Prevalence and bidirectional association of sleep quality and gut health among Chinese midwives: a large population, multi-center cross-sectional study.

Background: Shift work can disrupt sleep quality and gut health. Nurses and midwives constitute approximately half of the global healthcare shift-working workforce. Our previous study revealed that most midwives were experiencing suboptimal health conditions, characterized by poor sleep quality and a high prevalence of gastrointestinal diseases. The gut-brain axis theory highlights the potential interplay between sleep quality and gut health. However, limited research focuses on this relationship among midwives. Methods: A cross-sectional survey included 2041 midwives from 87 Chinese hospitals between March and October 2023. Participants completed standardized questionnaires assessing sleep quality, gut health, depression, anxiety, and work stress. Binary logistic regression analyzed factors associated with poor sleep, and multiple linear regression examined the influence of sleep quality on gut health. Results: Over 60% of midwives reported poor sleep, with many experiencing gastrointestinal disorders. We observed a bidirectional relationship between sleep quality and gut health among midwives. After multivariable adjustments, midwives with higher gut health scores were more likely to experience poor sleep quality (odds ratio = 1.042, 95% confidence interval = 1.03-1.054). Conversely, midwives with higher sleep quality scores were also more likely to have poor gut health (ß = 0.222, 95% confidence interval = 0.529-0.797). These associations remained robust across sensitivity analyses. Furthermore, depression, anxiety, and work stress significantly affected both sleep quality and gut health among midwives. Conclusion: This study enhances our understanding of the intricate relationship between sleep quality and gut health among midwives. Poor gut health was associated with a higher risk of poor sleep, and vice versa. To improve the overall wellbeing of midwives, the findings emphasize the importance of addressing poor sleep quality and promoting gut health through maintaining a healthy diet, lifestyle, and good mental health. Further studies are needed to confirm our findings and clarify the underlying mechanisms.

Effect of depressive symptoms on quality of work life in female nurses: a cross-sectional study using propensity score matching.

Background: Female nurses have been considered as a vulnerable population in the context of mental health, due to the nature of their work, which can be stressful and emotionally taxing. Understanding the relationship between depressive symptoms and quality of work life (QWL) can contribute to improving mental health and job performance. However, limited studies have focused on the effect of depressive symptoms on QWL in female nurses. Objectives: The present study aimed to assess the effect of depressive symptoms on female nurses' QWL using propensity score matching (PSM). Methods: A cross-sectional, online study using convenience sampling was conducted among 1,401 female nurses in China. PSM was used to minimize the impact of potential confounders between no depressive symptoms and depressive symptoms. Stepwise multiple linear regression analyses were performed on the PSM samples to explore the effects of depressive symptoms on the QWL. Results: The results revealed there were 33.5% of the female nurses reported depressive symptoms before PSM. And female nurses in this study had a moderate level of QWL before PSM (122.11 ± 18.15), which remained steady after PSM (118.33 ± 18.04). After PSM, the final sample contained 864 female nurses. Stepwise multiple linear regression results indicated that depressive symptoms were the most strongly associated with QWL (ß = -0.454, p < 0.001). Conclusion: This study highlights the importance of developing mental health plans and psychological interventions for female nurses to maintain mental health and QWL, which is critical to the nursing workforce's sustainability.

Mediating effects of social support, mental health between stress overload, fatigue and turnover intention among operating theatre nurses.

BACKGROUND: The high rate of nurses turnover and nursing staff shortage have been an ongoing concern issue and a challenge for global health systems. To explore the turnover intention among operating theatre nurses, and to test the hypothetical model for estimating the effects of stress overload and fatigue between social support, mental health and turnover intention. DESIGN: a multi-center and cross-sectional online survey. METHODS: This study was conducted from October 2020 to March 2021 comprised 1060 operating theatre nurses from 76 Chinese hospitals. The descriptive analysis, independent sample t test and one-way analysis of variance and Spearman correlation analysis were used to explore the relationships among variables by the SPSS software, and stepwise multiple linear regression analysis was utilized to identify influencing factors of turnover intention and its dimensions among operating theatre nurses. A structural equation model was analyzed by the AMOS software. RESULTS: Social support, mental health, stress overload and fatigue were important predictors of turnover intention among operating theatre nurses. Besides, stress overload positively affected fatigue, mental health and turnover intention; fatigue negatively affected social support, however, fatigue positively affected mental health; social support negatively affected mental health and turnover intention; mental health positively affected turnover intention. Moreover, social support, mental health mediated between stress overload, fatigue and turnover intention among operating theatre nurses. CONCLUSION: Social support, mental health mediated between stress overload, fatigue and turnover intention among operating theatre nurses.

Fruit, vegetable, and fruit juice consumption and risk of gestational diabetes mellitus: a systematic review and meta-analysis : List of all authors.

BACKGROUND: Fruit, vegetable, and fruit juice intake is associated with the risk of gestational diabetes mellitus (GDM). However, the conclusion is limited and conflicted. The purpose of this systematic review and meta-analysis is to investigate the association between fruit, vegetable, and fruit juice consumption and the risk of GDM. METHODS: To find relevant studies, we searched PubMed, The Cochrane Library, Web of Science, Embase, ScienceDirect, PsycINFO, CINAHL, Ovid, EBSCO, CBM, CNKI, Wanfang Data, and VIP for the report on prospective cohort studies published from inception to April 8, 2022. Summary relative risks (RR) and 95% confidence intervals (Cis) were estimated using a random-effects model. RESULTS: A total of 12 studies with 32,794 participants were included in the meta-analysis. Total fruit consumption was associated with a lower risk of GDM (RR = 0.92, 95% CI = 0.86-0.99). Whereas an increasing the consumption of vegetable, including all vegetable (RR = 0.95, 95% CI = 0.87-1.03), starchy vegetable (RR = 1.01, 95% CI = 0.82-1.26), and fruit juice (RR = 0.97, 95% CI = 0.91-1.04) was not associated with a reduction in the risk of GDM. In a dose‒response analysis of eight studies, a 3% reduction in risk of GDM for a 100 g/d increase in fruit consumption (RR = 0.97, 95% CI = 0.96-0.99). CONCLUSIONS: The findings suggest that higher fruit consumption may reduce the risk of GDM, with a 3% reduction in the risk of GDM for every 100 g/d increase in fruit intake. Higher-quality prospective studies or randomized clinical trials are required to validate the effect of different variations of fruits, vegetables, and fruit juice consumption on the risk of GDM.

The mediating effect of psychological empowerment on the relationship between work environment and clinical decision-making among midwives: a multicentre cross-sectional study.

BACKGROUND: Clinical decision-making is considered an essential behaviour in clinical practice. However, no research has been done to examine the associations among midwives' clinical decision-making, work environment and psychological empowerment. Thus, this study aimed to determine the influence of work environment on midwives' clinical decision-making and confirm the mediating role of psychological empowerment. METHOD: This study was designed as a multicentre cross-sectional study, and included 602 registered midwives from 25 public hospitals in China. A sociodemographic questionnaire, Work Environment Scale, Psychological Empowerment Scale and Clinical decision-making Scale were applied. A structural equation model was conducted to estimate the hypothesis model of the clinical decision-making among midwives and explore the potential mediating mechanism of midwives' clinical decision-making. This model was employed maximum likelihood estimation method and bootstrapping to examine the statistical significance. RESULTS: The mean score of clinical decision-making among midwives was 143.03 ± 14.22, at an intermediate level. The data of this hypothesis model fitted well, and the results showed that work environment positively affected psychological empowerment, which in turn positively affected clinical decision-making; psychological empowerment partly mediated the relationship between work environment and clinical decision-making among midwives. CONCLUSIONS: Midwives' clinical decision-making could be promoted directly or indirectly by providing a healthy work environment and improving psychological empowerment. It is essential for hospital managers to pay attention to the assessment of the midwives' work environment and actively improve it, such as establishing a supportive, fair and just workplace, and maintaining effective communication with midwives. Furthermore, managers can also promote midwives' clinical decision-making behaviour by enhancing their psychological empowerment via enhancing job autonomy.

The mothers' breastfeeding behaviour within six weeks postpartum: new scale development and psychometric validation study.

BACKGROUND: The evaluation of mothers' breastfeeding behaviour within 6 weeks postpartum could help health workers comprehensively identify maternal breastfeeding shortcomings, clarify nursing problems, and provide targeted interventions. However, no prior study was found, therefore this study aimed to develop and validate the reliability and validity of the mothers' breastfeeding behaviour scale within 6 weeks postpartum. METHODS: A main two-step approach was used: (1) a qualitative pilot study using the purposive sampling method was adopted to test the fitness, simplicity, and clarity of items with 30 mothers; (2) a cross-sectional survey using the convenient sampling method was conducted for item analysis and psychometric validation with 600 mothers. RESULTS: The final version of the scale consisted of 36 items with seven dimensions, explaining 68.852% of the total variance. The Cronbach's α, split-half, and retest coefficients were 0.958, 0.843, and 0.753, respectively. The validity of the scale: (1) Content validity: content validity index (CVI) range of items was between 0.882 and 1.000. The scale-level-CVI was 0.990. (2) Structure validity: The fitting indices were as follows: χ2/ⅆf =2.239, RMR = 0.049, RMSEA = 0.069, TLI = 0.893, CFI = 0.903, IFI = 0.904, PGFI = 0.674, and PNFI = 0.763. (3) Convergent validity: The composite reliability and average variance extracted (AVE) of the seven dimensions were between 0.876 and 0.920 and between 0.594 and 0.696. (4) Distinguish validity: The correlation coefficients were less than the square root of the AVE, except for self-decision behaviour, self-coping behaviour, and self-control behaviour. However, the fit index of the original three-factor model was better than that of the other new models, with significant differences (P < 0.001). (5) Calibration validity: The area under the curve was 0.860 or 0.898 when the scale was used to predict exclusive or any breastfeeding at 42 days. The correlation coefficients of the maternal breasting feeding evaluation scale, breastfeeding self-efficacy short-form scale, and the scale were 0.569 and 0.674, respectively. CONCLUSION: The newly developed mothers' breastfeeding behaviour scale within 6 weeks postpartum consists of 36 items belonging to seven dimensions with good reliability and validity and is a reliable and valid instrument to be used in future maternal breastfeeding behaviour assessments and interventions.

Effects of coping on nurses' mental health during the COVID-19 pandemic: Mediating role of social support and psychological resilience.

BACKGROUND: Fighting against the COVID-19 pandemic, front-line nurses were under unprecedented psychological pressure. Therefore, it is necessary to promptly evaluate the psychological status of nurses during the COVID-19 epidemic period. AIM: To investigate nurses' mental health during the COVID-19 pandemic, and to test the mediating role of social support and psychological resilience between coping and mental health. DESIGN: This was a descriptive, cross-sectional survey which used a structural equation model. METHOD: In total, 711 registered nurses were included. All participants were invited to complete a socio-demographic questionnaire, the general health questionnaire, the trait coping style questionnaire, the perceived social support scale and the Conner-Davidson Resilience scale. RESULTS: In total, 50.1% nurses had high risk of mental health. Positive coping positively affected social support and psychological resilience, while it negatively affected mental health. Negative coping negatively affected social support and psychological resilience, while it positively affected mental health. Social support positively affected psychological resilience, while it negatively affected mental health. In addition, social support mediated coping and psychological resilience, and coping and mental health. Moreover, psychological resilience negatively affected mental health, and it mediated coping and mental health.

Prevalence and risk factors of sub-health and circadian rhythm disorder of cortisol, melatonin, and temperature among Chinese midwives.

Objective: This study aimed to explore the influencing factors of sub-health and circadian rhythm disorder among midwives and whether circadian rhythm disorder was associated with sub-health. Methods: A multi-center cross-sectional study was conducted among 91 Chinese midwives from six hospitals through cluster sampling. Data were collected by demographic questionnaire, Sub-Health Measurement Scale version 1.0, and circadian rhythm detection. Minnesota single and population mean cosine methods were used to analyze the rhythm of cortisol, melatonin, and temperature. Binary logistic regression, nomograph model, and forest plot were performed to identify variables associated with midwives' sub-health. Results: There were 65 midwives with sub-health and 61, 78, and 48 midwives with non-validation of circadian rhythms of cortisol, melatonin, and temperature among 91 midwives, respectively. Midwives' sub-health was significantly related to age, duration of exercise, weekly working hours, job satisfaction, cortisol rhythm, and melatonin rhythm. Based on these six factors, the nomogram was presented with significant predictive performance for sub-health. Furthermore, cortisol rhythm was significantly associated with physical, mental, and social sub-health, whereas melatonin rhythm was significantly correlated with physical sub-health. Conclusion: Sub-health and circadian rhythm disorder were generally common among midwives. Nurse administrators are supposed to pay attention and take measures to prevent sub-health and circadian rhythm disorder among midwives.

Which mothers' breastfeeding behaviours within six weeks postpartum do health workers need to notice? Developing an indicator system based on the Delphi method and analytic hierarchy process.

OBJECTIVE: The six weeks postpartum is the high-incidence period of stopping breastfeeding. The clarity of the internal mechanism of behaviour was an effective way to promote breastfeeding. The aim was to reach a consensus on indicators what should be used and prioritised in evaluating mothers' breastfeeding behaviour within six weeks postpartum in order to provide a theoretical reference for health workers to take targeted strategies toward promoting breastfeeding practices. DESIGN: Two rounds of Delphi method and analytic hierarchy process was conducted in this study. The two-rounds Delphi was performed to select essential indicators and collect revised suggestion. The analytic hierarchy process was adopted for pairwise comparison to rank the significance of primary and secondary indicators. SETTING AND PARTICIPANTS: The panel included twenty experts with rich breastfeeding information and different general characteristics from China. FINDINGS: Consensus was achieved to include three primary indicators, seven secondary indicators, and forty-five tertiary indicators in the final indicators system of the mothers' breastfeeding behaviour within six weeks postpartum. The weight sequence of primary indicators was self-regulation behaviour (0.401), at-the-breast feeding behaviour (0.383), and resource utilisation behaviour (0.216). The rank of the secondary indicators was breastfeeding operation skills (0.267), self-decision behaviour (0.144), self-control behaviour (0.130), self-coping behaviour (0.127), breastfeeding self-perception (0.116), resource acquisition behaviour (0.115), and resource coordination behaviour (0.101). KEY CONCLUSION: The study builds a new and reliable indicators system that intuitively reflects the constituent elements of the mothers' breastfeeding behaviour within six weeks postpartum and provides priorities in primary indicators and secondary indicators. IMPLICATIONS FOR PRACTICES: The study helps form a clear and scientific cognition on mothers' breastfeeding behaviour within six weeks postpartum and provides a new perspective and intuitive theoretical reference for health workers to take targeted measures to promote breastfeeding practices and achieve substantial public health gains.

Auricular bean embedding improves urination in epidural labor analgesia: A single center randomized controlled study.

BACKGROUND: Acupoint buried beans on the auricle is a feasible method to prevent and treat postpartum urinary retention. OBJECTIVE: This study investigated the effect of auricular acupoint buried beans on postpartum urination and maternal and fetal outcomes following epidural analgesia for labor. METHODS: Two hundred forty primiparas underwent vaginal trial labor analgesia from May 2020 to January 2021 and were randomly placed into the intervention and control groups. Both groups received epidural labor analgesia. Maternal urination during labor, 2 h postpartum, and the time for first postpartum urination were recorded as primary outcomes, with maternal and infant outcomes documented as secondary results. Statistical analysis was performed using the independent sample t-test, non-parametric rank-sum, or chi-square test using the SPSS Statistics 25.0 software. RESULTS: Two hundred eight study participants were subsequently included in the results, i.e., 105 patients in the intervention group and 103 in the control group. The intervention group comprised a significantly lower number of patients with excessive residual urine volume at cervical dilatation of 5-6 cm (P< 0.05). The total postpartum score of the intervention group was lower than in the control group (P< 0.01), and the time to first urination was shorter compared with the control group (P< 0.05). In the intervention group, the time of labor analgesia, the duration of the first stage of labor, and the total labor time were shorter compared with the control group (P< 0.01). CONCLUSION: Auricular acupoint embedded beans can improve the urination status at cervical dilatation of 5-6 cm and 2 h postpartum, as well as significantly shorten the duration of labor.

Mediating effect of resilience between social support and compassion fatigue among intern nursing and midwifery students during COVID-19: a cross-sectional study.

AIMS: To examine the mediating effect of resilience between social support and compassion fatigue among intern nursing and midwifery students during COVID-19. BACKGROUND: Compassion fatigue has become exceedingly common among intern nursing and midwifery students, especially during the COVID-19 pandemic. Social support and resilience can help intern nursing and midwifery students control their negative emotions, reduce compassion fatigue, and increase their well-being. However, the mediating effect of resilience between social support and compassion fatigue remains unclear. DESIGN: A multicentre cross-sectional survey. METHODS: A total of 307 intern nursing and midwifery students were recruited from November 2020 to February 2021 in tertiary grade A hospitals in China. Structural equation modelling was applied to analyse the mediating effects of resilience between social support and compassion fatigue. The Social Support Rating Scale, the 10-item Connor-Davidson Resilience Scale, and the Chinese version of the Compassion Fatigue Short Scale were used to collect data. The hypothetical path model was tested by using IBM SPSS version 26.0 and AMOS version 26.0 software. RESULTS: Intern nursing and midwifery students had moderate compassion fatigue. Social support positively affected resilience (ß = 0.514, p < 0.01). Social support negatively affected compassion fatigue (ß = - 0.310, p < 0.01), while resilience negatively affected compassion fatigue (ß = - 0.283, p < 0.01). Resilience played a mediating role between social support and compassion fatigue. CONCLUSION: Social support can directly affect the compassion fatigue of intern nursing and midwifery students during COVID-19 and indirectly through resilience. Stronger resilience can reduce compassion fatigue. Accordingly, resilience-based interventions should be developed to reduce compassion fatigue.

Actual experience of the training effect of Baduanjin on patients with hemiplegic limb dysfunctions after cerebral infarction: A qualitative study.

AIM: To explore the actual experience of training effect of Baduanjin on patients with hemiplegic limb dysfunctions after cerebral infarction through semistructured interviews and promote Baduanjin training application in clinical and community settings. DESIGN: This qualitative study was conducted using the conventional content analysis approach. METHODS: Twenty-five patients with hemiplegic limb dysfunctions after cerebral infarction were recruited as participants by applying purposive sampling method between September 2017-December 2020 in the physical therapy department of a rehabilitation hospital affiliated with Fujian University of Traditional Chinese Medicine in China. Semistructured interviews were conducted after patients participated in Baduanjin training for 6 weeks. Data were analysed using qualitative content analysis method of Graneheim and Lundman. RESULTS: Three major themes were identified after analysis, namely improving functions of hemiplegic limbs, improving the condition of the entire body and the feelings of practice. The participants indicated that Baduanjin could improve the limb functions and general conditions of hemiplegic patients. Their experience in practicing Baduanjin was generally positive, and they were willing to continue practicing.

Mothers' breastfeeding six weeks postpartum and factors influencing exclusive breastfeeding during the first six months.

We aimed to assess the feeding pattern and influencing factors within six weeks postpartum on exclusive breastfeeding duration among Chinese mothers. This study was conducted using 2:1 matched case-control study. Cases and controls were matched for maternal age, parity and mode of birth. A total of 210 women were included. Approximately 67.9% of women stopped exclusive breastfeeding within the first six weeks postpartum. Maternal non-exclusive breastfeeding intention, lower maternal educational level, mother-infant skin to skin contact over one hour, unsatisfied breastfeeding self-evaluation and maternal unhealthy condition within the first six weeks were risk factors for ceasing exclusive breastfeeding early.

The association between circadian rhythm of cortisol and shift work regularity among midwives-A multicenter study in Southeast China.

Objective: This article aims to explore the association between the trends of cortisol rhythm and the regularity of shift work among midwives. Methods: Midwives from six Southeast Chinese hospitals were recruited through cluster sampling in a multi-center cross-sectional study. Urine samples were collected half an hour after waking up, at 11:00, 19:00, and 23:00 on two consecutive days in a longitudinal cohort. The urinary cortisol was assayed by the chemiluminescence method. Results: A total of 86 midwives were included in this study, contributing 688 cortisol samples. The midwives displayed a circadian rhythm in cortisol secretion, with zeniths in the morning and nadirs in the evening. The trend of the first day was repeated on the second day. Although the total working hours per week of the two groups, namely the regular shift group (N = 43) and the irregular shift group (N = 43), were the same, significant main effects of groups (F = 62.569, p < 0.001), time (F = 45.304, p < 0.001), and group-by-time interaction (F = 226.695, p < 0.001) were indicated through linear mixed models. The main effect of day was not statistically significant, with F = 0.105 and p = 0.746. The fluctuation range of cortisol curve in the group with irregular schedules was slightly lower than that in the group with regular schedules. Conclusion: Our results may indicate that cortisol was more inhibited in midwives with irregular shift patterns than those with regular shift patterns. It is necessary to further study the relationship between cortisol rhythm and patterns of midwives' shifts in future so as to lay a foundation for hospital managers to develop a more reasonable scheduling system for midwives with the further purpose to minimize their occupational fatigue and ensure the safety of mothers and infants.

Changes in the Gut Metabolic Profile of Gestational Diabetes Mellitus Rats Following Probiotic Supplementation.

The roles of gut microbiota and metabolomics in women with gestational diabetes mellitus (GDM) are not well understood. This study investigated the gut metabolomic profiling of GDM rats and GDM rats treated with probiotic supplements. Associations between gut metabolites and microbiota were also studied in GDM rats. Liquid chromatography-mass spectrometry was used to detect gut metabolites in GDM rats and GDM rats treated with probiotic supplements of 0.5 g (low-dose group) or 1 g (high-dose group) for 15 days. Each gram of probiotic supplement contained 5 × 107 colony-forming units (CFU) of Lactobacillus rhamnosus LGG and 1 × 108 CFU of Bifidobacterium animalis subspecies lactis Bb12. The association between gut metabolites and microbiota in GDM rats was investigated using Spearman's correlation. Finally, 10 rats in the normal pregnant group, eight rats in the GDM model group, eight GDM rats in the low-dose probiotics group, and nine GDM rats in the high-dose probiotics group were further studied. Serum parameters and pancreatic and colon histology were significantly changed in GDM rats, and these were restored using probiotic supplements. In total, 999 gut metabolites were detected in the feces, and GDM rats were distinguished from normal rats. The levels of 44 metabolites were increased in GDM rats, and they were alleviated using probiotic supplements. Changes in metabolites in GDM rats were associated with amino acids and bile acids metabolism signaling pathways. Furthermore, changes in metabolites after probiotic supplementation were associated with porphyrin and chlorophyll metabolism pathways. We found that the Allobaculum genus displayed strong positive correlations, whereas the Bryobacter and Gemmatimonas genera displayed strong negative correlations with metabolisms of amino acids and bile acids in GDM rats. The Lactobacillus and Bifidobacterium genera were positively correlated with gut metabolites. Overall, our results showed that metabolism signaling pathways of amino acids and bile acids are associated with the development of GDM. Probiotic supplements alleviate the pathology of GDM through the metabolism pathways of amino acids, bile acids, porphyrin, and chlorophyll.

Prepregnancy body mass index and gestational weight gain are associated with maternal and infant adverse outcomes in Chinese women with gestational diabetes.

The gestational weight gain (GWG) range of Chinese women with gestational diabetes mellitus (GDM) remains unclear. Our objective was to identify the ranges of GWG in Chinese women with GDM and to investigate the associations between prepregnancy body mass index (BMI), GWG and maternal-infant adverse outcomes. Cases of GDM women who delivered singletons from 2013 to 2018 in a public hospital were collected. Logistic regression analysis was used to assess the joint effects of prepregnancy BMI and GWG on maternal-infant adverse outcomes. Ultimately, 14,578 women were collected. The ranges of GWG in Chinese women with GDM were different from the National Academy of Medicine's (NAM) recommendation. The ranges of GWG of Chinese women with GDM in the underweight, normal weight, overweight and obese groups were 5.95-21.95 kg, 4.23-21.83 kg, 0.88-21.12 kg and - 1.76 to 19.95 kg, respectively. The risks of large for gestational age (LGA), macrosomia and caesarean delivery were significantly increased with the increasing prepregnancy BMI. Furthermore, the risks of LGA, macrosomia and caesarean delivery were significantly higher in the normal weight group with a GWG higher than the NAM recommendation. Similarly, in the overweight group with a GWG higher than the NAM recommendation, the risks of LGA were significantly higher, while the risks of macrosomia were significantly lower. Overall, we determined the range of GWG in different prepregnancy BMI groups. And GDM women with high prepregnancy BMI and excessive GWG were associated with the higher risks of maternal-infants adverse outcomes in China.

Probiotic Supplements Improve Blood Glucose and Insulin Resistance/Sensitivity among Healthy and GDM Pregnant Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Probiotic supplements may be seen as a promising way to improve glucose metabolism. This study aimed to evaluate the effects of probiotic supplements on blood glucose, insulin resistance/sensitivity, and prevention of gestational diabetes mellitus (GDM) among pregnant women. METHODS: Eleven electronic databases were searched from inception to May 2020. Two authors independently identified randomized controlled trials (RCTs), assessed the eligibility and quality of the included studies, and then extracted data. The primary outcomes were fasting plasma glucose (FPG), 1 h and 2 h plasma glucose after 75 g oral glucose tolerance test (OGTT), HbA1c, fasting plasma insulin, insulin resistance, and insulin sensitivity. Fixed and random effect models were used to pool the results. RESULTS: A total of 20 RCTs involving 2972 participants were included according to the inclusion and exclusion criteria. The pooled results of this research showed that probiotic supplements could reduce the level of FPG (mean difference (MD) = -0.11; 95% CI = -0.15 to -0.04; P=0.0007), serum insulin (MD = -1.68; 95% CI = -2.44 to -0.92; P < 0.00001), insulin resistance (MD = -0.36; 95% CI = -0.53 to -0.20; P < 0.00001), and insulin sensitivity (MD = -21.80; 95% CI = -31.92 to -11.67; P < 0.00001). Regarding the subgroup analysis of different pregnant women, the effects of probiotics on FPG, insulin, and insulin resistance were more obvious among GDM and healthy women than among overweight/obese women. Furthermore, the differences were not significant in HbA1c (MD = -0.05; 95% CI = -0.12 to 0.03; P=0.23), 1 h OGTT (MD = -0.07; 95% CI = -0.25 to 0.10; P=0.42), and 2 h OGTT (MD = -0.03; 95% CI = -0.17 to 0.12; P=0.72). CONCLUSION: This review found that probiotic supplements had certain functions to reduce the level of FPG and improve insulin, insulin resistance, and insulin sensitivity, especially for GDM and healthy pregnant women.

Probiotic supplements alleviate gestational diabetes mellitus by restoring the diversity of gut microbiota: a study based on 16S rRNA sequencing.

Probiotics effectively prevent and improve metabolic diseases such as diabetes by regulating the intestinal microenvironment and gut microbiota. However, the effects of probiotics in gestational diabetes mellitus are not clear. Here, we showed that probiotic supplements significantly improved fasting blood glucose in a gestational diabetes mellitus rat model. To further understand the mechanisms of probiotics in gestational diabetes mellitus, the gut microbiota were analyzed via 16S rRNA sequencing. We found that compared with the normal pregnant group, the gestational diabetes mellitus rats had decreased diversity of gut microbiota. Moreover, probiotic supplementation restored the diversity of the gut microbiota in gestational diabetes mellitus rats, and the gut microbiota structure tended to be similar to that of normal pregnant rats. In particular, compared with gestational diabetes mellitus rats, the abundance of Firmicutes and Actinobacteria was higher after probiotic supplementation. Furthermore, activating carbohydrate metabolism and membrane transport pathways may be involved in the potential mechanisms by which probiotic supplements alleviate gestational diabetes mellitus. Overall, our results suggested that probiotic supplementation might be a novel approach to restore the gut microbiota of gestational diabetes mellitus rats and provided an experimental evidence for the use of probiotic supplements to treat gestational diabetes mellitus.

Gestational Diabetes Mellitus and Risk of Delayed Onset of Lactogenesis: A Systematic Review and Meta-Analysis.

Background: Gestational diabetes mellitus (GDM) may be associated with delayed onset of lactogenesis (DOL), but it is still inconclusive. Objectives: The study aimed to evaluate the association between GDM and DOL, the prevalence and risk factors of DOL in GDM women. Materials and Methods: A comprehensive search was performed in 10 electronic databases from inception to June 1, 2020. To find more eligible studies, the references of finally eligible studies and relevant reviews were traced manually. A meta-analysis was conducted to calculate the pooled estimates of association, prevalence, and risk factors using random- or fixed-effects models. Results: Eleven eligible articles involving 8,150 women were included in this study. GDM women had a higher risk of DOL (odds ratio [OR] = 1.84, 95% confidence interval [CI] [1.34-2.52]). The prevalence of delayed lactogenesis onset in GDM women was 35.0% (effect size [ES] = 0.35, 95% CI [0.30-0.40]). Primipara (OR = 2.54, 95% CI [1.89-3.42]), advanced age (OR = 1.05, 95% CI [1.03-1.08]), prepregnancy obesity (OR = 1.55, 95% CI [1.19-2.03]), and insulin treatment (OR = 3.07, 95% CI [1.71-5.47]) were risk factors of delayed lactogenesis onset in GDM women. Conclusion: GDM negatively affects the timing of lactogenesis onset. The prevalence of delayed lactogenesis onset in GDM women is 35.0%. Primipara, advanced age, prepregnancy obesity, and insulin treatment are independent risk factors of delayed lactogenesis onset in GDM women.

Birthweight features of the infants of mothers diagnosed with diabetes at different gestational ages in South China from 2014 to 2018: a retrospective study.

OBJECTIVES: The primary purpose was to measure the birth weight of infants of mothers with gestational diabetes (IMGDs) at different gestational ages to develop new reference charts and curves for them. A further purpose was to compare them with those of 159 334 infants in China to provide more accurate reference charts for the diagnosis of suspected abnormal birth weight of IMGDs. The final purpose was to evaluate the key periods for such mothers to control their weight in line with the difference of fetal weight of each two neighbouring gestational ages. SETTING: A specialised hospital in South China PARTICIPANTS: IMGDs born here from January 2014 to December 2018. PRIMARY AND SECONDARY OUTCOME VARIABLES: Birth weight, gestational ages of IMGDs, gender and year of birth. RESULTS: Data of 14 311 singleton live births at the gestational weeks 25-42 here were collected. The proportions of low birth weight, normal birth weight and macrosomia were 7.26%, 87.04%, and 5.70%, respectively. The proportions of small for gestational age, appropriate for gestational age and large for gestational age were 5.69%, 84.42% and 9.89%, respectively. In the macrosomia group, the mean of all birth weight in 2017 decreased for the first time since 2014. Both the means of birth weight of male infants at gestational weeks 36-41 and of female at weeks 38-40 were greater than that of the 159 334 infants. The increase of each weekly mean of IMGDs at gestational weeks 27-31 and 33-35 was >10% compared with the former. Based on this, new reference charts of birth weight for IMGDs in terms of different gestational age and gender were formulated. CONCLUSION: These charts may be applied as reference for more accurate diagnosis and quick treatment of abnormal birth weight. This study showed that the identification of key periods for fetal weight gain was helpful for the management of the weight of women with gestational diabetes.