The association between dietary, physical activity and the DNA methylation of PPARGC1A, HLA-DQA1 and ADCY3 in pregnant women with gestational diabetes mellitus: a nest case-control study.

BACKGROUND: Gestational diabetes mellitus (GDM) is associated with DNA methylation and lifestyle. The effects of DNA methylation on GDM, and the interaction between DNA methylation and lifestyle factors are not well elucidated. The objective of this study was to explore the association between GDM, DNA methylation and lifestyle factors. METHODS: A nest case-control design was performed. Sociodemographic data, dietary intake and daily physical activity information of pregnant women were collected. Bisulfate pyrosequencing was used to detect the DNA methylation level of PPARGC1A, HLA-DQA1, and ADCY3 genes. The differences of DNA methylation levels between the GDM group and the control group were compared. The correlation between clinical characteristics, dietary, physical activity and DNA methylation level was analyzed. RESULTS: A total of 253 pregnant women were enrolled, of which, 60 participants (GDM: 30; control: 30) were included in the final analysis. There were no significant differences in DNA methylation levels of six methylated sites between the two groups in this study (P > 0.05). Daily intake of potato and poultry were associated with DNA methylation level of the CpG 1 site of the ADCY3 gene in all participants and the control group (P < 0.05). Duration of folic acid intake before pregnancy was correlated with the methylation level of the CpG 1 site of the ADCY3 gene in all participants (r = 0.341, P = 0.04) and the control group (r = 0.431, P = 0.025). Daily oil intake was correlated with the methylation level of CpG 2 (r = 0.627, P = 0.016) and CpG 3 (r = 0.563, P = 0.036) of PPARGC1A in the GDM group. CONCLUSION: The association between the DNA methylation levels and GDM wasn't validated. There were associations between dietary and DNA methylation in pregnant women. A large-sample-sized and longitudinal study is warranted to further investigate the impacts of lifestyle on DNA methylation.

One-year trajectories of nutritional status in perimenopausal women: a community-based multi-centered prospective study.

BACKGROUND: Nutritional status is a modifiable factor associated with perimenopausal women's health and quality of life. Assessing body composition indicators helps to comprehensively understand nutritional status compared with using body mass index (BMI) only. However, few published studies measured the trends in body composition among perimenopausal women. OBJECTIVES: To assess the one-year trajectory of the nutritional status of perimenopausal women and to explore its influential factors. METHODS: A community-based observational study with 3-wave repeated measurements at 6-month intervals was carried out. The nutritional status indicators include weight, body mass index (BMI), and body composition variables. Bioelectrical impedance analysis was used to assess body composition. Repeated measures ANOVA and Chi-square test were used to calculate the changes in nutritional status and generalized estimating equations were performed to explore their influential factors. RESULTS: 2760 participants completed the study. Increasing trajectories in weight (from 56.05 ± 7.55 to 57.02 ± 7.60), fat mass (from 17.99 ± 4.80 to 20.49 ± 4.90), and waist-hip ratio (from 0.86 ± 0.04 to 0.91 ± 0.15) were found (P < 0.001). Decreasing trajectories in skeletal muscle (from 20.30 ± 2.38 to 19.19 ± 2.46), protein level (from 7.39 ± 0.79 to 7.06 ± 0.81), and total body water (from 27.87 ± 2.92 to 27.00 ± 3.01) were found (P < 0.001). Being married/unmarried with a partner and without negative life events were associated with higher total body water, skeletal muscle, and protein level, while negatively associated with fat mass and waist-hip ratio. Age was positively associated with fat mass (P < 0.001). Participants with junior high school education were prone to increased fat mass (P = 0.018) compared with those holding primary school education and below. A per capita monthly income of 1500 to 3000 Yuan was associated with higher total body water, skeletal muscle, and protein level (P < 0.001) compared with a per capita monthly income of less than 1500 Yuan. CONCLUSION: Worsening nutritional status exists in perimenopausal women, which is characterized by increased weight, fat mass, and waist-hip ratio, and decreased skeletal muscle, total body water, and protein level. For greater efficiency, precision nutritional interventions are needed, and recipients should be classified into different risk levels based on their sociodemographic background.

Associations between the number of siblings, parent-child relationship and positive youth development of adolescents in mainland China: A cross-sectional study.

BACKGROUND: Positive development plays an important role in youth when dealing with stressful circumstances. According to the resource dilution theory, adolescents with or without siblings may receive different levels of emotional and material resources from their parents. The purpose of this study is to examine the association between the positive development of adolescents in China today with their family characteristics such as the number of siblings. METHODS: A total of 2072 junior high and senior high school students (13 to 18 years old) in Chengdu, Sichuan, China, were investigated by cluster sampling. The Chinese Positive Youth Development scales (CPYDs) were used to measure positive youth development. The generalized linear model was used to explore the relationships among the number of siblings, parent-child relationships and positive youth development. RESULTS: Adolescents from only-child families had better performance on positive development (H = 21.87, P < 0.001) and better relationships with parents (H = 15.1, P < 0.05). The positive development of male and female adolescents does not significantly differ in families with different numbers of siblings. The generalized linear model showed that a positive parent-child relationship is positively correlated with adolescent positive development (P < 0.05). CONCLUSION: Positive youth development is not only associated with the number of siblings but also other modifiable familial factors. The positive relationship between parents and adolescents is of great practical value in daily life to improve youth development, and this might be the real lesson the resource dilution theory tells.

Depressive symptoms and physical activity among community-dwelling perimenopausal women: a prospective longitudinal study.

BACKGROUND: Women in perimenopause are vulnerable to depressive symptoms, and physical activity was reported to be a potential protective factor. The trajectories of physical activity and depressive symptoms over time and their longitudinal relationships in Chinese perimenopausal women have not been explored yet, leaving a research gap hindering us from better understanding and managing perimenopause depressive symptoms. METHODS: A multi-center prospective longitudinal study was conducted in four cities in Sichuan Province, China. Depressive symptoms and physical activity in perimenopausal women were collected in March 2019, June 2019, September 2019, and December 2019, respectively. Multivariable linear regression by generalized estimation equation was used to identify the relevant factors associated with depressive symptoms and physical activity. A four-wave autoregressive and cross-lagged panel model was performed to explore their longitudinal relationships. RESULTS: A total of 1875 women who completed the four-wave data collection were included in the data analysis. Depressive symptoms exacerbated over time and were associated with women's age, monthly income, marital status, chronic disease, and negative life events. Physical activity decreased over time and was associated with educational background and monthly income. According to the cross-lagged panel model, perimenopausal women with more severe depressive symptoms tended to be less physically active, and similarly, perimenopausal women with less physical activity were more prone to report more severe depressive symptoms. CONCLUSION: The cross-lagged panel model disclosed longitudinal bidirectional relationships between depressive symptoms and physical activity in perimenopausal women. Appropriate physical activity should be recommended for perimenopausal women to improve their mental well-being. Tailored physical activity duration and maintenance measures should be proposed based on different sociodemographic statuses.

Efficacy and safety of non-vitamin K antagonist oral anticoagulants in patients (≥80 years of age) with atrial fibrillation: systematic review and meta-analysis.

Findings of prior studies about the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in patients (≥80 years of age) with atrial fibrillation (AF) are controversial. So we performed a meta-analysis to evaluate the efficacy and safety of NOACs versus vitamin K antagonists (VKAs) in patients (≥80 years of age) with AF. A systematic review of PubMed, Cochrane, Embase, Web of Science and Chinese BioMedical databases was conducted until 1 October 2022. Studies reporting the effects and safety of NOACs versus warfarin in patients (≥80 years of age) with AF were included. Two authors independently performed study selection and data extraction. Discrepancies were resolved by consensus or through an independent third reviewer. Data were synthesised according to the Preferred Reporting Items for Systematic Reviews guidelines. We identified 15 studies providing data of 70 446 participants (≥80 years of age) suffering from AF. According to the meta-analysis (odds ratio (OR) (95% confidence interval, CI)), NOACs conferred better efficacy profile than VKAs in stroke and systemic embolism (0.8 (0.73-0.88)) and all-cause mortality (0.61 (0.57-0.65)). Otherwise, NOACs conferred a better safety profile than VKAs in major bleeding (0.76 (0.70-0.83)) and intracranial haemorrhage (ICH; 0.57 (0.47-0.68)). In conclusion, for patients (≥80 years of age) with AF, the risks of stroke and systemic embolism, all-cause mortality, were lower in NOACs compared to warfarin. The risks of major bleeding and ICH were also lower in NOACs compared to warfarin. NOACs showed better efficacy and safety than warfarin.

Associations between adolescents' empathy and prosocial attributes before and during the COVID-19 pandemic.

BACKGROUND: Adolescence is a formative period of social development. Adolescents have experienced considerable changes in their lives due to the COVID-19 pandemic. We conducted a longitudinal study to examine the effects of the COVID-19 pandemic on adolescents' prosocial attributes and empathy, as well as their longitudinal bilateral relationships. METHODS: A total of 2,510 students from five junior schools in Sichuan Province were recruited via random cluster sampling. Data were collected in December 2019 (Wave 1, before the outbreak of the pandemic) and July 2020 (Wave 2, during the pandemic) in Chengdu, Sichuan, China. Prosocial attributes and empathy were measured with the Positive Youth Development Scale (GPYDS) subscale and Chinese Empathy Scale, respectively. RESULTS: During the pandemic, both empathy and prosocial attributes decreased significantly from 49.89 (9.12) and 49.89 (8.80) before to 48.29 (8.72) and 49.39 (9.26) (p < 0.001), respectively. A higher level of empathy at Wave 1 significantly predicted higher prosocial attributes at Wave 2 (ß = 0.173, SE = 0.021, t = 8.430, p < 0.001). A lower prosocial attributes score predicted a significantly lower empathy score from Wave 1 to Wave 2 (ß = 0.100, SE = 0.021, t = 4,884, p < 0.001). CONCLUSIONS: The COVID-19 pandemic has had detrimental effects on adolescents' empathy and prosocial attributes. Special attention should be given to these two longitudinally associated factors in any social crisis, such as the COVID-19 pandemic, considering their importance for adolescents' physical, mental, and social development.

Effectiveness of early essential newborn care on breastfeeding and maternal outcomes: a nonrandomized controlled study.

BACKGROUND: Breastfeeding and maternal health play crucial roles in improving newborn health, which is closely related to the development of families and society. Early essential newborn care, which emphasizes early exclusive breastfeeding and skin-to-skin contact, is recommended by the World Health Organization. This study aimed to explore the association of early essential newborn care with breastfeeding and maternal outcomes. METHODS: A nonrandomized controlled study was carried out from May 2020 to January 2021 in a tertiary hospital in Chengdu city, China. Pregnant women were recruited from the maternity ward before they gave birth. Early essential newborn care was performed for 91 mother-newborn pairs after birth in the intervention group, while routine birth care was performed for 91 mother-newborn pairs in the control group. Data on breastfeeding and maternal outcomes were collected pre-test and post-test and were recorded by trained data collectors and retrieved from hospital case record files. RESULTS: Compared with the control group, the intervention group had a higher incidence of early breastfeeding initiation, an earlier initiation and longer duration for the first breastfeeding, a higher incidence of successful first breastfeeding, more exclusive breastfeeding at hospital discharge, higher maternal breastfeeding self-efficacy, a shorter duration of the third stage of labour, lower postpartum blood loss, and lower scores of maternal pain and anxiety postpartum; the differences were statistically significant (p < 0.05). CONCLUSION: The implementation of high-quality early essential newborn care can help mothers initiate early breastfeeding, improve exclusive breastfeeding rates at hospital discharge, enhance breastfeeding self-efficacy, promote the woman's recovery from labour, and reduce maternal anxiety and pain in the postpartum period. High-quality early essential newborn care is recommended to policymakers and medical professionals to improve breastfeeding and maternal outcomes. TRIAL REGISTRATION: Chinese Clinical Trial Registry, Retrospective Registration (27/7/2021), registration number: ChiCTR2100049231.

Comparison of the effects of Tai Chi and general aerobic exercise on weight, blood pressure and glycemic control among older persons with depressive symptoms: a randomized trial.

BACKGROUND: Blood pressure and glycemic control are associated with the management of depressive symptoms in patients with depression. Previous studies have demonstrated that both Tai Chi and aerobic exercise have positive effects on blood pressure and glycemic control. Few studies have compared the physiological effects of Tai Chi versus aerobic exercise in older adults with depressive symptoms. The objective of this study was to compare the effects of Tai Chi and aerobic exercise on weight, body mass index, blood pressure and glycosylated hemoglobin (HbA1c) level in older persons with mild to moderate-severe depressive symptoms. METHODS: A randomized controlled trial was performed. The older persons (age ≥ 60 years old) with depressive symptoms were recruited. Then, participants were randomly allocated to the Tai Chi group and the aerobic exercise group received a 12-week 24-movement Yang's Tai Chi intervention and aerobic exercise, respectively. Data collection occurred at baseline and after completion of the interventions (week 12). RESULTS: A total of 238 participants with mild to moderate-to-severe depressive symptoms were included in the final analysis, including 120 in the Tai Chi group and 118 in the aerobic exercise group. The difference in weight and body mass index in the Tai Chi group was 2.0 kg (Z = -4.930, P < 0.001) and 0.77 kg/m2 (Z = -5.046, P < 0.001) higher than that in the aerobic exercise group, respectively. After the 12-week intervention, the systolic pressure and diastolic pressure in the Tai Chi group were 5.50 mmHg (Z = -2.282, P = 0.022) and 8.0 mmHg (Z = -3.360, P = 0.001) lower than that in the aerobic exercise group, respectively. The difference in HbA1c level in the Tai Chi group was 0.50% higher than that in the aerobic exercise group (Z = -4.446, P < 0.001). CONCLUSION: This study showed that Tai Chi exercise was more effective in improving blood pressure and HbA1c level than general aerobic exercise. It suggested that Tai Chi might be an effective approach for the management of blood pressure and long-term glucose control in older persons with depressive symptoms. TRIAL REGISTRATION: Trial registration: ChiCTR, ChiCTR2100042534 . Registration date: 23/01/2021, http://www.chictr.org.cn/showproj.aspx?proj=120602 .

Effects of early essential newborn care versus routine birth care on physiological variables and sleep state among newborn infants: a quasi-experimental design.

BACKGROUND: Early essential newborn care (EENC) was introduced to medical practice in China in 2016, but the number of medical institutions that have put EENC into practice remains low due to insufficient clinical evidence and the absence of awareness among health professionals. This study aimed to explore the effect of EENC on physiological variables and sleep state among newborn infants and to provide evidence to support the implementation of EENC. METHODS: A quasi-experimental design was conducted among 182 newborn infants in a tertiary maternity hospital in China from May 2020 to January 2021. A total of 91 newborn infants were included in the intervention group, and 91 were included in the control group to receive EENC or routine birth care, respectively. RESULTS: The newborn infants in the intervention group had a lower incidence of hypothermia than those in the control group at 75 min, 90 min, 105 min, and 120 min after birth (p < 0.05). The time of first breathing after birth in the intervention group was earlier than that in the control group (5 s vs. 7 s, p < 0.05), and the infants had a better sleep state at 30 min, 60 min, 90 min, and 120 min after birth (p < 0.05). CONCLUSIONS: EENC can decrease the incidence of hypothermia, promote the initiation of breathing, and improve the sleep state among newborn infants compared to routine birth care in China. More coaching should be provided to health professionals to promote the implementation of EENC in China. TRIAL REGISTRATION: Chinese Clinical Trial Registry, Retrospective Registration (27/7/2021), registration number: ChiCTR2100049231 .

Readiness for hospital discharge in primary caregivers for children with acute lymphoblastic leukaemia.

AIM: To investigate existing status and factors affecting the readiness for hospital discharge in primary caregivers for children with acute lymphoblastic leukaemia in China. BACKGROUND: Acute lymphoblastic leukaemia is the most common childhood cancer, but there is not enough research on the readiness for hospital discharge. DESIGN: A cross-sectional study was performed by convenience sampling and questionnaire survey. METHODS: A self-developed questionnaire of general and clinical characteristics of patients, self-developed questionnaire of general status of family and primary caregivers, questionnaire of readiness of hospital discharge scale and social support rating scale for primary caregivers were delivered to 264 primary caregivers of childhood acute lymphoblastic leukaemia patients. Data collection was carried out 24 h before discharge at bedside. In this study, the STROBE checklist was followed. RESULTS: In total, 253 patients aged 0-16 years, including their primary caregivers in the hospital, were included from November 2016 to August 2017. Based on the readiness scale, the total mean score of readiness was 157.36. Based on the social support scale, the total mean score was 42.17. According to multivariate analysis, periods of chemotherapy (p < .001), complications (p = .019), family economic situation (p = .023), understanding of leukaemia (p < .001), objective support (p = .004), subjective support (p < .001) and availability of support (p = .045) were the main influencers of readiness. CONCLUSIONS: The readiness for hospital discharge in primary caregivers for childhood lymphoblastic leukaemia patients is not satisfactory in China. RELEVANCE TO CLINICAL PRACTICE: This study has implications for public health administration, asking for better community services and disease education. In addition, more effort should be made to provide high-quality family and primary caregiver assessments and discharge education by nurses.

Tai chi improves depressive symptoms among community-dwelling older persons by mediating BDNF methylation: A preliminary study.

Tai Chi could alleviate depression, while the biological mechanisms underlying this effect remains unelucidated. This study recruited 18 community-dwelling older persons with a pre-post testing design, aiming to unveil the potential epigenetic effect by which Tai Chi in the alleviation of depression, using methylation of BDNF promoter as the biomarker. The methylation levels (determined by pyrosequencing using saliva samples) of the targeted BDNF sequence were positively associated with the existence and severity of depressive symptoms (measured with the 9-item Patient Health Questionnaire). Both methylation levels and depression decreased significantly after the Tai Chi intervention. Demethylation of BDNF promoter might be one of the potential mechanisms underlying the holistic depression alleviating effect of Tai Chi. BDNF methylation may potentially serve as a screening, diagnostic as well as disease activity biomarker to determine treatment effects for depression. Further adequately powered studies are needed to verify and strengthen our findings.

Effect of the COVID-19 Pandemic on Resilience Among Chinese Adolescents and Its Influential Factors: A Longitudinal Study.

The current study assessed the effect of the coronavirus disease 2019 (COVID-19) pandemic on resilience among Chinese adolescents and explored its influential factors. A total of 2,359 students were recruited from three middle schools through cluster randomization in Chengdu. Data were collected before and after home confinement due to the COVID-19 pandemic. Resilience, family function, and effect of the pandemic were measured using subscales of the Chinese Positive Youth Development Scale, Chinese Family Assessment Instrument, and Children's Revised Impact of Event Scale. Paired samples t test showed resilience decreased significantly after confinement. According to stepwise multiple linear regression, basal resilience, family dysfunction, higher frequencies of hyperarousal symptoms of posttraumatic stress, increased electronic device use, and relationship with caregivers were independent influential factors of resilience. COVID-19 negatively affected adolescents' resilience; therefore, stakeholders need to focus on improving resilience in this population to mitigate mental health impacts of acute stressful events. [Journal of Psychosocial Nursing and Mental Health Services, 60(12), 31-37.].

The association between soy intake and risk of gestational diabetes mellitus: a prospective cohort study.

BACKGROUND: The association between soy intake and adverse pregnancy outcomes remains unclear. The objectives of this study were to investigate the soy consumption of pregnant women in the second trimester and explore the prospective association between soy intake and the risk of adverse pregnancy outcomes. METHODS: Pregnant women between 13 and 24 weeks of gestation were recruited at a women's and children's hospital in southwest China from June to December 2019. Dietary intakes in the middle trimester were assessed by a semi-quantitative food frequency questionnaire. Participants were divided into the insufficient group (< 40 g/day) and the control group (≥40 g/day) according to daily soy consumption. Participants were followed up until delivery. Pregnancy outcomes including gestational diabetes mellitus (GDM), cesarean section, and macrosomia were obtained. Multiple logistic regression was used to analyze the association between soy intake and risk of adverse pregnancy outcomes. Sociodemographic information, histories of diseases, and duration of physical activities were obtained and used for covariate adjustments. RESULTS: A total of 224 participants were included in this study, of which identified 36 (16.1%) cases of GDM, and 120 (53.6%) cases of cesarean section. More than half (125, 55.8%) pregnant women consumed less soy than 40 g/day. Daily soy intake less than 40 g was associated with the increased risk of GDM (OR = 2.755 95%CI 1.230-6.174, P = 0.014) and cesarean section (OR = 1.792 95%CI 1.035-3.101, P = 0.037) without adjustment for confounders such as age, pre-pregnancy body mass index, parity, daily intake of vegetables, fruits, seafood and, nuts. After adjusting for these factors, daily soy intake of less than 40 g increased 2.116-fold risk of GDM (95%CI 1.228-7.907, P = 0.017), but not with the significantly increased risk of cesarean section. CONCLUSION: Insufficient soy intake may increase the risk of GDM, suggesting adequate soy intake may have a beneficial role in the prevention of GDM. TRIAL REGISTRATION: Registration number: ChiCTR1900023721 . Date of registration: June 9, 2019.

Risk of type 2 diabetes mellitus after gestational diabetes mellitus: A systematic review & meta-analysis.

Background &objectives: Women with gestational diabetes are at an increased risk of being diagnosed as type 2 diabetes, but the postpartum screening rate is low. To provide evidence-based data for health providers and promote postpartum screening, this systematic review and meta-analysis was conducted to access the risks of type 2 diabetes mellitus (T2DM) diagnosis after gestational diabetes mellitus (GDM) in different demographic and maternal subgroups. Methods: MEDLINE, Embase and Cochrane Library were searched systematically. Unadjusted relative risks (RRs) and 95 per cent confidence intervals (CIs) were calculated and pooled using a random-effects model. Heterogeneity was assessed with Cochrane's Q text and by calculating I2 values. Subgroup analyses were conducted to address the disparities of type 2 diabetes conversion after gestational diabetes in different demographic and maternal subgroups. Results: 1809 publications were screened and 39 cohort studies including 2,847,596 women were selected. In these studies, 78,893 women were diagnosed as T2DM at six weeks or later after delivery. The unadjusted RRs of women diagnosed T2DM at six weeks or later after delivery ranged from 1.32 (95% CI, 0.46-3.37) to 47.25 (95% CI, 2.95-758.01) with a pooled unadjusted RR of 8.92 (95% CI, 7.84-10.14). Older women, women with a family history of diabetes, Black and non-Hispanic White women and women living in Europe and South-East Asia had a higher risk of developing T2DM after GDM. Interpretation & conclusions: It is suggested that healthcare providers may focus on older women with GDM and women with GDM and a family history of diabetes. Black and non-Hispanic White women with GDM may receive more attention, and healthcare providers, especially those in Europe and South-East Asia, may pay more attention to preventive measures for postpartum T2DM.

Exploring the relationship between spiritual well-being and death anxiety in patients with gynecological cancer: a cross-section study.

BACKGROUND: In recent years, spiritual well-being has gradually gained the attention of health care providers in China, especially those in oncology departments, who have recognized the importance of improving spiritual well-being in cancer patients. Since most of the current research on spiritual well-being has been carried out in areas with religious beliefs, this study was conducted in the context of no development of formal religion. The purpose of this study was to explore the relationship between death anxiety and spiritual well-being and the related factors of spiritual well-being among gynecological cancer patients. METHODS: This cross-section study was conducted among 586 gynecological cancer patients. The European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-spiritual well-being32 (EORTC QLQ-SWB32) and Templer's Death Anxiety Scale (T-DAS) were used to measure spiritual well-being and death anxiety. The Multiple Linear Regression Model was used to determine the relationship between spiritual well-being and death anxiety. RESULTS: For all participants, the highest QLQ-SWB32 centesimal score was 75.13 on the Relationship with Other scale, and the lowest was 60.33 on the Relationship with Someone or Something Greater Scale. The mean Death Anxiety score was 5.31 (SD 3.18). We found that Relationship with Someone or Something Greater was the only scale not associated with death anxiety. Overall, patients with lower death anxiety have a higher level of spiritual well-being. Besides, a high Relationship with Other score was associated with living with a partner (B = 2.471, P < 0.001) and married (B = -6.475, P = 0.001). Patients with higher Global-SWB were retired (B = 0.387, P = 0.019). CONCLUSIONS: Our study found that the spiritual well-being of patients with gynecological cancer in China was no worse than in other countries with religious beliefs and patients with lower death anxiety have a higher level of spiritual well-being. Clinical staff should pay attention to the spiritual health of cancer patients, and spiritual care should be regarded as an essential element in cancer care.

Exploring the breastfeeding knowledge level and its influencing factors of pregnant women with gestational diabetes mellitus.

BACKGROUND: Studies reveal that promoting the breastfeeding knowledge level help to improve breastfeeding behaviors. Promoting breastfeeding knowledge is a simple and economical way to increase breastfeeding rates. However, there are no studies focus on the level of breastfeeding knowledge and factors influencing the knowledge in women with gestational diabetes mellitus (GDM), which is defined as any degree of glucose tolerance impairment first diagnosed during pregnancy. Thus, the objectives of this study were to investigate the breastfeeding knowledge level of GDM pregnant women and explore factors influencing the knowledge level. METHODS: Cross-sectional survey and convenience sampling were conducted in this study. The sociodemographic characteristics, caregivers in pregnancy, knowledge source, breastfeeding status and breast status information of participants were collected. Breastfeeding Knowledge Scale was used to assess the breastfeeding knowledge level of pregnant women with GDM. Multiple linear regression was used to analyze the influence factors of breastfeeding knowledge level in this study. RESULTS: A total of 226 questionnaires were issued and finally 212 valid questionnaires were collected. Some misconceptions still existed (e.g. 'breastfeeding cannot prevent your baby from being overweight' and 'it is advisable to breastfeed 3-4 times per day within 2-3 days after delivery'), although women with GDM had a good score of breastfeeding knowledge (mean score: 103.5 ± 10.4). Multiple linear regression analysis found that gestational age, family per capita monthly income, educational level, knowledge source were the independent protective factors for breastfeeding knowledge and minority nationality was the independent risk factor. The educational level had the greatest influence on the breastfeeding knowledge level of GDM pregnant women (ß = 0.210, t = 2.978, P = 0.003). CONCLUSION: GDM pregnant women with insufficient gestational age, low educational level, low family per capita monthly income and single access to knowledge should be included in the focus of health education on breastfeeding. In-depth and systematic health education should be conducted for pregnant women with GDM to improve their breastfeeding rate.

[Effect of Individualized Intervention on Postpartum Breast-feeding Behavior after Cesarean Section].

OBJECTIVE: To investigate the effects of individualized intervention on postpartum breast-feeding behavior and satisfaction after cesarean section (CS). METHODS: 341 pregnant women who had cesarean section in West China Second Hospital of Sichuan University from 1st July to 30th August in 2018 were randomly divided into intervention group (171 cases) and control group (170 cases). The participants in experimental group received individualized intervention through the combination of prenatal and postnatal. The participants in control group received routine nursing care. The basic clinical data and breastfeeding information at discharge and day 42 postpartum were compared between the two groups. RESULTS: There were no significant differences in age, ethnicity, anesthesia type, preoperative feeding time between the two groups (P>0.05). At the time of discharge and day 42 postpartum, the rate of exclusive breastfeeding, breastfeeding satisfaction and planned breastfeeding duration in the intervention group were higher than those in the control group (P < 0.05). The incidence and degree of breast distending pain, the incidence of cracked nipples, the times of adding formula milk in 24 h, the rate of using feeding bottle and the incidence of feeding problems were all higher in the control group than those in the intervention group (P < 0.05). The knowledge scores of breastfeeding in both groups were higher at discharge than at admission, and the score was higher in the intervention group than that in the control group at the time of discharge. CONCLUSION: The combination of prenatal and postnatal individualized intervention can significantly improve the knowledge, behavior and satisfaction of breastfeeding.

Effects of breast-feeding compared with formula-feeding on preterm infant body composition: a systematic review and meta-analysis.

We conducted a systematic review and meta-analysis to compare the effect of breast-feeding and formula-feeding on body composition of preterm infants. We searched the literature using PubMed, Cochrane Central Library Issue, Ovid (Medline), Embase and other resources such as Google Scholar, electronic databases and bibliographies of relevant articles; two reviewers collected and extracted data independently. All the authors assessed risk of bias independently using the Newcastle-Ottawa Scale (NOS). A fixed-effects meta-analysis was undertaken with RevMan 5 software (The Cochrane Collaboration) using the inverse variance method (P≥0·05; χ 2 test). In contrast, a random-effects meta-analysis was carried out. Altogether, 630 articles were identified using search strategy, and the references within retrieved articles were also assessed. A total of six studies were included in this systematic review. In formula-fed infants, fat mass was higher at term (mean difference 0·24 (95 % CI 0·17, 0·31) kg), fat-free mass was higher at 36 weeks of gestational (mean difference 0·12 (95 % CI 0·04, 0·21) kg) and the percentage of fat mass was higher at 36 weeks of gestation (mean difference 3·70 (95 % CI 1·81, 5·59) kg) compared with breast-fed infants. Compared with breast-feeding, formula-feeding is associated with altered body composition from birth to term in preterm infants. The effects of formula-feeding on preterm infant body composition from term to 12-month corrected age are inconclusive in our study. Well-designed studies are required in the future to explore the effects of formula-feeding compared with breast-feeding.

[A Survey and Analysis of Exercise Among Pregnant Women Conducted Using the Theory of Reasoned Action].

BACKGROUND: Prior research has highlighted the significant relationship between gestational weight gain and pregnancy outcomes. Exercise is one of the main factors that affects body weight. Therefore, exercising appropriately during pregnancy is an important activity for promoting healthy pregnancy outcomes. PURPOSE: To explore the status and features of maternal exercise during pregnancy and to analyze the related influence factors using the "theory of reasoned action" in order to provide evidence-based guidance on exercise during pregnancy. METHODS: Convenience sampling was used to recruit pregnant women from four hospitals of different administrative levels in Chengdu, China. A self-developed questionnaire was used to collect data. Data were input using Epidata and analyzed using SPSS 21.0. RESULTS: Data provided by 587 pregnant women in their first trimester, 522 in their second trimester, and 522 in their third trimester were used in analysis. Significant differences were found between the three groups in terms of housework loading and lifting. Further, participants in the third trimester were significantly more likely to exercise less than 3 times per week and less than 30 minutes per session than their first and second trimester peers (p < .001). Structural equation modeling identified that: behavior intention had a significant effect on level of physical activity; attitudes and norms affected behavior by affecting intention; monthly income and educational background affected behavior by influencing attitude; and educational background affected behavior by influencing perceived norms. CONCLUSIONS: The findings of the present study support that personal situation, the family, and social norms impact the behavior of women significantly more during pregnancy than before pregnancy.

[A Survey of Maternal Dietary Behavior Based on Theory of Reasoned Action].

OBJECTIVE: To detect the diet behavior and influencing factors of related behavior at different stages among pregnant women. METHODS: Based on the Theory of Reasoned Action (TRA), literature review, expert evaluation and preliminary investigation, we designed and finalized three questionnaires. Diet behaviors among women in early term, medium term and late term were investigated by using the questionnaires. RESULTS: 624 early term, 619 medium term and 738 late term valid questionnaires were returned. Participants ranged from 18 to 45 years of age. 74% pregnancy body mass index (BMI) was within the normal range. More than 43% care taking was provided by the mother, followed by the husband. The participants had a good eating behavior on the whole. At 3 stages, carbohydrate intake, protein intake and fat intake were no significant difference when compared with that of recommended value (P> 0. 05). The pregnant women intaked insufficient cereal, beans, dairy and aquatic products, while fruit and nuts were more than needed (P<0. 05). Subjective norms influenced their eating behavior indirectly through influencing their behavior attitude and behavioral intention. The attitude could influence behavior directly without involving the intention. CONCLUSION: The participants had relatively good diet behavior, but still had problems on food choice and a reasonable combination of a variety of food. Subjective norms influenced their behavior attitude and behavioral intention. The mother had the strongest influence on the pregnant woman's diet attitude and behavioral intention among all those had direct contact with the pregnant woman.