Predictions of Preterm Birth from Early Pregnancy Characteristics: Born in Guangzhou Cohort Study.

Preterm birth (PTB, <37 weeks) is the leading cause of death in children <5 years of age. Early risk prediction for PTB would enable early monitoring and intervention. However, such prediction models have been rarely reported, especially in low- and middle-income areas. We used data on a number of easily accessible predictors during early pregnancy from 9044 women in Born in Guangzhou Cohort Study, China to generate prediction models for overall PTB and spontaneous, iatrogenic, late (34⁻36 weeks), and early (<34 weeks) PTB. Models were constructed using the Cox proportional hazard model, and their performance was evaluated by Harrell's c and D statistics and calibration plot. We further performed a systematic review to identify published models and validated them in our population. Our new prediction models had moderate discrimination, with Harrell's c statistics ranging from 0.60⁻0.66 for overall and subtypes of PTB. Significant predictors included maternal age, height, history of preterm delivery, amount of vaginal bleeding, folic acid intake before pregnancy, and passive smoking during pregnancy. Calibration plots showed good fit for all models except for early PTB. We validated three published models, all of which were from studies conducted in high-income countries; the area under receiver operating characteristic for these models ranged from 0.50 to 0.56. Based on early pregnancy characteristics, our models have moderate predictive ability for PTB. Future studies should consider inclusion of laboratory markers for the prediction of PTB.

Early life vitamin D status and asthma and wheeze: a systematic review and meta-analysis.

BACKGROUND: Vitamin D deficiency has been linked to an increased risk of asthma. This study aimed to quantify the effect of early life vitamin D status on asthma and wheeze later in life. METHODS: PubMed, Embase, CINAHL, and CNKI databases, the Cochrane Central Register of Controlled Trials, and Google Scholar were searched up to July 2017. We included randomized controlled trials (RCTs) and cohort studies with vitamin D level in blood (maternal or cord or infant) or intake (maternal intake during pregnancy or infant intake) and asthma and/or wheeze. Two reviewers independently extracted data. Fixed- and random-effects models were used to summarize the risk estimates of comparisons between highest vs. lowest vitamin D categories. RESULTS: Of the 1485 studies identified, three RCTs and 33 cohort studies were included. We did not include the RCTs (1619 participants) in the meta-analysis as the comparators and outcome definitions were heterogenous. Three RCTs reported a non-statistically significant effect of vitamin D supplementation during pregnancy on offspring wheeze/asthma at 3 years of age. Pooled estimates of cohort studies suggest no association between antenatal blood vitamin D levels or vitamin D intake and offspring asthma assessed either > 5 years or ≤ 5 years. The estimate for blood vitamin D remained unchanged when two studies assessing asthma in adulthood were excluded, but a significant inverse association emerged between vitamin D intake and childhood asthma. We found no association between antenatal vitamin D level and wheeze. On the other hand, vitamin D intake during pregnancy may have a protective effect against wheeze. CONCLUSIONS: The pooled estimates from cohort studies show no association between antenatal blood vitamin D level and asthma/wheeze in later life. Whereas, the pooled estimates from cohort studies suggest that antenatal vitamin D intake may have an effect on childhood asthma > 5 years or childhood wheeze. The inconsistent results from studies assessing vitamin D either in blood or intake may be explained by previously reported non-linear association between blood vitamin D3 and childhood asthma. Further trials with enough power and longer follow-up time should be conducted to confirm the results.

Association Between Maternal Hyperglycemia and Composite Maternal-Birth Outcomes.

Objective: The overall impact of maternal hyperglycemia on maternal and birth outcomes is largely underestimated, therefore quantifying the true burden of hyperglycemia in a whole population it is a challenging task. This study aims at examining the association between blood glucose concentration during pregnancy and a composite score of adverse maternal-birth outcomes in a large-scale prospective cohort study in China. Methods: Pregnant women within "the Born in Guangzhou Cohort Study" China who underwent a standard 75-g oral-glucose-tolerance-test (OGTT) between 22 and 28 gestational weeks were included. A composite score of stillbirth, duration of pregnancy, birth weight, preeclampsia, and cesarean section was developed based on a published maternal-fetal outcomes scale, weighed by the relative severity of the outcomes. Multiple linear regression models were used to assess the associations between OGTT glucose measurements and log composite score. Logistic regression models were used to assess relations with outcome as a categorical variable (0, 1- < 3, and ≥3). Findings: Among 12,129 pregnancies, the composite score ranged from 0 to 100 with a median of 2.5 for non-zero values. Elevated fasting glucose level was associated with higher composite score (adjusted coefficients 0.03 [95% CI, 0.02-0.04] for 1-SD increase). For 1-SD increase in fasting glucose, the risk of having a composite score 1- < 3 and ≥3 rises by 13% (95% CI, 8-17%) and 15% (95% CI, 7-23%), respectively. Similar association and increase in risk was found for 1 and 2-h glucose. Conclusion: Elevated fasting, 1 and 2-h glucose levels are associated with a range of adverse maternal-birth outcomes. The composite score model can be applied to the risk assessment for individual pregnant women and to evaluate the benefits for controlling glucose levels in the population.

Associations between maternal exposure to incense burning and blood pressure during pregnancy.

Incense burning is a popular practice in Asian and Arabic countries. Previous studies show that incense burning was associated with increased risks of adverse outcomes among non-pregnant population. However, very few studies explored its health effects among pregnant women, who are more susceptible to environmental stressor. We aimed to examine the association between incense burning at home and hypertensive disorders as well as blood pressure levels during pregnancy, using data from 10,563 pregnant women recruited in Born in Guangzhou Cohort Study, China between January 2013 and December 2015. Information on frequency and duration of exposure to incense burning were collected at early and late pregnancy using questionnaire. Data on outcome variables, including hypertensive disorders diagnosis and blood pressure levels at the final antenatal visit before delivery, were extracted from medical records. We used Poisson regression model and general linear model to examine the associations between incense exposure and the outcomes. We found incense use at early pregnancy was not significantly associated with outcomes. Pregnant women who frequently smelled the incense burning at late pregnancy was associated with higher risk of hypertensive disorders (relative risk, 1.84; 95% confidence interval, 1.14-2.98) and higher levels of blood pressure (1.6mmHg increase of systolic blood pressure; 95% confidence interval, 0.4-2.8mmHg) before delivery, compared to those did not burn incense. These associations tended to more evident among women without active and passive smoking. We did not observe significant dose-response relationship between exposure duration and the risk of hypertensive disorders. We firstly reported exposure to incense burning was associated with the risk of hypertensive disorders and blood pressure levels during pregnancy. Given hypertensive disorders in pregnancy are well-established risk factors for a variety of adverse outcomes and the incense burning is a modifiable factor, our finding may have important public health significance.

Connections between the human gut microbiome and gestational diabetes mellitus.

The human gut microbiome can modulate metabolic health and affect insulin resistance, and it may play an important role in the etiology of gestational diabetes mellitus (GDM). Here, we compared the gut microbial composition of 43 GDM patients and 81 healthy pregnant women via whole-metagenome shotgun sequencing of their fecal samples, collected at 21-29 weeks, to explore associations between GDM and the composition of microbial taxonomic units and functional genes. A metagenome-wide association study identified 154 837 genes, which clustered into 129 metagenome linkage groups (MLGs) for species description, with significant relative abundance differences between the 2 cohorts. Parabacteroides distasonis, Klebsiella variicola, etc., were enriched in GDM patients, whereas Methanobrevibacter smithii, Alistipes spp., Bifidobacterium spp., and Eubacterium spp. were enriched in controls. The ratios of the gross abundances of GDM-enriched MLGs to control-enriched MLGs were positively correlated with blood glucose levels. A random forest model shows that fecal MLGs have excellent discriminatory power to predict GDM status. Our study discovered novel relationships between the gut microbiome and GDM status and suggests that changes in microbial composition may potentially be used to identify individuals at risk for GDM.

The Born in Guangzhou Cohort Study (BIGCS).

The Born in Guangzhou Cohort Study (BIGCS) is a large-scale prospective observational study investigating the role of social, biological and environmental influences on pregnancy and child health and development in an urban setting in southern China. Pregnant women who reside in Guangzhou and who attend Guangzhou Women and Children's Medical Center (GWCMC) for antenatal care in early pregnancy (<20 weeks' gestation) are eligible for inclusion. Study recruitment commenced in February 2012, with an overall participation rate of 76.3%. Study recruitment will continue until December 2018 to achieve the target sample size of 30,000 mother-child pairs. At 30 April 2016, a total of 75,422 questionnaires have been collected, while 14,696 live births have occurred with planned follow-up of cohort children until age 18 years. During the same period a total of 1,053,000 biological samples have been collected from participants, including maternal, paternal and infant blood, cord blood, placenta, umbilical cord, and maternal and infant stool samples. The dataset has been enhanced by record linkage to routine health and administrative records. We plan future record linkage to school enrolment and national examination records.

Does tea consumption during early pregnancy have an adverse effect on birth outcomes?

BACKGROUND: Tea, a common beverage, has been suggested to exhibit a number of health benefits. However, one of its active ingredients, caffeine, has been associated with preterm birth and low birthweight. We investigated whether tea consumption during early pregnancy is associated with an increased risk of preterm birth and abnormal fetal growth. METHODS: A total of 8775 pregnant women were included from the Born in Guangzhou Cohort Study. Tea consumption (type, frequency, and strength) during their first trimester and social and demographic factors were obtained by way of questionnaires administered during pregnancy. Information on birth outcomes and complications during pregnancy was obtained from hospital medical records. RESULTS: Overall habitual tea drinking (≥1 serving/week) prevalence among pregnant women was low, at 16%. After adjustment for potential confounding factors (eg, maternal age, educational level, monthly income) tea drinking during early pregnancy was not associated with an increased risk of preterm birth or abnormal fetal growth (small or large for gestational age) (P>.05). CONCLUSIONS: We did not identify a consistent association between frequency of tea consumption or tea strength and adverse birth outcomes among Chinese pregnant women with low tea consumption. Our findings suggest that occasional tea drinking during pregnancy is not associated with increased risk of preterm birth or abnormal fetal growth. Given the high overall number of annual births in China, our findings have important public health significance.

Validity and Reproducibility of a Dietary Questionnaire for Consumption Frequencies of Foods during Pregnancy in the Born in Guangzhou Cohort Study (BIGCS).

This study aimed to examine the reproducibility and validity of a new food frequency questionnaire (FFQ) used in a birth cohort study to estimate the usual consumption frequencies of foods during pregnancy. The reference measure was the average of three inconsecutive 24 h diet recalls (24 HR) administrated between two FFQs, and the reproducibility was measured by repeating the first FFQ (FFQ1) approximately eight weeks later (FFQ2). A total of 210 pregnant women from the Born in Guangzhou Cohort Study (BIGCS) with full data were included in the analysis. The Spearman's correlation coefficients of FFQ1 and FFQ2 ranged from 0.33 to 0.71. The intraclass correlation coefficients of the two FFQs ranged from 0.22 to 0.71. The Spearman's correlation coefficients of the 24 HR and FFQ2 ranged from 0.23 to 0.62. Cross-classification analysis showed 65.1% of participants were classified into same and contiguous quintiles, while only 3.2% were misclassified into the distant quintiles. Bland-Altman methods showed good agreement for most food groups across the range of frequencies between FFQ1 and FFQ2. Our findings indicated that the reproducibility and validity of the FFQ used in BIGCS for assessing the usual consumption frequencies of foods during pregnancy were acceptable.

[Induction and analysis for NIR features of frequently-used mineral traditional Chinese medicines].

In order to provide theoretical basis for the rapid identification of mineral traditional Chinese medicines(TCM) with near infrared (NIR)diffuse reflectance spectroscopy, Characteristic NIR spectra of 51 kinds of mineral TCMs were generalized and compared on the basis of the previous research, and the characteristic spectral bands were determined and analyzed by referring to mineralogical and geological literatures. It turned out that the NIR features of mineral TCMs were mainly at 8 000-4 000 cm ⁻¹ wavebands, which can be assigned as the absorption of water, -OH and[CO3 ²â»] and so on. Absorption peaks of water has regularity as follows, the structure water and -OH had a combined peak which was strong and keen-edged around 7 000 cm ⁻¹, the crystal water had two strong peak around 7 000 cm ⁻¹ and 5 100 cm ⁻¹, and water only has a broad peak around 5 100 cm ⁻¹. Due to the differences in the crystal form and the contents of water in mineral TCMs, NIR features of water in mineral TCMs which could be used for identification were different. Mineral TCMs containing sulfate are rich in crystal water, mineral TCMs containing silicate generally had structure water, and mineral TCMs containing carbonate merely had a little of water, so it was reasonable for the use of NIR spectroscopy to classify mineral TCMs with anionic type. In addition, because of the differences in cationic type, impurities, crystal form and crystallinity, mineral TCMs have exclusive NIR features at 4 600-4 000 cm ⁻¹, which can be assigned as Al-OH, Mg-OH, Fe-OH, Si-OH,[CO3 ²â»] and so on. Calcined mineral TCMs are often associated with water and main composition changes, also changes of the NIR features, which could be used for the monitoring of the processing, and to provide references for the quality control of mineral TCMs. The adaptability and limitation of NIR analysis for mineral TCMs were also discussed:the majority of mineral TCMs had noteworthy NIR features which could be used for the NIR analysis. And the NIR features of a few mineral TCMs were inapparent, such as Fluoritum, Realgar and Cinnabar, for which the Raman spectroscopy can be adopted alternatively.

C1q and tumor necrosis factor-related protein 3 is present in human cord blood and is associated with fetal growth.

BACKGROUND: To determine the presence of C1q and tumor necrosis factor-related protein 3 (CTRP3) in cord blood and its relationship with fetal growth among Chinese newborns. METHODS: This pilot study recruited 126 infants (small for gestational age [SGA], n=34; appropriate for gestational age [AGA], n=60; large for gestational age [LGA], n=32); cord blood CTRP3 levels were measured, and fetal growth parameters were collected. RESULTS: Median (25-75th percentile) CTRP3 levels in the SGA, AGA, and LGA groups were 297.2 (236.4-360.2), 297.5 (261.0-369.9), and 368.6 (298.5-507.1) ng/ml, respectively (P=0.01). LGA infants had higher CTRP3 levels than AGA infants (multiple linear regression analysis; P=0.01). The CTRP3 levels were positively correlated with birth weight (r=0.25, P<0.01), Ponderal index (r=0.28, P<0.01), and placental weight (r=0.20, P=0.03) in the total study population. In the subgroup analysis, CTRP3 levels were negatively correlated with birth length z scores (r=-0.39, P=0.03) and were positively correlated with the Ponderal index (r=0.43, P=0.02) only in the SGA group; no other significant correlations were observed. The CTRP3 levels were similar between the sexes (P=NS). CONCLUSIONS: CTRP3 is present in cord blood and might be involved in fetal growth.

Maternal dietary patterns and gestational diabetes mellitus: a large prospective cohort study in China.

Few studies have explored the relationship between dietary patterns and the risk of gestational diabetes mellitus (GDM). Evidence from non-Western areas is particularly lacking. In the present study, we aimed to examine the associations between dietary patterns and the risk of GDM in a Chinese population. A total of 3063 pregnant Chinese women from an ongoing prospective cohort study were included. Data on dietary intake were collected using a FFQ at 24-27 weeks of gestation. GDM was diagnosed using a 75 g, 2 h oral glucose tolerance test. Dietary patterns were determined by principal components factor analysis. A log-binomial regression model was used to examine the associations between dietary pattern and the risk of GDM. The analysis identified four dietary patterns: vegetable pattern; protein-rich pattern; prudent pattern; sweets and seafood pattern. Multivariate analysis showed that the highest tertile of the vegetable pattern was associated with a decreased risk of GDM (relative risk (RR) 0·79, 95% CI 0·64, 0·97), compared with the lowest tertile, whereas the highest tertile of the sweets and seafood pattern was associated with an increased risk of GDM (RR 1·23, 95% CI 1·02, 1·49). No significant association was found for either the protein-rich or the prudent pattern. The protective effect of a high vegetable pattern score was more evident among women who had a family history of diabetes (P for interaction=0·022). These findings suggest that the vegetable pattern was associated with a decreased risk of GDM, while the sweets and seafood pattern was associated with an increased risk of GDM. These findings may be useful in dietary counselling during pregnancy.

[Study on identification of traditional Chinese medicine Yangqishi and Yinqishi by X-ray diffraction].

The aim of this paper is to clarify the mineral origin of traditional Chinese medicine (TCM) Yangqishi and Yinqishi and guide identification of the both, by X-ray diffraction (XRD) Fourier patterns. Morphological identification and conventional physical and chemical analysis wee used to identify 22 batches of Yangqishi and Yinqishi. It used XRD Fourier patterns which has been collected from sample powders to analyze phase composition. It has been found experimentally that the mineral origin of Yinqishi is Talc schist and the mineral origin of Yangqishi is tremolite and actinolite. The results also showed that the method using XRD can get not only an accurate but also rapid identification of Yangqishi and Yinqishi. There are many differences in medicinal properties, efficacy, indications and composition of Yangqishi and Yinqishi, so be careful not to mix them up.

[Quantitative models of Raman spectroscopy for five kinds of traditional Chinese medicine containing CaCO3 based on an improved siPLS].

The aim of this paper is to apply Raman spectroscopy technique to develop rapid quantitative models for five kinds of Traditional Chinese Medicine containing CaCO3. In the experiment, Raman spectras of 67 batch of sample including Otolithum Sciaenae, Galaxeae Os, Ophicalcitum, Calcite, Stalactite and their mixture which had different content of CaCO3 were collected, and the quantitative models were established by using an improved siPLS to optimize the characteristic spectral bands and using the CaCO3 contents which were measured by EDTA titration method as references. Compared with the results by EDTA titration, the established quantitative model for CaCO, content showed a prediction result that the average relative deviation of the prediction results is 2. 71% and the average recovery rate was 100.46%, when the content is between 0.465 4-0.999 7, and when the characteristic spectral bands of 1 290-1 280, 730-714, 700-690, 660-650, 465-460, 455-445, 405-385 cm(-1) had been optimized. The result also showed that the model using Raman spectroscopy and based on an improved siPLS can get a rapid determination for contents of 5 kinds of Traditional Chinese Medicine containing CaCO3.

[A NIR qualitative and quantitative model of 8 kinds of carbonate-containing mineral Chinese medicines].

The aim of this paper is to apply near infrared spectroscopy techniques to construct a rapid identification method for 8 kinds of mineral Chinese Medicines containing carbonates. The qualitative model using clustering analysis method in OPUS software can identify accurately 8 kinds of carbonate-containing mineral Chinese medicines. The near-infrared quantitative model was established by using partial least squares method (PLS) for 7 mineral Chinese Medicines in which main component is calcium carbonate. Compared with the results by EDTA titration, the established quantitative analysis model for calcium carbonate content showed a good prediction result that when the content is between 47.61% -99.17%, the average relative deviation of the prediction result is 0.24% and the average recovery rate was 100.3%. The results also showed that the model using near infrared spectroscopy can get not only a rapid identification of the 8 mineral Chinese medicines containing carbonates, but also an accurate and reliabe content determination of calcium carbonate for the 7 mineral Chinese medicines which contain the component.