Associations of maternal serum concentration of iron-related indicators with birth outcomes in Chinese: a pilot prospective cohort study.

BACKGROUND: Previous studies of maternal iron and birth outcomes have been limited to single indicators that do not reflect the comprehensive relationship with birth outcomes. We aimed to investigate the relationship between maternal iron metabolism and neonatal anthropometric indicators using comprehensive iron-related indicators. METHODS: A total of 914 Chinese mother-child dyads were enrolled in this prospective study. Subjects' blood samples were collected at ≤ 14 weeks of gestation. Serum concentrations of iron-related indicators were measured by enzyme-linked immunosorbent assay (ELISA). Femur length was measured by B-ultrasound nearest delivery. Neonatal anthropometric indicators were collected from medical records. RESULTS: After adjustment for potential covariates, higher iron (per one standard deviation, SD increase) was detrimentally associated with - 0.22 mm lower femur length, whereas higher transferrin (per one SD increase) was associated with 0.20 mm higher femur length. Compared with normal subjects (10th-90th percentiles), subjects with extremely high (> 90th percentile) iron concentration were detrimentally associated with lower femur length, birth weight, and chest circumference, and a higher risk of low birth weight, LBW (HR: 3.92, 95%CI: 1.28, 12.0). Subjects with high concentration of soluble transferrin receptor, sTFR and transferrin (> 90th percentile) were associated with higher femur length. Subjects with low concentration of iron and ferritin concentrations (< 10th percentile) were associated with a higher risk of LBW (HR: 4.10, 95%CI: 1.17, 14.3) and macrosomia (HR: 2.79, 95%CI: 1.06, 7.35), respectively. CONCLUSIONS: Maternal iron overload in early pregnancy may be detrimentally associated with neonatal anthropometric indicators and adverse birth outcomes.

Associations of early pregnancy serum uric acid levels with risk of gestational diabetes and birth outcomes: a retrospective cohort study.

BACKGROUND: Previous evidence suggests that higher blood uric acid (UA) levels are associated with adverse cardiovascular outcomes during pregnancy and subsequent birth outcomes. However, it has been relatively unclear whether these associations persist in normotensive pregnant women. METHODS: The study was based on a retrospective analysis of 18,250 mother-infant pairs in a large obstetric center in China. Serum UA concentrations in early pregnancy (median: 17.6, IQR: 16.3, 18.6 gestational weeks) were assessed. Hyperuricemia was defined as ≥ one standard deviation (SD) of the reference value for the corresponding gestational age. Outcomes of gestational diabetes mellitus (GDM), preterm birth (PB), low birth weight (LBW), macrosomia, small for gestational age (SGA) and large for gestational age (LGA) were extracted from the medical records. RESULTS: The mean maternal UA level was 0.22 ± 0.05 mmol/L, and 2,896 (15.9%) subjects had hyperuricemia. After adjustment for several covariates, UA was associated with several adverse outcomes. The ORs (95%CI) per one SD increase in serum UA concentration were 1.250 (1.136, 1.277) for GDM, 1.137 (1.060, 1.221) for PB, 1.134 (1.051, 1.223) for LBW, and 1.077 (1.020, 1.137) for SGA, respectively. Similar adverse associations were found between hyperuricemia and GDM, PB (ORs: 1.394 and 1.385, P < 0.001), but not for LBW, macrosomia, SGA, and LGA. Adverse associations tended to be more pronounced in subjects with higher BMI for outcomes including PB, LBW, and SGA (P interaction = 0.001-0.028). CONCLUSION: Higher UA levels in early pregnancy were associated with higher risk of GDM, PB, LBW, and SGA in normotensive Chinese women.

Associations of serum concentrations of metal nutrients with postpartum anemia among pregnant Chinese women: A large retrospective cohort study.

Background and Aims: The association between serum concentrations of metal nutrients in pregnancy and postpartum anemia has not been widely studied. This study aimed to determine this association in a large retrospective cohort study. Methods: We included 14,829 Chinese women with singleton pregnancies. Serum concentrations of metals before 28 weeks of gestation, the occurrence of postpartum anemia and other potential covariates were obtained from their laboratory or medical records. Cox regression and restricted cubic spline regression models were used to explore the relationship between serum concentrations of metal nutrients in pregnancy and postpartum anemia. Results: After adjustment for covariates, higher concentrations of iron (Fe), magnesium (Mg) and zinc (Zn) and lower concentrations of copper (Cu) were associated with a lower risk of postpartum anemia. Compared with those whose serum concentrations of metal nutrients were in the bottom quintile (Q1), the hazard ratios (HRs) of those whose serum concentrations of metal nutrients were in the top quintile (Q5) were 0.57 (95% confidence interval (CI): 0.50, 0.64) for Fe, 0.67 (95% CI: 0.60, 0.76) for Mg, 0.82 (95% CI: 0.73, 0.93) for Zn, and 1.44 (95% CI: 1.28, 1.63) for Cu. L-shaped curve relationships were found between increasing concentrations of Fe, Mg, and Zn and incidence of postpartum anemia. Higher serum concentrations of Cu were associated with an increased risk of postpartum anemia. Serum concentrations of Fe in Q5 were associated with a lower risk of postpartum anemia when they coincided with serum concentrations of Mg in Q5, Zn in Q5, or Cu in Q1. Conclusion: Higher serum concentrations of Fe, Mg, and Zn, and lower serum concentrations of Cu were associated with a lower risk of postpartum anemia among pregnant women.

Relationship between family cohesion/adaptability and postpartum depressive symptoms: A single-center retrospective study.

BACKGROUND: Depression is the most common mental illness in postpartum mothers, and the etiology of postpartum depression remains poorly understood. Over the past several decades, studies have reported that postpartum depression is caused by multiple factors, such as genetic, psychological, pregnancy, and environmental factors, with the family environment being an important environmental factor. The theory of family cohesion and adaptability put forward by Olson is a classic model that describes the level of family function. However, to date, this model has not been examined regarding its applicability to patients with postpartum depression. AIM: To investigate the relationship between family cohesion and adaptability and the risk of postpartum depressive symptoms. METHODS: We retrospectively analyzed 1446 patients admitted to the postpartum healthcare clinic of the Affiliated Foshan Maternity and Child Healthcare Hospital from April 2021 to December 2021. Patients were grouped according to whether postpartum depression symptoms were reported (symptoms, n = 454; no symptoms, n = 992). All patients completed the Edinburgh Postpartum Depression Scale and the Chinese version of the Family Cohesion and Adapt-ability Assessment Scale II. Baseline and clinical data were compared between groups. Univariate regression analysis was used to investigate the association between different types of family cohesion and postpartum depressive symptoms and the association between different family adaptability types and postpartum depressive symptoms. RESULTS: After adjusting for age, education, occupation, gravidity, parity, and mode of delivery, disengaged [adjusted odds ratio (AOR) = 3.36, 95%CI: 1.91-5.91], and separated (AOR = 1.97, 95%CI: 1.34-2.90) family cohesion types showed a higher risk of postpartum depression than the connection type, whereas the enmeshed type (AOR = 0.38, 95%CI: 0.28-0.51) protected against postpartum depressive symptoms. Rigid (AOR = 4.41, 95%CI: 3.02-6.43) and structured families (AOR = 1.88, 95%CI: 1.34-2.63) had a higher risk of postpartum depressive symptoms than flexible families, whereas chaotic families (AOR = 0.35, 95%CI: 0.24-0.51) protected against postpartum depressive symptoms. CONCLUSION: Family cohesion and adaptability are influencing factors for postpartum depressive symptoms, with higher family cohesion and adaptability being associated with a lower risk of postpartum depressive symptoms.

Associations between thyroid function and gestational diabetes mellitus in Chinese pregnant women: a retrospective cohort study.

BACKGROUND: Thyroid function is known to be closely linked with type 2 diabetes, but data on the association between thyroid function and gestational diabetes mellitus (GDM) are inconsistent. METHODS: A total of 2849 pregnant women were included in this retrospective study. Serum concentrations of thyroid indicators (free tetraiodothyronine, FT4; thyroid-stimulating hormone, TSH; and thyroid peroxidase antibody, TPO Ab) were obtained from a clinical laboratory. The presence of GDM were drawn from medical records. The clinical subtypes of thyroid function (euthyroidism, subclinical hypothyroidism, hyperthyroidism, and isolated hypothyroxinemia) were categorized according to the thresholds of the 2.5th/97.5th and 10th/90th percentiles of TSH and FT4 concentrations. A concentration of > 34 IU/L was defined as indicating TPO Ab-positivity. RESULTS: Two hundred and thirty-five (8.25%) of the 2849 women were TPO Ab-positive. Higher serum concentrations of FT4 (top vs. bottom tertiles) was found to be negatively associated with the risk of GDM. The corresponding odds (OR) values (top tertile vs. bottom tertile) were 0.71 [95% confidence interval (CI): 0.54, 0.93]. No significant associations were observed between the extremely 2.5th/97.5th or 10th/90th percentiles of FT4 concentration, TSH concentration, thyroid function subtypes (vs. euthyroidism), TPO Ab-positivity (vs. -negativity), and the GDM risk. The corresponding results remained similar when TPO Ab-positive subjects were excluded. CONCLUSIONS: A negative association with the risk of GDM was observed for the highest FT4 concentrations tertile. No significant associations were found between the TSH concentration, thyroid function subtypes, TPO Ab positivity, and the GDM risk.

Early pregnancy vitamin D and the risk of adverse maternal and infant outcomes: a retrospective cohort study.

BACKGROUND: Previous evidence has suggested that lower gestational vitamin D levels might increase the risks of adverse pregnancy and birth outcomes. The results remain inconsistent and require further exploration. METHODS: A total of 2814 Chinese mother-infant pairs were included in this retrospective cohort study. Serum concentrations of 25(OH)D were reviewed in early pregnancy (16.3 ± 2.3 weeks). Outcomes of maternal gestational diabetes mellitus (GDM), cesarean section, fetal distress, preterm birth, low birth weight (LBW), and macrosomia were extracted from the medical records. Cox regression analysis was used to explore these associations. RESULTS: In total, 19.3% of mothers were pregnant at an advanced age (≥35 years), and 40.3% of pregnant women had vitamin D deficiency (< 50 nmol/L). After adjusting for potential covariates, the hazard ratio (HR) (95% CI) per standard deviation (SD) increase of serum 25(OH)D concentrations was 0.86 (0.779, 0.951) for GDM, 0.844 (0.730, 0.976) for preterm birth, and 0.849 (0.726, 0.993) for LBW. Similar protective associations were found for GDM, cesarean section, and preterm birth for a better vitamin D status when compared with vitamin D deficiency. CONCLUSION: Higher early pregnancy vitamin D was associated with a lower risk of GDM, cesarean section, preterm birth, and LBW.

Associations Between Maternal Thyroid Function and Birth Outcomes in Chinese Mother-Child Dyads: A Retrospective Cohort Study.

Objective: Although research suggests a close association between maternal thyroid function and birth outcomes, no clear conclusion has been reached. We aimed to explore this potential association in a retrospective cohort study. Methods: This study included 8985 mother-child dyads. The maternal serum free tetraiodothyronine (FT4), thyroid-stimulating hormone (TSH), and thyroid peroxidase antibody (TPO Ab) concentrations and birth outcome data were reviewed from medical records. Subjects with TPO Ab concentrations of >34 and ≤34 IU/ml were classified into the TPO Ab positivity (+) and TPO Ab negativity (-) groups, respectively. Results: Compared with subjects in the normal group (0.1 ≤ TSH < 2.5 mIU/L and TPO Ab-), those with TSH concentrations of 2.5-4.0 mIU/L and TPO Ab- had a 0.65-fold lower risk of low birth weight (LBW). In contrast, those with TSH concentrations of >4.0 mIU/L, regardless of the TPO Ab status, had a 2.01-fold increased risk of LBW. Subclinical hypothyroidism, regardless of the TPO Ab status, was associated with a 1.94-fold higher risk of LBW when compared with that in subjects with euthyroidism and TPO Ab-. No other significant associations were observed. Conclusion: A maternal TSH concentration of 2.5-4.0 mIU/L was associated with a lower risk of LBW when combined with TPO Ab-, whereas subjects with a TSH concentration of >4.0 mIU/L had an increased risk of LBW. Subclinical hypothyroidism appears to be associated with a higher risk of LBW.

[Effect of ROUX-en-Y anastomosis and Billroth-II anastomosis after subtotal gastrectomy on blood glucose in type 2 diabetic patients].

OBJECTIVE: To evaluate the effect of ROUX-en-Y anastomosis and Billroth-II anastomosis after subtotal gastrectomy on blood glucose in patients with type 2 diabetes. METHODS: From January 2006 to December 2009, 26 and 24 type 2 diabetic patients underwent subtotal gastrectomy for gastric cancer or gastric ulcer and received subsequent ROUX-en-Y anastomosis and Billroth-II anastomosis, respectively. Perioperative and postoperative blood glucose and glycosylated hemoglobin (HbA1c) were detected in these patients to identify the variations. RESULTS: In ROUX-en-Y group, the fasting blood glucose (FBG) of the patients decreased significantly in the first month after the operation (t=4.46, P<0.05), and the 2-hour postprandial glucose (2hPG) and HbA1c also underwent significant reductions in the first postoperative week and month, respectively (t=3.5, P<0.05; t=2.21, P<0.05). In Billroth-II group, the FBG decreased significantly till 6 months after the operation (t=2.0, P<0.05), and HbA1c reduction occurred 3 months after the operation (t=2.61, P<0.05). There were significant differences in FBG in the first postoperative month, 2hPG in the 6th month, and HbA1c in the 3rd month between the two groups (P<0.05). CONCLUSION: The ROUX-en-Y anastomosis and Billroth-II anastomosis after subtotal gastrectomy can both reduce blood glucose of type 2 diabetic patients, but the former approach has better effect.