Increased risk of postpartum depression in women with lactational mastitis: a cross-sectional study.

Background: A high incidence of lactational mastitis mainly occurs during the first month of breastfeeding. It may cause severe pain, frustration, fatigue, stress, and breastfeeding concerns. However, few studies investigated the effects of lactational mastitis on postpartum depression. This study investigated the potential association between lactational mastitis and postpartum depression. Methods: We examined the associations of lactational mastitis with postpartum depression in 1,551 Chinese women. Lactational mastitis was diagnosed by breast specialists. The presence of depression symptoms was evaluated by the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire 9 (PHQ9) at 6 weeks after delivery. Multiple linear regression analysis and multivariable log-binomial regression analysis were performed to estimate the association between lactational mastitis and postpartum depression. Results: Among the 1,551 mothers, 147 (9.5%) experienced lactational mastitis diagnosed by breast specialists during the postpartum period. Compared with women without lactational mastitis, the proportion of women with depression symptoms was significantly higher (38.1% vs. 27.4%, p = 0.008), and the risk of postpartum depression increased by 68% (RR = 1.68, 95% CI, 1.18, 2.40) in women who had experienced lactational mastitis. In addition, the risk of self-harm or suicidal ideation increased by 89% (RR = 1.89, 95% CI, 1.08, 3.29) in women who experienced lactational mastitis. In stratified analysis, the associations of lactational mastitis with postpartum depression appeared stronger among women aged ≥35 years, with maternal comorbidities, and who delivered a female neonate. Conclusion: The study results suggest that lactational mastitis is a risk factor for depression during the postpartum period. The impact of lactational mastitis on maternal mental health requires further attention. Clinical trial registration: chictr.org.cn, ChiCTR2000041519.

Prenatal exposure to fine particulate matter and the risk of spontaneous preterm birth: A population-based cohort study of twins.

Background: Studies in singletons have suggested that prenatal exposure to fine particulate matter (PM2.5) and some of its chemical components is associated with an increased risk of preterm birth (PTB). However, no study has been conducted in twins. Purpose: To examine the associations of maternal exposure to total PM2.5 mass and its carbonaceous components with PTB in twin pregnancies. Methods: A total of 1,515 pairs of twins and their mothers were enrolled from a previous twin birth cohort that had been conducted at the Shanghai First Maternity and Infant Hospital School of Medicine of Tongji University in China. Participants who had iatrogenic PTBs were excluded. Maternal exposure to total PM2.5 mass and two carbonaceous components, namely, organic carbon (OC) and black carbon (BC), was estimated by a satellite-based model. The associations between PM2.5 exposure and the risk of spontaneous PTB were evaluated by logistic regression analysis. Results: This study found that exposure to total PM2.5 mass and OC during the second trimester of pregnancy was significantly associated with an increased risk of spontaneous PTB. An interquartile range (IQR) increase in total PM2.5 mass and OC exposure during the second trimester was associated with 48% (OR = 1.48, 95% CI, 1.06, 2.05) and 50% (OR = 1.50, 95% CI, 1.00, 2.25) increases in the odds of PTB, respectively. However, no significant association was found between BC exposure during any exposure window and the risk of PTB. Conclusion: The findings suggest that exposure to ambient air pollution with fine particles may be a risk factor for spontaneous PTB in twin pregnancies. The middle stage of pregnancy seems to be a critical window for the impacts of PM2.5 exposure on PTB in twin pregnancies.

Association of History of Spontaneous or Induced Abortion With Subsequent Risk of Gestational Diabetes.

IMPORTANCE: Gestational diabetes (GD) is one of the most common and important complications of pregnancy. Identifying pregnant women who are at high risk of GD is crucial for implementing early prevention and intervention. OBJECTIVE: To examine whether a history of spontaneous abortion (SAB) or induced abortion is associated with increased risk of GD in subsequent pregnancies. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted at a tertiary hospital in Shanghai, China. Pregnant women who received routine antenatal care between January 2014 and December 2019 were included. Data analysis was performed from December 2020 to June 2021. EXPOSURES: Maternal history of abortion, including SAB and induced abortion, were extracted from medical records. MAIN OUTCOMES AND MEASURES: GD was diagnosed with a 75-g diagnostic oral glucose tolerance test. A multivariable-adjusted log-binomial analysis was used to estimate relative risks (RRs) and 95% CIs of GD associated with history of abortion. RESULTS: Among the 102 259 included pregnant women (mean [SD] age, 29.8 [3.8] years), 14 579 (14.3%) experienced only SAB, 17 935 (17.5%) experienced only induced abortion, and 4017 (3.9%) experienced both SAB and induced abortion. A total of 12 153 GD cases were identified, and the prevalence of GD was 11.9% (12 153 of 102 259 women) in this cohort. Pregnant women who experienced only SAB (RR, 1.25; 95% CI, 1.18-1.31) or both SAB and induced abortion (RR, 1.15; 95% CI, 1.05-1.27) were at higher risk of developing GD. The association of SAB history with GD occurred in a number-dependent manner. Compared with pregnant women with no history of abortion, the RR for GD increased by 18% (RR, 1.18; 95% CI, 1.11-1.26) for pregnant women with 1 SAB, by 41% (RR, 1.41; 95% CI, 1.27-1.57) for those with 2 SABs, and by 43% (RR, 1.43; 95% CI, 1.22-1.67) for those more than 2 SABs. However, no association between history of induced abortion and GD was observed. CONCLUSIONS AND RELEVANCE: This study found that a history of SAB was associated with increased risk of GD in subsequent pregnancies. Further research is needed to clarify this association and explore the potential biological mechanisms underlying the association.

Gestational exposure to BDE-209 induces placental injury via the endoplasmic reticulum stress-mediated PERK/ATF4/CHOP signaling pathway.

Several epidemiological studies have reported significant associations between prenatal polybrominated diphenyl ethers (PBDEs) exposure and adverse birth outcomes. Placental injury is thought to mediate these associations. However, few study has investigated the adverse effects of PBDEs exposure on placental growth and development. We examined the impacts of gestational exposure to BDE-209, the most abundant PBDE conger detected in human samples, on placental structure and function, and its model of action in vivo and in vitro. Pregnant mice were exposed to 0, 2, 20, 200 mg/kg/day of BDE-209 by gavages from gestational day (GD) 0 to GD18. Results showed that gestational BDE-209 exposure significantly reduced placental weight, impaired placental vascular development and induced placental cell apoptosis. In addition, gestational BDE-209 exposure impaired placental transport and endocrine function as demonstrated by markedly downregulated expression of Glut1, Znt1, Pgf and Igf2 in BDE-209-treated placentas. Mechanistically, gestational exposure to BDE-209 upregulated the expression of GRP78, and 3 downstream proteins (p-eIF2α, ATF4 and CHOP) of the PERK signaling, suggesting the activation of endoplasmic reticulum (ER) stress and PERK signaling pathway in mouse placentas. Further in vitro study showed that PERK siRNA pretreatment markedly reversed BDE-209-induced cell apoptosis in human JEG-3 cells. Collectively, our results suggest that the activation of the ER stress-mediated PERK/ATF4/CHOP signaling pathway played a role in BDE-209-induced placental injury. Our findings provide new insight into the mechanisms of BDE-209 induced reproductive and developmental toxicity.

Serum uric acid in early pregnancy and risk of gestational diabetes mellitus: A cohort study of 85,609 pregnant women.

AIMS: Higher serum uric acid (UA) has been associated with increased risk of Type 2 diabetes mellitus. This cohort study examined whether there are any associations between serum UA in early pregnancy and the subsequent risk of gestational diabetes mellitus (GDM). METHODS: This cohort study was conducted in Shanghai, China, and included 85,609 pregnant women. Generalised additive models were used to estimate the associations of serum UA with risk of GDM. RESULTS: The prevalence of GDM was 14.0% (11,960/85,609). Non-linear associations between serum UA and GDM risk were observed and these associations varied by gestational ages. Only elevated serum UA levels at 13-18 weeks gestation was associated with substantially increased risk of GDM. Analysis by UA quintiles at 13-18 weeks gestation showed the odds ratios for GDM were 1.11 (95%CI, 1.03-1.20) for the second, 1.27 (95%CI, 1.17-1.37) for the third, 1.37 (95%CI, 1.27-1.48) for the fourth and 1.70 (95%CI, 1.58-1.84) for the fifth quintile of serum UA in comparison with the first quintile. Stratified analysis showed the associations of serum UA with GDM were stronger among pregnant women aged 35 years or older. CONCLUSION: We found higher serum UA at 13-18 gestational weeks was a risk factor for GDM. Our findings provide new evidence for the role of serum UA in the prevention and early intervention of GDM, and highlighted the need for monitoring serum UA at 13-18 gestational weeks.

A Novel Formononetin Derivative Promotes Anti-ischemic Effects on Acute Ischemic Injury in Mice.

Natural flavonoids, formononetin and ononin, possess antioxidant, antibacterial, anti-inflammatory and neuroprotective effects. Many complications caused by SARS-CoV-2 make patients difficult to recover. Flavonoids, especially formononetin and ononin, have the potential to treat SARS-CoV-2 and improve myocardial injury. However, their poor water solubility, poor oral absorption, high toxicity, and high-cost purification limit industrial practical application. Succinylation modification provides a solution for the above problems. Formononetin-7-O-ß-(6″-O-succinyl)-D-glucoside (FMP), a new compound, was succinyl glycosylated from formononetin by the organic solvent tolerant bacteria Bacillus amyloliquefaciens FJ18 in a 10.0% DMSO (v/v) system. The water solubility of the new compound was improved by over 106 times compared with formononetin, which perfectly promoted the application of formononetin and ononin. The conversion rate of formononetin (0.5 g/L) was almost 94.2% at 24 h, while the yield of formononetin-7-O-ß-(6″-O-succinyl)-D-glucoside could achieve 97.2%. In the isoproterenol (ISO)-induced acute ischemia mice model, the myocardial injury was significantly improved with a high dose (40 mg/kg) of formononetin-7-O-ß-(6″-O-succinyl)-D-glucoside. The lactate dehydrogenase level was decreased, and the catalase and superoxide dismutase levels were increased after formononetin-7-O-ß-(6″-O-succinyl)-D-glucoside treatment. Thus, formononetin-7-O-ß-(6″-O-succinyl)-D-glucoside has high water solubility, low toxicity, and shows significant antimyocardial ischemia effects.