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Objective Objective To investigate the changes in hippocampal astrocytes and neuronal primary cilia, and neuronal apoptosis in the offspring brain of advanced maternal age and the role of LKB1/AMPK pathway. Methods The 12-month-old SD female rats were mated with 3-month-old SD male rats to produce offspring as the advanced maternal age (AMA) group, and the 3-month-old SD female rats were mated with 3-month-old SD males to produce offspring as the appropriate age (Control, Ctl) group. The following studies were conducted on postnatal days 14, 28 and 60 (P14, P28 and P60) in the 2 groups (14 rats per group at each time point, half males and half females). HE staining and Nissl staining were used to observe the changes in the morphology and the number of hippocampal neurons and their internal Nissl bodies. Immunofluorescence assay was employed to detect the expression of hippocampal primary cilia marker, anti-ADP ribosylation factor-like protein-13B (ARL13B), and Western blotting was applied to measure the expression of hippocampal intraflagellar transport protein 88 (IFT88) to assess functional changes in primary ciliogenesis. TUNEL staining and Western blotting were performed to detect the expression levels of pro-apoptotic BAX, and anti-apoptotic protein, BCL-2 to observe the changes of apoptosis in the hippocampus. Western blotting was also used to detect the expression levels of liver kinase B1 (LKB1), adenosine monophosphate-activated protein kinase (AMPK), mammalian target of rapamycin (mTOR) and the levels of their corresponding phosphorylated proteins to assess LKB1/AMPK pathway changes. Results Compared with the Ctl group: HE staining and Nissl staining showed that the number of hippocampal neurons was significantly reduced in the AMA group at P14 (P < 0.05), and there were abnormal changes in hippocampal neuron morphology and Nissl body number and morphology in the AMA group at all time points; the incidence of ARL13B primary cilia was significantly decreased in the AMA group at both P14 (P < 0.05) and P28 (P < 0.001), and the length of ARL13B was obviously shortened in the AMA group at both P14 (P < 0.05) and P28 (P < 0.05); the hippocampal expression level of IFT88 was notably lower in the AMA group at the P14 (P < 0.01). TUNEL staining showed that the apoptotic rate of hippocampal neurons at P14 was remarkably higher in the AMA group (P < 0.05), while Western blotting indicated that the expression of BAX was significantly higher (P < 0.001) and that of BCL-2 was lower (P < 0.01). In the AMA group, the expression of p-LKB1 was significantly decreased at P14 (P < 0.05), that of p-AMPK was statistically elevated at P28 (P < 0.01) and P60 (P < 0.01), and that of p-mTOR was notably decreased at P60 (P < 0.05). Conclusion Neuronal damage, defective primary ciliogenesis and growth inhibition, and abnormal activation of apoptosis are present in the hippocampus of juvenile offspring brain of advanced maternal age. Meanwhile, the LKB1/AMPK pathway, which is regulated by primary cilia in hippocampal astrocytes and neurons of advanced maternal age offspring brain, is abnormally activated at all ages.

Objective: To investigate effect of preimplantation genetic testing for aneuploidies (PGT-A) on the reproductive outcomes of women of advanced maternal age (AMA) (≥38 years), and to analyze factors influencing the live birth rate in AMA women who have received PGT-A., Methods: A retrospective cohort study was conducted. AMA women undergoing PGT-A were enrolled in the PGT-A group. All of them underwent their first oocyte retrieval cycle between January 2019 and June 2023. AMA women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and their first oocyte retrieval cycle over the same period of time were enrolled in the control group (the non-PGT-A group) via propensity score matching. The PGT-A group and the non-PGT-A group each included 193 cycles, which were followed up until January 2024. Follow-up concerning live births was completed for all oocyte retrieval cycles conducted between January 2019 and October 2022. The reproductive outcomes were compared between the two groups. The primary outcome indicator was cumulative live birth rate (CLBR) per oocyte retrieval, while the secondary outcome indicators were cumulative clinical pregnancy rate (CCPR) per oocyte retrieval and spontaneous abortion rate. For the 145 cycles in the PGT-A group with completed live birth follow-up, binary logistic regression analysis and receiver operator characteristic (ROC) curves were used to analyze the influencing factors of live birth rates., Results: A total of 145 cycles in the PGT-A group and 161 cycles in the non-PGT-A group completed follow-up for live births. The CLBR per oocyte retrieval of the PGT-A group was 25.52% (37/145), while that of the non-PGT-A group was 28.50% (46/161), with no significant difference being observed between the two groups ( P <0.05). Of the 193 oocyte retrieval cycles in each group, 53 cycles in the PGT-A group and 72 cycles in the non-PGT-A group resulted in clinical pregnancies, with the difference in the CCPR per oocyte retrieval being statistically significant (27.46% vs. 37.31%, P <0.05). Concerning clinical pregnancies, the spontaneous abortion rate of the PGT-A group was lower than that of the non-PGT-A group, with the difference being statistically significant (7.55% vs. 25.00%, P <0.05). In AMA women who had undergone PGT-A for reproductive assistance, maternal age (odds ratio [OR]=0.786, 95% confidence interval [CI]: 0.635-0.973) and the antral follicle count (AFC) (OR=1.110, 95% CI: 1.013-1.216) were correlated with the outcome of live births outcome. The probability of live births decreased with increasing maternal age and decreasing AFC. When the female age was ≥42 years or when AFC≤8, the expected live birth outcome of PGT-A assisted pregnancy was poor., Conclusion: PGT-A does not affect the CLBR per oocyte retrieval in AMA women, but it can effectively reduce the risks of implantation failure and spontaneous abortion due to fetal aneuploidies. For PGT-A-assisted pregnancy in AMA women, maternal age and AFC are important factors affecting the live birth outcomes., Competing Interests: 利益冲突　所有作者均声明不存在利益冲突, (© 2024《四川大学学报（医学版）》编辑部 版权所有Copyright ©2024 Editorial Office of Journal of Sichuan University (Medical Sciences).)

Objective To explore the vaginal microbiota status and pregnancy outcomes in women with advanced maternal age (AMA),so as to provide laboratory evidence for reducing the occurrence of adverse pregnancy outcomes.Methods A total of 213 AMA pregnant women (delivery age ≥ 35 years old) hospitalized in the obstetrics department of the hospital from January to December 2020 were selected as the AMA group,and 975 non-AMA (NMA) pregnant women (delivery age < 35 years old) hospitalized in the obstetrics department of the hospital in the same period were selected as the NMA group.The gestation times,parity,incidence of preterm birth (gestcetional week <37 weeks),chorioamnionitis,premature rupture of membranes and puerperal infection were compared between the two groups.The incidence of neonatal asphyxia and newborn infant infection were compared between the two groups.The microecological balance rate,abnormal cleanliness rate,white blood cell esterase positive rate,lactobacillus deficiency rate,trichomonas vaginitis detection rate,fungal vaginitis detection rate,and bacterial vaginitis detection rate were compared between the two groups.Results The incidences of premature delivery,chorioamnionitis,premature rupture of membranes and puerperal infection in the AMA group were higher than those in the NMA group,the differences were statistically significant (P <0.05).The incidences of neonatal asphyxia and neonatal infection in the AMA group were higher than those in the NMA group,the differences were statistically significant (P < 0.001).The vaginal microecological balance rate of pregnant women in the AMA group was lower than that in the NMA group,the difference was statistically significant (P <0.001).The abnormal rate of cleanliness,the abnormal rate of white blood cell count,the rate of lactobacillus deficiency,bacterial vaginitis,trichomonas vaginitis,fungal vaginitis detection rates in the AMA group were higher than those in the NMA group,and the differences were statistically significant (P <0.05).Conclusion The incidence of adverse pregnancy outcomes in the AMA group is higher than those in the NMA group.The women in advanced maternal age are more prone to have imbalance of vaginal microbiota than that in non-advanced maternal ages. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective：To investigate the pregnancy outcomes of in vitro fertilization-embryo transfer (IVFET) therapy in women aged ≥ 40 years, so as to provide a clinical reference for the fertility counseling the individualized assisted reproductive treatment (ART) for those ageing women. Methods：The clinical data of 2 467 women aged 40 and older years who used autologous oocytes in ART cycles between January 2015 and December 2017 in our center were retrospectively analyzed. Results：In the IVF -ET cycles, the retrieved oocytes were decreased with increased age in women aged ≥40 years (the average retrieved oocytes in women aged 40-48 years were 2.97, 2.69, 2.17, 2.01, 1.77, 1.61, 1.68, 1.29 and 1.00; when compared the 44-48 years′ group and the 40- 43 years′ group, P＜0.05). In particular, the embryo development potential was decreased significantly, especially in women aged ≥44 years (the percentage of blastocyst formation in women aged 40-48 years were 48.90%, 43.72%, 33.67%, 34.29%, 24.39%, 21.14%, 26.32%, 16.67%, and 0%; when compared the 44-48 years′ group and the 40-43 years′ group, P＜0.05). There were a total of 518 cases with fresh embryo transfer cycles. The clinical pregnancy rate (in women aged 40-48 years, were 26.92%, 21.15%, 20.79%, 10.96%, 18.87%, 11.11%, 5.88% , 0% and 0% ; when compared the 43 -48 years′ group and the 40 -42 years′ group, P＜0.05), the implantation rate (in women aged 40-48 years, were 23.65%, 19.51%, 17.70%, 8.54%, 7.49%, 10.81%, 5.56%, 0% and 0%; when compared the 43-48 years′ group and the 40-42 years′ group, P＜0.05) and the live-birth rate (in women aged 40-46 years, were 18.46%, 10.58%, 9.90%, 5.48%, 5.66%, 2.78%, and 5.88%; when compared the 43-46 years′ group and the 40-42 years′ group, P＜0.05) were decreased with age, while these parameters in women aged over 43 years were worse. The abortion rate was increased significantly in women aged ≥44 years (in women aged 40-45 years, were 31.43%, 50.00%, 52.38%, 50.00%, 70.00%, and 75.00%; when compared the 44-45 years′ group and the 40-43 years′ group, P＜0.05), while there was only one case of pregnancy and delivery in all woman aged 46 years, and no successful pregnant case in those women aged 47 and 48 years. The pregnancy rate, implantation rate and live birth rate in the AMH≤1.0 ng/mL group were significantly decreased than those in the AMH＞1.0 ng/mL group (27.04% vs. 14.74%, 22.99% vs. 13.50%, and 15.88% vs. 7.37%; all P＜0.05), while the abortion rate was increased significantly (41.27% vs. 50.00%, P＜0.05). Conclusions：The fertility was declined gradually with the increased age in women aged ≥40 years. It is still worthy to do ART in women aged 40 43, especially in women with potential ovarian reserve (AMH＞1.0 ng/mL). However, in principle, ART treatment should not be recommended for women aged over 44 years, and oocytes donation or adoption should be strongly recommended for those women aged over 46 years and with the exhausted ovarian function. [ABSTRACT FROM AUTHOR]

At present, the proportion of pregnant women with advanced maternal age is increasing. The risk of diabetes, hypertension, hyperlipidemia, obesity and other metabolic diseases increases with age. And age is an independent risk factor for these diseases. Therefore, women with advanced maternal age will have greater risks than younger ones, and need better management. However, there are lacks of attention on postpartum management and long-term rehabilitation of those patients. Health care is still limited. In order to improve the health quality of pregnant women with advanced maternal age, we will review the management of postpartum chronic metabolic diseases in this article. Obstetricians should pay more attention to pregnant women with advanced maternal age. We recommend a comprehensive follow-up concept to strengthen the standardized management of these women after delivery. They need a regular detection of blood sugar level, blood lipid level, blood pressure, body mass and waistline to reduce the risk of future metabolic diseases. [ABSTRACT FROM AUTHOR]

Copyright of Nursing of Integrated Traditional Chinese & Western Medicine is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To evaluate the clinical application of array-based comparative genomic hybridization (a-CGH) in the prenatal diagnosis of fetal chromosomal aberrations in gravidas with advanced maternal age (AMA)., Methods: A total of 3 677 amniotic fluid samples from pregnant women who underwent amniocentesis for prenatal diagnosis solely due to AMA were selected. Array-CGH was performed on the Agilent CGX TM (8X60K) platform and the data were analyzed by the Genoglyphix software., Results: The overall detection rate of chromosomal aberration was 2.04% (75/3677), with 53.33% (40/75) being aneuploidies, including 22 cases of trisomy-21, 5 cases of trisomy-18, 8 cases with XXY, 3 cases of XYY and 2 cases of mosaic monosomy X, 32.00% (24/75) being pathogenic copy number variations (pCNVs), including 19 cases of microdeletion and 5 cases of microduplication, with the fragment size ranging from 323 kb to 26 780 kb, and 14.67% (11/75) being likely pathogenic CNVs (lpCNVs), including 7 cases of microdeletion and 7 cases of microduplication, with the fragment size ranging from 358 kb to 16 873 kb. Besides, the detection rate of CNVs of unknown clinical significance (VUS) was 0.84% (31/3 677). The detection rate of aneuploidies increased significantly with increased maternal age ( P <0.05). However, there were no significant differences in the detection rate of p/lpCNVs among different maternal age groups ( P >0.05)., Conclusion: Our findings suggest that, compared with traditional karyotype analysis, a-CGH not only detects aneuploidies, but also detect pathogenic CNVs, including microdeletion/microduplication syndromes. The detection rate of fetal aneuploidies was closely correlated to maternal age. However, no correlation was found between the detection rate of p/lpCNVs and maternal age., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Sciences).)

Objective: To compare the preterm birth rate among different age groups and analyze relative high-risk factors of preterm birth. Methods: A retrospective analysis was conducted on clinical data of single pregnant women ≥28 gestational weeks from January 2013 to May 2019 in the First Affiliated Hospital of Chongqing Medical Hospital. All involved women were divided into three groups according to age, Group 1 (aged<35 years), Group 2 (aged 35-39 years), and Group 3 (aged ≥40 years). The preterm birth rate among 3 groups was compared and their high-risk factors were analyzed. Results: There were 48 288 singleton pregnancies during the study period, of which 3 351 were preterm births， preterm birth rate was 6.94% (3 351/48 288). In Group 1, there were 42 020 women, of which 2 699 were preterm births (6.42%, 2 699/42 020); in Group 2, there were 5 061 women, of which 491 were preterm births (9.70%, 491/5 061); and in Group 3, there were 1 207 women, of which 161 were preterm births (13.34%, 161/1 207). Comparing the spontaneous preterm birth rates among the three groups, Group 1 was the lowest one and Group 3 was the highest one (3.72% vs 4.51% vs 5.88%); comparing the medical preterm birth rates among the three groups, Group 1 also was the lowest one and Group 3 also was the highest one (2.70% vs 5.20% vs 7.46%); the differences were statistically significant ( P <0.05). The incidence of spontaneous and medical preterm birth according gestational weeks were compared among three groups and there were no significant differences ( P >0.05). Comparing and analyzing the high-risk factors of medical preterm birth, the incidence of intrahepatic cholestasis of pregnancy and fetal distress in Group 1 were higher than those in Group 2 and 3; the incidence of placenta praevia were significantly higher in Group 2 and 3 than that in Group 1; the differences were statistically significant ( P <0.05). Conclusions: Maternal age is a significant high-risk factor of both spontaneous preterm birth and medical preterm birth, and the risk of preterm birth increases with age. For medical preterm birth, compared with right-age pregnant women, placenta praevia is the high-risk factor for women in advanced maternal age(AMA), which have great effect on medical preterm birth rate of AMA.

Objective: To explore the characteristics of serum D-dimer level before and after delivery in women with advanced maternal age (VTE), and to assess the value of the characteristics for the diagnosis of venous thromboembolic disease. Methods: The objects were 785 puerperae with advanced maternal age (AMA) who experienced delivery in Women's Hospital, Zhejiang University School of Medicine during 1(st) Jan 2017 to 31(st) Dec 2017, and 327 puerperae with appropriate maternal age as controls were randomly selected from puerperae who gave birth in the same period. Their serum D-dimer levels before and after delivery were evaluated, and AMAs with high-level postnatal serum D-dimer were specially observed for the prognosis. Besides, puerperae complicated with VTE were retrieved from the medical database during 2014-2018, and their clinical characteristics and dynamic variation of serum D-dimer levels were analyzed. Result: The significant difference of D-dimer levels neither before nor after delivery was not observed between AMAs and controls (antenatal: 1.64(1.19, 2.29) mg/L vs 1.53(1.04, 2.23) mg/L, and postnatal: 2.70(1.71, 2.97) mg/L vs 2.63(1.17, 4.13) mg/L, P< 0.05 for both; None of AMAs with high-level serum D-dimer after delivery were complicated with VTE, and most of their serum D-dimer levels decreasedsharply with in four postnatal days (the average decrease was 9.2(7.69,12.74) mg/L, and 96.2% of the sepuerperae's decrease was more than 50%). Eight puerperae complicated with VTE were found in the database from 2014 to 2018, among which five were AMAs. The eight puerperae all received a B ultrasound because of the discomfort of lower limbs or abnormal variation of serum D-dimer levels (a slow decrease or an increase trend), so that a diagnosis of VTE was established; besides, the diagnosis or symptoms all emerged in the 3(rd) to 5(th) day after caesarean. Conclusions: The factor of advanced maternal age has little influence on the serum D-dimer level before or after delivery among pregnant women. It is not a single detection for serum D-dimer level, but the intensive monitoring of clinical symptoms and dynamic change of serum D-dimer level, that helps early diagnosis of VTE.