Serum parameters of inflammatory markers as prognostic biomarkers with maternal-neonatal outcome in patients with GDM.

Objective: Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy, which is increasing annually. GDM can cause serious harm to both the mother and the offspring. However, the clinical indicators that predict pregnancy outcomes with GDM remain limited. Methods: This study included 3,229 pregnancies. Inflammatory markers were defective in the mother's peripheral blood. Also, the Chi-square test, logistic regression analyses and Spearman rank correlation coefficient were performed to evaluate inflammatory markers with pregnancy outcomes. The association between inflammatory markers and pregnancy outcomes was analyzed. The optimal cut-off values of inflammatory markers were calculated. Results: Finally, 3,229 women were included. 1852 (57.36%) participants suffered good pregnancy outcomes. This study revealed that the maternal age, the baseline BMI (kg/m2), the times of parity, and the level of lymphocyte, SII and SIRI significantly increased in poor pregnancy outcomes groups. Additionally, inflammatory markers, such as white blood cells (WBC), neutrophils, monocytes, platelet counts, lymphocytes, systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) were related to pregnancy outcomes. Furthermore, the results revealed that the SII level had the highest odd rates (OR) [OR = 6.957; 95% CI (5.715-8.468)], followed by SIRI level [OR = 2.948; 95% CI (2.382-3.649)], the WBC counts [OR = 1.930; 95% CI (0.901-2.960)], the lymphocyte counts [OR = 1.668; 95% CI (1.412-1.970)], and baseline BMI [OR = 1.050; 95% (1.021-1.080)]. Conclusion: This study presented that the baseline SII and SIRI levels can be valuable biochemical markers to predict the pregnancy outcome with GDM with non-invasive procedures. They can help identify high-risk pregnant women with GDM early, provide a personalized intervention in time, and enhance perinatal surveillance.

Significance of cervical secretion culture in predicting maternal and fetal outcome in pregnant women with premature rupture of membranes: a retrospective cohort study.

Background: To investigate the clinical value of cervical secretion culture in pregnant women with premature rupture of membranes (PROM) in predicting maternal and fetal outcomes. Methods: We retrospectively reviewed clinical records of pregnant women who underwent obstetric examination and delivered in Fujian Maternal and Child Healthcare from December 2013 to December 2016. Pregnant women with a clear diagnosis of PROM, who underwent cervical secretion culture immediately after hospital admission were selected for the study. The primary outcome was the occurrence of chorioamnionitis. The secondary outcome was neonatal admission to the neonatal intensive care unit (NICU). Correlation between maternal and fetal outcomes and the results of the cervical secretion culture was analyzed by one-way analysis and multifactorial analysis, respectively. The predictive efficacy of cervical secretion culture was evaluated using receiver operating characteristic curve (ROC), area under the curve (AUC) and the integrated discrimination improvement (IDI). Results: A total of 7,727 pregnant women with PROM were included in the study. Of them, 1812 had positive cervical secretion cultures (635 positive for mycoplasma infection, 475 for bacterial, 637 for fungal, and 65 for chlamydial infections). Pregnant women with positive mycoplasma and bacterial cultures had higher rates of developing chorioamnionitis compared to women with negative cervical secretion cultures (9%, 12% vs. 1%, respectively). Similarly, positive mycoplasma and bacterial cultures were associated with higher rate of the preterm (before 34 weeks) labor (3%, 3% vs. 1% in women with negative cultures, respectively), and neonatal admission to the NICU (9%, 11% vs. 7%, respectively). After adjusting for various confounding factors, our analysis demonstrated that a positive cervical secretion culture for mycoplasma or bacterial pathogens remained an independent risk factor for chorioamnionitis. Cervical secretion culture outcome was less effective in predicting chorioamnionitis (AUC 0.569) compared to white blood count (WBC) (AUC 0.626) and C-reactive protein (CRP) levels (AUC 0.605). The IDI of the combined predictive model incorporating WBC, CRP, maternal fever and cervical secretion culture results was 0.0029. Conclusion: Positive cervical secretion cultures, especially for mycoplasma and bacteria, are associated with higher incidence of adverse maternal and fetal outcomes. However, the predictive value of this test is poor, and cannot be efficiently used for predicting chorioamnionitis.

Application of Team-Based Flipped Classroom and Traditional Learning on the Antenatal Education Center Course.

Background: The goal is to evaluate the effects of a flipped class strategy on knowledge, self-directed learning ability, learning satisfaction and pregnancy outcomes in primiparas undergoing antenatal education. Methods: A random sampling method was adopted. A total of 600 primiparas who were diagnosed with early pregnancy in a first-class hospital in southeast China and received continuous prenatal health education from May to July 2020 were selected as the research subjects. In order to make the baseline of the two groups of primipara comparable, we divided the two groups in the antenatal education centre according to the odd-even number of the lesson card number. The odd-numbered group was the experimental group, who used the prenatal health education model based on blended learning; the even-numbered group was the control group, who used the traditional mode of prenatal health education. The two groups were compared on the following outcomes: knowledge, self-directed learning ability, learning satisfaction and pregnancy outcomes. Results: Compared with traditional learning, the blended learning approach can effectively controlled the gestational weight gain (GWG), alleviated the anxiety and depression during pregnancy, improved the natural delivery rate of the primipara, shortened the delivery process and reduced the risk of gestational diabetes mellitus (GDM), the difference was statistically significant (all P<0.05). Conclusion: Blended learning may be an effective strategy because of its validity and practicality in antenatal education.

Relationship between gestational weight gain during different phases and maternal complications or neonatal outcomes.

OBJECTIVES: Improper gestational weight gain (GWG) causes many adverse obstetrical and neonatal outcomes. This study evaluates the relationship between weight gain in different phases and maternal outcomes or neonatal outcomes. MATERIAL AND METHODS: Finally, this study recruited 2,608 women delivered at Fujian Provincial Maternity and Child Health, affiliated hospital of Fujian Medical University from December 2017 to January 2019. To evaluate the relationship between maternal outcome and neonatal outcome, the participants were divided into four groups based on their baseline BMI and weight gain in the second/third trimester of pregnancy. RESULTS: This study demonstrated that neonate weight, small-for-gestational-age infants, macrosomia, neonatal death, cesarean delivery, and GDM significantly differed across the baseline BMI, weight gain in the second and third trimester. The umbilical cord's abnormality, bulging membrane, abruptio placentae, and postpartum hemorrhage were significantly related to baseline BMI. Furthermore, gestational hypertension and pre-eclampsia/eclampsia were significantly correlated with baseline BMI and weight gain in the second trimester. The maternal and infant outcomes are different, and the GWG curves are significantly different. Finally, multivariate regression analysis showed that baseline BMI and weight gain in the second/third trimester were the independent risk factors for GDM and macrosomia. Also, baseline BMI and weight gain in the third trimester were the independent risk factors for developing gestational hypertension and pre-eclampsia/eclampsia, respectively. CONCLUSIONS: The baseline BMI and weight gain in the second/third trimester are significant with maternal outcomes and neonatal outcomes to a varying degree. Thus, maintaining appropriate baseline BMI and weight gain in different phases are essential in preventing pregnancy complications and maternal and neonatal prognosis.

Effects of paternal obesity on maternal-neonatal outcomes and long-term prognosis in adolescents.

Objective: This study evaluated whether paternal body mass index (BMI) before pregnancy was a risk factor for maternal-neonatal outcomes and long-term prognosis in offspring. Methods: This study included 29,518 participants from eight cities in Fujian, China using a stratified cluster random sampling method from May to September 2019. They were divided into four groups based on paternal BMI. Univariate and multivariate logistic regression were used to explore the relationship between paternal BMI groups, maternal-neonatal outcomes, and long-term prognosis in offspring. Further subgroup analysis was conducted to examine the stability of the risk. Results: The incidences of hypertensive disorder complicating pregnancy (HDCP), cesarean delivery, gestational weight gain (GWG) over guideline, and macrosomia were significantly higher in the paternal overweight and obesity group. Importantly, this study demonstrated that the incidence of asthma, hand-foot-and-mouth disease (HFMD), anemia, dental caries, and obesity of adolescents in paternal obesity increased. Furthermore, logistic regression and subgroup analysis confirm paternal obesity is a risk factor for HDCP, cesarean delivery, and macrosomia. It caused poor long-term prognosis in adolescents, including asthma, dental caries, and HFMD. Conclusions: Paternal obesity is a risk factor for adverse maternal-neonatal outcomes and poor long-term prognosis in adolescents. In addition to focusing on maternal weight, expectant fathers should pay more attention to weight management since BMI is a modifiable risk factor. Preventing paternal obesity can lead to better maternal and child outcomes. It would provide new opportunities for chronic diseases.

[Study on the relationship between semen HBV-DNA load and offspring-paternal-vertical- transmission of HBV].

OBJECTIVE: To explore the relationship between HBV-DNA load and the offspring vertical transmission of HBV. METHODS: 138 families who had taken the examination between August 2009 and November 2011 but the HBsAg of the housewife was negative, were chosen as research objects. Blood from the couples and sperms from the husbands during pregnancy were followed and collected for detection on related indicators. Cord blood was sampled after delivery for HBVM and HBV-DNA quantification. Those with HBV-DNA load ≥5×10(2) copies/ml were chosen as cases while those <5 × 10(2) copies/ml were formed as controls, respectively. RESULTS: 1) The positive rates of HBV-DNA was 34.8% (48/138)in the neonatal cord blood while the positive rates of cord blood HBsAg and HBeAg were 28.3% (39/138) and 15.2% (21/138) respectively. 2) The positive rate of semen HBV-DNA was 21.0% (29/138) while the positive rates of paternal serum HBV-DNA and HBeAg were 76.8% (106/138) and 42.8% (59/138). 3) Among the positive ones on paternal serum HBV-DNA, paternal serum HBeAg, semen HBV-DNA, items as measures taken for HBV vertical transmission and prevention on the fathers and the first class family histories on HBV appeared to be the risk factors for HBV paternal transmission (P < 0.05). 4) Data from Multivariate analysis showed that positivities on paternal serum HBV-DNA, paternal serum HBeAg and semen HBV-DNA were risk factors for HBV paternal transmission (OR = 5.7, 95%CI:1.1-29.1; OR = 4.2, 95%CI:1.7-10.0; OR = 6.7, 95% CI:2.4-18.9). 5)Dose-response relationships were seen between levels of paternal serum HBV-DNA load and cord blood HBV-DNA load, between levels of paternal serum HBV-DNA load and semen HBV-DNA load, between levels of semen HBV-DNA load and cord blood HBV-DNA load. 6)Results from the analysis on ROC curve showed that paternal serum HBV-DNA load level (10(5) copies/ml)and semen HBV-DNA load level (10(3) copies/ml) were better demarcation points to forecast the occurrence of paternal transmission of HBV, because of the better sensitivity and specificity they had. CONCLUSION: Items as positives on paternal serum HBV-DNA, paternal serum HBeAg and semen HBV-DNA were risk factors for HBV paternal transmission. When paternal serum HBV-DNA load >10(5) copies/ml and semen HBV-DNA load >10(3) copies/ml appeared, the positive rate of HBV paternal transmission would increase.

[Study on the risk factors related vertical transmission of HBV positive couples to their infant].

OBJECTIVE: To explore the risk factors and the rate of HBV vertical transmission from HBsAg-positive couple to their infant. METHODS: 46 families who had antenatal examination at Fujian Provincial Maternal and Child Health Hospital during August 2010 and November 2011 were chosen as research object. Cord blood was sampled after delivery for HBVM and HBV-DNA quantification. Those with HBV-DNA load ≥ 5 × 10(2) copies/ml were involved in the case group while those having < 5 × 10(2) copies/ml were chosen as controls. RESULTS: The average positive rate of neonatal cord blood HBV-DNA was 45.7% (21/46), while the positive rates of cord blood HBsAg and HBeAg were 34.8% (16/46) and 23.9% (11/46) respectively. The positive rates of maternal serum HBV-DNA and paternal serum HBV-DNA were 52.2% (24/46) and 69.6% (32/46) respectively, with the positive rate of couple serum HBeAg as 39.1% (18/46) and 32.6% (15/46) respectively. Results from univariate analysis showed that hepatitis B surface markers, serum HBeAg-positive, serum HBV-DNA positive, and serum HBV-DNA load of the couples were risk factors to the HBV vertical transmission (χ(2) = 8.731, 8.414, 8.932, 9.663, 10.823, 3.962, 13.638, 36.501; P < 0.05). Data from the multivariate analysis showed that maternal serum HBV-DNA positive and paternal serum HBV-DNA load were risk factors to the HBV vertical transmission[OR = 17.6 (1.3 - 238.4) ; OR = 3.5 (1.6-7.6)]. Serum HBV-DNA loads of the couples were positively correlated with the cord blood HBV-DNA load, while the load levels of the couple's serum HBV-DNA were higher than cord blood HBV-DNA. There appeared dose-response relationship between couple's serum HBV-DNA load level and the cord blood HBV-DNA load level. RESULTS: from the analysis of ROC curve showed that both maternal serum HBV-DNA load level (10(3) copies/ml) and paternal serum HBV-DNA load level (10(4) copies/ml) were demarcation points to better forecast the occurrence of vertical transmission of HBV, because there showed higher sensitivity and specificity for the forecasting process. Neonatal outcomes showed no significant difference between the case group and the control group. The negative conversion rate became 15.0% (3/20) when the HBV-DNA positive infants were followed up for 7 months. CONCLUSION: Both maternal serum HBV-DNA positive and paternal serum HBV-DNA load were risk factors of HBV vertical transmission. When the maternal serum HBV-DNA load appeared > 10(3) copies/ml and paternal serum HBV-DNA load > 10(4) copies/ml, the rate of HBV vertical transmission would increase.

[Study on the influence of maternal physiology, mentality and prenatal health care on children born with low birth weight].

OBJECTIVE: To explore the role of maternal physiology, mentality and prenatal health care on low birth weight (LBW). METHODS: A LBW-small for gestation age (SGA)-control group retrospective study was conducted based upon a population of infants born from November 2004 to June 2006. 896 cases involved in this study were entirely under voluntary participation and subject could withdraw their consent at any point. All subject recruitment and enrollment took place at Fujian Provincial Maternal and Children Hospital at the time of delivery. Using chi2 test for single factor analysis and logistic regression for multiple analyses. RESULTS: There were 15 out of 22 single factors having statistical significances, including 2 maternal psychological, 4 physiological, 6 pathological and 3 prenatal health care factors respectively. When multi-factorial stepwise regression analyses was performed, there were 9 factors for main relative factors of LBW, including women's height, number of prenatal examination, in-normal non-stress test, umbilical cord around the neck, retardation of the umbilical blood flow, week of gestation when the first examination was performed, premature rupture of membrane, preference on the sex of the infant, abnormal family history etc. were influencing the existence of LBW. Awareness on health information appeared to be a protective factor, suggesting that LBW could be prevented during the pregnant period. CONCLUSION: Multiple factors seemed to be contributing to the incidence of low birth weight.

[Epidemiological study on 38 418 syphilis cases during pregnancy].

OBJECTIVE: To explore the prevalence of syphilis and risk factors on pregnant women in Fujian province. METHODS: From July 1st, 2004 to June 30th, 2006, epidemiologic methods as questionnaires to fill in and rapid plasma reagent testing (RPR) were performed. Pregnant women with positive RPR test and then were confirmed by treponema pallidum test (TP). Intervention was provided to the pregnant women who were followed up to the postpartum periods. Results were compared during the peri-neonatal stage between syphilis-infected and non-infected women. Factors which were relative to syphilis infection were analyzed by simple and then further logistic regression analysis. RESULTS: There were 38 418 pregnant women under study, of whom 772 were confirmed including 60 who were still pregnant. The prevalence of syphilis during pregnancy was 1.85% (712/38 418), with mostly underlying syphilis which played an important role during the neonatal stage. Main risk factors to have been found as: women's occupation, cultural background, place of living, husband's occupation, family income, having sexually transmitted disease(STD) infection. The prognosis of peri-neonatal stage was worse if the mother was having blood RPR test positive. Mortality of peri-neonatal, preterm birth rate and low-birth weight rate were found also higher among mothers when RPR was positive (P < 0.01). CONCLUSION: The prevalence of syphilis in Fujian province was going up yearly. 8 factors including women's occupation, cultural background, place of living, received poor health education, having multiple sexual partners, husband's occupation, family income and having STD were main risk factors in the province, the mother's status of syphilis infection would strongly relate to the peri-neonatal stage of pregnancy.

[Study on interventional methods and the pattern of maternal-fetal transmission of syphilis during pregnancy].

OBJECTIVE: To explore the maternal-fetal transmission patterns and interventional methods of syphilis during pregnancy. METHODS: A total of 847 cases of syphilis in pregnancy confirmed by rapid plasma reagin test (RPR) and treponema pallidum hemoagglutination test (TPHA) were treated with procaine benzylpenicillin intramuscular injection, and with erythrocin oral medication if hypersensitive to benzylpenicillin. Eight hundred forty seven cases of syphilis during pregnancy were followed up for pregnancy outcomes. And their newborn babies were tested using the RPR. The newborns with positive results were given intervention and followed up until 24 months after birth. RESULTS: (1) A total of 733 cases among the total 847 have given birth to living-babies, in which 626 cases were tested using RPR, and the positive rate was 55.1% (345/626). (2) The RPR positive rate, neonatal mortality, preterm birth rate and low birth rate in the newborn of mothers with an RPR titer higher than or at 1:8 were higher than those of mothers with an RPR titer lower than 1:8 (P < 0.01). (3) The neonatal RPR positive rate was related to the timing of the treatment of the women. (1) The neonatal RPR positive rate was 22.4% (15/67) for treatment compared with 49.6% (330/666) for non-treatment before pregnancy (P < 0.01). (2) The positive RPR rate of neonates between treatment before pregnancy and treatment during pregnancy was different, being 22.4% (15/67) and 40.3% (240/595) respectively (P < 0.05) (3) In comparison between treatment both in the early pregnancy and in late pregnancy with only treatment in the late pregnancy, the positive RPR rate of neonates was 28.5% (45/158) and 56.9% (95/167) respectively (P < 0.01). In comparison between treatment both in the mid-term pregnancy and in late pregnancy and treatment in only one period in the terminal, the positive RPR rate of neonates was 37.0% (100/270) and 56.9% (95/167) respectively (P < 0.01). CONCLUSIONS: The maternal-fetal transmission rate and perinatal prognosis are related to maternal RPR titer and the timing of maternal treatment. Inborn syphilis can be prevented and cured in fetal time. For neonates with anti-syphilis treatment in protestation, RPR positive rate is significantly lower than that without treatment in protestation. Treatment prior to pregnancy is a powerful measure to prevent the maternal-fetal transmission of syphilis.

[An intervention study on preventing maternal-fetal transmission of syphilis during pregnancy].

OBJECTIVE: To study the prevalence and principal rules of women with syphilis during pregnancy and to develop relative methods to prevent maternal-fetal transmission. METHODS: A nested case control study on epidemiologic research was used based on review and preview methods on prevention and cure. Targeting pregnant women with syphilis diagnosed during premarital or pregnancy stages and were identified through rapid plasma reagin test (RPR) but confirmed by treponema pallidum test (TP),a total number of 339 women receiving treatment, intervention and being followed throughout the pregnant and neonatal periods. RESULTS: The prevalence of syphilis in pregnancy was 2.33%, and the positive rate in neonatal cord blood was closely associated with the opportunity of getting maternal treatment. The lowest RPR positive rate was among these women who got pregnant after receiving the treatment. The RPR positive rate of neonatal cord blood was positively relative to the mother's RPR titer. The higher was the mother's blood RPR titer, the worse the prenatal prognosis would turn to. CONCLUSION: Mother's blood RPR titer and the opportunity of getting treatment were strongly associated with the positive rate in neonatal cord blood. Pregnancy after receiving the treatment was a powerful measure to prevent the maternal-fetal transmission of syphilis.