Growth and development of syphilis-exposed and -unexposed uninfected children during their first 18 months of life in Suzhou, China: a nested case-control study with propensity score matching.

Background: With the successful implementation of Prevention of Mother-to-Child Transmission (PMTCT) policies, the proportion of infants with exposure to both syphilis and antibiotic medication in utero has increased in China, but there is limited evidence about the early growth and development of such infants. Methods: We conducted a retrospective nested case-control study based on data from the China PMTCT program conducted in Suzhou from 2016 to 2021. Propensity score matching (PSM) was employed to extract 826 syphilis-exposed but uninfected (SEU) infants and 1,652 syphilis-unexposed uninfected (SUU) infants from a total of 712,653 infants. Maternal characteristics were collected through questionnaires, such as parity, age, education level, smoking and drinking habits during pregnancy. Infantile characteristics were retrieved from medical records or via questionnaires, such as gestational age, gender, mode of delivery, Apgar scores, birth weight and length, outdoor time, vitamin D intake, and feed pattern. Mixed effects models, adjusting for potential influencing factors, were used to investigate the early infantile growth pattern of SEU and SUU infants. All statistical analysis were conducted using R (version 4.2.0). Results: Length and weight were slightly higher in SEU infants than in the SUU infants at some time points (months 0 and 18 for length, p-values <0.05; months 0, 6, and 18 for weight, p < 0.05). In the mixed effects model, SEU group was found to be associated with higher weight [exponentiated beta exp.(ß) = 1.15, 95% Confidence Interval (CI) = 1.06, 1.25], length [exp(ß) = 1.42, 95% CI = 1.14, 1.77], and BMI z-score [exp(ß) = 1.09, 95% CI = 1.00, 1.19]. Conclusion: With the effective prevention of congenital syphilis under the PMTCT program, SEU infants have non-inferior growth patterns during their first 18 months of life compared with SUU controls in Suzhou, China.

Maternal exposure to ambient air pollution and risk of congenital heart defects in Suzhou, China.

Background: More and more studies have investigated the association between maternal exposure to ambient air pollution during pregnancy and incidence of congenital heart defects (CHDs), but results are controversial. The aim of this study was to investigate whether maternal exposure to air pollutants (PM10, PM2.5, NO2, CO, SO2) are associated with an increased risk of congenital heart defects in Suzhou city, China. Methods: Based on the birth defect monitoring system of Suzhou city and the Environmental Health Department of Suzhou CDC, the birth defect monitoring data and concentrations of five air pollutants (PM10, PM2.5, NO2, CO, SO2) in Suzhou city from 2015 to 2019 were obtained. The distribution of demographic characteristics of children with birth defects and exposure to air pollutant concentrations during different pregnancy periods were analyzed, Chi-square test was used to analyze whether there were statistical differences in the distribution of parturient woman age, pregnant weeks, times of pregnancy, as well as fetal sex and birth weight among children with congenital heart defects and other defects. Logistic regression model was further established to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CI) for the association between exposure to these ambient air pollutants during pregnancy and CHDs. Results: A total of 5,213 infants with birth defects were recruited in this study from 2015 to 2019, the top five birth defects in Suzhou were syndactyly, congenital heart disease, ear malformation, cleft lip and palate, and hypospadias, and the proportion of congenital heart disease increased. The level of maternal exposures (mean ± sd) was highest in first trimester amongst pregnant women in Suzhou city. Compared to other birth defects, we observed significant increasing associations between PM2.5 exposure during second and third trimester with risk of CHDs, aORs were 1.228 and 1.236 (95% CI: 1.141-1.322, 1.154-1.324 separately) per a 10 µg/m3 change in PM2.5 concentration. Maternal NO2 exposure was significantly associated with CHDs in first trimester (aOR = 1.318; 95% CI: 1.210-1.435). Conclusions: Our study contributes to explore the current state of Suzhou air quality and the association between maternal air pollution exposure and congenital heart defects. Exposure to PM2.5 and NO2 is thought to increase the risk of CHDs, but comprehensive description of these associations will be needed in future studies.

Treatment evaluation to improve preventing mother to child transmission among women with syphilis.

The aim of this study was to evaluate the effectiveness of preventing mother to child syphilis transmission to improve pregnancy outcomes. We performed a retrospective analysis of municipal databases of mother-to-child syphilis transmission. Pregnant women with syphilis were included. Group specific pregnancy outcomes were analyzed according to treatment. A total of 28 pregnant women were diagnosed with syphilis in 2012; 321 were diagnosed with syphilis in 2018. A prevalence of 0.14% was observed amongst pregnant women in Suzhou city from 2012-2018. Primary treatments included benzathine penicillin, ceftriaxone sodium or erythromycin when patients were allergic to Benzathine penicillin. The treatment coverage was 81.57%, and only 52.86% of pregnant women were adequately treated. Adverse pregnant outcomes were higher amongst untreated women. Expanding early screening coverage and promoting treatment were key to improving pregnancy outcomes amongst women with syphilis.

Investigation of prevention of mother to child HIV transmission program from 2011 to 2017 in Suzhou, China.

The vertical transmission of HIV, from mother to child remains one of the biggest challenges all over the world. This study evaluated the implementation and effectiveness of the prevention of mother to child HIV transmission (PMTCT) program from 2011 to 2017 in Suzhou. A total of 107 HIV positive women were enrolled in the program, of which 11 were diagnosed through premarital examination, and 96 women were diagnosed through prenatal examination. Among the 96 pregnant women, 67 gave birth to 68 live neonates. Only one infant was diagnosed HIV infected because the HIV positive mother did not enter the PMTCT program until delivery. The HIV prevalence in Suzhou city showed a low-level tendency. To increase the prenatal health utility and antiretroviral medication compliance of the migrant population in Suzhou, there are improvements to make in order to achieve the 90-90-90 targets.

Serum homocysteine level and gestational diabetes mellitus: A meta-analysis.

AIMS/INTRODUCTION: Homocysteine levels during pregnancy in women with gestational diabetes mellitus (GDM) have been studied; however, it remains unclear whether hyperhomocysteinemia is a useful predictor of insulin resistance. The present study aimed to evaluate the relationship between homocysteine level and GDM. MATERIALS AND METHODS: PubMed, Elsevier, Web of Science and CNKI were searched for relevant studies published up to January 2015. Manual searches of references of the relevant original studies were carried out. Meta-analysis was used to assessed the relationship between homocysteine level and GDM using the stata 12.0 software. RESULTS: Homocysteine levels were significantly elevated in women with GDM compared with those without GDM (weighted mean difference 0.77, 95% confidence interval 0.44-1.10). This evidence was more consistent during the second trimester measurement of homocysteine (weighted mean difference 0.95, 95% confidence interval 0.67-1.23) and for women aged older than 30 years (weighted mean difference 0.90, 95% confidence interval 0.63-1.17). CONCLUSIONS: The present meta-analysis shows that homocysteine level is significantly elevated among women with GDM compared with women with normal glucose tolerance, and this finding persists more during the second trimester.