Association of trimester-specific gestational weight gain with birth weight and fetal growth in a large community-based population.

BACKGROUND: Previous studies showed that the association of gestational weight gain (GWG) with fetal birthweight and offspring developmental growth was unclear. The aim of this study is to investigate the respective effect of 1 kg of GWG during three trimesters on birthweight and offspring growth from birth to 3 years of age. METHODS: We extracted the decoded information from the Maternal and Child Health Information Management System of Zhoushan Maternal and Child Health Hospital in Zhejiang, China from October 2001 to March 2015, and used multiple linear and logistic regression models. RESULTS: This study included 20,232 women with a full-term singleton birth and 15,557 newborns who took regular health check-ups. Compared to that in the 2nd and 3rd trimester, 1 kg GWG increasing in the 1st trimester had the strongest positive association with higher birthweight, body weight, and height from 1 to 36 months. Their associations with BMI after birth were similar among the three trimesters. In addition, some positive dose-response effects found between quartiles of GWG in the 1st trimester and offspring body weight, as well as BMI. The 1 kg GWG in 1st trimester played the strongest role in contributing to birth weight and benefiting to body growth among children aged up to 3 years. CONCLUSION: The 1 kg GWG in 1st trimester contributed more to birth weight and body development from birth to 3 years compared to the 2nd and 3rd trimesters. The possible beneficial effects of GWG in the 1st trimester on birthweight and offspring development in under/normal weight mothers are found.

Prevalence and relevant factors of anxiety and depression among pregnant women in a cohort study from south-east China.

OBJECTIVE: To describe the prevalence rate of prenatal anxiety and depression among pregnant women in a prospective cohort study and to explore the relevant factors of anxiety and depression during each trimester. METHODS: Pregnant women were recruited into the Zhoushan Pregnant Women Cohort at Zhoushan Maternal and Child Care Hospital from September 2011 to March 2015. A self-made questionnaire was used to collect information about social demography, reproductive history, physical activity, and life behaviour at the first, second and third trimester, respectively. The Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS) were used to assess anxiety and depression status at each trimester, respectively. Prevalence rates of prenatal anxiety and depression at each trimester were described. RESULTS: The prevalence of anxiety status was 22.7%, 17.4% and 20.8% in the first, second and third trimester, respectively. The corresponding prevalence rate of depression status was 35.7%, 24.0% and 26.1%, respectively. Furthermore, women with a lower education level (junior high school or below) and a more physical occupation had higher prevalence of anxiety and depression status. CONCLUSIONS: The prevalence of prenatal anxiety and depression status was very common during pregnancy among pregnant women. Lower educational level and more physical occupations were associated with higher prevalence of anxiety and depression status.

The association of gestational diabetes mellitus with fetal birth weight.

AIMS: Gestational diabetes mellitus (GDM) and different time-point glucose levels might have different effects on fetal birth weight. The aim of this study was to further evaluate the associations of GDM and different time-point blood glucose levels with fetal birth weight in a prospective cohort study. METHODS: This prospective cohort study was conducted in Zhoushan Maternal and Child Health Hospital, Zhejiang, from August 2011 to May 2015. 1232 pairs of singleton, full-term newborns and their mothers without other pregnant and perinatal complications were selected as participants. RESULTS: Of the 1232 women, 234 had GDM. GDM was positively associated with birth weight (ß = 99.5 g, P = 0.0002), gestational age-specific Z-score of birth weight (ß = 0.23, P = 0.0003), and an increased risk of large for gestational age (LGA; OR = 1.79, 95%CI: 1.11-2.89) and macrosomia (OR = 2.13, 95%CI: 1.34-3.40). Compared with abnormal fasting plasma glucose (FPG) during the second trimester, abnormal postload glucose in oral glucose tolerance test had significantly higher birth weight and gestational age-specific Z-score of birth weight, and an increased risk of macrosomia. Abnormal FPG and abnormal postload glucose had significantly joint effect on birth weight (ß = 161.4 g, P = 0.0192), gestational age-specific Z-score of birth weight (ß = 0.42, P = 0.0121) and risk of macrosomia (OR = 3.24, 95%CI: 1.21-8.67) and LGA (OR = 5.73, 95%CI: 2.20-14.90). Compared with abnormal blood glucose during the first trimester, GDM had significantly higher birth weight and gestational age-specific Z-score of birth weight. Abnormal blood glucose during the first trimester and GDM had significantly joint effect on birth weight (ß = 125.8 g, P = 0.0010), gestational age-specific Z-score of birth weight (ß = 0.30, P = 0.0013) and risk of macrosomia (OR = 2.34, 95%CI: 1.28-4.30) and LGA (OR = 2.53, 95%CI: 1.37-4.67). However, we did not find blood glucose during the first trimester independently associated with birth weight. CONCLUSIONS: GDM was significantly associated with higher birth weight and an increased risk of LGA and macrosomia. Fetal growth was mostly influenced by postload glucose levels, rather than FBG. Moreover, different time-point blood glucose levels had significantly joint effects on birth weight and risk of LGA and macrosomia.

Vitamin D pathway gene polymorphisms influenced vitamin D level among pregnant women.

AIMS: To explore the relationship between vitamin D pathway genes, gene-environment interactions and vitamin D level among southeast Chinese pregnant women. METHODS: 759 participants from Zhoushan Pregnant Women Cohort (ZPWC) study, were enrolled from August 2011 to April 2014 in China. Plasma 25(OH)D levels and genetic variants in vitamin D pathway (NADSYN1/DHCR7, GC, CYP3A4, CYP2R1, CYP27A1, CYP27B1, VDR, CYP24A1, and LRP2) were measured using the blood sample collected at the first trimester. Information on demographics, lifestyle, and health behavior were collected using a questionnaire. Multilinear regression and logistic regression models were performed to estimate the associations between SNPs and 25(OH)D level. RESULTS: Mean plasma 25(OH)D concentrations were 15.6 ng/mL among the pregnant women. Variants of GC rs16846876, rs17467825, rs2282679, rs3755967, rs2298850, rs4588, rs7041 and rs1155563, CYP3A4 rs2242480 and CYP24A1 rs2209314 were significantly associated with both 25(OH)D concentrations and vitamin D deficiency (25(OH)D < 15 ng/mL). Variants of NADSYN1/DHCR7 were significantly associated with 25(OH)D concentrations among pregnant women without vitamin D supplements. Pregnant women with vitamin D binding protein (Gc) Gc-1f (P = 0.02) and Gc-1s (P = 0.005) had higher plasma 25(OH)D levels compared to women with Gc-2. Genotype risk score (GRS) calculated from rs7041, rs2242480 and rs2209314 shown a significantly negative association with 25(OH)D levels. Participants with GRS > 3 had a higher risk for vitamin D deficiency than individuals with GRS ≤ 3 (OR = 1.71, 95% CI = 1.25-2.35). Interactions between seasons and CYP27A1 rs933994, CYP3A4 rs2246709 on plasma 25(OH)D concentrations were also observed. Haplotypes of GC and LRP2 genes shown significant associations with 25(OH)D levels among pregnant women, respectively. CONCLUSIONS: Genetic mutants in vitamin D pathway (GC, CYP3A4, CYP24A1, and NADSYN1/DHCR7) had significant associations with 25(OH)D levels among pregnant women in southeast China. Furthermore, their associations were modified by vitamin D supplementation and season.

Sleep was associated with depression and anxiety status during pregnancy: a prospective longitudinal study.

The purpose of this study was to reveal the cross-sectional and longitudinal association of sleep with depression and anxiety among Chinese pregnant women. Pregnant women were recruited in Zhoushan Pregnant Women Cohort at Zhoushan Maternal and Child Care Hospital from 2011 to 2015. Self-rating depression scales (SDS) and self-rating anxiety scales (SAS) were used for evaluating depression and anxiety status at each trimester; corresponding sleep quality and duration were reported by pregnant women. Ordinary or multilevel linear and logistic regression model were used to estimate the cross-sectional or longitudinal association of sleep with depression and anxiety. The prevalence rates were 35.64, 24.23, and 26.24% for depression and 22.57, 17.41, and 21.04% for anxiety at 1st (T1), 2nd (T2), and 3rd trimester (T3), respectively. Controlling for potential confounders, it revealed significant cross-sectional and longitudinal associations of sleep with depression and anxiety status. In cross-sectional analysis, women who slept less than 8 h/day had higher risk of depression (T1: OR (95%CI) = 1.75 (1.39, 2.20); T2: 1.52 (1.26, 2.05); T3: 1.60 (1.18, 2.05)) and anxiety (T1: 2.00 (1.57, 2.55); T2: 1.86 (1.37, 2.54); T3: 1.33 (0.99, 1.79)). In the longitudinal analysis, multilevel model revealed that women with subjective "fair" or "bad" sleep quality had elevated risk of depression (OR ranging from 1.54 to 3.71) and anxiety (2.38 to 7.53) during pregnancy. Prenatal depression and anxiety status were prevalent in pregnant women. Sleep quality was associated with depression and anxiety status in both cross-sectional and longitudinal analyses, implying that improving sleep quality should benefit for mental health of pregnant women.

Serum thyroid hormone levels among Chinese pregnant women.

AIM: The aim of this study is to examine gestational serum thyroid hormone levels and influencing factors among Chinese pregnant women with high dietary iodine intake. METHODS: The study was conducted from 2011 and 2013 in Zhoushan Women & Children's Hospital, Zhejiang, China. A total of 1991 pregnant women were enrolled and their serum levels of free thyroid hormones (FT4, FT3, and TSH) were detected by chemiluminescence method. RESULTS: Gestational serum FT4 and FT3 decreased with gestational week while TSH increased. Furthermore, the prevalence rate of subclinical hypothyroid increased with gestational stages, especially in the third trimester. Women aged more than 30 years had lower FT4 and FT3 in the first trimester and lower FT4 in the second trimester. No significant difference was found in the association of gestational serum thyroid hormones with maternal height and the gender of fetuses. CONCLUSION: Gestational serum thyroid hormones significantly changed with gestational week and were associated with the age of women. Specific normal range of thyroid hormones might be modified so as to better evaluate the thyroid hormone levels of pregnant women during pregnancy.

Outdoor temperature and temperature maintenance associated with blood pressure in 438,811 Chinese adults.

OBJECTIVES: The association of temperature maintenance with blood pressure (BP) has not been studied and the association of temperature with season-related BP was not being well understood. The present study aims to be further aware of season-related BP variation in Chinese adults. METHODS: We used decoded data from adults who visited the hospital for health examination from January 2008 to November 2013. Multivariate regression models were used to analyses the association between outdoor temperature and BP. RESULTS: The analysis included 438,811 adults. Larger change of BP accompanied with unit change of average outdoor temperature among outpatient than inpatient patients. The association of temperature with BP was stronger in normotensives than that in hypertensives. Compared with temperature variation, the impact of temperature maintenance on BP was smaller. These associations were stronger in men, older individuals. CONCLUSIONS: Temperature was strongly inversely associated with BP in Chinese adults. Temperature maintenance was mildly associated with BP compared to temperature variance. Seasonal temperature variation should be considered when screening for hypertension.

Maternal dyslipidemia during pregnancy may increase the risk of preterm birth: A meta-analysis.

Epidemiological studies have reported an inconsistent relationship between maternal lipid levels and preterm birth (PTB). We performed this meta-analysis to evaluate the association between maternal dyslipidemia and PTB. Overall, three nested case-control studies and eight cohort studies were eligible. Effect estimates [odds ratio(OR)/relative risk] were pooled using a fixed-effects or a random-effects model. Subgroup and metaregression analyses were conducted to evaluate the sources of heterogeneity. Eleven studies involving 13,025 pregnant women were included. Compared with pregnant women with normal lipid levels, the women with elevated levels of lipids had an increased risk of PTB, and the pooled OR was 1.68 [95% confidence interval (CI): 1.25-2.26)]; meanwhile, women with lower levels of lipids also had a trend of an increased risk of PTB (OR=1.52, 95% CI=0.60-3.82). The pooled ORs for elevated levels of total cholesterol, triglycerides, low density lipoprotein-cholesterol, and lower levels of high density lipoprotein-cholesterol were 1.71 (95% CI: 1.05-2.79), 1.55 (95% CI: 1.13-2.12), 1.19 (95% CI: 0.95-1.48), and 1.33 (95% CI: 1.14-1.56), respectively. The present meta-analysis found that maternal dyslipidemia during pregnancy, either the elevated total cholesterol or triglycerides, was associated with an increased risk of PTB. These findings indicate that a normal level of maternal lipid during pregnancy may reduce the risk of PTB.

Nutrient Status of Vitamin D among Chinese Children.

BACKGROUND: Vitamin D deficiency is considered to be a public health problem. However, the nutrient status of vitamin D in Chinese children is unclear. The aim of this study was to describe the vitamin D status among children aged under 18 years in southeast China. METHODS: Children who visited the Huzhou Maternal and Child Care Hospital from January 2012 to August 2015 were included in this large cross-sectional study. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured by electrochemiluminescence immunoassay. Vitamin D status was defined as deficiency (25(OH)D < 20 ng/mL), insufficiency (25(OH)D: 20-29 ng/mL) and sufficiency (25(OH)D ≥ 30 ng/mL). The association between relevant variables and vitamin D status was analyzed by a using generalized estimated equation model and a multivariate regression model. RESULTS: 13,997 children aged under 18 years were included. Of these, 23.3% children suffered from low vitamin D status (deficiency and insufficiency), while 76.7% had a sufficient vitamin D status. The prevalence of low vitamin D status was 29.7% in winter and 23.4% in spring, which was higher than that in summer (21.4%) and autumn (19.9%). Clinical visiting children (32.1%) suffered more from low vitamin D than health examination children (17.6%). Additionally, age and season were independently and significantly associated with 25(OH)D concentrations, respectively. CONCLUSIONS: The deficiency and insufficiency status of vitamin D was very common among newborns and children aged one to 17 years. This indicates that more sunshine and vitamin D-fortified foods are necessary among Chinese children.

Effects of electromagnetic fields exposure on plasma hormonal and inflammatory pathway biomarkers in male workers of a power plant.

PURPOSE: The potential health risks of electromagnetic fields (EMFs) have currently raised considerable public concerns. The aim of this study was to evaluate the effects of EMF exposure on levels of plasma hormonal and inflammatory pathway biomarkers in male workers of an electric power plant. METHODS: Seventy-seven male workers with high occupational EMF exposure and 77 male controls with low exposure, matched by age, were selected from a cross-sectional study. Moreover, high EMF exposure group was with walkie-talkies usage and exposed to power frequency EMF at the work places for a longer duration than control group. A questionnaire was applied to obtain relevant information, including sociodemographic characteristics, lifestyle factors, and EMF exposures. Plasma levels of testosterone, estradiol, melatonin, NF-κB, heat-shock protein (HSP) 70, HSP27, and TET1 were determined by an enzyme-linked immunosorbent assay. RESULTS: EMF exposure group had statistically significantly lower levels of testosterone (ß = -0.3 nmol/L, P = 0.015), testosterone/estradiol (T/E2) ratio (ß = -15.6, P = 0.037), and NF-κB (ß = -20.8 ng/L, P = 0.045) than control group. Moreover, joint effects between occupational EMF exposure and employment duration, mobile phone fees, years of mobile phone usage, and electric fees on levels of testosterone and T/E2 ratio were observed. Nevertheless, no statistically significant associations of EMF exposures with plasma estradiol, melatonin, HSP70, HSP27, and TET1 were found. CONCLUSIONS: The findings showed that chronic exposure to EMF could decrease male plasma testosterone and T/E2 ratio, and it might possibly affect reproductive functions in males. No significant associations of EMF exposure with inflammatory pathway biomarkers were found.

Effects of electromagnetic fields on serum lipids in workers of a power plant.

This study aimed to evaluate the effects of electromagnetic fields (EMF) exposure on levels of serum lipids in workers of an electric power plant. A cross-sectional study was carried out in an electric power plant in Zhejiang province, China, from August to September 2011. All participants were divided into two groups with high occupational EMF exposure and low occupational EMF exposure. The occupational EMF exposure included radiofrequency EMF and extremely low-frequency EMF. Occupational EMF exposure was associated with an increased level of low-density lipoprotein cholesterol (LDL-c; ß = 0.17 mmol/L, P = 0.022). High EMF exposure group with longer employment duration, longer daily EMF exposure duration, and more mobile phone or electric fee per month had significantly higher levels of total cholesterol, LDL-c, or triglyceride than the corresponding reference group. However, significantly decreased level of high-density lipoprotein cholesterol was only observed in high EMF exposure group with more mobile phone fee per month. Similar results were also found in 544 participants with available data of serum lipids in 2010. The findings showed that chronic EMF exposure was associated with the change of serum lipid levels. EMF exposure might modulate the process of lipid metabolism.

The Difference in Nutrient Intakes between Chinese and Mediterranean, Japanese and American Diets.

Across countries, the predominant diets are clearly different and highly related with human health. Therefore, it is necessary to evaluate dietary nutrients between them. This study aimed to evaluate dietary nutrients in China and compare those between Chinese and Mediterranean (Italian), Japanese and American diets. Dietary intakes of 2659 subjects in south-east China, Zhejiang province, from 2010 to 2012, were estimated by three consecutive 24-h dietary recalls. The contribution of carbohydrate to total energy in Chinese subjects was lower than that in Japanese and American subjects, but higher than that in Italian subjects. However, the energy contribution from fat in Chinese subjects was higher than that in Japanese and American subjects, and similar to that in Italian subjects. Moreover, the Chinese diet had lower daily intakes of fiber, calcium, phosphorus, potassium, selenium, vitamin A, vitamin B1, vitamin B2 and vitamin C, compared with the Japanese, American and Italian diets. Nevertheless, intakes of sodium, iron, copper and vitamin E were higher among Chinese people relative to the people of other three countries. The present study demonstrated that the structure of the Chinese diet has been shifting away from the traditional diet toward high-fat, low-carbohydrate and low-fiber diets, and nutrients intakes in Chinese people have been changing even worse than those in American people.

Social relationships play a role in sleep status in Chinese undergraduate students.

The purpose of this study was to examine whether social relationships were associated with sleep status in Chinese undergraduate students. A cross-sectional questionnaire survey was conducted in November 2012 at Huzhou Teachers College, China. The questionnaire involved demographic characteristics, personal lifestyle habits, social relationships and Pittsburgh Sleep Quality Index (PSQI). The associations between social relationships and sleep status were analyzed by using regression models after adjustment for potential factors. Poor sleep quality was prevalent among Chinese undergraduate students. Men tended to have better sleep than women. Lower social stress, better management of stress and good social support were correlated with better sleep status, and stress or support from friends, family and classmates were all related with sleep variables. While only weak associations between number of friends and sleep were detected. The results were consistent in men and women. Educators and instructors should be aware of the importance of social relationships as well as healthy sleep in undergraduates.

Gender susceptibility for cigarette smoking-attributable lung cancer: a systematic review and meta-analysis.

OBJECTIVES: As the primary cause of lung cancer, whether smoking confers the same risk of lung cancer for women as men is unclear. Therefore, we aimed to compare male and female susceptibility for cigarette smoking-attributable lung cancer. METHODS: A systematic review and meta-analysis was conducted by searching articles published up to July 2013 in three online databases (MEDLINE, EMBASE, and Cochrane Database). All studies estimated the association of cigarette smoking with the risk of lung cancer between men and women, respectively. A random effects model with inverse variance weighting was used to pool data. Male to female ratio of relative risk (RRR) was calculated to compare male and female susceptibility for cigarette smoking-attributable lung cancer. RESULTS: 47 articles containing 404,874 individuals were included in the final analysis. Compared with non-smokers, male to female RRR was 1.61 (95%CI: 1.37, 1.89) among current smokers. Based on pathological type, adenocarcinoma had the highest RRR (1.42; 95%CI: 0.86, 2.35), followed by squamous cancer and small cell lung cancer. Furthermore, compared with non-smoking men, current smoking men had higher risk of lung cancer than women in spite of smoking quantity, smoking duration or years since quitting. CONCLUSIONS: These findings indicated that males had higher susceptibility for cigarette smoking-attributable lung cancer than females. It is contradicted with traditional opinion that females would be more easily suffered from cigarette smoking-attributable health problems than males. Hence, tobacco control is very crucial in both males and females.

Decreased plasma neuroactive amino acids and increased nitric oxide levels in melancholic major depressive disorder.

BACKGROUND: Amino acid neurotransmitters and nitric oxide (NO) are involved in the pathogenesis of major depressive disorder (MDD). Here we want to establish whether changes in their plasma levels may serve as biomarker for the melancholic subtype of this disorder. METHODS: Plasma levels of glutamic acid (Glu), aspartic acid (Asp), glycine (Gly), gamma-aminobutyric acid (GABA), and NO were determined in 27 medicine-naïve melancholic MDD patients and 30 matched controls. Seven of the MDD patients participated also in a follow-up study after 2 months' antidepressant treatment. The relationship between plasma and cerebral-spinal fluid (CSF) levels of these compounds was analyzed in an additional group of 10 non-depressed subjects. RESULTS: The plasma levels of Asp, Gly and GABA were significantly lower whereas the NO levels were significantly higher in melancholic MDD patients, also after 2 months of fluoxetine treatment. In the additional 10 non-depressed subjects, no significant correlation was observed between plasma and CSF levels of these compounds. CONCLUSION: These data give the first indication that decreased plasma levels of Asp, Gly and GABA and increased NO levels may serve as a clinical trait-marker for melancholic MDD. The specificity and selectivity of this putative trait-marker has to be investigated in follow-up studies.

High-performance liquid chromatographic determination of histamine in biological samples: the cerebrospinal fluid challenge--a review.

Histamine, a neurotransmitter crucially involved in a number of basic physiological functions, undergoes changes in neuropsychiatric disorders. Detection of histamine in biological samples such as cerebrospinal fluid (CSF) is thus of clinical importance. The most commonly used method for measuring histamine levels is high performance liquid chromatography (HPLC). However, factors such as very low levels of histamine, the even lower CSF-histamine and CSF-histamine metabolite levels, especially in certain neuropsychiatric diseases, rapid formation of histamine metabolites, and other confounding elements during sample collection, make analysis of CSF-histamine and CSF-histamine metabolites a challenging task. Nonetheless, this challenge can be met, not only with respect to HPLC separation column, derivative reagent, and detector, but also in terms of optimizing the CSF sample collection. This review aims to provide a general insight into the quantitative analyses of histamine in biological samples, with an emphasis on HPLC instruments, methods, and hyphenated techniques, with the aim of promoting the development of an optimal and practical protocol for the determination of CSF-histamine and/or CSF-histamine metabolites.

[Progress in determination of histamine levels in biological samples].

Neuronal histamine is crucially involved in a number of physiological functions as well as in neuropsychiatric diseases. Determination of histamine in biological samples is thus of importance in the clinical studies. The aim of this review is to summarize the progress or effort made in this field, with focus on the high-performance liquid chromatography.