Plain Water Intake, Sleep Quality, and Hydration Status of Pregnant Woman in Hainan, China: A Cross-Sectional Study.

OBJECTIVE: Both short and long sleep durations are associated with decreased kidney function; however, few studies have examined the relationship between sleep, hydration status, and plain water intake. This study aimed to assess the relationship between sleep quality, hydration status, and plain water intake in pregnant women. METHODS: A cross-sectional study method was used to collect data from 380 pregnant women with regular examinations at the hospital between May 2019 and February 2021. RESULTS: There were statistically significant differences in daily plain water intake (x2 = 14.118, p = 0.001), PSQI score (x2 = 77.708, p < 0.001), sleep duration (x2 = 67.569, p > 0.001), subjective sleep quality (x2 = 67.441, p = 0.001), time to fall asleep (x2 = 64.782, p < 001), sleep disorders (x2 = 70.853, p < 0.001), and daytime dysfunction (x2 = 38.441, p < 0.001) among different hydration status groups. Ordinal logistic regression results indicated that the intake of plain water ≥1500 mL/d (OR = 0.40, 95% CI = 0.24~0.67), good subjective sleep quality (OR = 0.15, 95% CI = 0.07~0.32), short time to fall asleep (OR = 0.32, 95% CI = 0.14~0.70), 8 h of sleep (OR = 0.06, 95% CI = 0.02~0.17), 6-7 h of sleep (OR = 0.19, 95% CI = 0.07~0.54), no sleep disturbance (OR = 0.31, 95% CI = 0.11~0.89), and high sleep efficiency (OR = 0.46, 95% CI = 0.03~0.79) were factors that were correlated with optimal hydration status. Sleep duration and daytime dysfunction partially mediated the effect of plain water intake on hydration status. The mediating effect of sleep duration was -0.036, accounting for 14.006% of the overall effect. The mediating effect of daytime dysfunction was -0.024, accounting for 9.459% of the overall effect. CONCLUSION: The hydration status in pregnant women may be affected by daily plain water intake and sleep quality.

A Study of Fluid Intake, Hydration Status, and Body Composition of Pregnant Women in Their Third Trimester, and Relationships with Their Infant's Birth Weight in China: A Prospective Cohort Study.

BACKGROUND: Water intake and hydration status may potentially influence maternal and child health. However, there is little research regarding this topic. OBJECTIVES: This study aimed to investigate pregnant women's total fluid intake (TFI) levels, hydration status, and body composition and further explore their relationship with infant birth weight. METHODS: A 7-day, 24 h fluid intake recorded was applied to determine participants' TFI levels. Morning urine samples were collected and tested to evaluate their hydration status. Maternal body compositions in their third trimester and infant birth weights were measured. RESULTS: A total of 380 participants completed the study. The TFI was insufficient for pregnant women during their third trimester (median = 1574 mL), with only 12.1% of participants meeting the recommended adequate fluid intake level for pregnant women living in China (1.7 L per day). With the increasing TFI values, the urine osmolality decreased, which showed statistical significance among the four groups (χ2 = 22.637, p < 0.05). The participants displayed a poor hydration status. Meanwhile, the percentage of participants who were in dehydrated status decreased (χ2 = 67.618, p < 0.05), while body water content and basal metabolic rate increased with the increase in TFI levels (χ2 = 20.784, p < 0.05; χ2 = 14.026, p < 0.05). There were positive linear relationships between plain water intake, the basal metabolic rate of pregnant women and their infant birth weight (SE = 0.153, p < 0.05; SE = 0.076, p < 0.05). CONCLUSIONS: Water intake was insufficient, and poor hydration status was common among pregnant women in China. There may be potential relationships between plain water intake, basal metabolic rate, and infant birth weight.

The Amount of Fluid Intake among Pregnant Women in China Increases with Pregnancy Progression: A Prospective Cohort Study.

Fluid intake and hydration status during pregnancy may have influences on maternal and infant health. However, few studies have recorded and analyzed total fluid intake (TFI) levels during the whole pregnancy. This study mainly aimed to investigate the TFI levels of pregnant women in three trimesters, and further to assess their hydration status. The relationships of TFI and hydration status were also analyzed. A convenience sampling method was used to recruit pregnant women from the Haikou Maternity and Child Health Hospital in China in this prospective cohort study. A 7-day 24 h fluid intake questionnaire was used for recording the fluid intake of the participants in their three trimesters. Fasting blood samples and first morning urine samples were also collected and tested. Hydration status was evaluated using urine osmolality. Finally, 142 pregnant women completed the study. The median TFIs in the first, second, and third trimesters were 1336, 1477, and 1584 mL, respectively. The TFI levels increased with pregnancy progression (χ2 = 134.155, p < 0.05). Out of 142 participants, 100.0%, 97.2%, and 85.2% of participants did not reach the recommendation amount for an adequate TFI among Chinese pregnant women in the three trimesters, respectively (χ2 = 29.840, p < 0.05). Plain water was the main source of fluid intake, accounting for 92.0%, 94.2%, and 93.4% of TFI, respectively. The median values of dairy product intake were 61, 57, and 59 mL in the three trimesters. The frequency of participants without an optimal hydration status in the three trimesters was 71.8%, 76.1%, and 83.1%, respectively (χ2 = 29.909, p < 0.05). The participants of each trimester were divided into four groups according to quartiles of TFI, including participants with a lower fluid intake (LFI1 and LFI2) and higher fluid intake (HFI1 and HFI2). As the TFI values increased from the LFI1 group to the HFI2 group, the urine osmolality decreased (all p < 0.05). Moderate-intensity negative correlations were found between urine osmolality, hydration status, and TFI (all p < 0.05). It is suggested that fluid intake strategies should be promoted and health education should be conducted to improve the hydration status of pregnant women.

A Study of the Fluid Intake, Hydration Status, and Health Effects among Pregnant Women in Their Second Trimester in China: A Cross-Sectional Study.

The fluid intake and hydration status during pregnancy may influence the health outcomes of both the mother and the fetus. However, there are few studies related to this. The aim of the present study was to investigate fluid intake behaviors among pregnant women in their second trimester, to evaluate their hydration status and pregnancy complications, and to further explore the association of fluid intake and the amniotic fluid index (AFI). Participants' total fluid intake (TFI) levels were determined using a 7-day 24 h fluid intake questionnaire. The levels of water intake from food were not recorded or measured. Morning urine samples were collected, and both urine osmolality levels and urine specific gravity (USG) were tested to evaluate their hydration status. Fasting blood samples were also collected and measured for osmolality and complete blood count (CBC). A total of 324 participants completed the study. They were divided into four groups based on quartiles of TFI, including participants with lower (LFI1 and LFI2) and higher (HFI1 and HFI2) fluid intake levels. The median TFI was 1485 mL, and the median values of the four groups with different TFI levels were 1348, 1449, 1530, and 1609 mL, respectively. Only 3.4% of the participants attained the recommended value following an adequate water intake (1.7 L) level for pregnant women in China. Plain water was the main TFI resource (78.8~100.00%), and differences in the plain water intake levels among the four groups were evident (χ2 = 222.027, p < 0.05). The urine osmolality decreased sequentially with increasing TFI values from the LFI1 to HFI2 group, and significant differences in the urine osmolality levels among the four groups were evident (p < 0.05). Meanwhile, the percentage of dehydrated participants decreased from 26.8% in the LFI1 group to 0.0% in the HFI2 group (χ2 = 131.241, p < 0.05). Participants with higher TFI values had higher AFI values (χ2 = 58.386, all p < 0.05), and moderate-intensity correlations were found between TFI and urine osmolality, hydration status, and AFI (all p < 0.05). A large proportion of the participants had insufficient TFIs during the second trimester of pregnancy, and a proportion of the participants were dehydrated. The preliminary analysis showed that the AFI was correlated with the TFI during the second trimester of pregnancy. A sufficient TFI is necessary for pregnant women to improve their hydration status and may have effects on their health. The results can provide appropriate scientific references for the development of beneficial recommendations concerning adequate water intake levels for pregnant women in China.

Chronic non-communicable diseases: Hainan prospective cohort study.

PURPOSE: The Hainan Cohort was established to investigate the incidence, morbidity and mortality of non-communicable diseases and their risk factors in the community population. PARTICIPANTS: The baseline investigation of the Hainan Cohort study was initiated in five main areas of Hainan, China, from June 2018 to October 2020. A multistage cluster random-sampling method was used to obtain samples from the general population. Baseline assessments included a questionnaire survey, physical examination, blood and urine sample collection, and laboratory measurements, and outdoor environmental data were obtained. FINDINGS TO DATA: A total of 14 443 participants aged 35-74 years were recruited at baseline, with a participation rate of 90.1%. The mean age of the participants was 48.8 years; 51.8% were men, and 83.7% had a secondary school or higher education. The crude prevalence of diabetes, coronary heart disease, stroke, hypertension, hyperuricaemia, chronic bronchitis, pulmonary tuberculosis, asthma, cancer, chronic hepatitis and metabolic syndrome were 8.6%, 9.2%, 2.0%, 37.1%, 7.1%, 2.3%, 1.4%, 2.1%, 4.1%, 2.2% and 14.5%, respectively. FUTURE PLANS: The Hainan Cohort is a dynamic cohort with no end date. All participants will be monitored annually for cause-specific mortality and morbidity until death. Long-term follow-up will be conducted every 5 years. The baseline population is considered to expand in the next wave of follow-up, depending on the availability of funding support.

Clinical and epidemiological investigation of a child with asymptomatic COVID-19 infection following reoccurrence.

Objective: To investigate the case of a child infected with coronavirus disease 2019 (COVID-19) who had subsequent viral reactivation. Methods: We retrospectively analyzed the clinical manifestations, epidemiological data, laboratory and imaging examinations, treatment, and follow-up of the child. And then, we searched related literature using PubMed. Results: The 9-year-old boy was exposed to COVID-19 in Malawi and tested positive for NAT in Haikou, China. He was asymptomatic and admitted to our hospital. After six negative NATs, he was discharged from the hospital and quarantined in a hotel. His infection was reactivated again after 22 days (interval between first and last positive NATs). The cycle threshold (Ct) values of positive tests were 25 and 31, and the gene sequencing viral loads were very low. The viral strain Kenya/P2601/2020, a variant of the hCoV-19/Wuhan/IVDC-HB-01/2019 genome (GISAID accession IL: EPI_ISL_402119), was found when polymerase chain reaction enrichment was used to sequence the virus. However, people around him tested negative for COVID-19. Conclusion: First, we confirmed the reactivation of COVID-19 in a child. The risk of recurrent infection with SARS-CoV-2 was low, and the policy of strictly isolating patients carrying long-term viral ribonucleic acid should be reconsidered. The interval positivity was most likely due to incorrect sampling and/or testing methods. SGS and aB testing are recommended for children with viral reactivation. Second, SARS-CoV-2 viral reactivation cannot be ruled out. The possible mechanisms, such as prolonged infection and viral latent reactivation, need further investigation.

Epidemiological investigation of a COVID-19 family cluster outbreak transmitted by a 3-month-old infant.

OBJECTIVE: To investigate the clinical characteristics, epidemiological characteristics, and transmissibility of coronavirus disease 2019 (COVID-19) in a family cluster outbreak transmitted by a 3-month-old confirmed positive infant. METHODS: Field-based epidemiological methods were used to investigate cases and their close contacts. Real-time fluorescent reverse transcription polymerase chain reaction (RT-PCR) was used to detect Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) for all collected specimens. Serum SARS-CoV-2 IgM and IgG antibodies were detected by Chemiluminescence and Gold immnnochromatography (GICA). RESULTS: The outbreak was a family cluster with an attack rate of 80% (4/5). The first case in this family was a 3-month-old infant. The transmission chain was confirmed from infant to adults (her father, mother and grandmother). Fecal tests for SARS-CoV-2 RNA remained positive for 37 days after the infant was discharged. The infant's grandmother was confirmed to be positive 2 days after the infant was discharged from hospital. Patients A (3-month-old female), B (patient A's father), C (patient A's grandmother), and D (patient A's mother) had positive serum IgG and negative IgM, but patients A's grandfather serum IgG and IgM were negative. CONCLUSION: SARS-CoV-2 has strong transmissibility within family settings and presence of viral RNA in stool raises concern for possible fecal-oral transmission. Hospital follow-up and close contact tracing are necessary for those diagnosed with COVID-19.

Associations between hydration state and pregnancy complications, maternal-infant outcomes: protocol of a prospective observational cohort study.

BACKGROUND: Water requirements increases with gestational age. Insufficient water intake causes dehydration, which may adversely affect maternal health and birth outcomes. However, few related studies have been conducted. The purposes are to assess the water intake and hydration state among pregnant women, and to investigate the associations with pregnancy complications and maternal and infant outcomes. METHODS: A prospective observational cohort study will be applied. A total of 380 pregnant women will be recruited from the First Affiliated Hospital of Hainan Medical University. Hydration biomarkers and health outcomes will be tested during 15~17 weeks' gestation, 20~22 weeks' gestation, 30~32 weeks' gestation, during childbirth and 42 days after childbirth. Daily fluid intake will be collected using a 24-h fluid intake record for 7 consecutive days. A semi-quantified food frequency method will be used to assess food intake and water intake from food. Anthropometric measurement will be taken following standardized processes. Intracellular fluid (ICF) and extracellular fluid (ECF) will be measured using a body composition analyzer. Morning fasting urine and blood osmolality will be tested by laboratory physicians using an osmotic pressure molar concentration meter. Pregnancy complications will be assessed and diagnosed throughout pregnancy and childbirth. Maternal-infant outcomes will be monitored using related indicators and technologies. In order to explore the internal mechanism and interactions from the perspective of endocrine, pregnancy related hormones (estradiol, prolactin, progesterone) and the hydration-related hormones (copeptin) will be tested during pregnancy. A mixed model of repeated measures ANOVA will be analyzed using SAS 9.2. RESULTS: The results may provide basic data on water intake among pregnant women. The association between hydration state and maternal-infant outcomes will also be explored. CONCLUSIONS: This preliminary exploratory study findings will fill the gaps in the research on water intake, hydration and maternal health, birth outcomes, provide scientific reference data for updating recommendation on water adequate intake among pregnant women, and provide suggestion for developing water intake interventions. TRIAL REGISTRATION: The protocol has been registered on the website of Chinese Clinical Trial Registry. The Identifier code is ChiCTR1800019284. The Registry date is 3 November, 2018. Registry name is "Study for the correlation between hydration state and pregnancy complications, maternal and infant outcomes during pregnancy".