Knowledge and intake of folic acid to prevent neural tube defects among pregnant women in urban China: a cross-sectional study.

BACKGROUND: The prevalence of neural tube defects (NTDs) in China declined during 2000-2017 with periconceptional folic acid (FA) supplementation, which is effective in reducing the risk of birth defects. We aimed to assess the knowledge and actual use of FA among Chinese pregnant women and to explore factors associated with FA use before pregnancy. METHODS: All data were collected in face-to-face interviews during health visits among pregnant women. We collected information about knowledge and use of FA supplements and demographic, socioeconomic, and health status. One maternity and childcare hospital was chosen in each of four cities: Beijing, Huaibei, Kunming, and Haikou. In total, 435 pregnant women were randomly recruited for interviews conducted from June to December 2016. RESULTS: A total of 428 pregnant women were included in this survey. Of these, 82.0% (351/428) knew that FA can prevent NTDs, and 75.9% (325/428) knew the correct time to take FA. Overall, 65.9% (282/428) of women knew both that FA can prevent NTDs and the recommended time to take FA before pregnancy. Approximately 95.1% (407/428) of women reported having ever taken FA, only 46.3% (198/428) had begun to take FA supplementation before conception, and 64.5% (109/169) of women from rural areas failed to take FA before pregnancy. Women living in northern China (odds ratio [OR] = 1.81, 95% confidence interval [CI], 1.18-2.77), those with unplanned pregnancy (OR = 1.99, 95% CI 1.30-3.04), and highly educated women (OR = 2.37, 95% CI 1.45-3.88) were more likely to know about FA. Women who were homemakers (OR = 1.94, 95% CI 1.21-3.11) and had unplanned pregnancy (OR = 6.18, 95% CI 4.01-9.53) were less likely to begin taking FA before pregnancy. CONCLUSIONS: Our survey showed that most pregnant women knew about FA. Although preconception intake of FA can help to reduce NTDs, improving the rate of FA intake before pregnancy is needed in urban areas of China, especially among homemakers and women from rural areas or with unplanned pregnancy. Campaigns are needed to increase awareness about FA and FA use before pregnancy among rural women, homemakers, and those with unplanned pregnancy and lower education levels.

[Trend of central obesity prevalence among the farmers in nine provinces (autonomous region) of China and social-demographic difference from 1993 to 2015].

OBJECTIVE: To analyze the changes in central obesity prevalence, and the differences by demographic and economic factors among adult farmers in nine provinces(autonomous region) of China. METHODS: Farmers, including fishmen or hunters, aged 18 to 64 were selected as study subjects from the database of China Health and Nutrition Survey from 1993 to 2015. Basic information(age, gender, education level, occupation), socioeconomic data(income, geographical location) and anthropometric data(waist) were included. Central obesity was determined by the health industry standard of the People's Republic of China(WS/T 428-2013). Multivariate Logistic regression was used to analyze the influence of demographic and economic factors in central obesity rate of adult farmers in 2015. RESULTS: From 1993 to 2015, the prevalence of central obesity of adult farmers in nine provinces(autonomous region) significantly increased(P<0. 05). The prevalence of central obesity in 2015(36. 1%) was 3. 8 times higher than that in 1993(9. 4%). The prevalence of central obesity was increased in farmers with different demographic and economic characteristics. Results of multivariate Logistic analysis using data of 2015 showed that farmers aged 35-49 years or 50-64 years were 119%(95%CI 1. 15-4. 17) and 157%(95%CI 1. 37-4. 83) more likely to suffer from central obesity than those aged 18-34 years, respectively. Farmers living in south area were 63%(95%CI 0. 27-0. 51) less likely to suffer from central obesity than those in the control group(living in north area). No significant correlation was found between gender, education level, income level and central obesity. CONCLUSION: The central obesity prevalence among adult farmers in nine provinces(autonomous region) of China has been increasing year by year from 1993 to 2015. In 2015, older farmers and those living in northern areas were more likely to sufer from central obesity.

[Perceived stress level and its related factors in Chinese adult residents aged 18-65 in 15 provinces (autonomous regions and municipalities) in 2015].

OBJECTIVE: To investigate the perceived stress prevalence of adult residents aged 18-65 in 15 provinces(autonomous regions and municipalities) and its related factors. METHODS: Adults aged 18 to 65 years, with middle school education or above and complete demographic and socioeconomic characteristics, lifestyle, disease history and physical measurements were selected as study subjects from the database of Nutritional Status and Health Transition of Chinese Residents Project in 2015. Chinese perceived stress scale(CPSS) was used to evaluate the perceived stress level of participants, and percentile regression model was used to analyze the correlation between related factors and perceived stress. RESULTS: A total of 6679 subjects were enrolled in this study. The mean and median of perceived stress scores were 22. 6 and 24. 0, respectively. The percentile regression model showed that age was positively associated with perceived stress in the 5 th, 25 th, 50 th and 95 th percentiles, and the difference between the two groups decreased with the increase of perceived stress score(P5, ß=1. 31, 95%CI 0. 38-2. 24; P25, ß=0. 91, 95%CI 0. 28-1. 53). Compared with the control group, adults with junior high school education had a high level of perceived stress in higher percentiles(P50, ß=0. 81, 95%CI 0. 32-1. 30; P75, ß=0. 42, 95%CI 0. 11-0. 72; P95, ß=0. 62, 95%CI 0. 06-1. 18). Perceived stress levels in the 50 th, 75 th and 95 th percentiles were lower in the married adults than in the control group(P50, ß=-0. 81, 95%CI-1. 40--0. 23; P75, ß=-0. 39, 95%CI-0. 68--0. 10; P95, ß=-0. 95, 95%CI-1. 79--0. 12). In the 5 th, 25 th, 50 th and 75 th percentiles, the perceived stress level of no workers is higher than that of workers, and the difference decreases with the increase of perceived stress score(P5, ß=1. 31, 95%CI 0. 32-2. 31; P75, ß=0. 53, 95%CI 0. 35-0. 71). Income level showed a positive association with perceived stress across the entire conditional perceived stress distribution(P<0. 05). People with low levels of physical activity had higher levels of perceived stress in the 25 th, 50 th, and 75 th percentiles than the control group(P25, ß=1. 15, 95%CI 0. 41-1. 90; P50, ß=1. 09, 95%CI 0. 62-1. 56; P75, ß=0. 28, 95%CI 0. 07-0. 49). Urbanization level and alcohol consumption and other factors had influence on perceived stress in different percentile(P<0. 05). No significant correlation was found between housing ownership, smoking, sleep duration and perceived stress. CONCLUSION: The perceived stress level of adult residents aged 18 to 65 in 15 provinces of China is on the high level on the whole, which is correlated with age, marital state employment, annual per capita income, physical activity level and other factors.

Secular trends in age at menarche among women born between 1955 and 1985 in Southeastern China.

BACKGROUND: Improvements in socioeconomic conditions and population health have been linked to declining age at menarche. In China, secular trends in age at menarche following extensive economic reform during recent decades have not been thoroughly investigated. This study examined the overall trend in age at menarche and assessed differences in the rate of change of age at menarche over time, and between urban and rural populations and education levels in southeastern China. METHODS: Age at menarche was retrospectively collected from 1,167,119 Han Chinese women born 1955-1985, who registered in the Perinatal Health Care Surveillance System in 19 cities and counties in two southeast provinces during 1993-2005. Multivariable linear regression was used to estimate trends in age at menarche overall and stratified by urban/rural residence and education level. RESULTS: Age at menarche declined by 0.33 [95% CI 0.33, 0.32] years/decade overall, with the fastest decline in women born in 1966-1975. For the earliest birth cohorts (1955-1965), age at menarche declined faster in urban versus rural regions, and for women with high school education or above versus primary school or less. In contrast, age at menarche declined slower among urban women born 1976-1985, and among those with higher education born 1966-1985. CONCLUSIONS: Mean age at menarche declined for women born in 1955-1985 in southeast China. Further study is warranted to identify specific factors contributing to earlier age at menarche and associated health outcomes.

Pre-pregnancy body mass index, gestational diabetes mellitus, and gestational weight gain: individual and combined effects on fetal growth.

Background: Pre-pregnancy body mass index (BMI), gestational diabetes mellitus (GDM), and gestational weight gain (GWG) are interlinked and may play a complex role in fetal growth. We aimed to examine the relationship between pre-pregnancy BMI, GDM, GWG, and fetal growth outcomes and explore the contribution of GDM and GWG to the relationship between Pre-pregnancy obesity/overweight and large-for-gestational-age (LGA) in a prospective cohort. Methods: We prospectively recruited women in the first trimester and having one-step GDM screened with a 75-g oral glucose tolerance test between 24 and 28 weeks of gestation (n = 802). Outcomes included LGA, small-for-gestational-age (SGA), and preterm birth. To assess the individual and cumulative associations between pre-pregnancy BMI, GDM, GWG, and these outcomes, we used multivariate logistic regression analysis. Furthermore, we employed structural equation modeling (SEM) to investigate the mediating role of GDM and excessive GWG in the correlation between pre-pregnancy overweight/obesity and LGA. Results: Pre-pregnancy obesity, GDM, and excessive GWG were all independently associated with increased odds of LGA. Inadequate GWG was associated with higher odds of preterm birth. Compared with women unexposed to pre-pregnancy overweight/obesity, GDM, or excessive GWG, women exposed any two conditions had higher odds for LGA (AOR 3.18, 95% CI 1.25-8.11) and women with coexistence of all had the highest odds for LGA (AOR 8.09, 95% CI 2.18-29.97). The mediation analysis showed that GDM explained 18.60% (p < 0.05) of the total effect of pre-pregnancy overweight/obesity on LGA, and GWG explained 17.44% (p < 0.05) of the total effect. Conclusion: Pre-pregnancy obesity/overweight, GDM, and excessive GWG are associated with higher odds of fetal growth disturbances as individual factors and when they co-exist. The effect of pre-pregnancy overweight/obesity on LGA is partially achieved through GDM and excessive GWG.

The association of maternal fat-soluble antioxidants in early pregnancy with gestational diabetes mellitus: a prospective cohort study.

INTRODUCTION: Oxidative stress is linked to the development of gestational diabetes mellitus (GDM). Maternal antioxidant vitamins in early pregnancy may play a role in GDM occurrence. We aimed to investigate the associations of vitamins A and E in early pregnancy with the risk of GDM and to explore whether these antioxidant vitamins can be biomarkers for the early prediction of GDM. METHODS: We carried out a prospective cohort study conducted in Beijing and enrolled pregnant women (n = 667) with vitamins A and E measurements at 9 weeks (IQR 8-10) of gestation and having one-step GDM screened with a 75-g oral glucose tolerance test between 24 and 28 weeks of gestation. RESULTS: The vitamin A levels in early pregnancy were significantly higher in women with GDM than in those without GDM (p < 0.0001) and positively correlated with fasting blood glucose. In multivariate models, vitamin A levels were significantly associated with GDM (OR, 1.46; 95% CI: 1.14-1.88; p = 0.0032) per SD. A significant trend of risk effect on GDM risk across quartiles of vitamin A was observed (ptrend = 0.016). No significant association of serum vitamin E with GDM was observed overall. However, a noted trend of protective effect on GDM risk across quartiles of vitamin E/cholesterol ratio was observed (ptrend = 0.043). In ROC analysis, the multivariate model consisting of vitamin A and other risk factors showed the best predictive performance (AUC: 0.760; 95% CI: 0.705-0.815; p < 0.001). CONCLUSIONS: Higher levels of vitamin A in early pregnancy were significantly associated with an increased risk of GDM. Vitamin A has the potential to be a biomarker indicating pathogenesis of GDM.

Effect of vitamin A on the relationship between maternal thyroid hormones in early pregnancy and fetal growth: A prospective cohort study.

Background: Fetal growth patterns are influenced by maternal thyroid function and vitamin A level during pregnancy. Vitamin A presents interactions with thyroid tissues and hormonal systems. We examined whether vitamin A status modified the associations of maternal thyroid hormones in early pregnancy and fetal growth outcomes among euthyroid pregnant women in a prospective cohort study (n = 637). Methods: We performed multiple linear regression and multinomial logistic regression analysis to investigate the effects of thyroid hormones in early pregnancy on fetal growth according to different levels of serum vitamin A based on median value. Results: A 1 pmol/L increase in maternal free triiodothyronine (FT3) levels was associated with an increased birth weight of 0.080 kg (p = 0.023) in women with lower maternal vitamin A levels in early pregnancy. Increased maternal free thyroxine (FT4) was associated with decreased odds for both small size for gestational age (SGA) [odds ratios (OR) = 0.66, 95% confidence interval (CI): 0.45-0.95] and large size for gestational age (LGA) (OR = 0.66, 95% CI: 0.45-0.98) in women with higher vitamin A level in early pregnancy after adjustment for maternal prepregnancy body mass index, gestational weight gain, maternal employed, parity, gestational week at sampling, and gestational diabetes mellitus. Conclusions: In Chinese pregnant women without overt thyroid dysfunction, maternal FT4 in early pregnancy was positively associated with optimal fetal growth among women with higher serum vitamin A concentrations.

Possible Catch-Up Developmental Trajectories for Children with Mild Developmental Delay Caused by NAA15 Pathogenic Variants.

Variants in NAA15 are closely related to neurodevelopmental disorders (NDDs). In this study, we investigated the spectrum and clinical features of NAA15 variants in a Chinese NDD cohort of 769 children. Four novel NAA15 pathogenic variants were detected by whole-exome sequencing, including three de novo variants and one maternal variant. The in vitro minigene splicing assay confirmed one noncanonical splicing variant (c.1410+5G>C), which resulted in abnormal mRNA splicing. All affected children presented mild developmental delay, and catch-up trajectories were noted in three patients based on their developmental scores at different ages. Meanwhile, the literature review also showed that half of the reported patients with NAA15 variants presented mild/moderate developmental delay or intellectual disability, and possible catch-up sign was indicated for three affected patients. Taken together, our study expanded the spectrum of NAA15 variants in NDD patients. The affected patients presented mild developmental delay, and possible catch-up developmental trajectories were suggested. Studying the natural neurodevelopmental trajectories of NDD patients with pathogenic variants and their benefits from physical rehabilitations are needed in the future for precise genetic counseling and clinical management.

Current epidemiology and factors contributing to postnatal growth restriction in very preterm infants in China.

BACKGROUND: Postnatal growth restriction (PGR) is common in very preterm infants (VPIs) and is associated with adverse short and long-term developmental outcomes. Postnatal growth status for VPIs in middle- or low-income countries remains unclear. AIMS: To evaluate PGR in VPIs and identify maternal and neonatal factors, clinical practice, and major neonatal morbidities associated with PGR in China. STUDY DESIGN: Prospective cohort study. SUBJECTS: We included 6085 infants born at <32 weeks gestation who were admitted at 57 hospitals in the Chinese Neonatal Network in 2019. OUTCOME MEASURES: Birth and discharge weights were converted to age-specific Z-scores. PGR was defined as a decrease in weight z-score from birth to discharge >2. RESULTS: The overall incidence of PGR was 19.9 %. The mean (standard deviation [SD]) weight Z-score was 0.12 (0.78) at birth and decreased to -1.36 (0.98) at discharge. About 4.0 % of VPIs were small for gestational age (SGA) at birth and 25.5 % of SGA infants had PGR. The incidence of PGR increased with decreasing gestational age except in the SGA subgroup. Each 1-unit increase in birthweight Z-score was associated with a 1.49-fold increased risk for PGR. Late initiation of enteral feeds and late achievement of full enteral feeds were positively associated with PGR. The common morbidities that influenced PGR were necrotizing enterocolitis ≥ stage II, patent ductus arteriosus requiring medical or surgical treatment, sepsis, bronchopulmonary dysplasia, and respiratory distress syndrome requiring surfactants. CONCLUSION: Nearly one fifth of VPIs were PGR, and one fourth of SGA had PGR, which warranted further study to investigate underlying causes by which to improve postnatal growth in very preterm infants in future.

Prevalence of and factors associated with myopia in primary school students in the Chaoyang District of Beijing, China.

PURPOSE: To determine the prevalence of and risk factors for myopia in primary school children in Chaoyang District, Beijing. METHODS: This cross-sectional prevalence survey was conducted in September to October 2011 in 4 schools randomly chosen from among the 126 primary schools in Chaoyang District. Students were assessed with autorefractometry under cycloplegia and checked with retinoscopy for accuracy. Questionnaires were completed by the students' parents. RESULTS: Myopia was present in 36.7 ± 0.7% of 4249 students aged 5-14 years old. The prevalence of myopia in girls (38.6 ± 1.1%) was significantly higher than in boys (35.0 ± 1.0 %) (p = 0.015) and increased with age (p < 0.001), with the highest prevalence observed in children aged ≥11 years (67.5 ± 1.8%). After adjustment, having a myopic parent (aOR 3.10; 95% CI 2.49-3.86), incorrect reading posture (aOR 2.09; 95% CI 1.75-2.50), reading a book at a distance of <20 cm (aOR 1.60; 95% CI 1.16-2.21), studying at home for >3 h daily (aOR 1.50; 95% CI 1.12-2.01), studying for >1 h continuously (aOR 1.21; 95% CI 1.02-1.45), and reading extracurricular books that utilize a font larger than that used in textbooks (aOR 0.74; 95% CI 0.59-0.94) were all significantly associated with myopia. CONCLUSIONS: The prevalence of myopia among primary school children in Beijing increased with age, and was significantly higher in girls ≥10 years old. Myopia was significantly associated with parental myopia, reading posture, distance between the eyes and the book being read, font size used in extracurricular reading material, time spent studying at home, and the duration of continuous study time.

Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks' gestation.

IMPORTANCE: Neonatal hypothermia has been associated with higher mortality and morbidity; therefore, thermal control following delivery is an essential part of neonatal care. Identifying the ideal body temperature in preterm neonates in the first few hours of life may be helpful to reduce the risk for adverse outcomes. OBJECTIVES: To examine the association between admission temperature and neonatal outcomes and estimate the admission temperature associated with lowest rates of adverse outcomes in preterm infants born at fewer than 33 weeks' gestation. DESIGN, SETTING, AND PARTICIPANTS: Retrospective observational study at 29 neonatal intensive care units in the Canadian Neonatal Network. Participants included 9833 inborn infants born at fewer than 33 weeks' gestation who were admitted between January 1, 2010, and December 31, 2012. EXPOSURE: Axillary or rectal body temperature recorded at admission. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite adverse outcome defined as mortality or any of the following: severe neurological injury, severe retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, or nosocomial infection. The relationships between admission temperature and the composite outcome as well as between admission temperature and the components of the composite outcome were evaluated using multivariable analyses. RESULTS: Admission temperatures of the 9833 neonates were distributed as follows: lower than 34.5°C (1%); 34.5°C to 34.9°C (1%); 35.0°C to 35.4°C (3%); 35.5°C to 35.9°C (7%); 36.0°C to 36.4°C (24%); 36.5°C to 36.9°C (38%); 37.0°C to 37.4°C (19%); 37.5°C to 37.9°C (5%); and 38.0°C or higher (2%). After adjustment for maternal and infant characteristics, the rates of the composite outcome, severe neurological injury, severe retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, and nosocomial infection had a U-shaped relationship with admission temperature (α > 0 [P < .05]). The admission temperature at which the rate of the composite outcome was lowest was 36.8°C (95% CI, 36.7°C-37.0°C). Rates of severe neurological injury, severe retinopathy of prematurity, necrotizing enterocolitis (95% CI, 36.3°C-36.7°C), bronchopulmonary dysplasia, and nosocomial infection (95% CI, 36.9°C-37.3°C) were lowest at admission temperatures ranging from 36.5°C to 37.2°C. CONCLUSIONS AND RELEVANCE: The relationship between admission temperature and adverse neonatal outcomes was U-shaped. The lowest rates of adverse outcomes were associated with admission temperatures between 36.5°C and 37.2°C.