Prevalence of Reproductive Tract Infections and Association with Human Papillomavirus Infection Among Reproductive-Age Women - Six Tertiary Hospitals, China, June 2021-December 2022.

What is already known about this topic?: Previous studies have indicated a possible association between reproductive tract infections (RTIs) and high-risk human papillomavirus (HPV) infection, but the evidence is still inconclusive. What is added by this report?: This multicenter study found significantly higher positive rates of HPV, including general HPV, high-risk HPV, and HPV 16/18 infections, among women who tested positive for single or multiple RTIs compared to women who tested negative for RTIs in gynecological outpatient clinics. What are the implications for public health practice?: Infection with HPV, especially high-risk types, is linked to RTIs and imbalances in the vaginal microbiota. Implementing standardized protocols for identifying and treating RTIs could support the establishment of a healthy vaginal microenvironment. This, in turn, may offer a novel approach to preventing cervical cancer.

Knowledge of Cervical Cancer and HPV, and Willingness to Receive HPV Vaccination Among 20-45-Year-Old Women - Six Provinces, China, 2018.

What is already known about this topic?: Cervical cancer is a significant public health problem with approximately 570,000 cases and 311,000 deaths occurring in 2018 globally. It is imperative to raise awareness of cervical cancer and human papillomavirus (HPV). What is added by this report?: Compared to previous studies, this is one of the largest cross-sectional studies of cervical cancer and HPV in Chinese adult females in recent years. We found that knowledge level of cervical cancer and HPV vaccine was still inadequate among women aged 20-45 years old, and the willingness to receive HPV vaccination was highly associated with knowledge level. What are the implications for public health practice?: Intervention programs should aim to improve awareness and knowledge about cervical cancer and HPV vaccines, primarily focusing on women of lower socio-economic status.

Prevalence and risk factors for depressive and anxiety symptoms in middle-aged Chinese women: a community-based cross-sectional study.

BACKGROUND: Depression and anxiety have become main public health concerns globally. However, risk factors for depression and anxiety remain unclear. This study was to examine the prevalence and risk factors of depressive and anxiety symptoms in middle-aged Chinese women. METHODS: This cross-sectional study, conducted in 2018, included 7,727 women aged 40-60 years from the eastern, central and western regions of China. Depressive and anxiety symptoms were determined by the Patient Health Questionnaire-9 and the Generalized Anxiety Disorders-7, respectively. Logistic regression models were used to estimate odds ratios (ORs) for depressive and anxiety symptoms in relation to sociodemographic, lifestyle and menopausal factors. RESULTS: Among all participants, 19.5% (1 422/7 275) and 14.2% (1 035/7 275) of participants experienced depressive and anxiety symptoms, respectively. The multivariable logistic regression models showed that age, household income, regular physical activity, chronic diseases, menopausal status, vasomotor symptoms, somatic symptoms and urogenital symptoms were associated with depressive symptoms, while place of residence, regular physical activity, chronic diseases, vasomotor, somatic and urogenital symptoms were associated with anxiety symptoms. CONCLUSION: Depressive and anxiety symptoms were common among middle-aged Chinese women, and certain sociodemographic, lifestyle and menopausal symptoms have an important impact on the risk of depressive and anxiety symptoms.

Evaluating factors that influenced the successful implementation of an evidence-based neonatal care intervention in Chinese hospitals using the PARIHS framework.

BACKGROUND: Evidence based interventions (EBIs) can improve patient care and outcomes. Understanding the process for successfully introducing and implementing EBIs can inform effective roll-out and scale up. The Promoting Action on Research Implementation in Health Services (PARIHS) framework can be used to evaluate and guide the introduction and implementation of EBIs. In this study, we used kangaroo mother care (KMC) as an example of an evidence-based neonatal intervention recently introduced in selected Chinese hospitals, to identify the factors that influenced its successful implementation. We also explored the utility of the PARIHS framework in China and investigated how important each of its constructs (evidence, context and facilitation) and sub-elements were perceived to be to successful implementation of EBIs in a Chinese setting. METHOD: We conducted clinical observations and semi-structured interviews with 10 physicians and 18 nurses in five tertiary hospitals implementing KMC. Interview questions were organized around issues including knowledge and beliefs, resources, culture, implementation readiness and climate. We used directed content analysis to analyze the interview transcript, amending the PARIHS framework to incorporate emerging sub-themes. We also rated the constructs and sub-elements on a continuum from "low (weak)", "moderate" or "high (strong)" highlighting the ones considered most influential for hospital level implementation by study participants. RESULTS: Using KMC as an example, our finding suggest that clinical experience, culture, leadership, evaluation, and facilitation are highly influential elements for EBI implementation in China. External evidence had a moderate impact, especially in the initial awareness raising stages of implementation and resources were also considered to be of moderate importance, although this may change as implementation progresses. Patient experience was not seen as a driver for implementation at hospital level. CONCLUSION: Based on our findings examining KMC implementation as a case example, the PARIHS framework can be a useful tool for planning and evaluating EBI implementation in China. However, it's sub-elements should be assessed and adapted to the implementation setting.

Association of Nighttime Sleep Duration with Depressive Symptoms and Its Interaction with Regular Physical Activity among Chinese Adolescent Girls.

Depression has become a major mental health concern among adolescents globally, and the relationship between depressive symptoms and nighttime sleep duration among adolescent girls remains unclear. This study aimed to examine the association between nighttime sleep duration and depressive symptoms among Chinese adolescent girls. This cross-sectional study, conducted in 2018, included 4952 girls aged 10-19 years from the eastern, central, and western regions of China. Depressive symptoms were assessed by the Patient Health Questionnaire-9, and categorized into depressive symptoms and non-depressive symptoms. Logistic regression models were used to estimate the odds ratios (ORs) of depressive symptoms. After adjustment for covariates, adolescent girls with a nighttime sleep duration of <7 h/night (OR = 2.28, 95% CI: 1.76-2.95) and 7 h/night (OR = 1.82, 95% CI: 1.48-2.24) were associated with increased risk of depressive symptoms, compared to those with a sleep duration of 8 h/night. An interaction between nighttime sleep duration and regular physical activity on the risk of depressive symptoms was observed (p for interaction = 0.036). Among both girls with and without regular physical activity, a sleep duration of <7 h/night was associated with increased odds of depressive symptoms, and the magnitude of the ORs among girls with regular physical activity was lower than those without regular physical activity. This study found a significant association of short nighttime sleep duration with increased risk of depressive symptoms, and demonstrates the importance of maintaining adequate nighttime sleep duration and ensuring regular physical activity in improving depressive symptoms among adolescent girls.

Maternal experience of intermittent kangaroo mother care for late preterm infants: a mixed-methods study in four postnatal wards in China.

OBJECTIVE: To describe how mothers of late preterm infants experienced the provision of intermittent kangaroo mother care (KMC) in four postnatal wards in different hospitals in China, under a pilot KMC project. DESIGN: A concurrent mixed-methods approach incorporating quantitative maternal questionnaires and qualitative semistructured interviews. SETTING: Four postnatal wards in level-III hospitals based in different provinces of Southeast and Northwest China. PARTICIPANTS: All 752 mothers who provided intermittent KMC to their late preterm newborns in the four participating postnatal wards consented to participate in the study (quantitative component), as well as six nurses, two obstetricians and two mothers from two of the participating postnatal wards (qualitative component). OUTCOME MEASURES: Maternal KMC experiences during a hospital stay, patients' perceptions of KMC initiation, processes, benefits and challenges. RESULTS: Most mothers had not heard of KMC before being introduced to it in the postnatal ward. On average, mothers and newborns stayed in postnatal wards for 3.6 days; during their stay, mothers provided an average of 3.5 KMC sessions, which is an average of 1.1 sessions a day. Each KMC session lasted an average of 68 min, though there was much variation in the length of a session. Common reasons given for discontinuing a KMC session included restroom use, infant crying and perceived time limitations. Some mothers would have preferred to provide KMC for longer periods of time and nurses encouraged this. Most mothers experienced no difficulty providing KMC, received support from family and medical staff and intended to continue with KMC postdischarge. CONCLUSION: In order to improve the maternal experience of KMC, it is recommended that raising awareness of KMC should be included in antenatal care and after birth. Longer periods of KMC provision should be encouraged, greater privacy should be provided for mothers providing KMC in postnatal wards and family members should be encouraged to support KMC.

Prevalence and risk factors for menopausal symptoms in middle-aged Chinese women: a community-based cross-sectional study.

OBJECTIVES: To examine the prevalence and risk factors of menopausal symptoms in middle-aged Chinese women. METHODS: A cross-sectional, community-based study recruited 6,745 women aged 40 to 55 years in the eastern, central, and western regions of China during 2018. Menopausal status was categorized into reproductive stage (defined as regular menstruation or subtle changes in menstrual cycle characteristics), menopausal transition (the beginning of a persistent difference of 7 d in the length of consecutive cycles, or the last menstruation having occurred no more than 12 mo), or postmenpause (the end of the 12 mo period of amenorrhea) according to the Stages of Reproductive Aging Workshop classification. Menopausal symptoms were determined by the modified Kupperman Menopausal Index (KMI) questionnaire and considered nonmenopausal symptoms (total KMI score<15) and menopausal symptoms (total KMI score≥15). Demographic, lifestyle, physical, and menopausal characteristics were collected by face-to-face interviews. Logistic regression models were used to identify factors associated with the risk of menopausal symptoms. RESULTS: Among all participants, the mean age was 46.9 years, and 15.7% (1,001/6,364) of participants reported experiencing menopausal symptoms. The prevalence of menopausal symptoms was 9.3% (303/3,256), 23.9% (293/1,227), and 21.5% (405/1,881) in the reproductive stage, menopausal transition, and postmenopausal stage, respectively. Overall, the three most prevalent menopausal symptoms were insomnia (44.7%), fatigue (40.4%), and mood swings (37.2%). The multivariable logistic regression model showed that menopausal status, residence, nulliparity, and chronic diseases were associated with the risk of menopausal symptoms (all P < 0.05). Women during menopausal transition (OR = 2.66, 95% CI: 2.21-3.20) or postmenopause (OR = 2.26, 95% CI: 1.82-2.80) had significantly increased risk of menopausal symptoms compared with those in the reproductive stage. CONCLUSIONS: Menopausal status, residence, nulliparity, and chronic diseases were associated with menopausal symptoms in middle-aged Chinese women.

Construction of China national newborn growth standards based on a large low-risk sample.

Most published newborn growth references are based on conventional monitoring data that usually included both low- and high-risk pregnancies. We sought to develop a set of neonatal growth standards constructed from only a large sample of low-risk pregnancies. A total of 24,375 naturally conceived singleton live births with gestational ages of 24-42 weeks were collected in 69 hospitals in thirteen Chinese cities between 2015 and 2018. Unhealthy infants or those with high-risk mother were excluded. Smoothed percentile curves of six anthropometric indicators were established using the Generalized Additive Model for Location, Scale and Shape. The 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentile references for birth weight, length, head circumference, weight/length, body mass index, and ponderal index were calculated for neonates with gestational ages of 24-42 weeks. This set of neonatal growth standards with six anthropometric indicators can provide more tools for growth and nutrition assessment and body proportionality in neonatal clinical practice. These standards might also help to show the differences between growth curves based on low-risk and mixed low- and high-risk pregnancies.

Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study.

BACKGROUND: Kangaroo mother care (KMC) has been proved to be a safe and cost-effective standard of care for preterm babies. China hasn't adopted the KMC practice widely until recently. We aim to assess barriers and facilitators of KMC adoption in neonatal intensive care units (NICUs) and postnatal wards in China. METHODS: We conducted clinical observations and semi-structured interviews with nurses, physicians, and parents who performed KMC in seven NICUs and postnatal wards housed in five hospitals in different provinces of China between August and September 2018. The interviews provided first-hand stakeholder perspectives on barriers and facilitators of KMC implementation and sustainability. We further explored health system's readiness and families' willingness to sustain KMC practice following its pilot introduction. We coded data for emerging themes related to financial barriers, parent- and hospital-level perceived barriers, and facilitators of KMC adoption, specifically those unique in the Chinese context. RESULTS: Five hospitals with KMC pilot programs were selected for clinical observations and 38 semi-structured interviews were conducted. Common cultural barriers included concerns with the conflict with traditional postpartum confinement (Zuo-yue-zi) practice and grandparents' resistance, while a strong family support is a facilitator for KMC adoption. Some parents reported anxiety and guilt associated with having a preterm baby, which can be a parental-level barrier to KMC. Hospital-level factors such as fear of nosocomial infection and shortage of staff and spaces impeded the KMC implementation, and supportive community and peer group organized by the hospital contributed to KMC uptake. Financial barriers included lodging costs for caregivers and supply costs for hospitals. CONCLUSIONS: We provided a comprehensive in-depth report on the multi-level KMC barriers and facilitators in China. We recommend policy interventions specifically addressing these barriers and facilitators and increase family and peer support to improve KMC adoption in China. We also recommend that well-designed local cultural and economic feasibility and acceptability studies should be conducted before the KMC uptake.

Intermittent kangaroo mother care and the practice of breastfeeding late preterm infants: results from four hospitals in different provinces of China.

BACKGROUND: China has an extremely low exclusive breastfeeding rate. Kangaroo mother care (KMC) has been shown to increase the exclusive breastfeeding rate among infants born extremely or very preterm. However, there is limited evidence surrounding intermittent KMC and exclusive breastfeeding in late preterm infants. In our study we investigated the association between the provision of intermittent KMC and breastfeeding practice for late preterm infants in four hospitals in different provinces of China. METHODS: Intermittent KMC was recommended to the mothers of all preterm infants admitted to the postnatal wards of participating hospitals between March 2018 and March 2019. Those who agreed to practice KMC were enrolled in the "KMC group", those who did not were enrolled in the "No KMC group". Basic maternal socio-demographic information was collected, feeding practice; outcome and method, were recorded daily whilst in hospital. A follow-up survey of feeding practice was conducted 42 days after discharge. Calculations for feeding practice were performed separately for both groups. Logistics regression was used to analyze the association between KMC and feeding outcome and method, adjusting for socio-demographic covariates. RESULTS: Among the 844 mothers participating in the study, 627 (74.3%) chose to perform KMC. More of the mothers who provided KMC were exclusively breast milk feeding their infants in the 24 h before hospital discharge (54.6%) and at follow-up (57.3%), compared to mothers who did not provide KMC (34.6% at discharge and 33.2% at follow-up,). Mothers in the KMC group were more likely to be breastfeeding (method) than mothers in the No KMC group (65.3% vs. 52.1% at discharge, and 83.1% vs. 67.3% at follow up). Logistic regression indicated that compared with the No KMC group, mothers who provided KMC were twice as likely to be exclusively breast milk feeding their infants at discharge (OR = 2.15 (95% CI 1.53, 3.02)), use breastfeeding method at discharge as opposed to other means such as bottle or cup feeding (OR = 1.61 (95% CI 1.15, 2.25)), be exclusive breast milk feeding at follow-up (OR = 2.55 (95% CI 1.81, 3.61)), and use breastfeeding method at follow-up (OR = 2.09 (95% CI 1.44, 3.02)). CONCLUSIONS: Intermittent KMC was associated with a nearly doubled increase in exclusive breast milk feeding (outcome) and breastfeeding (method) at both discharge and 42 days after discharge for late preterm infants. This is especially important in China where exclusive breastfeeding rates are low, intermittent KMC provides a feasible means to increase the likelihood of these vulnerable infants receiving the benefits of exclusive breastmilk.

Utilization pattern of kangaroo mother care after introduction in eight selected neonatal intensive care units in China.

BACKGROUND: Kangaroo mother care (KMC) is an evidence-based and cost-effective intervention that could prevent severe complications for preterm babies, however it has not been widely adopted in China. In this study, we aim to investigate the feasibility and parental experience of adopting KMC in a Chinese context by studying the implementation of a KMC program in eight self-selected neonatal intensive care units (NICUs). METHODS: A cross-sectional study of 135 preterm infants discharged from eight NICUs in April 2018. For infants information was collected on postnatal day and corrected gestational age (GA) at KMC initiation, frequency and duration of KMC provision and whether the infant was receiving respiratory support. A nurse-administered questionnaire on parents' knowledge and experience of KMC provision was administered to parents providing KMC. RESULTS: One hundred thirty-five preterm infants received KMC, 21.2% of all preterm infants discharged. 65.2% of those who received KMC were below 32 weeks GA, 60.7% had a birth weight below 1500 g, and 20.7% needed respiratory support at KMC initiation. Average KMC exposure was greater in infants born at GA < 28 weeks that babies born at greater GA. 94.8% of parents that participated in the parental survey indicated that KMC was positively accepted by their family members; 60.4% of the parents claimed that KMC could relieve anxiety, 57.3% claimed it prompted more interactions with medical staff and 69.8% suggested it increased parental confidence in care for their infants. CONCLUSIONS: After advocacy, training and promotion, intermittent KMC was initiated on more immature and high-risk infants, and well-accepted by parents. We suggest continuing to promote KMC education to parents and enhancing preterm infant health.

The Health Status of 50-70 Years Old Women in Some Areas - China, 2018.

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: After menopause, women are prone to chronic diseases such as cardiovascular disease, diabetes and osteoporosis and gynecological diseases such as pelvic floor dysfunction and reproductive tract infection. WHAT IS ADDED BY THIS REPORT?: The prevalence of hypertension, diabetes, cardiovascular disease and osteoporosis increased with age, while the prevalence of vaginitis and cervicitis decreased with the increase of age. The proportions of women aged 50-70 years old suffering from chronic and gynecological diseases in western and rural areas were significantly higher than those in eastern, central and urban areas. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: It is necessary to take targeted intervention measures in the western region and rural areas, in order to narrow the gap in health of menopausal and older women between different areas of China.

The Utilization of Health Examination by Menopausal and Older Women - 6 Provinces, China, 2018.

What is already known about this topic? Improving their utilization of health examination is important for improving the health of menopausal and older women. What is added by this report? Only 32.3% and 29.7% of women had been screened for cervical cancer and breast cancer, respectively. The overall utilization rate of health examination for menopausal and older women is low. The health examination services for menopausal and older women were utilized less in the western regions and in rural areas than in the eastern and central regions and in urban areas. What are the implications for public health practice? The imbalance of development is an important factor affecting the utilization of health examination for menopausal and older women. It is necessary to take effective measures to improve the level of service utilization in the western region and rural areas, in order to narrow the gap in health between different regions.

[Relationship between prenatal negative life events and pregnancy outcomes].

OBJECTIVE: To assess the prevalence of prenatal negative life events, and explore the effect of prenatal negative life events on pregnancy outcomes. METHODS: A total of 9137 postpartum women( average age: 28. 76±6. 53 years) who delivered live neonates with gestational age ≥28 weeks between April, 2012 to March, 2013 in 15 hospitals in Beijing, Guangdong, Hunan, Hubei, Sichuan and Shaanxi provinces were enrolled. Self-made questionnaire was used to collect general information, occurrence of negative life events during pregnancy, complications during pregnancy and pregnancy outcomes. Logistic regression models were used to analyze the effect of prenatal negative life events on adverse pregnancy outcomes and influencing factors of adverse pregnancy outcomes. RESULTS: In total of 1395 women( 15. 3%) had experienced prenatal negative life events, and 5439 women( 59. 5%) had adverse pregnancy outcomes. After adjusting for covariates, women who experienced prenatal negative life events had an increased risk of preterm birth( OR = 1. 257, 95% CI 1. 051-1. 504), and delivering low birth weight infants( OR = 1. 316, 95% CI 1. 055-1. 643). Multivariate Logistic regression models showed that prenatal negative life events( OR = 1. 201, 95% CI1. 056-1. 365), pregnancy-induced hypertension( OR = 2. 278, 95% CI 1. 867-2. 781), pre-pregnancy overweight or obese( OR = 1. 299, 95% CI 1. 140-1. 480) and delivery age above 35 years old( OR = 1. 197, 95% CI 1. 014-1. 413) were risk factors for adverse pregnancy outcomes; and primiparity( OR = 0. 808, 95% CI 0. 715-0. 913) were protective factors for adverse pregnancy outcomes. Among different types of negative life events, women with family disharmony had increased risk of adverse pregnancy outcomes than those without family disharmony after adjusting for covariates( OR = 1. 259, 95% CI1. 076-1. 473). CONCLUSION: In this study, prenatal negative life events were prevalent, and prenatal negative life events may increase the risk of pregnancy outcomes.

Exploring an Appropriate Method of Cervical Cancer Screening in Rural China.

Background. To explore the feasibility of careHPV (human papillomavirus) with cytology triage as a cervical cancer screening in rural areas of China. Methods. A total of 7138 women aged 35 to 64 years were divided into 2 groups. Women in careHPV group (n = 3536) underwent careHPV and 288 positive subjects underwent cytology, of which 65 women were ≥ASC-US (atypical squamous cells of undetermined significance). Women in the cytology group (n = 3602) underwent cytology and 111 women were ≥ASC-US. All subjects with ≥ASC-US were referred to colposcopy and biopsy. Results. The average age of subjects was 48.2 ± 7.8 years. In the careHPV group, the HPV-positive rate was 8.1%. The detection rate of ≥ASC-US was 1.8% in the careHPV group and 3.1% in the cytology group (P = .001). There was no significant difference in detection rate of ≥CINII (cervical intraepithelial neoplasia) in the careHPV group (0.7%) and the cytology group (0.6%; P = .416). In addition, to identify 1 case ≥CINII, an average of 2.6 colposcopies were needed in the careHPV group, and 5.3 colposcopies were performed to diagnose 1 case ≥CINII in the cytology group. Conclusions. careHPV with cytology triage offered similar efficiency in identifying abnormalities of CINII and above compared with cytology screening. With the reduced requirement for cytology testing and colposcopy, careHPV may be a more favorable cervical cancer screening strategy in areas of China where there is a lack of cytology services.

Epidemiological investigation of the relationship between common lower genital tract infections and high-risk human papillomavirus infections among women in Beijing, China.

BACKGROUND: The incidence of lower genital tract infections in China has been increasing in recent years. The link between high-risk human papillomavirus (HR-HPV) and other sexually transmitted diseases (STDs) remains unclear. METHODS: From March to October 2014, gynecological examinations and questionnaires were conducted on 1218 married women. Cervical secretions and vaginal swab specimens were tested for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Ureaplasma urealyticum (UU), yeast, clue cells and HR-HPV. RESULTS: Laboratory results were available for 1195 of 1218 married women. HR-HPV was detected in 7.0% of participants. Forty-seven percent of women had lower genital tract infections (LGTIs). UU was the most common infection (35.5%), followed by bacterial vaginosis (BV) (10.5%), yeast infection (3.7%), CT (2.2%), and Trichomonas vaginalis (1.7%). BV was associated with an increased risk of HR- HPV (P < 0.0001; odds ratio, 3.0 [95% CI, 1.7-5.4]). There was a strong correlation between abnormal cervical cytology and HR-HPV infection (P < 0.0001). CONCLUSIONS: The prevalence of LGTIs in Beijing is at a high level. It is clinically important to screen for the simultaneous presence of pathogens that cause co-infections with HR-HPV.

Low-Dose Iron Supplementation in Infancy Modestly Increases Infant Iron Status at 9 Mo without Decreasing Growth or Increasing Illness in a Randomized Clinical Trial in Rural China.

BACKGROUND: Previous trials of iron supplementation in infancy did not consider maternal iron supplementation. OBJECTIVE: This study assessed effects of iron supplementation in infancy and/or pregnancy on infant iron status, illnesses, and growth at 9 mo. METHODS: Enrollment occurred from December 2009 to June 2012 in Hebei, China. Infants born to women in a pregnancy iron supplementation trial were randomly assigned 1:1 to iron [∼1 mg Fe/(kg · d) as oral iron proteinsuccynilate] or placebo from 6 wk to 9 mo, excluding infants with cord ferritin <35 µg/L. Study groups were pregnancy placebo/infancy placebo (placebo/placebo), pregnancy placebo/infancy iron (placebo/iron), pregnancy iron/infancy placebo (iron/placebo), and pregnancy iron/infancy iron (iron/iron). The primary outcome was 9-mo iron status: iron deficiency (ID) by cutoff (≥2 abnormal iron measures) or body iron <0 mg/kg and ID + anemia (hemoglobin <110 g/L). Secondary outcomes were doctor visits or hospitalizations and weight or length gain from birth to 9 mo. Statistical analysis by intention to treat and dose-response (between number of iron bottles received and outcome) used logistic regression with concomitant RRs and general linear models, with covariate control as applicable. RESULTS: Of 1482 infants randomly allocated, 1276 had 9-mo data (n = 312-327/group). Iron supplementation in infancy, but not pregnancy, reduced ID risk: RRs (95% CIs) were 0.89 (0.79, 0.998) for placebo/iron compared to placebo/placebo, 0.79 (0.63, 0.98) for placebo/iron compared to iron/placebo, 0.87 (0.77, 0.98) for iron/iron compared to placebo/placebo, and 0.86 (0.77, 0.97) for iron/iron compared to iron/placebo. However, >60% of infants still had ID at 9 mo. Receiving more bottles of iron in infancy was associated with better infant iron status at 9 mo but only among iron-supplemented infants whose mothers were also iron supplemented (i.e., the iron/iron group). There were no group differences in hospitalizations or illnesses and no adverse effects on growth overall or among infants who were iron sufficient at birth. CONCLUSIONS: Iron supplementation in Chinese infants reduced ID at 9 mo without adverse effects on growth or illness. Effects of iron supplementation in pregnancy were observed only when higher amounts of iron were distributed in infancy. This trial was registered at clinicaltrials.gov as NCT00613717.

Risk factors for preterm birth: a case-control study in rural area of western China.

Preterm birth is the leading cause of perinatal morbidity and mortality in China, the study is to learn risk factors for preterm birth in rural area of western China. A 1:1 case-control study in which cases included the pregnant women of preterm birth and controls included the matched pregnant women of normal deliver was conducted in 5 counties in western China. Data about the general situation, pregnancy history, reproductive health infection (RTI) symptoms, pregnancy complications, et al were obtained by using questionnaire. The results showed that the risk factors related to preterm birth were including: family income, mother's age ≥ 35 years old, antennal visiting ≤ 4 times, low education level, preterm birth history, abnormal vaginal discharge, pregnancy complications. The logistic regression analysis showed that only 3 factors of preterm birth were left at the last step, which of antenatal visiting ≤ 4 times, PROM and placenta previa had significant difference. We show that family income, age, antennal visiting, low education level, preterm birth history, abnormal vaginal discharge, pregnancy complications are the risk factors of preterm birth.

Prenatal Iron Supplementation Reduces Maternal Anemia, Iron Deficiency, and Iron Deficiency Anemia in a Randomized Clinical Trial in Rural China, but Iron Deficiency Remains Widespread in Mothers and Neonates.

BACKGROUND: Previous trials of prenatal iron supplementation had limited measures of maternal or neonatal iron status. OBJECTIVE: The purpose was to assess effects of prenatal iron-folate supplementation on maternal and neonatal iron status. METHODS: Enrollment occurred June 2009 through December 2011 in Hebei, China. Women with uncomplicated singleton pregnancies at ≤20 wk gestation, aged ≥18 y, and with hemoglobin ≥100 g/L were randomly assigned 1:1 to receive daily iron (300 mg ferrous sulfate) or placebo + 0.40 mg folate from enrollment to birth. Iron status was assessed in maternal venous blood (at enrollment and at or near term) and cord blood. Primary outcomes were as follows: 1) maternal iron deficiency (ID) defined in 2 ways as serum ferritin (SF) <15 µg/L and body iron (BI) <0 mg/kg; 2) maternal ID anemia [ID + anemia (IDA); hemoglobin <110 g/L]; and 3) neonatal ID (cord blood ferritin <75 µg/L or zinc protoporphyrin/heme >118 µmol/mol). RESULTS: A total of 2371 women were randomly assigned, with outcomes for 1632 women or neonates (809 placebo/folate, 823 iron/folate; 1579 mother-newborn pairs, 37 mothers, 16 neonates). Most infants (97%) were born at term. At or near term, maternal hemoglobin was significantly higher (+5.56 g/L) for iron vs. placebo groups. Anemia risk was reduced (RR: 0.53; 95% CI: 0.43, 0.66), as were risks of ID (RR: 0.74; 95% CI: 0.69, 0.79 by SF; RR: 0.65; 95% CI: 0.59, 0.71 by BI) and IDA (RR: 0.49; 95% CI: 0.38, 0.62 by SF; RR: 0.51; 95% CI: 0.40, 0.65 by BI). Most women still had ID (66.8% by SF, 54.7% by BI). Adverse effects, all minor, were similar by group. There were no differences in cord blood iron measures; >45% of neonates in each group had ID. However, dose-response analyses showed higher cord SF with more maternal iron capsules reported being consumed (ß per 10 capsules = 2.60, P < 0.05). CONCLUSIONS: Prenatal iron supplementation reduced anemia, ID, and IDA in pregnant women in rural China, but most women and >45% of neonates had ID, regardless of supplementation. This trial was registered at clinicaltrials.gov as NCT02221752.