Trajectories of antepartum depressive symptoms and birthweight: a multicenter and prospective cohort study.

BACKGROUND: Antepartum depression is a prevalent unhealthy mental health problem worldwide, particularly in low-income countries. It is a major contributor to adverse birth outcomes. Previous studies linking antepartum depression to birthweight have yielded conflicting results, which may be the reason that the depressive symptoms were only measured once during pregnancy. This study aimed to explore the associations between trajectories of antepartum depressive symptoms and birthweight. METHODS: Depressive symptoms were assessed prospectively at each trimester in 3699 pregnant women from 24 hospitals across 15 provinces in China, using the Edinburgh Postpartum Depression Scale (EPDS). Higher scores of EPDS indicated higher levels of depressive symptoms. Associations between trajectories of depressive symptoms and birthweight were examined using group-based trajectory modeling (GBTM), propensity score-based inverse probability of treatment weighting (IPTW), and logistic regression. RESULTS: GBTM identified five trajectories. Compared with the low-stable trajectory of depressive symptoms, only high-stable (OR = 1.35, 95% CI: 1.15-2.52) and moderate-rising (OR = 1.18, 95% CI: 1.12-1.85) had an increased risk of low birthweight (LBW) in the adjusted longitudinal analysis of IPTW. There was no significant increase in the risk of LBW in moderate-stable and high-falling trajectories. However, trajectories of depressive symptoms were not associated with the risk of macrosomia. CONCLUSION: Antepartum depressive symptoms were not constant. Trajectories of depressive symptoms were associated with the risk of LBW. It is important to optimize and implement screening, tracking, and intervention protocols for antepartum depression, especially for high-risk pregnant women, to prevent LBW.

Inhibitory activity of flavonoids fraction from Astragalus membranaceus Fisch. ex Bunge stems and leaves on Bacillus cereus and its separation and purification.

Introduction: Astragalus membranaceus Fisch. ex Bunge is a traditional botanical drug with antibacterial, antioxidant, antiviral, and other biological activities. In the process of industrialization of A. membranaceus, most of the aboveground stems and leaves are discarded without resource utilization except for a small amount of low-value applications such as composting. This study explored the antibacterial activity of A. membranaceus stem and leaf extracts to evaluate its potential as a feed antibiotic substitute. Materials and methods: The antibacterial activity of the flavonoid, saponin, and polysaccharide fractions in A. membranaceus stems and leaves was evaluated by the disk diffusion method. The inhibitory activity of the flavonoid fraction from A. membranaceus stems and leaves on B. cereus was explored from the aspects of the growth curve, cell wall, cell membrane, biofilm, bacterial protein, and virulence factors. On this basis, the flavonoid fraction in A. membranaceus stems and leaves were isolated and purified by column chromatography to determine the main antibacterial components. Results: The flavonoid fraction in A. membranaceus stems and leaves had significant inhibitory activity against B. cereus, and the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were 1.5625 and 6.25 mg/mL, respectively. A. membranaceus stem and leaf flavonoid fraction can induce death of B. cereus in many ways, such as inhibiting growth, destroying cell wall and cell membrane integrity, inhibiting biofilm formation, inhibiting bacterial protein synthesis, and downregulating virulence factor expression. In addition, it was clear that the main flavonoid with antibacterial activity in A. membranaceus stems and leaves was isoliquiritigenin. Molecular docking showed that isoliquiritigenin could form a hydrogen bonding force with FtsZ. Conclusion: A. membranaceus stem and leaf flavonoid fractions had significant inhibitory activity against B. cereus, and the main chemical composition was isoliquiritigenin.

Trajectories of depressive symptoms during pregnancy and risk of premature birth: A multicenter and prospective cohort study.

Previous studies only assessed the association between depressive symptoms and risk of preterm birth (PTB) at a time-point during pregnancy, resulting in inconsistent or contradictory results. Therefore, we aimed to explore the associations between the trajectories of depressive symptoms during pregnancy and risk of PTB. In total, 7732 pregnant women were included in 24 hospitals from 15 provinces of China. The Edinburgh Postpartum Depression Scale (EPDS) was used to evaluate depressive symptoms in the first, second, and third trimesters. Associations between depressive symptoms and risk of PTB were performed by group-based trajectory modeling (GBTM), propensity score-based inverse probability of treatment weighting (IPTW), and logistic regression. GBTM identified five trajectories: compared with persistently low-stable trajectory of depressive symptoms, women with moderate-stable (OR = 1.23, 95% CI: 1.02-1.76), high-falling (OR = 1.35, 95% CI: 1.11-2.21), moderate-rising (OR = 1.38, 95% CI: 1.06-2.04), and high-stable trajectory of depressive symptoms (OR = 1.40, 95% CI: 1.16-3.28) had an increased risk of PTB. In addition, the associations between trajectories of depressive symptoms and risk of PTB were most significant in multiparous women with a history of PTB. There was no difference in the risk of early-moderate PTB among different trajectories of depressive symptoms and only the risk of late PTB was different among different trajectories. In conclusion, the depressive symptoms of pregnant women were not constant during pregnancy, and different trajectories of depressive symptoms were associated with different risks of PTB.

Pre-pregnancy body mass index and risk of maternal or infant complications with gestational diabetes mellitus as a mediator: A multicenter, longitudinal cohort study in China.

AIMS: We explored the complex relationships between pre-pregnancy body mass index (pBMI) and maternal or infant complications and the mediating role of gestational diabetes mellitus (GDM) in these relationships. METHODS: Pregnant women from 24 hospitals in 15 different provinces of China were enrolled in 2017 and followed through 2018. Propensity score-based inverse probability of treatment weighting, logistic regression, restricted cubic spline models, and causal mediation analysis were utilized. In addition, the E-value method was used to evaluate unmeasured confounding factors. RESULTS: A total of 6174 pregnant women were finally included. Compared to women with a normal pBMI, obese women had a higher risk for gestational hypertension (odds ratio [OR] = 5.38, 95% confidence interval [CI]: 3.48-8.34), macrosomia (OR = 2.65, 95% CI: 1.83-3.84), and large for gestational age (OR = 2.05, 95% CI: 1.45-2.88); 4.73% (95% CI: 0.57%-8.88%), 4.61% (95% CI: 0.51%-9.74%), and 5.02% (95% CI: 0.13%-10.18%) of the associations, respectively, were mediated by GDM. Underweight women had a high risk for low birth weight (OR = 1.42, 95% CI: 1.15-2.08) and small for gestational age (OR = 1.62, 95% CI: 1.23-2.11). Dose-response analyses indicated that 21.0 kg/m2 may be the appropriate tipping point pBMI for risk for maternal or infant complications in Chinese women. CONCLUSION: A high or low pBMI is associated with the risk for maternal or infant complications and partly mediated by GDM. A lower pBMI cutoff of 21 kg/m2 may be appropriate for risk for maternal or infant complications in pregnant Chinese women.

Cohort profile: the Chinese Pregnant Women Cohort Study and Offspring Follow-up (CPWCSaOF).

PURPOSE: A multicentre prospective cohort study, known as the Chinese Pregnant Women Cohort Study (CPWCS), was established in 2017 to collect exposure data during pregnancy (except environmental exposure) and analyse the relationship between lifestyle during pregnancy and obstetric outcomes. Data about mothers and their children's life and health as well as children's laboratory testing will be collected during the offspring follow-up of CPWCS, which will enable us to further investigate the longitudinal relationship between exposure in different periods (during pregnancy and childhood) and children's development. PARTICIPANTS: 9193 pregnant women in 24 hospitals in China who were in their first trimester (5-13 weeks gestational age) from 25 July 2017 to 26 November 2018 were included in CPWCS by convenience sampling. Five hospitals in China which participated in CPWCS with good cooperation will be selected as the sample source for the Chinese Pregnant Women Cohort Study (Offspring Follow-up) (CPWCS-OF). FINDINGS TO DATE: Some factors affecting pregnancy outcomes and health problems during pregnancy have been discovered through data analysis. The details are discussed in the 'Findings to date' section. FUTURE PLANS: Infants and children and their mothers who meet the criteria will be enrolled in the study and will be followed up every 2 years. The longitudinal relationship between exposure (questionnaire data, physical examination and biospecimens, medical records, and objective environmental data collected through geographical information system and remote sensing technology) in different periods (during pregnancy and childhood) and children's health (such as sleeping problem, oral health, bowel health and allergy-related health problems) will be analysed. TRAIL REGISTRATION NUMBER: CPWCS was registered with ClinicalTrials.gov on 18 January 2018: NCT03403543. CPWCS-OF was registered with ClinicalTrials.gov on 24 June 2020: NCT04444791.

Association among pre-pregnancy body mass index, gestational weight gain and neonatal birth weight: a prospective cohort study in China.

BACKGROUND: This study aims to explore the relationships between pre-pregnancy body mass index (BMI), gestational weight gain (GWG), rate of GWG during the second and third trimesters (GWGrate) and birth weight among Chinese women. METHODS: Women were enrolled by 24 hospitals in 15 different provinces in mainland China from July 25th, 2017 to 26 November 2018. Pre-pregnancy BMI, GWG and GWGrate were calculated and divided in to different groups. The multinomial logistic regression model and restrictive cubic spline model were used to explore the relationships. RESULTS: Of the 3585 participants, women who were underweight, had insufficient GWG or GWGrate had 1.853-, 1850- or 1.524-fold higher risks for delivering small-for-gestational-age (SGA) infant compared with women who had normal BMI, sufficient GWG or GWGrate. Women who were overweight/obese, had excessive GWG or GWGrate had 1.996-, 1676- or 1.673-fold higher risks for delivering large-for-gestational-age (LGA) infant. The effects of GWG and GWGrate on birth weight varied by pre-pregnancy BMI statuses. Dose-response analysis demonstrated L-shaped and S-shaped relationships between pre-pregnancy BMI, GWG, GWGrate and neonatal birth weight. CONCLUSIONS: Pre-pregnancy BMI, GWG or GWGrate were associated with neonatal birth weight among Chinese women. Both body weight before and during pregnancy should be maintained within the recommendations to prevent abnormal birth weight.

Dietary patterns in relation to gestational depression and sleep disturbance in Chinese pregnant women.

AIM: To investigate the association of dietary patterns with gestational depression and sleep disturbance. METHODS: Women in early pregnancy were recruited from the Chinese Pregnant Women Cohort Study (CPWCS) through July 25th, 2017 to November 26th, 2018, and eventually 7615 participants were included in this study. The qualitative food frequency questionnaire (Q-FFQ), Edinburgh Postnatal Depression Scale (EPDS), and the Pittsburgh Sleep Quality Index (PSQI) were used to assess dietary, depression and sleep quality during pregnancy, respectively. Dietary patterns were derived by factor analysis. Logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (95% CI) of each outcome according to quartiles of each dietary pattern. RESULTS: Five dietary patterns were identified. Participants with the highest quartile in plant-based pattern had a significantly lower likelihood of mental problems (OR: 95% CI for depression: 0.66, 0.55-0.79; sleep disturbance: 0.80, 0.68-0.93); Similar results were observed in vitamin-rich pattern (OR: 95% CI for depression: 0.46, 0.38-0.55; sleep disturbance: 0.76, 0.65-0.89); However, contrary results were found in high-fat pattern (OR: 95% CI for depression: 2.15, 1.25-1.85; sleep disturbance: 1.43, 1.22-1.67); In animal protein-rich pattern, participants with the highest quartile had a decreased likelihood of depression (OR: 0.80, 95% CI: 0.67-0.96). As for bean products pattern, participants with the highest quartile had an increased risk of depression (OR: 1.28, 95% CI:1.06-1.53). Interactions of dietary patterns and lifestyles on mental disorders were observed. CONCLUSION: Dietary patterns were associated with gestational depression and sleep disturbance. Relevant departments and maternal and child health personnel should conduct health education for pregnant women and guide them to eat properly.

Main Traits of Breast Fibroadenoma Among Adolescent Girls.

Objective: To investigate the clinicopathological features of breast fibroadenoma among female teenagers and provide some bases for its diagnosis and treatment, the authors conducted this study. Methods: Retrospective analysis on 80 female teenagers with fibroadenoma was carried out. The histological sections of H&E were reviewed, and immunohistochemical staining with ki67, CD34, and SMA were performed. The patients were followed up. Results: The age of included patients ranged from 12 to 18 years old, with a mean age of 17. Bilateral lesions occurred in 10% of the patients, and mean tumor diameter was 2.8 cm. Histologically, tumors in most cases showed clear boundary with no capsule. Also, 90% of the cases were confirmed to be pericanalicular mixed types, while about 20% had atypical foliation structure. The mean density of mesenchymal cells was 30%. The upper limit of mitotic figure was 2/10HPF in 80% of the cases, and the positive index of ki-67 was no more than 5% in 80% of cases. Sixteen percent of the cases also simultaneously suffered epithelial micropapillary hyperplasia. Six cases (6/39, 15%) faced relapse after tumor resection, with an average recurrence interval of 4.9 years after surgery. Tumor size, mitotic activity, ki67 positive index, and the density of mesenchymal cells were not associated with relapse. Conclusions: Adolescent fibroadenoma is a group of biphasic breast tumors with unique clinical and pathological features. Although fibroadenoma shows a local recurrence rate to a certain degree, its recurrent lesions grow slowly.

[Clinical analysis of uterine rupture during pregnancy].

OBJECTIVE: To explore the clinical characteristics of pregnant uterine rupture, enhance its early diagnosis rate and improve its prognosis. METHODS: For this retrospective study, a total of 55 143 delivery cases at Tongzhou District Maternal & Child Health Hospital from January 1, 2003 to May 31, 2012 was analyzed. There were 2490 cases of scarred uterus and 68 cases had uterine rupture. And 62 of them belonged to scarred uterus rupture. And there were 52 653 cases of non-scarred uterus childbirth and 6 of them had rupture. RESULTS: Significant differences existed in the rupture of scarred versus non-scarred uterus and maternal versus primipara women. Uterus rupture usually occurred at the incomplete rupture position of original surgical scar at 39 weeks or more. The scar thickness of lower uterine segment was ≤ 3 mm on ultrasound. Three cases with laparoscopic myoma removal within 1 year had complete rupture at 36-38 weeks. Postpartum hemorrhage incidence was 42.65%. There were two cases of hysterectomy and 11 cases of neonatal asphyxia. CONCLUSION: For second pregnancy of cesarean section, pregnancy should be terminated before 39 weeks if scar thickness of lower uterine segment is ≤ 3 mm. Late rupture is to be monitored closely for those with laparoscopic myoma removal within 1 year. Meanwhile, we should strengthen the management of migrant and unemployed women.