Long-term risk of overweight in offspring of Chinese women with gestational diabetes defined by IADPSG's but not by WHO's criteria.

AIMS: To examine long-term risk of overweight in offspring of women with gestational diabetes mellitus (GDM) defined by the International Association of Diabetes and Pregnancy Study Group (IADPSG)'s criteria but not by the 1999 World Health Organization (WHO)'s criteria. METHODS: We followed up 1681 mother-child pairs for 8 years in Tianjin, China. Overweight in children aged 1-5 and 6-8 were respectively defined as body mass index-for-age and -sex above the 2 z-score and 1 z-score curves of the WHO's child growth standards. Logistic regression was performed to obtain odds ratios (ORs) and 95% confidence intervals (CIs) of hyperglycemia indices at oral glucose tolerance test and GDMs defined by different criteria for offspring overweight at different ages. RESULTS: Offspring of women with fasting plasma glucose ≥5.1 mmol/L were at increased risk of overweight at 6-8 years old (OR:1.45, 95% CI: 1.09-1.93). GDM defined by the IADPSG's criteria only was associated with increased risk of childhood overweight at 6-8 years old (1.65, 1.13-2.40), as compared with non-GDM by either of the two sets of criteria. CONCLUSIONS: Newly defined GDM by the IADPSG's criteria increased the risk of offspring overweight aged 6-8 years.

Three-Dimensional Lumbosacral Reconstruction by An Artificial Intelligence-Based Automated MR Image Segmentation for Selecting the Approach of Percutaneous Endoscopic Lumbar Discectomy.

BACKGROUND: Assessing the 3-dimensional (3D) relationship between critical anatomical structures and the surgical channel can help select percutaneous endoscopic lumbar discectomy (PELD) approaches, especially at the L5/S1 level. However, previous evaluation methods for PELD were mainly assessed using 2-dimensional (2D) medical images, making the understanding of the 3D relationship of lumbosacral structures difficult. Artificial intelligence based on automated magnetic resonance (MR) image segmentation has the benefit of 3D reconstruction of medical images. OBJECTIVES: We developed and validated an artificial intelligence-based MR image segmentation method for constructing a 3D model of lumbosacral structures for selecting the appropriate approach of percutaneous endoscopic lumbar discectomy at the L5/S1 level. STUDY DESIGN: Three-dimensional reconstruction study using artificial intelligence based on MR image segmentation. SETTING: Spine and radiology center of a university hospital. METHODS: Fifty MR data samples were used to develop an artificial intelligence algorithm for automatic segmentation. Manual segmentation and labeling of vertebrae bone (L5 and S1 vertebrae bone), disc, lumbosacral nerve, iliac bone, and skin at the L5/S1 level by 3 experts were used as ground truth. Five-fold cross-validation was performed, and quantitative segmentation metrics were used to evaluate the performance of artificial intelligence based on the MR image segmentation method. The comparison analysis of quantitative measurements between the artificial intelligence-derived 3D (AI-3D) models and the ground truth-derived 3D (GT-3D) models was used to validate the feasibility of 3D lumbosacral structures reconstruction and preoperative assessment of PELD approaches. RESULTS: Artificial intelligence-based automated MR image segmentation achieved high mean Dice Scores of 0.921, 0.924, 0.885, 0.808, 0.886, and 0.816 for L5 vertebrae bone, S1 vertebrae bone, disc, lumbosacral nerves, iliac bone, and skin, respectively. There were no significant differences between AI-3D and GT-3D models in quantitative measurements. Comparative analysis of quantitative measures showed a high correlation and consistency. LIMITATIONS: Our method did not involve vessel segmentation in automated MR image segmentation. Our study's sample size was small, and the findings need to be validated in a prospective study with a large sample size. CONCLUSION: We developed an artificial intelligence-based automated MR image segmentation method, which effectively segmented lumbosacral structures (e.g., L5 vertebrae bone, S1 vertebrae bone, disc, lumbosacral nerve, iliac bone, and skin) simultaneously on MR images, and could be used to construct a 3D model of lumbosacral structures for choosing an appropriate approach of PELD at the L5/S1 level.

Serum Sulfur-Containing Amino Acids and Risk of Maternal Gestational Diabetes and Adverse Growth Patterns in Offspring.

BACKGROUND: To estimate associations of sulfur-containing amino acids (SAAs) in the early trimester of pregnancy and gestational diabetes mellitus (GDM) and estimate associations of maternal SAAs with adverse growth patterns in offspring. METHODS: We established a 1:1 matched case-control study (n = 486) from our cohort of pregnant women, and 401 children were followed up at ages 1 to 8 years. We conducted binary conditional logistic regression to estimate the risk associations of serum SAAs with GDM. Multinomial logistic regression was implemented to explore associations of maternal SAAs with adverse growth patterns in the offspring. RESULTS: High serum methionine and cystine were independently associated with increased GDM risk (OR: 1.92, 95%CI: 1.18-3.13 and 2.69, 1.59-4.53). Conversely, a low level of serum taurine was independently associated with increased GDM risk (2.61, 1.64-4.16). Maternal high cystine and low taurine were also associated with an increased risk of persistent obesity growth pattern (POGP) in offspring (OR: 2.79, 95%CI: 1.09-7.17 and 3.92, 1.11-13.89) and the effect was largely independent of GDM. CONCLUSIONS: High serum methionine, cystine and low serum taurine in the early trimester of pregnancy were associated with a greatly increased risk of GDM. Maternal high cystine and low taurine were associated with elevated risk of offspring POGP, largely independent of GDM.

The association between breastfeeding and childhood obesity/underweight: a population-based birth cohort study with repeated measured data.

BACKGROUND: The impact of breastfeeding on childhood obesity has long been under debate, with most research showing significant association, and others showing weak or no association between breastfeeding and childhood obesity. What's more, almost all of the previous studies focused on the association between breastfeeding and childhood obesity, and no studies have assessed the association between breastfeeding and childhood underweight. This study aimed to examine the association between breastfeeding and childhood obesity as well as childhood underweight from 1 to 6 years old. METHODS: A retrospective population-based cohort study of 59,564 children born between May 2009 and April 2013 in China was conducted using the healthcare records data from the Tianjin Maternal and Child Healthcare System. Information on infant breastfeeding (exclusive breastfeeding, mixed feeding, and exclusive formula feeding) within 6 months old and childhood growth (6 times of repeated measured weight and height from 1 to 6 years old) was collected. Multinomial logistic regression was used to test the potential associations between infant feeding modalities and childhood growth (underweight, normal weight and obesity). RESULTS: Compared with exclusive formula feeding, breastfeeding was inversely associatied with childhood obesity from 2 to 6 years old, and there was a trend from mixed feeding to exclusive breastfeeding (Ptrend < 0.05). The largest association with obesity was displayed at 3 years old, with the multivariable adjusted odds ratios (ORs) for exclusive formula feeding, mixed feeding and exclusive breastfeeding of 1.00, 0.62 (95% CI 0.49, 0.80) and 0.57 (95% CI 0.44, 0.74) (Ptrend = 0.001), respectively. Compared with exclusive breastfeeding, exclusive formula feeding may increase the risk of childhood underweight at 3 and 5 years old. CONCLUSIONS: Breastfeeding was inversely associated with the risk of childhood obesity from 2 to 6 years old, and there was a trend from mixed feeding to exclusive breastfeeding. Infant exclusive formula feeding might be a risk factor for childhood underweight at preschool time.

Increased Gestational Weight Gain is Associated with a Higher Risk of Offspring Adiposity Before Five Years of Age: A Population-Based Cohort Study.

Objective: We aim to investigate the influence of weight gain during pregnancy on the risk of offspring adiposity before five years old. Methods: We retrospectively collected health information from the Tianjin mother-child cohort. Offspring outcome was BMI Z-score and prevalence of childhood adiposity from 0.5-5 years old. Gestational weight gain was analyzed using continuous and categorical variables evaluated by the IOM guidelines. Multivariate analysis adjusted maternal age, prepregnancy BMI, maternal height, smoking, cesarean section, gestational age at birth, birth weight, birth length, and mode of infant feeding during 0-6 months. Results: Gestational weight gain contributed to offspring's BMI Z-score from 1-5 years old, and the effect was most obvious in the first half of pregnancy (multivariate analysis, at 1, 2, 2.5, 3, 4, and 5 years of age: ß 0.011, 95% CI 0.008-0.014; ß 0.017, 95% CI 0.015-0.020; ß 0.005, 95%CI 0.002-0.008; ß 0.018, 95% CI 0.015-0.021; ß 0.014, 95% CI 0.009-0.020; ß 0.013, 95% CI 0.005-0.021). Excessive weight gain was associated with a higher prevalence of offspring adiposity before five years, even if prepregnancy BMI is normal. Multivariate regression analysis further confirmed that excessive weight gain during the first half of pregnancy significantly increased the risk of childhood obesity at aged one and three (AOR 1.083, 95% CI 1.003-1.169; AOR 1.158, 95% CI 1.036-1.293). Conclusion: Offspring have a higher risk of preschool adiposity when gestational weight gain was excessive during the first half of pregnancy.

Automatic Grading of Disc Herniation, Central Canal Stenosis and Nerve Roots Compression in Lumbar Magnetic Resonance Image Diagnosis.

Aim: Accurate severity grading of lumbar spine disease by magnetic resonance images (MRIs) plays an important role in selecting appropriate treatment for the disease. However, interpreting these complex MRIs is a repetitive and time-consuming workload for clinicians, especially radiologists. Here, we aim to develop a multi-task classification model based on artificial intelligence for automated grading of lumbar disc herniation (LDH), lumbar central canal stenosis (LCCS) and lumbar nerve roots compression (LNRC) at lumbar axial MRIs. Methods: Total 15254 lumbar axial T2W MRIs as the internal dataset obtained from the Fifth Affiliated Hospital of Sun Yat-sen University from January 2015 to May 2019 and 1273 axial T2W MRIs as the external test dataset obtained from the Third Affiliated Hospital of Southern Medical University from June 2016 to December 2017 were analyzed in this retrospective study. Two clinicians annotated and graded all MRIs using the three international classification systems. In agreement, these results served as the reference standard; In disagreement, outcomes were adjudicated by an expert surgeon to establish the reference standard. The internal dataset was randomly split into an internal training set (70%), validation set (15%) and test set (15%). The multi-task classification model based on ResNet-50 consists of a backbone network for feature extraction and three fully-connected (FC) networks for classification and performs the classification tasks of LDH, LCCS, and LNRC at lumbar MRIs. Precision, accuracy, sensitivity, specificity, F1 scores, confusion matrices, receiver-operating characteristics and interrater agreement (Gwet k) were utilized to assess the model's performance on the internal test dataset and external test datasets. Results: A total of 1115 patients, including 1015 patients from the internal dataset and 100 patients from the external test dataset [mean age, 49 years ± 15 (standard deviation); 543 women], were evaluated in this study. The overall accuracies of grading for LDH, LCCS and LNRC were 84.17% (74.16%), 86.99% (79.65%) and 81.21% (74.16%) respectively on the internal (external) test dataset. Internal and external testing of three spinal diseases showed substantial to the almost perfect agreement (k, 0.67 - 0.85) for the multi-task classification model. Conclusion: The multi-task classification model has achieved promising performance in the automated grading of LDH, LCCS and LNRC at lumbar axial T2W MRIs.

Interactions between Prepregnancy Overweight and Passive Smoking for Macrosomia and Large for Gestational Age in Chinese Pregnant Women.

INTRODUCTION: Previous analysis showed that passive smoking and overweight were associated with an increased risk of gestational diabetes mellitus (GDM) in a synergistic manner, while GDM increased the risk of macrosomia/large for gestational age (LGA). This study aimed to examine any interactive effects between passive smoking and overweight/obesity on risk of macrosomia/LGA. METHODS: From 2010 to 2012, 22,302 pregnant women registered for pregnancy at a primary hospital in Tianjin, China. Data were collected longitudinally; that is, from their first antenatal care visit, at the glucose challenge test (GCT) time (24-28 weeks of gestation) and at delivery. Passive smoking was self-reported. Macrosomia was defined as birth weight ≥4,000 g. Binary logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Additive interaction was used to test the synergistic effect. RESULTS: Passive smokers accounted for 57.4% of women (n = 8,230). Using nonpassive smoking and prepregnancy body mass index (BMI) <24.0 kg/m2 as the reference, the adjusted ORs of overweight alone and passive smoking alone for macrosomia were 2.39 (95% CI: 2.11-2.71) and 1.17 (95% CI: 1.04-1.32). Copresence of passive smoking and prepregnancy BMI ≥24.0 kg/m2 increased the OR to 2.70 (95% CI: 2.28-3.20), with a significant additive interaction. After further adjustment for GDM or GCT, the OR of copresence of both risk factors was slightly attenuated to 2.52 (2.13-3.00) and 2.51 (2.11-2.98), with significant additive interaction. However, the additive interaction between prepregnancy overweight/obesity and passive smoking for LGA was nonsignificant. CONCLUSIONS: Prepregnancy overweight/obesity was associated with an increased risk of macrosomia in Chinese women synergistically with passive smoking during pregnancy, and most of the association was not modified by hyperglycemia during pregnancy.

Abnormal glucose in pre-school children and the association with obesity/physical activity: A large population-based study.

AIM: The rise of diabetes mellitus (DM) and impaired fasting glucose (IFG) in children has become a worldwide challenge, but population-based survey targeted on pre-school children is lacking. The aim of the study was to determine the prevalence of DM and IFG in pre-school children and their association with obesity and susceptible behaviours. METHODS: A population-based survey was conducted and 21,571 Chinese children aged 5-6 years were recruited from 66 kindergartens in Tianjin, China during the year of 2016-2018. Fasting glucose was measured for all participants. Children with fasting glucose over 7.0 mmol/L was defined as DM, and 5.6-6.9 mmol/L was defined as IFG. RESULTS: The prevalence of DM and IFG in the current study among Chinese children aged 5-6 years old was 0.05% and 1.18%, respectively, with significant gender and regional disparities (p < 0.001). The risk of abnormal fasting glucose increased with obesity (OR 1.44, 95% CI 1.00-2.06, p < 0.05), especially with moderate/severe obesity (OR 1.84, 95% CI 1.10-3.10, p < 0.05). Further analyses found that as compared to children who had at least 2 h/day physical activity, physical activity <1 h/day increased the risk of abnormal fasting glucose independently of BMI z-score (OR 1.79, 95% CI 1.10-2.91, p < 0.05). CONCLUSIONS: The study was the first population-based large-scale survey of DM and IFG which targeted on pre-school children, and demonstrated that moderate/severe obesity and inadequate physical activity raised the risk of DM and IFG early from pre-school. The findings highlighted the necessity of early detection for abnormal glucose and control of obesity and susceptible behaviours.

Maternal education and newborn thyroid-stimulating hormone level in a congenital hypothyroidism screening program.

Objective: To examine the relationship between neonatal thyroid function and the formal education of mothers.Study design: Participants came from a population-based congenital hypothyroidism (CH) screening program in Tianjin, China.Methods: Of 66,390 registered births in 2015, 60,568 mothers and newborns had complete data. Mothers were categorized into one of four categories based on their educational attainment: (a) midschool or less; (b) high school or equivalent; (c) university; or (d) post graduate. Newborn thyroid-stimulating hormone (TSH) level was measured on day 3-7. Two neonatal groups were created using cutoffs of TSH > 10 µIU/ml and TSH > 20 µIU/ml. Odds ratios (OR) for CH risk by maternal education were estimated from logistic regression models after adjusting for potential confounders.Results: For TSH > 10 µIU/ml, the screen positive incidence rate for CH was 1:201 or 4.98 per 1000 births; for TSH > 20 µIU/ml, the incidence rate was 1:2222 or 0.45 per 1000 births. Screen positive incidence rates decreased with increasing maternal education level. Compared to mothers with a postgraduate education, the ORs (95% CI) for midschool or less, high school or equivalent, and university were 2.09 (1.08, 4.04), 1.45 (0.73, 2.90), and 1.61 (0.85, 3.06) using a cutoff of TSH > 10 µIU/ml. At the higher cutoff of TSH > 20 µIU/ml ORs (95% CI) for midschool or less and high school or equivalent were 3.05 (1.20,7.74) and 3.34 (1.24, 8.97), when compared to a composite reference category of university and postgraduate level education.Conclusion: Maternal education is inversely related to neonatal thyroid function though the mechanism remains unexplained.

A sandwich-type catalytic composite reassembled with a birnessite layer and metalloporphyrin as a water oxidation catalyst.

High purity birnessite was synthesized and exfoliated into a negatively charged monolayer structure. A positively charged 5, 10, 15, 20-tetrakis (4-aminophenyl) manganese porphyrin (MnTAPP) was synthesized. Driven by the electrostatic force and the coordination effect of the amino nitrogen on the manganese ion in birnessite, the single-layer birnessite was reassembled with MnTAPP, forming a new sandwich-type catalytic composite MnTAPP@bir. The structure and chemical properties of the composite were characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), transmission electron microscopy (TEM), thermogravimetric analysis (TGA) and Brunauer-Emmett analysis (BET). Electrocatalytic studies showed that the MnTAPP@bir exhibited an overpotential for water oxidation of 450 mV (at 10 mA cm-2) and a Tafel slope of 121.5 mV dec-1 compared to birnessite with 700 mV (at 10 mA cm-2) and 230 mV dec-1. Impedance spectroscopy results suggested that the charge transfer resistivity of MnTAPP@bir was significantly lower than that of birnessite, suggesting that MnTAPP in the interlayer increased the conductivity of birnessite. Through a chronoamperometry test, the new material also showed excellent stability within 4000 s.

Gestational diabetes and offspring's growth from birth to 6 years old.

OBJECTIVES: The objective of this study was to compare the children's body mass index (BMI) growth between offspring exposed to maternal gestational diabetes mellitus (GDM) and those not exposed, and assess the associations between maternal hyperglycemia and their offspring's overweight risk from 1 to 6 years of age. METHODS: Using the healthcare records data from the Tianjin Maternal and Child Healthcare System, we conducted a population-based cohort study, which is composed of 27,155 mother-child pairs with all mothers undergoing GDM screening test in pregnancy. RESULTS: After adjustment for maternal and children's characteristics, children born to mothers with abnormal glucose (including GDM or abnormal glucose challenge test (GCT) but normal oral glucose tolerance test (OGTT) results) during pregnancy had higher mean values of Z-scores for BMI for age at 1, 2, 3, 5, and 6 years of age, in comparison with those born to mothers with normal glucose (all P values < 0.05). Moreover, maternal abnormal glucose was associated with a higher risk of childhood overweight with multivariate-adjusted hazard ratios of 1.07 (95% confidence interval (CI) 1.01-1.14), 1.09 (95% CI 1.04-1.15), 1.10 (95% CI 1.04-1.15), 1.08 (95% CI 1.03-1.14), 1.08 (95% 1.03-1.13), and 1.07 (95% 1.02-1.12) at 1-6 years of age compared with children of mothers with normal glucose. CONCLUSIONS: Abnormal maternal glucose tolerance during pregnancy was independently associated with children's higher BMI and overweight risk from 1 to 6 years of age. Women with positive GCT results but negative OGTT can be neglected by the health system. More attention should be paid to the health of these mothers and their offspring.

Association of early pregnancy body mass index and children's birth weight with risk of being overweight in childhood.

OBJECTIVES: To examine the potential effects of mothers' early pregnancy body mass index (BMI) and children's birth weight on childhood overweight/obesity at 1-6 years of age. METHODS: We performed a cohort study in Tianjin, China, using the health care records from the Tianjin maternal and child health care system with 36 719 mother-child pairs from early pregnancy to children at 6 years of age. Logistic regression analyses were used to assess the single and joint associations of maternal early pregnancy BMI and children's birth weight with the risks of children being overweight at 1-6 years of age in multivariable-adjusted models. RESULTS: Both maternal early pregnancy BMI and children's birth weight were positively associated with the risk of children being overweight at 1-6 years of age. Compared with children who were born to normal weight mothers and had low or normal birth weight (NBW; birth BMI < 85%), higher risks of being overweight at 1-6 years were found among children with low or NBW who were born to overweight mothers, and children with high NBW (BMI ≥ 85%) or macrosomia who were born to normal weight or overweight mothers. Lower risks of being overweight were found among those with low birth weight who were born to normal weight mothers. CONCLUSIONS: Maternal early pregnancy BMI may play a more important role than children's birth weight in the risk of being overweight from 4 to 6 years of age. Children with high or NBW need to be given more attention to prevent excessive weight gain.

Indicators of socio-economic status and risk of gestational diabetes mellitus in pregnant women in urban Tianjin, China.

AIMS: To examine associations between the indicators of socio-economic status (SES) and gestational diabetes mellitus (GDM). METHODS: From 2010 to 2012, 17 659 women underwent glucose challenge test (GCT) and oral glucose tolerance test if GCT ≥ 7.8 mmol/L at 24-28 gestational weeks in 6 urban districts of Tianjin, China. Binary logistic regression was used to obtain adjusted odds ratio (OR) of SES for GDM, as defined by education attainment and family monthly income. RESULTS: A total of 1264 women (7.2%) were found to have GDM. If the women with low-middle income and high school or below used as the reference group, the middle-high income group and the high income group were associated with decreased risks of GDM (OR: 0.85, 95%CI: 0.71-1.00 & 0.80, 0.65-0.98) while tertiary education attainment was associated with decreased risk of GDM (0.75, 0.58-0.97). Women with higher income and/or higher education attainment tended to have a decreased risk of GDM (P for trend: 0.0105). All these significant ORs were attenuated to be non-significant by adjustment for pre-pregnancy body mass index (BMI), but not by adjustment for gestational weight gain (GWG). CONCLUSIONS: In urban Tianjin, indicators of high SES were associated with decreased risk of GDM via decreased pre-pregnancy BMI.

Maternal gestational diabetes and childhood obesity at age 9-11: results of a multinational study.

AIMS/HYPOTHESIS: The aim of this study was to examine the association between maternal gestational diabetes mellitus (GDM) and childhood obesity at age 9-11 years in 12 countries around the world. METHODS: A multinational cross-sectional study of 4740 children aged 9-11 years was conducted. Maternal GDM was diagnosed according to the ADA or WHO criteria. Height and waist circumference were measured using standardised methods. Weight and body fat were measured using a portable Tanita SC-240 Body Composition Analyzer. Multilevel modelling was used to account for the nested nature of the data. RESULTS: The prevalence of reported maternal GDM was 4.3%. The overall prevalence of childhood obesity, central obesity and high body fat were 12.3%, 9.9% and 8.1%, respectively. The multivariable-adjusted (maternal age at delivery, education, infant feeding mode, gestational age, number of younger siblings, child unhealthy diet pattern scores, moderate-to-vigorous physical activity, sleeping time, sedentary time, sex and birthweight) odds ratios among children of GDM mothers compared with children of non-GDM mothers were 1.53 (95% CI 1.03, 2.27) for obesity, 1.73 (95% CI 1.14, 2.62) for central obesity and 1.42 (95% CI 0.90, 2.26) for high body fat. The positive association was still statistically significant for central obesity after additional adjustment for current maternal BMI but was no longer significant for obesity and high body fat. CONCLUSIONS/INTERPRETATION: Maternal GDM was associated with increased odds of childhood obesity at 9-11 years old but this association was not fully independent of maternal BMI.

Trends in the Prevalence of Overweight and Obesity among Chinese Preschool Children from 2006 to 2014.

OBJECTIVE: To examine the trends in the prevalence of overweight and obesity among preschool children from 2006 to 2014. METHODS: A total of 145,078 children aged 3-6 years from 46 kindergartens finished the annual health examination in Tianjin, China. Height, weight and other information were obtained using standardized methods. Z-scores for weight, height, and BMI were calculated based on the standards for the World Health Organization (WHO) child growth standards. RESULTS: From 2006 to 2014, mean values of height z-scores significantly increased from 0.34 to 0.54, mean values of weight z-scores kept constant, and mean values of BMI z-scores significantly decreased from 0.40 to 0.23. Mean values of height z-scores, weight z-scores, and BMI z-scores slightly decreased among children from 3 to 4 years old, and then increased among children from 4 to 6 years old. Between 2006 and 2014, there were no significant changes in prevalence of overweight (BMI z-scores >2 SD) and obesity (BMI z-scores >3 SD) among 3-4 years children. However, prevalence of obesity (BMI z-scores >2 SD) increased from 8.8% in 2006 to 10.1% in 2010, and then kept stable until 2014 among 5-6 years children. Boys had higher prevalence of obesity than girls. CONCLUSIONS: Mean values of BMI z-scores decreased from 2006 to 2014 among Chinese children aged 3-6 years old due to the significant increase of height z-scores. Prevalence of obesity increased from 2006 to 2010, and then kept stable until 2014 among children aged 5-6 years. The prevalence of obesity was higher in boys than in girls.

Prevalence of congenital heart disease and its related risk indicators among 90,796 Chinese infants aged less than 6 months in Tianjin.

BACKGROUND: Congenital heart disease (CHD) represents one of the most prevalent congenital malformations. However, few studies use whole-population screening by colour Doppler ultrasonic diagnostic system to identify CHD among live infants. We estimate the prevalence of CHD and its major risk indicators among infants aged less than 6 months in urban Tianjin, China. METHODS: A colour Doppler ultrasonic diagnostic system was used as the screening tool for the diagnosis of CHD. A total of 90,796 infants aged less than 6 months, living in the nine urban districts of Tianjin, China, participated in the CHD screening programme between July 2009 and June 2011. RESULTS: A total of 1817 children were identified as having CHD. The overall prevalence of congenital heart disease was 16.4 per 1000 live births among 47,697 boys, 24.1 per 1000 live births among 43,099 girls, and 20.0 per 1,000 live births among 90,796 boys and girls combined. Atrial septal defect was the most common heart lesion of CHD, with the prevalence of 10.6 per 1000 live births. Several maternal antenatal factors, such as older age, pregnant infections, pregnancy-induced hypertension, gestational diabetes, family history of CHD, and lower education level, and several child factors, such as early screening age, lower birthweight and short gestational age, were associated with an increased risk of CHD. CONCLUSIONS: The prevalence of CHD of live infants in Tianjin was found to be relatively high by using a colour Doppler ultrasonic diagnostic system to screen CHD. Several maternal factors were associated with CHD risk.

Maternal prepregnancy body mass index and gestational weight gain on pregnancy outcomes.

OBJECTIVE: The aim of the present study was to evaluate the single and joint associations of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) with pregnancy outcomes in Tianjin, China. METHODS: Between June 2009 and May 2011, health care records of 33,973 pregnant women were collected and their children were measured for birth weight and birth length. The independent and joint associations of prepregnancy BMI and GWG based on the Institute of Medicine (IOM) guidelines with the risks of pregnancy and neonatal outcomes were examined by using Logistic Regression. RESULTS: After adjustment for all confounding factors, maternal prepregnancy BMI was positively associated with risks of gestational diabetes mellitus (GDM), pregnancy-induced hypertension, caesarean delivery, preterm delivery, large-for-gestational age infant (LGA), and macrosomia, and inversely associated with risks of small-for-gestational age infant (SGA) and low birth weight. Maternal excessive GWG was associated with increased risks of pregnancy-induced hypertension, caesarean delivery, LGA, and macrosomia, and decreased risks of preterm delivery, SGA, and low birth weight. Maternal inadequate GWG was associated with increased risks of preterm delivery and SGA, and decreased risks of LGA and macrosomia, compared with maternal adequate GWG. Women with both prepregnancy obesity and excessive GWG had 2.2-5.9 folds higher risks of GDM, pregnancy-induced hypertension, caesarean delivery, LGA, and macrosomia compared with women with normal prepregnancy BMI and adequate GWG. CONCLUSIONS: Maternal prepregnancy obesity and excessive GWG were associated with greater risks of pregnancy-induced hypertension, caesarean delivery, and greater infant size at birth. Health care providers should inform women to start the pregnancy with a BMI in the normal weight category and limit their GWG to the range specified for their prepregnancy BMI.

Relationship between maternal fasting glucose levels at 4-12 gestational weeks and offspring growth and development in early infancy.

OBJECTIVE: To evaluate the association of maternal fasting glucose levels at 4-12 gestational weeks with anthropometry in the offspring from birth to 12 months in Tianjin, China. DESIGN AND METHODS: A total of 57,454 pregnant women underwent a fasting glucose test during the first trimester, and their children had body weight/length measured from birth to 12 months of age. RESULTS: Maternal fasting glucose concentrations at 4-12 gestational weeks were positively associated with Z scores for birth weight, birth length, birth weight for length, and birth body mass index (BMI). Infants born to mothers with fasting glucose concentrations ≥126mg/dL (7.0mmol/l) had had the highest mean Z scores for birth weight, birth length, birth weight for length and birth BMI for gestational age, and the lowest mean Z scores for weight and length for age at months 3, 6, 9, and 12, the smallest changes in Z scores for weight for age, weight for length, and BMI for age from birth to month 3, and largest changes in Z scores for weight for age, and BMI for age after 6 months. CONCLUSIONS: Higher maternal fasting glucose during pregnancy was associated with larger birth weight and birth length, less weight gain and length gain in the first 3 months of life, and more weight gain in months 6-12 of life.

Maternal prepregnancy body mass index and gestational weight gain on offspring overweight in early infancy.

OBJECTIVE: The aim of the present study was to evaluate the association of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) with anthropometry in the offspring from birth to 12 months old in Tianjin, China. METHODS: Between 2009 and 2011, health care records of 38,539 pregnant women had been collected, and their children had been measured body weight and length at birth, 3, 6, 9 and 12 months of age. The independent and joint associations of pre-pregnancy BMI and GWG based on the Institute of Medicine (IOM) guidelines with anthropometry in the offspring were examined using General Linear Model and Logistic Regression. RESULTS: Prepregnancy BMI and maternal GWG were positively associated with Z-scores for birth weight-for-gestational age, birth length-for-gestational age, and birth weight-for-length. Infants born to mothers with excessive GWG had the greatest changes in Z-scores for weight-for-age from birth to Month 3, and from Month 6 to Month 12, and the greatest changes in Z-scores for length-for-age from birth to months 3 and 12 compared with infants born to mothers with adequate GWG. Excessive GWG was associated with an increased risk of offspring overweight or obesity at 12 months old in all BMI categories except underweight. CONCLUSIONS: Maternal prepregnancy overweight/obesity and excessive GWG were associated with greater weight gain and length gain of offspring in early infancy. Excessive GWG was associated with increased infancy overweight and obesity risk.

Newborn hearing concurrent genetic screening for hearing impairment-a clinical practice in 58,397 neonates in Tianjin, China.

OBJECTIVE: Newborn hearing screening (NHS) is used worldwide due to its feasibility and cost-efficiency. However, neonates with late-onset and progressive hearing impairment will be missed by NHS. Genetic factors account for an estimated 60% of congenital profound hearing loss. Our previous cohort studies were carried out in an innovative mode, i.e. hearing concurrent genetic screening, in newborns to improve the abilities or early diagnosis and intervention for the hearing defects. In this study, we performed the first clinical practice of this mode in Tianjin city. METHODS: A large cohort of 58,397 neonates, born between December 2011 and December 2012, in 44 hospitals in Tianjin, were screened for 20 hot spot hearing loss associated mutations from GJB2, GJB3, SLC26A4 and MTRNR1(12S rRNA). The data of genetic screening results was comprehensively analyzed with newborn hearing screening (NHS) results. RESULTS: We developed an accurate, high throughput genetic screening method and applied it to a total of 58,397 newborns in Tianjin. 3225 (5.52%) infants were detected to carry at least one mutation allele in GJB2, GJB3, SLC26A4 or MTRNR1. 34 (0.58‰) infants were positive for hearing loss caused by GJB2 or SLC26A4 mutations (homozygote or compound heterozygote). 54(0.93‰) infants are heterozygous of various genes. 109(1.87‰) infants had the pathological mitochondrial DNA mutation. CONCLUSION: Accurate, comprehensive hearing loss associated genetic screening can facilitate genetic counseling and provides valuable prognostic information to affected infants. This united screening mode of this study was a promising clinical practice.