Risk of adverse pregnancy outcomes in pregnant women with gestational diabetes mellitus by age: a multicentric cohort study in Hebei, China.

Gestational diabetes mellitus (GDM) is an unique metabolic disorder that occurs during pregnancy. Both GDM and advanced age increase the risk of adverse pregnancy outcomes. This study used a GDM cohort study to investigate the role of age in the adverse pregnancy outcomes for pregnant women with GDM. From 2015 to 2021, 308,175 pregnant women were selected, and the data received from 22 hospitals by the Hebei Province Maternal Near Miss Surveillance System. There were 24,551 pregnant women with GDM that were divided into five groups by age (20-24, 25-29, 30-34, 35-39, 40-44 years old). Because the prevalence of adverse pregnancy outcomes was lower in pregnant women with GDM aged 25-29, they were used as a reference group (P < 0.05). Compared with GDM women aged 25-29 years, GDM women aged 35-44 years had a significant higher risk of cesarean delivery (aOR: 2.86, 95% CI 2.52-3.25) (P < 0.001), abnormal fetal position (aOR: 1.78, 95% CI 1.31-2.37) (P < 0.001), pre-eclampsia (aOR: 1.28, 95% CI 1.01-1.61) (P < 0.05), macrosomia (aOR: 1.25, 95% CI 1.08-1.45) (P < 0.05), and large for gestational age (LGA) (aOR: 1.16, 95% CI 1.02-1.31) (P < 0.05), GDM women aged 40-44 years had a higher risk of placenta previa (aOR: 2.53, 95% CI 1.01-6.35) (P < 0.05), anemia (aOR: 3.45, 95% CI 1.23-9.68) (P < 0.05) and small for gestational age (aOR: 1.32, 95% CI 1.01-1.60) (P < 0.05). Advanced maternal age was an independent risk factor for abnormal fetal position, pre-eclampsia, anemia, macrosomia, and LGA in pregnant women with GDM.

Prevalence and adverse perinatal outcomes of anaemia in the third trimester of pregnancy in Hebei Province, China.

BACKGROUND: Anaemia in pregnancy is one of the most frequent complications related to pregnancy and is a public health concern. This article examines the prevalence of anaemia in the third trimester of pregnancy and the associations between anaemia and adverse perinatal outcomes in Hebei Province, China. METHODS: We used SPSS software to describe the incidence of anaemia in the third trimester of pregnancy in Hebei Province and analysed the clinical characteristics in anaemic patients and the relationship between anaemia and adverse pregnancy outcomes. RESULTS: The overall prevalence of anaemia in the third trimester of pregnancy was 35.0% in Hebei Province. The prevalence of anaemia in the population with a high education level was lower than that in the population with a low education level. The incidence rate in rural areas was higher than that in urban areas. After adjustment for confounding factors, anaemia in the third trimester of pregnancy is an independent risk factor in terms of placenta previa, placental abruption, uterine atony, pre-eclampsia, gestational diabetes mellitus, heart disease, postpartum haemorrhage, premature birth, laceration of birth canal, puerperal infection, caesarean section and large for gestational age. CONCLUSIONS: The prevalence of anaemia in the third trimester of pregnancy is associated with an increased risk of adverse perinatal outcomes. A comprehensive approach to prevent anaemia is needed to improve maternal and child health outcomes.

The Effect of 2016 Chinese second-child policy and different maternal age on pregnancy outcomes in Hebei Province, China.

OBJECTIVE: To explore the effect of the 2016 Chinese second child policy and different maternal ages on adverse perinatal outcomes. METHODS: Clinical data were collected from 22 monitoring hospitals in Hebei Province from January 1, 2013, to December 31, 2021. A total of 413,892 parturient were divided into 3 groups based on delivery age: 20-34, 35-39, and 40-55 years old. The clinical data were analyzed to explore the relationship among the 2016 Chinese second-child policy, maternal age, and various pregnancy risks. RESULTS: Pregnancy complications showed an upward trend from 2013 to 2021.The top 10 incidences of pregnancy complications in Hebei Province were anemia, small for gestational age (SGA), large for gestational age (LGA), macrosomia, gestational diabetes mellitus (GDM), premature delivery, preeclampsia (PE), postpartum hemorrhage (PPH), placenta previa, and placental abruption. The two-child policy was implemented in 2016. The incidence of pregnancy complications, anemia, GDM, PE, placental abruption, cesarean delivery, premature delivery, SGA, LGA, macrosomia in 2016-2021 was significantly higher than that in 2013-2015 (P<0.05), and the proportion of women of advanced maternal age (AMA, ≥ 35 years old) increased from 2013 to 2021. Advanced maternal age was a risk factor for most assessed adverse pregnancy outcomes, including GDM, PE, placenta previa, placenta abruption, cesarean delivery, PPH, premature delivery, SGA, LGA and macrosomia. CONCLUSION: After the adjustment of the "second-child" policy, the incidence of pregnancy complications increased. Moreover, the risk of adverse pregnancy outcomes in AMA has increased. Early prevention and intervention should be implemented to cope with the occurrence of adverse perinatal outcomes.

Secular increase in the prevalence of gestational diabetes and its associated adverse pregnancy outcomes from 2014 to 2021 in Hebei province, China.

Objective: We aimed to investigate the secular prevalence of gestational diabetes mellitus (GDM) and evaluate its adverse pregnancy outcomes among pregnant women in Hebei province, China. Methods: We analyzed the data from the monitoring information management system for pregnant women in 22 hospitals of Hebei province, China. In this study, 366,212 individuals with singleton live births from 2014 to 2021 were included, of whom 25,995 were diagnosed with gestational diabetes. We described the incidence of common complications and further analyzed the clinical characteristics in GDM patients and the relationship between GDM and adverse pregnancy outcomes. Results: The top 3 pregnancy complications in Hebei province are anemia, gestational hypertension, and GDM. The average incidence of GDM was 7.10% (25,995/366,212). The incidence rate of GDM significantly increased from 2014 to 2021 (χ2 trend = 7,140.663, P < 0.001). The top 3 regions with GDM incidence were Baoding (16.60%), Shijiazhuang (8.00%), and Tangshan (3.80%). The incidence of GDM in urban pregnant women (10.6%) is higher than that in rural areas (3.7%).The difference between the GDM and Non-GDM groups was statistically significant in terms of maternal age, gravidity, parity, education level, and incidence of pregnancy complications (gestational hypertension, heart diseases, and anemia) (P < 0.05). GDM individuals were at significantly increased risk of most assessed adverse pregnancy outcomes, including premature delivery, Cesarean delivery, uterine inertia, neonatal intensive care unit (NICU) admission, Apgar (activity-pulse-grimace-appearance-respiration) score at 1 min, and macrosomia (P < 0.05). The multivariate logistic regression analysis showed that GDM was an independent risk factor in terms of premature birth, Cesarean delivery, uterine inertia, placental abruption, NICU admission, and macrosomia. Conclusion: The risk of adverse pregnancy outcome in pregnant women with GDM is significantly increased. In order to reduce the occurrence of adverse pregnancy outcomes, effective interventions are needed.

The adverse maternal and perinatal outcomes of adolescent pregnancy: a cross sectional study in Hebei, China.

BACKGROUND: The adverse pregnancy outcomes caused by teenage pregnancy are major public health problems with significant social impact. While China is the most populous country in the world, and 8.5% of the women aged 10-50 years are adolescent women, we aimed to analyze the adverse maternal and perinatal outcomes of the adolescent pregnancy in Hebei Province, China. METHODS: There were 238,598 singleton pregnant women aged 10-34 years from January 1, 2013 to December 31, 2017 in the database of Hebei Province Maternal Near Miss Surveillance System (HBMNMSS). The 238,598 pregnant women were divided into two groups: adolescent group (aged 10-19 years) and adult group (aged 20-34 years). The adolescent group was divided into two subgroups (aged 10-17 years, aged 18-19 years), the adult group was divided into two subgroups (aged 20-24 years, aged 25-34 years). We compared the risk of adverse pregnancy outcomes using univariate and multivariate logistic regression. We also made a stratified analysis of nulliparous and multiparous adolescent pregnancy. RESULTS: Compared with women aged 20-34 years, women aged 10-19 years had lower risk of cesarean delivery [adjusted risk ratio (aRR): 0.75, 95% confidence interval (CI): 0.70-0.80], gestational diabetes mellitus (GDM) (aRR: 0.55, 95%CI: 0.41-0.73). Women aged 10-19 years had higher risk of preterm delivery (aRR: 1.76, 95%CI: 1.54-2.01), small for gestational age (SGA) (aRR: 1.19, 95%CI: 1.08-1.30), stillbirth (aRR: 2.58, 95%CI: 1.83-3.62), neonatal death (aRR: 2.63, 95%CI: 1.60-4.32). The adolescent women aged 10-17 years had significantly higher risk of stillbirth (aRR: 5.69, 95%CI: 3.36-9.65) and neonatal death (aRR: 7.57, 95%CI: 3.74-15.33) compared with the women aged 25-34 years. Younger adults (20-24 years) also had higher risks of preterm delivery (aRR: 1.26, 95%CI: 1.20-1.32), stillbirth (aRR: 1.45, 95%CI: 1.23-1.72), and neonatal death (aRR: 1.51, 95%CI: 1.21-1.90) compared with women aged 25-34 years. The structural equation model showed that preterm delivery and cesarean delivery had an indirect effect on neonatal death in adolescent pregnancy. CONCLUSIONS: The adolescent pregnancy was related to adverse perinatal (fetal and neonatal) outcomes, such as preterm delivery, stillbirth and neonatal death, especially in younger adolescent pregnancies.

Silencing of Annexin A1 suppressed the apoptosis and inflammatory response of preeclampsia rat trophoblasts.

Preeclampsia (PE) is a disorder that is characterized by pregnancy­induced hypertension. It has been reported that Annexin A1 (ANXA1) is highly expressed in the plasma of women diagnosed with PE. Therefore, the present study aimed to examine the effect of ANXA1 on PE rats. The PE animal model was constructed in rats using Nω­nitro­L­arginine methyl ester (L­NAME), and the blood pressure and urine protein levels of rats were detected. The pathological features of placental tissue, and the levels of inflammatory factors and ANXA1 were respectively measured by hematoxylin­eosin staining, enzyme­linked immunosorbent assay and immunohistochemical assay. The activity of trophoblasts obtained from PE placental tissue was measured using immunofluorescence staining, while cell apoptosis was assessed using flow cytometry. The levels of associated factors were determined by reverse transcription­quantitative polymerase chain reaction and western blot analysis. The results identified that systolic blood pressure, diastolic blood pressure, mean arterial pressure and urine protein levels were enhanced, and that the contents of ANXA1, tumor necrosis factor alpha (TNF­α), interleukin (IL)­1ß, IL­6 and IL­8 were increased in the L­NAME group. Transfection with small interfering RNA (siRNA)­ANXA1 markedly decreased the apoptosis and inflammatory response of trophoblasts. In addition, siRNA­ANXA1 upregulated the levels of B­cell lymphoma­2 (Bcl­2) and pro­caspase­3, and downregulated the levels of Bcl­2­associated X protein, cleaved­caspase­3, TNF­α, IL­1ß, IL­6 and IL­8. Furthermore, siRNA­ANXA1 repressed the phosphorylation of Janus kinase 2 (JAK2) and signal transducer and activator of transcription 3 (STAT3); however, siRNA­ANXA1 did not alter the levels of JAK2 and STAT3. Therefore, silencing of ANXA1 suppressed the apoptosis and inflammatory response of PE rat trophoblasts, and downregulated JAK2/STAK3 pathway.

The effect of rehabilitation exercises combined with direct vagina low voltage low frequency electric stimulation on pelvic nerve electrophysiology and tissue function in primiparous women: A randomised controlled trial.

AIM AND OBJECTIVE: To evaluate the effect of rehabilitation exercises combined with Direct Vagina Low Voltage Low Frequency Electric Stimulation (DES) on pelvic nerve electrophysiology and tissue function after delivery. BACKGROUND: Whether and how DES effects pelvic floor dysfunction (PFD) are not known clearly. DESIGN: This was a randomised, controlled clinical trial. METHODS: The 189 primiparous women 20-35 years old and with an episiotomy or second degree episiotomy tear were divided into three groups: the control group (n = 60) received routine postpartum guidance 2 hr postpartum, the training group (n = 63) performed rehabilitation exercises (Kegel exercises and pelvic movements) from 2 days postpartum until 3 months postpartum, and the combination group (n = 66) received DES 15 times (3 times a week for 30 min at a time) beginning at the sixth week postpartum in addition to performing rehabilitation exercises. Adopt international standard scale and score method to inspect maternal life treatment, such as pelvic organ prolapse situation (POP-Q division), the degree of incontinence score and pelvic floor muscle intensity of muscular contraction. Data were collected during the third month after delivery. RESULTS: Three months postpartum, there were differences among the three groups in the POP-Q grade, the degree of incontinence score, the Oxford grade for pelvic floor muscle strength and the pelvic floor muscle electrophysiology condition. Additionally, there were significant differences regarding the pubic symphysis clearance. Rehabilitation exercises can promote healing of the maternal pubic symphysis and recovery of the pelvis. The total electrical value, type I muscle fibre strength and type II muscle fibre strength were significantly increased in the combination group after treatment than before treatment. CONCLUSION: Rehabilitation exercises combined with DES were beneficial to the recovery of postpartum pelvic nerve tissue function, and a synergistic effect was observed when the two methods were combined. RELEVANCE TO CLINICAL PRACTICE: These conclusions justify that rehabilitation exercise combined with DES can better relieve uncomfortable symptoms postpartum and improve the women's quality of life.