High hemoglobin level is a risk factor for maternal and fetal outcomes of pregnancy in Chinese women: A retrospective cohort study.

BACKGROUND: To examine the association of hemoglobin (Hb) levels during gestation with the risk of selected adverse pregnancy outcomes such as preterm birth (PTB), low-birth-weight infants (LBW) and small-for-gestational-age infants (SGA) in Chinese women. METHODS: This retrospective cohort study was conducted in the Department of Gynecology and Obstetrics at the Union Shenzhen Hospital of the Huazhong University of Science and Technology, using routinely collected maternity and hospital data on pregnancies (2015-2018). Hb levels were measured during the second (16-18th weeks) and third (28-30th weeks) trimesters of pregnancy, and pregnancy outcomes were recorded in the hospital information system. Hb levels were categorized into four groups as follows: < 110 g/L, 110-119 g/L, 120-130 g/L, and > 130 g/L. The second group (Hb 110-119 g/L) was defined as the reference group. Statistical analysis was performed using multivariate logistic regression. RESULTS: A total of 1911 singleton mothers were included. After multivariable adjustment, Hb levels > 130 g/L in the second trimester increased the risk of LBW (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.12-5.76). In the third trimester of gestation, compared with women whose Hb levels between 110 and 119 g/L, women with Hb levels > 130 g/L had an increased risk of LBW (OR, 2.20; 95% CI, 1.07-4.51) and SGA (OR, 2.00; 95% CI, 1.05-3.80). When we compared the highest and lowest quartiles of changes in the Hb across the second and third trimesters, the adjusted ORs were 0.35 (95% CI: 0.18-0.68) for PTB and 0.47 (95% CI: 0.23-0.98) for LBW. CONCLUSION: Maternal Hb > 130 g/L was associated with increased risk of adverse pregnancy outcomes. Reduction of the risks of PTB and SGA were observed with the appropriate increase of Hb level during the third trimester.

Serum urea acid and urea nitrogen levels are risk factors for maternal and fetal outcomes of pregnancy: a retrospective cohort study.

BACKGROUND: In recent years, results on the association between serum uric acid (UA) and pregnancy outcomes have been inconsistent, and the association between urea nitrogen (UN) and adverse pregnancy outcomes in normal pregnant women has not been reported. Thus, we examined the association of UA and UN levels during gestation with the risk of adverse pregnancy outcomes in a relatively large population. METHODS: A total of 1602 singleton mothers from Union Shenzhen Hospital of Huazhong University of Science and Technology at January 2015 to December 2018 were included. Both UA and UN levels were collected and measured during the second (16-18th week) and third (28-30th week) trimesters of gestation respectively. Statistical analysis was performed using multivariate logistic regression. RESULTS: After adjustment, the highest quartile of UA in the third trimester increased the risk of premature rupture of membranes (PROM) and small for gestational age infants (SGA) by 48% (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.04-2.10) and 99% (95% CI: 1.01-3.89) compared to those in the lowest quartile. The adjusted OR (95% CI) in the highest quartile of UN for the risk of SGA was 2.18 (95% CI: 1.16-4.13) and 2.29 (95% CI: 1.20-4.36) in the second and third trimester, respectively. In the second trimester, when UA and UN levels were both in the highest quartile, the adjusted OR (95% CI) for the risk of SGA was 2.51 (95% CI: 1.23-5.10). In the third trimester, when the group 1 (both indicators are in the first quartile) was compared, the adjusted ORs (95% CI) for the risk of SGA were 1.98 (95% CI: 1.22-3.23) and 2.31 (95% CI: 1.16-4.61) for group 2 (UA or UN is in the second or third quartile) and group 3 (both indicators are in the fourth quartile), respectively. CONCLUSIONS: Higher UA and UN levels increased the risk of maternal and fetal outcomes. The simultaneous elevation of UA and UN levels was a high-risk factors for the development of SGA, regardless of whether they were in the second or third trimester.

Adverse pregnancy outcomes are important public health problems in terms of high mortality and long-term health effects of maternal and newborn babies. This study assessed the association between serum urea acid and urea nitrogen levels during pregnancy and the risk of adverse pregnancy outcomes in Chinese women. The study was conducted between January 2015 and December 2018. Serum uric acid and urea nitrogen were measured at weeks 16­18 and 28­30, respectively. A total of 1602 singleton pregnant women participated in the study. We found that elevated levels of uric acid and urea nitrogen increased the risk of maternal and infant outcomes. In addition, we found for the first time that elevated uric acid and urea nitrogen concentrations were a risk factor for SGA, both in the second and third trimesters. Therefore, monitoring maternal uric acid and urea nitrogen biochemical parameters during pregnancy is necessary to optimize nursing and intervention. Furthermore, uric acid and urea nitrogen are simple, inexpensive, and readily available tests and should be evaluated additionally.

[Multicenter analysis of risk factors and clinical characteristics of shoulder dystocia].

OBJECTIVE: To explore the risk factors and clinical characteristics of shoulder dystocia. METHODS: The data of 44 580 single pregnancy and full-term head delivery were colleceted in the Third Affiliated Hospital of Guangzhou Medical University, Nanfang Hospital, Shenzhen Nanshan Hospital, Peking University Shenzhen Hospital and Yue Bei People's Hospital from January 2008 to September 2013. Totally 116 cases of shoulder dystocia were defined as the shoulder dystocia group, and the others were in the control group. The clinical data of the two groups were analyzed retrospectively, including the maternal age, maternal height, pre-gestational body mass index, weight gain during pregnancy, gestational weeks, gravidity, parity, fundal height, fetal abdominal perimeter, shoulder dystocia medical history, macrosomia, gestational diabetes mellitus, pre-gestational diabetes mellitus, post-term pregnancy and the condition of labor stages. RESULTS: (1) The incidence of shoulder dystocia was 0.260% (116/44 580). The maternal age, pre-gestational body mass index and weight gain during pregnancy in the shoulder dystocia group were higher than those in the control group (all P < 0.01). While the maternal height, gestational weeks, gravidity, parity, fundal height, abdominal circumference in the two groups had no significant difference (all P > 0.05). (2) In the shoulder dystocia group, the incidence of shoulder dystocia medical history (11.21%, 13/116), macrosomia (13.79% , 16/116), pre-gestational diabetes mellitus (7.76% , 9/116), post-term pregnancy (10.34%, 12/116), prolongation of maximum acceleration phase (8.62%, 10/116) and prolongation of second labor stage (7.76%, 9/116) were different from those in the control group[1.43% ( 636/44 464), 1.48% (658/ 44 464), 0.57% ( 252/44 464), 1.15% (513/44 464),0.72% (322/44 464), 0.65% (289/44 464), respectively; all P < 0.05]. (3) Logistic regression analysis showed that the risk factors of shoulder dystocia were maternal age over thirty-five years (OR = 1.116, 95%CI: 1.022-2.445), pre-gestational body mass index more than 27 kg/m(2) (OR = 1.893, 95% CI: 1.358-2.228), weight gain more than 20 kg during pregnancy (OR = 2.031, 95% CI: 1.749-3.231), shoulder dystocia medical history (OR = 2.138, 95%CI:1.564-3.853), macrosomia (OR = 3.276, 95% CI:2.315- 4.638), pre-gestational diabetes mellitus (OR = 3.261, 95% CI:2.237- 4.943), post-term pregnancy (OR = 1.473, 95% CI:1.003-2.721), prolongation of the maximum acceleration phase (OR = 2.022, 95% CI:1.681- 3.732), prolongation of second labor stage(OR = 1.943, 95% CI:1.285- 3.215). CONCLUSION: Maternal age over thirty-five years old, pre-gestational body mass index more than 27 kg/m(2), weight gain more than 20 kg during pregnancy, shoulder dystocia medical history, macrosomia, pre-gestational diabetes mellitus, post-term pregnancy, prolongation of the maximum acceleration phase, and prolongation of second labor stage are risk factors and clinical characteristics of shoulder dystocia.

Genome-wide association study of maternal plasma metabolites during pregnancy.

Metabolites are key indicators of health and therapeutic targets, but their genetic underpinnings during pregnancy-a critical period for human reproduction-are largely unexplored. Using genetic data from non-invasive prenatal testing, we performed a genome-wide association study on 84 metabolites, including 37 amino acids, 24 elements, 13 hormones, and 10 vitamins, involving 34,394 pregnant Chinese women, with sample sizes ranging from 6,394 to 13,392 for specific metabolites. We identified 53 metabolite-gene associations, 23 of which are novel. Significant differences in genetic effects between pregnant and non-pregnant women were observed for 16.7%-100% of these associations, indicating gene-environment interactions. Additionally, 50.94% of genetic associations exhibited pleiotropy among metabolites and between six metabolites and eight pregnancy phenotypes. Mendelian randomization revealed potential causal relationships between seven maternal metabolites and 15 human traits and diseases. These findings provide new insights into the genetic basis of maternal plasma metabolites during pregnancy.

Changes in serum total bile acid concentrations are associated with the risk of developing adverse maternal and perinatal outcomes in pregnant Chinese women.

BACKGROUND AND AIMS: We aimed to investigate the association between total bile acid (TBA) concentrations changes during the second and third trimesters and the risk of developing adverse maternal and perinatal outcomes (AMPO). METHODS: A total of 1569 pregnant Chinese women were enrolled. Serum TBA concentrations were measured during the 16-18th and 29-34th weeks of gestation. Logistic regression models were performed. RESULTS: After multivariable adjustment, each standard deviation increase in the TBA concentrations in the second trimester was associated with a 30% (odds ratio [OR] = 1.30, 95% confidence interval [CI]: 1.13, 1.50) increased risk of gestational diabetes mellitus (GDM) and a 22% (OR = 1.22, 95% CI: 1.07, 1.63) increased risk of premature rupture of membranes (PROM). When we compared the highest and lowest quartiles of changes in the TBA Z-scores across the second and third trimesters, the adjusted ORs were 1.84 (95% CI: 1.28, 2.65) for PROM and 1.47 (95% CI: 1.07, 2.28) for macrosomia. CONCLUSION: Elevated serum TBA concentrations during pregnancy were positively associated with increased risks of GDM and PROM. Women with more drastic changes in TBA concentrations across the second and third trimesters were at a higher risk of developing PROM and macrosomia.

Association of Serum Uric Acid, Urea Nitrogen, and Urine Specific Gravity Levels at 16-18 Weeks of Gestation with the Risk of Gestational Diabetes Mellitus.

OBJECTIVE: To evaluate the associations of serum uric acid (UA), urea nitrogen (UN), and urine specific gravity (USG) levels in the first trimester of pregnancy with the risk of gestational diabetes mellitus (GDM). PATIENTS AND METHODS: A retrospective cohort study was conducted in 1,769 pregnant women aged 31.55 ± 3.91 years. UA, UN, and USG levels were measured during the 16-18th week of gestation. GDM was diagnosed by an oral 75 g glucose tolerance test during the 24-28th week of gestation. RESULTS: A multivariate adjusted logistic regression analysis showed that UA levels in the highest quartile increased the risk of GDM by 55.7% (odds ratio [OR]: 1.557, 95% confidence interval [CI]: 1.055-2.298; p = 0.026) compared to those in the lowest quartile. USG levels in the second, third, and fourth quartiles increased the risk of GDM by 67.6% (95% CI: 1.090-2.421), 112.4% (95% CI: 1.446-3.119), and 94.5% (95% CI: 1.314-2.880), respectively, compared to those in the first quartile (p trend = 0.001). No significant association between UN levels and the GDM risk was observed. When the extreme composite biomarker score quartiles were compared, the adjusted OR (95% CI) for GDM was 1.909 (95% CI: 1.332-2.736). Age-stratified analyses revealed similar results in women aged ≤35 years only, but not in those aged >35 years. CONCLUSION: Higher levels of UA and USG and a higher composite kidney function biomarker score during the 16-18th week of gestation were positively and independently associated with an increased risk of GDM.

[Clinicopathological characteristics in hereditary nonpolyposis colorectal carcinoma-associated endometrial carcinoma].

OBJECTIVE: To study clinicopathological characteristics of hereditary nonpolyposis colorectal carcinoma (HNPCC)-associated endometrial carcinoma (EC). METHODS: Totally 421 EC patients admitted to General Hospital of Tianjin Medical University from 1981 to 2006 were divided into three groups: group A: sporadic EC; group B: familial aggregation of EC; group C: HNPCC-associated EC. RESULTS: HNPCC-associated EC accounted for 6.4% (27/421). Mean age at time of diagnosis was 49.7 years in group C, earlier than 56.3 years in group A (P = 0.004) and 55.2 years in group B (P = 0.035). There were 33.3% (9/27) patients with multiple primary carcinomas in group C. It was higher than 14.3% (9/63) in group B and 5.1% (17/331) in group A respectively (P = 0.038, P < 0.01). There was no difference among the three groups in histological type or menopausal status (P > 0.05). The numbers of patients with low grade EC in group C (70.4%, 19/27) and group B (61.35, 38/62) were more than that in Group A (P = 0.013, P = 0.023). Prognosis for group C was better than that in group A (P = 0.021), and 5- and 10-year survival rate in groups A, B and C was 80%, 70%; 88%, 85%; and 96%, 96% respectively. CONCLUSIONS: Mean age at time of diagnosis is earlier in HNPCC-associated EC than that in sporadic EC; patients with HNPCC-associated EC are more frequently complicated with multiple primary carcinomas and of low grade; prognosis is better.