416/958) vs 48.1％(3 937/8 185),x2=7.393,P=0.007],and pregnant complications,including anemia,premature rupture of membranes,intrauterine infection,pregnancy complication heart diseases,oligohydramnios,placental abruption,placental previa,fetal distress,multiple gestation,etc [59.9％(574/958) vs 38.9％(3 184/8 185),x2=156.47l,P=0.000].Logistic regression multivariate analysis showed that the following factors were significantly associated with preterm birth:antenatal visits ＜5 times (OR=1.916,95％CI:1.060-3.462),intrauterine infection (OR=5.441,95％CI:1.723-17.176),severe preeclampsia during pregnancy (OR=11.220,95％CI:1.041-2.149),premature rupture of membranes (OR=3.188,95％CI:1.916-5.305) and placenta previa (OR=6.607,95％CI:2.919-14.801).Conclusions There are multiple factors for preterm birth in urban hospitals in east-northern part of China,and quality of antenatal care should be improved and pregnant complications should be closely monitored and managed timely.
ABSTRACT
Objective To study the effect of 1,25-dihydroxyvitamin D3 on bone metabolism in diabetic rats and the related molecular mechanism.Methods A total of 45 healthy 6-8 weeks old male Sprague Dawley (SD) rats were treated with streptozotocin.The streptozotocin-induced diabetic rats were randomly assigned to diabetic group (DM),low dose vitamin D treated group(LD),and high dose vitamin D treated group(HD).Another 12 healthy SD rats were used as normol control group(NC).The rats in NC group and DM group were fed with 0.05 ml/d nut oil;those in the LD group and HD group were fed respectively with 0.03 and0.10 μg · kg-1 · d-1 1,25-dihydroxyvitamin D3 dissolved in 0.05 ml nut oil.12 weeks later,serum calcium,phosphorus,osteocalcin,type Ⅰ collagen cross-linked telopeptide (NTX),and 24 h urinary calcium were determined.Right femurs were harvested for pathohistological analysis by hematoxylin-eosin (HE) staining.Expressions of osteoprotegerin,receptor activator nuclear factor κB ligand (RANKL),core binding factor α1(Cbfa1) were detected by immunohistochemical staining.The osteoprotegerin,RANKL,Cbfa1,osteocalcin mRNA levels of bone tissue were performed by realtime quantitative reverse transcription polymerase chain reaction assay.Results (1) Compared with the NC group,serum calcium and 24 h urinary calcium in LD and HD groups were significantly higher (P＜0.05) ; 24 h urinary calcium in DM group was significantly higher than that in NC group (P ＜ 0.05).(2) Serum osteocalcin level in DM and LD groups was significantly lower than that in NC group (P＜0.05) ; there was no significant difference between the serum NTX levels of all groups (P＞0.05).(3) There was no significant difference in the mRNA expression of Cbfa1 in all groups (P＞0.05).The mRNA expression of osteocalcin in DM group was significantly lower than that in NC group (P ＜0.05).The mRNA expression of RANKL in DM group was significantly lower than that in NC group (P＜0.05) ; and that in LD and HD group was significantly higher than that in DM group (P＜0.05),and that in HD group was significantly higher than that in LD group (P＜0.05).The mRNA expression of osteoprotegerin in DM group was significantly lower than that in NC group (P＜0.05).The ratio of RANKL to osteoprotegerin in HD group was significantly higher than that in DM group (P＜0.05).Conclusions Vitamin D may promote bone metabolism in diabetic rats by up-regulating the expressions of osteocalcin and RANKL or in addition to other means.