Retracted and republished from: "The current state of research on influenza antiviral drug development: drugs in clinical trial and licensed drugs".

Influenza viruses (IVs) threaten global human health due to the high morbidity, infection, and mortality rates. Currently, the influenza drugs recommended by the Food and Drug Administration are oseltamivir, zanamivir, peramivir, and baloxavir marboxil. These recommended antivirals are currently effective for major subtypes of IVs as the compounds target conserved domains in neuraminidase or polymerase acidic (PA) protein. However, this trend may gradually change due to the selection of antiviral drugs and the natural evolution of IVs. Therefore, there is an urgent need to develop drugs related to the treatment of influenza to deal with the next pandemic. Here, we summarized the cutting-edge research in mechanism of action, inhibitory activity, and clinical efficacy of drugs that have been approved and drugs that are still in clinical trials for influenza treatment. We hope this review will provide up-to-date and comprehensive information on influenza antivirals and generate hypotheses for screens and development of new broad-spectrum influenza drugs in the near future.

Tailored Out-of-Oven Energy Efficient Manufacturing of High-Performance Composites with Two-Stage Self-Regulating Heating via a Double Positive Temperature Coefficient Effect.

The needs for sustainable development and energy efficient manufacturing are crucial in the development of future composite materials. Out-of-oven (OoO) curing of fiber-reinforced composites based on smart conductive polymers reduces energy consumption and self-regulates the heating temperature with enhanced safety in manufacturing, presenting an excellent example of such energy efficient approaches. However, achieving the desired curing processes, especially for high-performance systems where two-stage curing is often required, remains a great challenge. In this study, a ternary system consisting of graphene nanoplatelets/HDPE/PVDF was developed, with a double positive temperature coefficient (PTC) effect achieved to fulfill stable self-regulating heating at two temperatures (120 and 150 °C). Systematic studies on both single and double PTC effects were performed, with morphological analysis to understand their pyroresistive behaviors. Compared to the oven curing process, up to 97% reduction in the energy consumption was achieved by the ternary system, while comparable thermal and mechanical properties were obtained in the carbon fiber/epoxy laminates. This work presents a new route to achieve OoO curing with two-stage self-regulating heating, which can be utilized in many high-performance composite applications.

Factors affecting social phobia among Chinese college students in the context of COVID-19 pandemic: a cross-sectional study.

Social phobia (SP) refers to excessive anxiety about social interactions. College students, with their exposure to academic, familial, and job-related pressures, are an ideal population for early screening and intervention of social phobia. Additionally, COVID-19 prevention measures including keeping social distance may further impact social phobia. This study aims to investigate the influencing factors of social phobia among Chinese college students and to tentatively explore the impact of COVID-19 prevention measures on social phobia. Respondents were recruited through Chinese Internet social platforms for an online survey. College students' social phobia scores in pre- and early-COVID-19 periods were measured using Peters' short form of the Social Interaction Anxiety Scale and Social Phobia Scale (SIAS-6/SPS-6). Demographic information, family information, social relations, self-evaluation, and subjective feelings regarding the impact of COVID-19 preventive measures on social phobia were collected. A multivariable logistic regression model was used to analyze the influencing factors. A total of 1859 valid questionnaires were collected, revealing that the social phobia scores increased from 12.3 ± 11.9 to 13.4 ± 11.9 between pre- and early-COVID-19 periods, with an increase of 1.0 ± 6.4 (p < 0.001). Low GPA rank, mobile phone dependence, distant family relationships, indulgent parents, childhood adversity, and childhood bullying were risk factors for social phobia among Chinese college students. Female gender, being a senior university student or postgraduate, satisfaction with physical appearance, self-reported good mental health and high level of interpersonal trust were protective factors for social phobia. Although most respondents believed that COVID-19 prevention measures (e.g., mask wearing and social distancing rules) reduced their social phobia, these measures were not significantly associated with social phobia levels in the multivariable analyses. In conclusion, Chinese college students' social phobia was widely influenced by diverse factors and warrants increased attention, with early intervention aimed at high-risk individuals being crucial for their mental health. Additional research is necessary to understand the impact of COVID-19 preventive measures on social phobia among college students.

Photoelectrocatalytic modification of nanofiltration membranes with SrF2/Ti3C2Tx to simultaneously enhance heavy metal ions rejection and permeability.

Heavy metal pollution can significantly harm water systems and human health. Combining photoelectrocatalytic (PEC) and nanofiltration (NF) membrane separation technologies can effectively remove heavy metal ions from wastewater. In this study, a water bath method was used to form SrF2/Ti3C2Tx (ST) nanoparticles on the surface of polyvinylidene fluoride (PVDF) membranes and an additional polyamide (PA) functional layer was formed at the interface by crosslinking. ST@PA composite NF membranes (STPP) with good photocatalytic performance were obtained. The separation and catalytic properties of the STPP membranes were controlled by the ST content, which modifies the surface structure and properties of the membranes. The membrane with optimal ST crosslinking exhibited a water contact angle of 50.8°, pure water flux of 24.6 L·m-2·h-1·bar-1, and rejection rates of Mn2+, Ni2+, Cu2+, and Zn2+ of 98.8%, 95.3%, 95.7%, and 97.3%, respectively, under PEC-assisted separation with visible light illumination from a Xe lamp (300 W) and an applied voltage (2 V). The STPP membranes showed improved rejection rates of heavy metal ions under PEC-assisted operation. The mechanism for the improved membrane performance under PEC conditions was preliminarily clarified considering the relationship between the photocatalytic and filtration properties of STPP membranes along with the influence of light irradiation and an external voltage on the heavy metal ions. The generation of electrons, holes, superoxide radicals, and hydroxyl radicals during membrane operation enhances the rejection rates of heavy metal ions. Based on these results, STPP membranes are considered a promising technology for industrial applications in heavy metal removal.

The current state of research on influenza antiviral drug development: drugs in clinical trial and licensed drugs.

Influenza viruses (IVs) threaten global human health due to the high morbidity, infection, and mortality rates. Currently, the influenza drugs recommended by the FDA are oseltamivir, zanamivir, peramivir, and baloxavir marboxil. Notably, owing to the high variability of IVs, no drug exists that can effectively treat all types and subtypes of IVs. Moreover, the current trend of drug resistance is likely to continue as the viral genome is constantly mutating. Therefore, there is an urgent need to develop drugs related to the treatment of influenza to deal with the next pandemic. Here, we summarized the cutting-edge research in mechanism of action, inhibitory activity, and clinical efficacy of drugs that have been approved and drugs that are still in clinical trials for influenza treatment. We hope this review will provide up-to-date and comprehensive information on influenza antivirals and generate hypotheses for screens and development of new broad-spectrum influenza drugs in the near future.

Preparation and application of cinnamon-Litsea cubeba compound essential oil microcapsules for peanut kernel postharvest storage.

This research developed a novel, efficient and safe antimildew for peanut kernel postharvest storage. The antimildew, cinnamon-Litsea cubeba compound essential oil (CLCEO) microcapsule (CLCEOM), was synthesized with CLCEO as core materials and ß-cyclodextrin as wall materials. Fourier transform infrared spectroscopy and gas chromatography-mass spectrometry analyses indicated that major antifungal compounds of CLCEO were encapsulated in the cavity of ß-cyclodextrin. The inhibition zone experiment showed that CLCEOM retained antifungal effect on Aspergillus spp. strains even after storage for 2 months at 4 â„ƒ. Besides, CLCEOM reduced total number of fungal colonies, relative abundance of Aspergillus spp., and aflatoxin B1 content of peanut kernels, and had positive effect on slowing down the increase in acid value of peanut oil without causing any adverse effect on the viability and sensory properties during storage process. Overall, CLCEOM presented good preservative effects on peanut kernels, providing evidence for its potential use as antimildew for peanut storage.

Regulated synthesis of Zr-metal-organic frameworks with variable hole size and its influence on the performance of novel MOF-based heterogeneous amino acid-thiourea catalysts.

We present an efficient and easy synthesis method for incorporating organocatalytic moieties into Zr-metal organic frameworks (Zr-MOFs). The catalytic activity and selectivity of the new chiral catalysts were improved by adjusting the aperture of the MOF cavities. The hole size of the Zr-MOF was modulated by adding acid and replacing bridge ligands during synthesis. The difunctional chiral units of amino acid-thiourea are anchored onto the Zr-MOF by a mild synthesis method from an isothiocyanate intermediate which could effectively avoid the racemization of chiral moieties in the synthesis process. By means of specific surface area measurement (BET), scanning electron microscopy (SEM) and powder X-ray Diffraction (PXRD), it was confirmed that Zr-MOFs with different pore sizes were synthesized without breaking the basic octahedral structure of the MOF. Finally, good yields (up to 83%) and ee values (up to 73%) were achieved with the new heterogeneous catalysts in 48 hours for the aldol reaction of 4-nitrobenzaldehyde with acetone. By contrast, using the catalyst support without modulating the synthesis, the yield (30%) and the ee-value (26%) were both low. Experiments have confirmed the important influence on the reaction selectivity of providing a suitable reaction environment by controlling the aperture of MOF cavities.

The Antifungal Activity of Cinnamon-Litsea Combined Essential Oil against Dominant Fungal Strains of Moldy Peanut Kernels.

The antifungal activity of cinnamon (Cinnamomum cassia Presl), litsea [Litsea cubeba (Lour.) Pers.], clove (Syzygium aromaticum L.), thyme (Thymus mongolicus Ronn.) and citronella (Cymbopogon winterianus Jowitt) essential oils (EOs) against the dominant fungi isolated from moldy peanuts was investigated in this research. Firstly, strain YQM was isolated and identified by morphological characterization and 18S rRNA gene sequence analysis to be Aspergillus flavus (A. flavus). Next, antifungal effects of single or mixed EOs on strain YQM were evaluated by the inhibition zone test. The cinnamon-litsea combined essential oil (CLCEO, Vcinnamon oil:Vlitsea oil = 3:5) displayed the best antifungal effect on strain YQM. The chemical composition of CLCEO was identified and quantified by gas chromatograph-mass spectrometry (GC-MS), and results revealed that the major components of CLCEO were cinnamaldehyde and citral. Finally, the effect of EOs on the microstructure of strain YQM mycelia was observed under scanning electron microscope (SEM). The mycelia exposed to cinnamon essential oil (CEO) and litsea essential oil (LEO) were partly deformed and collapsed, while the mycelia treated with CLCEO were seriously damaged and the deformation phenomena such as shrinking, shriveling and sinking occurred. Therefore, CLCEO has great potential for using as anti-mildew agents during peanut storage.

Impact of COVID-19 Vaccination Status and Confidence on Dietary Practices among Chinese Residents.

Healthy diets promote immune functions and have been shown to reduce COVID-19 severity. In 2021, COVID-19 vaccines have become available to the general public. However, whether vaccination status could affect individual and populational health behaviors is unknown. This study aimed to investigate the impacts of vaccination status and confidence on dietary practices. An online survey was conducted in August 2021. We collected data on dietary intake, diversity and behaviors, vaccination status and confidence and socio-demographic characteristics. Among the 5107 responses received, a total of 4873 study participants were included in the final analysis. Most of our participants aged between 18 and 45 years and 82% of them were fully vaccinated against COVID-19. Household level dietary diversity was found to be higher among people who were fully vaccinated (ß = 0.321, 95%CI: 0.024 to 0.618) or who were more confident in the protectiveness of the vaccine (ß for tertile 3 comparing with lowest tertile = 0.544, 95%CI: 0.407, 0.682). Vaccination promoted the intake of seafood, but it was also positively associated with the consumption of sugar, preserved, fried and barbequed foods and reduced vegetable intake. Higher vaccination confidence was associated with increased consumption of seafood, bean, fruits and vegetables and reduced fat intake. Changes in dietary behaviors compared with early 2021 (when vaccination was not common) were observed and differed by vaccination status and confidence level. Conclusion: COVID-19 vaccination status and confidence had varied, and possibly negative, impacts on dietary intake and behaviors. Our results suggest that vaccination status and confidence might be significant influencing factors affecting people's health behaviors and highlight that healthy eating should be consistently promoted to prevent poor dietary practices during global health crisis.

The Association between Postpartum Practice and Chinese Postpartum Depression: Identification of a Postpartum Depression-Related Dietary Pattern.

Conflicting results of Chinese traditional postpartum practices have aroused concerns over their health effects. The role of postpartum practices in postpartum depression (PPD) is still a matter of discussion, especially from a dietary practice point of view. The current study was designed to (1) explore the association between postpartum practices and PPD, (2) to identify the dietary pattern related to PPD, and (3) to identify the possible pathways among postpartum practices and PPD. This study is part of the YI Study, which was a cross-sectional study conducted in 10 cities in China. Data for 955 postpartum women were used in the current analysis. The Edinburgh Postnatal Depression Scale (EPDS-10) was used to evaluate PPD with a cutoff value of 9. Postpartum practice was based on the participants' self-reported practices. Individual practices were recorded and categorized as dietary and non-dietary practices. The dietary pattern was identified based on the food intake frequencies of 25 food groups using the method of reduced rank regression. Structural equation modeling was used to explore the potential pathways between postpartum practices and PPD. The current study observed significant associations between postpartum practices and PPD (Adjusted OR = 1.41, 95% CI: 1.04-1.90). A similar trend was also found between dietary postpartum practices and PPD (Adjusted OR = 1.39, 95%CI: 1.03-1.88) but not for non-dietary practices and PPD (Adjusted OR = 1.26, 95%CI: 0.92-1.75). A PPD-related dietary pattern was identified with the characteristics of a high intake of meat and eggs and a lower intake of vegetables, mushrooms, and nuts. This dietary pattern was significantly associated with a higher chance of adhering to postpartum practice (Adjusted OR = 1.26, 95% CI: 1.10-1.44). Based on the pathway analysis, this study also observed the association between postpartum practices and PPD, and the association between dietary practices and PPD were both mediated by sleep quality. In conclusion, this study demonstrated that a substantial proportion of women in modern China experience traditional postpartum Chinese practices and that either overall or dietary-related postpartum practices are associated with a higher risk of PPD. The current dietary practices in postpartum rituals may play an important role in developing PPD. A culturally embedded, science-based dietary guideline is required to help women to achieve both physical and psychological health in the postpartum period.

Neutralizing monoclonal antibodies against highly pathogenic coronaviruses.

The pandemic of Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome 2 coronavirus (SARS-CoV-2) is a continuing worldwide threat to human health and social economy. Historically, SARS-CoV-2 follows SARS and MERS as the third coronavirus spreading across borders and continents, but far more dangerous with long-lasting symptomatic consequences. The current situation is strong evidence that coronaviruses will continue to be pathogens of consequence in the future, thus calling for the development of neutralizing antibody-based prophylactics and therapeutics for prevention and treatment of COVID-19 and other human coronavirus diseases. This review summarized the progresses of developing neutralizing monoclonal antibodies against infection of SARS-CoV-2, SARS-CoV, and MERS-CoV, and discussed their potential applications in prevention and treatment of COVID-19 and other human coronavirus diseases.

Supercoiling Structure-Based Design of a Trimeric Coiled-Coil Peptide with High Potency against HIV-1 and Human ß-Coronavirus Infection.

Hexameric structure formation through packing of three C-terminal helices and an N-terminal trimeric coiled-coil core has been proposed as a general mechanism of class I enveloped virus entry. In this process, the C-terminal helical repeat (HR2) region of viral membrane fusion proteins becomes transiently exposed and accessible to N-terminal helical repeat (HR1) trimer-based fusion inhibitors. Herein, we describe a mimetic of the HIV-1 gp41 HR1 trimer, N3G, as a promising therapeutic against HIV-1 infection. Surprisingly, we found that in addition to protection against HIV-1 infection, N3G was also highly effective in inhibiting infection of human ß-coronaviruses, including MERS-CoV, HCoV-OC43, and SARS-CoV-2, possibly by binding the HR2 region in the spike protein of ß-coronaviruses to block their hexameric structure formation. These studies demonstrate the potential utility of anti-HIV-1 HR1 peptides in inhibiting human ß-coronavirus infection. Moreover, this strategy could be extended to the design of broad-spectrum antivirals based on the supercoiling structure of peptides.

Recent advances in developing small-molecule inhibitors against SARS-CoV-2.

The COVID-19 pandemic caused by the novel SARS-CoV-2 virus has caused havoc across the entire world. Even though several COVID-19 vaccines are currently in distribution worldwide, with others in the pipeline, treatment modalities lag behind. Accordingly, researchers have been working hard to understand the nature of the virus, its mutant strains, and the pathogenesis of the disease in order to uncover possible drug targets and effective therapeutic agents. As the research continues, we now know the genome structure, epidemiological and clinical features, and pathogenic mechanism of SARS-CoV-2. Here, we summarized the potential therapeutic targets involved in the life cycle of the virus. On the basis of these targets, small-molecule prophylactic and therapeutic agents have been or are being developed for prevention and treatment of SARS-CoV-2 infection.

Circulating irisin level in chronic kidney disease patients: a systematic review and meta-analysis.

BACKGROUND: Irisin is not only a myokine but also an adipokine that is critical in many diseases including in the development of such diseases as obesity, diabetes mellitus, metabolic syndrome, coronary artery disease, and chronic inflammation. However, the association between irisin and chronic kidney disease (CKD) is unclear. This systematic review aimed to assess circulating irisin levels in patients with CKD and compare them with those in non-CKD patients. METHODS: PubMed, EMBASE, CENTRAL, ISI Web of Science, and CNKI were searched to identify observational studies of circulating irisin levels in patients with CKD. Two reviewers independently searched the databases and screened studies according to the inclusion criteria. Data were extracted using a standardized collection form. Meta-analysis was performed to compare the differences in circulating irisin levels between CKD and non-CKD patients. RESULTS: A total of 9 studies (6 cross-sectional and 3 case controls) involving 859 CKD patients and 393 non-CKD individuals were selected. The pooled data indicated that circulating irisin concentrations were significantly lower in CKD nondialysis patients (WMD = - 84.79, 95% CI - 170.23, 0.50; p < 0.05), peritoneal dialysis patients (WMD = - 235.81, 95% CI - 421.99, - 49.62; p = 0.01), and hemodialysis patients (WMD = - 217.46, 95% CI - 381.35, - 53.57; p = 0.009) than in healthy controls. CONCLUSIONS: This study confirmed that irisin levels were decreased in patients with CKD. Moreover, circulating irisin levels were lower in dialysis patients than in nondialysis patients.

Food and Nutrition Related Concerns Post Lockdown during COVID-19 Pandemic and Their Association with Dietary Behaviors.

This study aimed to explore food and nutrition related concerns during the post-lockdown period and their impacts on food shopping, preparation, and eating behaviors. DESIGN: A cross-sectional study was conducted through online questionnaire. We collected data on food and nutrition related concerns, socio-demographic characteristics, and changes in dietary behaviors. PARTICIPANTS: A total of 2267 responses were received from people living in 31 provinces across mainland China and 1994 participants were included in the final analysis. ANALYSIS: Linear and multinomial logistic regression analyses were performed to evaluate the association among food and nutrition related concerns, socio-demographic factors, and dietary behaviors Results: About 56% of participants reported moderate to high levels of concerns related to food and nutrition. Contracting the virus when dining out or through contaminated foods were the top two concerns, followed by overnutrition. Higher levels of concerns were found among people who were older, overweight, or obese, having lower income and education, and living in urban areas, or whose family contained vulnerable individuals. Compared with the pre-COVID-19 period, people who were more concerned about food and nutrition were more likely to report changes in their food purchases and consumption; they were also more likely to eat from individual plates, using serving chopsticks, and separating plates and utensils for raw and cooked foods during the post COVID-19 lockdown period. CONCLUSION AND IMPLICATION: Food and nutrition related concerns during the post-lockdown period were prevalent and associated with changes in dietary behaviors. Preventative policies and nutritional guidance should be developed to address these concerns in order to reduce inappropriate dietary behaviors amid public health crises.

Donkey-derived anti-CDV IgG, as a passive immunotherapy agent, can effectively increase survival rates of the experimental CDV-infected dogs.

BACKGROUND: Humoral immunity plays an important role in the prevention of canine distemper. Anti-CD virus (CDV) antibody has strong antiviral activity and is widely used in the treatment of CD. However, with the increase of CD cases, the availability of therapeutic CD antibody fell short of the clinical needs. RESULTS: The high-titer antiserum with the high-titer neutralizing activity against CDV was obtained from the donkeys (Dezhou Donkey) immunized with the inactivated CDV vaccine. The donkey anti-CDV IgG was purified from the donkey serum, which was identified to significantly inhibit the CDV replication in the cultured Vero cells and effectively reduce the clinical symptoms and increase the survival rates (75%) of CDV-infected dogs (Shih-tzu Dog), similar to that treated with the dog-derived anti-CDV IgG. These results indicate that donkey-derived IgG is a potential substitute for dog-derived IgG to treat the CD in clinic. CONCLUSIONS: Administration of donkey-derived anti-CDV IgG can ameliorate clinical symptoms and inhibit virus replication, thereby increasing the survival of CDV-infected dogs. This study opens up a new source of therapeutic antibody for CD treatment.

Molecular mechanism of interaction between SARS-CoV-2 and host cells and interventional therapy.

The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in an unprecedented setback for global economy and health. SARS-CoV-2 has an exceptionally high level of transmissibility and extremely broad tissue tropism. However, the underlying molecular mechanism responsible for sustaining this degree of virulence remains largely unexplored. In this article, we review the current knowledge and crucial information about how SARS-CoV-2 attaches on the surface of host cells through a variety of receptors, such as ACE2, neuropilin-1, AXL, and antibody-FcγR complexes. We further explain how its spike (S) protein undergoes conformational transition from prefusion to postfusion with the help of proteases like furin, TMPRSS2, and cathepsins. We then review the ongoing experimental studies and clinical trials of antibodies, peptides, or small-molecule compounds with anti-SARS-CoV-2 activity, and discuss how these antiviral therapies targeting host-pathogen interaction could potentially suppress viral attachment, reduce the exposure of fusion peptide to curtail membrane fusion and block the formation of six-helix bundle (6-HB) fusion core. Finally, the specter of rapidly emerging SARS-CoV-2 variants deserves a serious review of broad-spectrum drugs or vaccines for long-term prevention and control of COVID-19 in the future.

Tanshinone IIA attenuates atherosclerosis via inhibiting NLRP3 inflammasome activation.

Tanshinone IIA (Tan IIA) possesses potent anti-atherogenic function, however, the underlying pharmacological mechanism remains incompletely understood. Previous studies suggest that oxidized LDL (oxLDL)-induced NLRP3 (NOD-like receptor (NLR) family, pyrin domain-containing protein 3) inflammasome activation in macrophages plays a vital role in atherogenesis. Whether the anti-atherogenic effect of Tan IIA relies on the inhibition of the NLRP3 inflammasome has not been investigated before. In this study, we found that Tan IIA treatment of high-fat diet fed ApoE-/- mice significantly attenuated NLRP3 inflammasome activation in vivo. Consistently, Tan IIA also potently inhibited oxLDL-induced NLRP3 inflammasome activation in mouse macrophages. Mechanically, Tan IIA inhibited NF-κB activation to downregulate pro-interleukin (IL) -1ß and NLRP3 expression, and decreased oxLDL-induced expression of lectin-like oxidized LDL receptor-1 (LOX-1) and cluster of differentiation 36 (CD36), thereby attenuating oxLDL cellular uptake and subsequent induction of mitochondrial and lysosomal damage - events that promote the NLRP3 inflammasome assembly. Through regulating both the inflammasome 'priming' and 'activation' steps, Tan IIA potently inhibited oxLDL-induced NLRP3 inflammasome activation, thereby ameliorating atherogenesis.

The associated factors of cesarean section during COVID-19 pandemic: a cross-sectional study in nine cities of China.

BACKGROUND: Improving and maintaining the health of mothers and newborns is indisputably a global priority, especially during a pandemic. This study intends to examine the factors associated with cesarean section (CS) during lockdown time. METHODS: A total of 678 women who just gave birth within 7 days were enrolled from maternal and children hospitals in nine cities of China from April to May 2020. The delivery modes and potential influencing factors were investigated. The subgroup analysis and sensitivity analysis were used to examine the association of CS and risk factors among populations with different characteristics and to control for possible confounding, respectively. RESULTS: The overall rate of cesarean delivery was 37.3%. In multi-variant model, maternal age > 30 years (OR, 95% CI = 1.71, 1.21-2.41), higher pre-gestational BMI (OR, 95% CI = 1.16, 1.10-1.23), living in regions with confirmed COVID-19 cases > 500 (OR, 95% CI = 2.45, 1.74-3.45), and excess gestational weight gain (OR, 95% CI = 1.73, 1.17-2.55) were associated with cesarean delivery. These trends of associations were not changes in sensitivity analysis and subgroup analysis. Cesarean delivery occurred more in women who got more nutrition instruction during the pandemic period in the univariant model; however, this association showed insignificance in the multiple-variant analysis. CONCLUSION: A high cesarean delivery rate was found in uninfected women who experienced lockdown in their third trimester. During the COVID-19 pandemic, more medical support should be provided in severely affected regions to ensure and promote health in pregnancy.