Evaluation of dietary habits and cooking confidence using virtual teaching kitchens for perimenopausal women.

BACKGROUND: The transition to menopause is a time when women are at increased risk for chronic and cardiovascular diseases, and weight gain. This study evaluates the efficacy of virtual teaching kitchen (TK) interventions on cooking confidence and consumption of a healthy diet in women over 45. METHODS: This teaching kitchen intervention is a synchronous online series of classes for perimenopausal women, with 45 min of live cooking and 15 min of nutrition discussion. From September 2020 through January 2022, participants completed online pre- post-intervention surveys addressing weight, eating habits, cooking confidence and self-efficacy. Analysis used paired samples t-test and Wilcoxon signed rank sum test for normally and non-normal distributed data respectively. RESULTS: Of the 609 unique participants, 269 women completed both pre and post surveys after attending classes. Participants self-reported a statistically significant decreased weight (p < 0.001), increased daily consumption of fruit/vegetables (p < 0.039), fish (p < 0.001) and beans (p < 0.005), and decreased daily consumption of red meat (p < 0.001), sugary beverages (p < 0.029) and white grains (p < 0.039). There was significant improvement in cooking self-efficacy and confidence. CONCLUSIONS: Virtual teaching kitchens were effective in improving culinary and dietary habits among peri- and post-menopausal women. This early evidence suggests that teaching kitchens can effectively reach larger populations for healthy behavioral modification. TRIAL REGISTRATION: Study obtained IRB exemption.

Delivery mode and perinatal outcomes after diagnosis of oligohydramnios at term in China.

Objective: The purpose of this study is to assess the incidence of oligohydramnios at term and evaluate whether the mode of delivery in patients with oligohydramnios influences perinatal outcomes in China.Methods: A cross-sectional survey of all deliveries in 39 hospitals in China from 1 January 2011-31 December 2011 was evaluated for the mode of delivery and perinatal outcomes in women with oligohydramnios compared to those without known oligohydramnios after excluding preterm births, polyhydramnios, and oligohydramnios secondary to premature rupture of membranes.Results: Oligohydramnios complicated 3954 (4.4%) of the 89,050 pregnancies, analyzed. Pregnancy cases with oligohydramnios compared those without known oligohydramnios had a significantly higher incidence of preexisting or gestational diabetes mellitus, fetal growth restriction, nonreassuring fetal heart tracings, obesity and malpresentation (p<.001). The cesarean delivery (CD) rate was significantly higher in pregnancies with identified oligohydramnios compared to those without (84.4 versus 54.7%; p<.001). Furthermore, in 2/3 of these CD in pregnancies with oligohydramnios, the identification of oligohydramnios was the only indication for the CD. In pregnancies with oligohydramnios, vaginal delivery did not significantly increase the risks of adverse outcomes compared to vaginal delivery without oligohydramnios, except postpartum complication.Conclusion: CD is not indicated in term pregnancies with isolated oligohydramnios. Vaginal delivery of oligohydramnios is not associated with increased perinatal mortality.

Association of China's universal two child policy with changes in births and birth related health factors: national, descriptive comparative study.

OBJECTIVE: To measure the association of China's universal two child policy, announced in October 2015, with changes in births and health related birth characteristics. DESIGN: National, descriptive before-and-after comparative study. SETTING: Every county in 28 of 31 provinces of mainland China. PARTICIPANTS: Births included in two national databases: 67 786 749 births from county level monthly aggregated data between January 2014 and December 2017; and 31 786 279 deliveries from individual level delivery information records between January 2015 and December 2017. MAIN OUTCOME MEASURES: Monthly mean number of births and mean proportion of multiparous mothers and mothers aged 35 and over, preterm deliveries, and caesarean deliveries. RESULTS: The study had two phases: the baseline period (up to and including June 2016, nine months after the policy announcement) and the effective period (from July 2016 to December 2017). The estimated number of additional births attributable to the new policy between July 2016 and December 2017 was 5.40 million (95% confidence interval 4.34 to 6.46). The monthly mean percentage of multiparous mothers and mothers aged 35 and over increased by 9.1 percentage points (95% confidence interval 6.4 to 11.7) and 5.8 percentage points (5.2 to 6.4), respectively. This increase in older mothers, however, was not associated with a concurrent increase in the overall rate of preterm birth. The monthly mean caesarean delivery rate among multiparous mothers increased by 1.2 percentage points (0.8 to 1.6) from 39.7% to 40.9%, and decreased by 3.0 percentage points (-3.5 to -2.5) among nulliparous mothers from 39.6% to 36.6%. CONCLUSIONS: Since its announcement in October 2015, the universal two child policy has been associated with a rise in births in China and with changes in health related birth characteristics: women giving birth have been more likely to be multiparous, and more likely to be aged 35 and over. No evidence of concurrent worsening outcomes (that is, premature births) was seen.

Cross sectional study of mode of delivery and maternal and perinatal outcomes in mainland China.

BACKGROUND: Cesarean delivery (CD) rates have risen globally with nearly 50% of the non-indicated CDs worldwide in China and Brazil. In China's One Child Policy era (1979-2015) most deliveries were women having their only child. Family size is a major determinant of the safety of medically non-indicated CD or CD on maternal request. The goal of this study is to document CD rates, indications, and analyze the relative safety of non-indicated CD compared to SVD and intrapartum CD. METHODS: Univariate and multivariate logistic regression analyses of the association between mode of delivery and short-term maternal and perinatal outcomes were performed on a cross-section of all deliveries at 39 hospitals in 14 provinces of China in 2011, presented as adjusted odds ratio (aOR), 99% confidence intervals (CI). FINDINGS: Among 108,847 deliveries, 59,415 were CD (54.6%) with 20.8% of deliveries or 38.2% of all cesareans were non-indicated CD. Compared to SVD, antepartum non-indicated CD was associated with a decreased likelihood of post-partum hemorrhage (PPH) (aOR = 0.80, CI = 0.69-0.92) and was not associated with maternal death or combined severe outcomes (maternal death, transfusion, or hysterectomy). Intrapartum indicated CD was associated with an increased risk of PPH (aOR = 1.68, CI = 1.50-1.89) compared to SVD. Compared to SVD, antepartum non-indicated CD was associated with lower likelihood of neonatal death (aOR = 0.14, CI = 0.06-0.34), neonatal ICU admission (aOR = 0.50, CI = 0.36-0.69), 5-minute Apgar<4 (aOR = 0.06, CI = 0.10-0.36), and respiratory distress syndrome (RDS) (aOR = 0.31, CI = 0.16-0.58), but not significantly associated with changes in rates of infection, hypoxic ischemic encephalopathy (HIEE), birth trauma or meconium aspiration rates. CONCLUSIONS: In 2011 when 81% of deliveries were women having their first child antepartum non-indicated CD had short-term maternal and perinatal outcomes as safe as SVD. Now that all Chinese women can have a second child the safety profile may change.

Caesarean deliveries in China.

BACKGROUND: The caesarean section rate has risen rapidly in China. The purpose of this retrospective study was to estimate caesarean section rates and indications by hospital facility level in Mainland China to investigate reasons contributing to the high rate. METHODS: This cross-sectional hospital-based study collected data from 39 hospitals in three geographical regions in China, covering 14 different provinces, municipalities, and autonomous regions, including 20 tertiary health hospitals and 19 secondary hospitals. Data from all women who gave birth at these hospitals during 2011 were included. RESULTS: A total of 112,138 women who gave birth after 24 weeks of gestation were surveyed. Of these pregnancies, 54.5% (61,084 cases) resulted in caesarean section, non-indicated caesarean section accounted for 38.4% of caesarean sections. Overall caesarean section rates were higher at the tertiary level hospitals (55.9%) compared to the secondary level hospitals (50.9%). The secondary level hospitals had higher rates of non-indicated caesarean section (48.9% of caesarean sections) compared to tertiary level hospitals (34.5% of caesarean sections). The rate of caesarean section on maternal request was higher in the secondary hospitals (16.6%) than in the tertiary hospitals (10%) (P < 0.001), as well as the caesarean section rate for CPD prior to labour. Operative vaginal deliveries were overall rare (1.2%) with 90.9% (1200/1320 cases) performed in the tertiary hospitals. CONCLUSIONS: Caesarean section on maternal request accounts for a large portion of China's high caesarean section rate, especially in the secondary hospitals. The first step to reduced caesarean section rates is to decrease the number of non-indicated caesarean sections.

Geographic Variations and Temporal Trends in Cesarean Delivery Rates in China, 2008-2014.

Importance: The increasing use of cesarean delivery is an emerging global health issue. Prior estimates of China's cesarean rate have been based on surveys with limited geographic coverage. Objective: To provide updated information about cesarean rates and geographic variation in cesarean use in China. Design, Setting, and Data Sources: Descriptive study, covering every county (n = 2865) in mainland China's 31 provinces, using county-level aggregated information on the number of live births, cesarean deliveries, maternal deaths, and perinatal deaths, collected by the Office for National Maternal & Child Health Statistics of China, from 2008 through 2014. Exposures: Live births. Main Outcomes and Measures: Annual rate of cesarean deliveries. Results: Over the study period, there were 100 873 051 live births, of which 32 947 229 (32.7%) were by cesarean delivery. In 2008, there were 13 160 634 live births, of which 3 788 029 (28.8%) were by cesarean delivery and in 2014 there were 15 123 276 live births, of which 5 280 124 (34.9%) were by cesarean delivery. Rates varied markedly by province, from 4.0% to 62.5% in 2014. Despite the overall increase, by 2014 rates of cesarean delieries in 14 of the nation's 17 "super cities" had declined by 4.1 to 17.5 percentage points from their earlier peak values (median, 11.4; interquartile range, 6.3-15.4). In 4 super cities with the largest decreases, there was no increase in maternal or perinatal mortality. Conclusions and Relevance: Between 2008 and 2014, the overall annual rate of cesarean deliveries increased in China, reaching 34.9%. There was major geographic variation in rates and trends over time, with rates declining in some of the largest urban areas.

Survey of Obstetric Care and Cesarean Delivery Rates in Shanghai, China.

BACKGROUND: China has one of the highest cesarean delivery rates in the world, with most cesareans done without indication. METHODS: Observation of how perinatal care is delivered in a range of Shanghai hospitals was done to gain insight into the 50 percent cesarean delivery rate. A mixed methods approach combined a descriptive structured survey of obstetric services with standardized interview with obstetricians and qualitative observation of obstetric services in six different Shanghai obstetric facilities. RESULTS: The volume was extremely high: physicians in public hospitals routinely saw up to 80-120 prenatal patients per day. Frequent prenatal testing substituted for time spent in patient-doctor interactions. Family members were not allowed in delivery wards where women labored alone. Obstetrics services had low levels of nursing support and anesthesia for labor. Physical space favored rapid surgical turnover over longer labor. Physicians reported practical incentives to perform cesarean sections. DISCUSSION: Cesarean delivery was an efficient way to move patients through the systems observed, given the staffing and physical limitations of the public facilities. Physicians reported that patients and families perceived cesarean delivery as safer. Physicians also reported fear of charges of malpractice, for which they might be found to be financially liable or in physical danger. Societal expectations are high, and in a "one child" society, perception that cesarean section was safer may also have driven cesarean rates. Given the end of the One Child Policy, the preference for cesarean delivery may change.

A prospective study of pregravid oral contraceptive use in relation to fetal growth.

OBJECTIVE: Because oral contraceptives are so widely used, any health consequences may have substantial public health implications. Whether pregravid oral contraceptives could affect subsequent pregnancies has not been adequately studied. The study objectives were to examine whether pregravid oral contraceptive use affects fetal growth and pregnancy hormone levels. DESIGN: A prospective study of pregnant women followed through pregnancy. SETTING: A major teaching hospital in Boston, USA. POPULATION: Two hundred and sixty Caucasian pregnant women, with a mean age of 31, and a parity of no more than two. Seventy-nine percent of the women were pregravid oral contraceptive users. METHODS: Exposure and covariate data were collected through structured questionnaires. Blood was drawn for hormonal analysis during the 16th and 27th gestational week. Information on pregravid oral contraceptive use included duration and recency of use, and oral contraceptive formulation. Multivariate regression models were used to examine the effect of pregravid oral contraceptive use on birth outcomes and the studied pregnancy hormones. MAIN OUTCOME MEASURES: Birthweight, placental weight, gestational age, pregnancy hormone levels of oestriol and progesterone at 16th and 27th gestational week. RESULTS: Adjusting for confounders, pregravid oral contraceptive use increased birthweight (mean difference =+207.3 g, 95% CI =+77.6 to +337.1) and placental weight (mean difference =+64.9 g, 95% CI =+13.0 to +116.9) compared with never use. Women with prior oral contraceptive use had higher levels of serum progesterone (P= 0.002) and oestriol (P= 0.12) at the 27th gestational week measurement. The effect on birthweight, placental weight and hormones was stronger among those using oral contraceptives in the previous year and those using a high progestin/high oestrogen potency preparation. CONCLUSIONS: Pregravid oral contraceptive use is positively associated with fetal growth, and this effect may be mediated through oestriol and progesterone.

Pregnancy hormones, pre-eclampsia, and implications for breast cancer risk in the offspring.

The aim of this study is to prospectively assess pregnancy hormone levels as correlates of subsequent development of pre-eclampsia, a condition that has been shown to be inversely associated with breast cancer risk in the offspring. A cohort of 260 Caucasian women in Boston, Massachusetts, was followed through pregnancy. Maternal blood was collected at the 16th and 27th weeks of gestation, and 18 women were diagnosed with pre-eclampsia after blood collection. Information on sociodemographic variables and risk factors of pre-eclampsia was collected through an interviewer-administered questionnaire and review of medical records. At the 16th week, there was a nonsignificant positive association between progesterone levels and pre-eclampsia [relative risk (RR) = 1.63, 95% confidence interval (CI), 0.97-2.74, per 1 SD increase]. By the 27th week, the association between progesterone and pre-eclampsia was strengthened (RR = 2.65, 95% CI, 1.46-4.81, per SD), and sex hormone-binding globulin levels were somewhat inversely related to pre-eclampsia (RR = 0.61, 95% CI, 0.31-1.20, per SD). No difference was found with respect to prolactin, estradiol, and estriol levels. Our findings indicate that progesterone may have a role in the late manifestation of pre-eclampsia pathology but are also compatible with the hypothesis that increases in progesterone represent an early compensatory mechanism.