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Aim: To describe changed epidemiological features of advanced maternal age (AMA) and to examine the effect of AMA on the risk for Cesarean section (CS) in a Chinese pregnant population. Methods: This retrospective single‐center cohort study investigated the changes of epidemiological features of AMA parturients with respect to the revised reproductive policy in China in 43 702 singleton deliveries with live birth at ≥28 weeks managed from January 2005 to December 2016. We also evaluated the pregnancy outcomes in different age groups and risk factors of CS with multivariate analysis. Results: In this 12‐year study period, the average maternal age increased from 28.5 to 30.2 years, and the proportion of AMA raised from 6.5% to 17.2%. AMA was significantly associated with increased risk of adverse pregnancy outcomes, and after adjustment for confounding factors, AMA remained a significant independent risk factor for CS. Furthermore, the effect of AMA in nulliparous women on the risk of CS was more significant than in multiparous women, while the history of previous CS (adjusted odds ratio 39.85) and interdelivery interval ≥10 years (adjusted odds ratio 1.52) also increased the risk of CS in multiparous women. Conclusion: AMA increased the risk of a number of adverse pregnancy outcomes, and was independently associated with increased risk for CS. The increasing number of AMA parturients with risk factors is likely to increase CS rate in China in the near future, thus it is imperative to reduce the rate of primary CS as a matter of policy. [ABSTRACT FROM AUTHOR]

Background: It is unclear that how prepregnancy body mass index (BMI), gestational weight gain (GWG), and gestational diabetes mellitus (GDM) affect pregnancy outcomes in -China. Thus, we explored how BMI, GWG, and GDM affect the risks of adverse pregnancy outcomes. Methods: We performed a retrospective, population-based study included all births in Xiamen, China, 2011–2018. Demographic data and pregnancy outcomes of 73,498 women were acquired from the Medical Birth Registry of Xiamen. Women were categorized into groups on prepregnancy BMI and GWG in order to assess the risk of pregnancy outcomes. Multivariable logistic regression was performed to evaluate risk factors. Results: Overall, 6,982 (9.37%) women were obese, and 8,874 (12.07%) women were overweight. Obese women are more vulnerable to cesarean delivery, preterm birth, large-for-gestational age (LGA), and macrosomia (crude OR [cOR] 2.00, 1.89–2.12; 1.35, 1.20–1.51; 2.12, 1.99–2.26; 2.53, 2.25–2.86, respectively, adjusted ORs 1.73, 1.62–1.84; 1.25, 1.10–1.42; 2.03, 1.90–2.18; 2.77, 2.44–3.16, respectively). Similar results were observed in overweight women (cORs 1.49, 1.42–1.57; 1.02, 0.91–1.15; 1.60, 1.50–1.70; 2.01, 1.78–2.26, respectively). Furthermore, women who gain weight in excessive group were 1.43, 2.06, and 2.16 times to deliver cesarean, LGA, and macrosomia, respectively. Additionally, GDM women were easily subjected to cesarean section, preterm birth, LGA, low birth weight, and macrosamia (cORs 1.52, 1.55, 1.52, 1.37, 1.27, respectively). Conclusions: Obesity prior to pregnancy, excessive GWG, and GDM were all associated with increased odds of cesarean, LGA, and macrosomia. Blood glucose and weight control before and during pregnancy are needed that may reduce the complications of pregnancy. [ABSTRACT FROM AUTHOR]

Both inadequate and excessive gestational weight gain (GWG) have been shown to increase the risk of adverse pregnancy outcomes, but the risk profiles of GWG rate are unclear. We aimed to examine the associations between GWG rate in the second/third trimester and a spectrum of pregnancy outcomes. This study consisted of 14 219 Chinese rural nulliparous women who participated in a randomised controlled trial of prenatal micronutrient supplementation during 2006–2009. The outcomes included stillbirth, neonatal and infant death, preterm birth, macrosomia, low birth weight (LBW) and large and small for gestational age (LGA and SGA, respectively). GWG rate was divided into quintiles within each BMI category. Compared with women in the middle quintile, those in the lowest quintile had higher risks of neonatal death (adjusted OR 2·27; 95 % CI 1·03, 5·02), infant death (adjusted OR 1·85; 95 % CI 1·02, 3·37) and early preterm birth (adjusted OR 2·33; 95 % CI 1·13, 4·77), while those in the highest quintile had higher risks of overall preterm birth (adjusted OR 1·28; 95 % CI 1·04, 1·59), late preterm birth (adjusted OR 1·25; 95 % CI 1·00, 1·56), LBW (adjusted OR 1·48; 95 % CI 1·02, 2·15), macrosomia (adjusted OR 1·89; 95 % CI 1·46, 2·45) and LGA (adjusted OR 1·56; 95 % CI 1·31, 1·85). In conclusion, very low and very high GWG rates in the second/third trimester appear to be associated with adverse pregnancy outcomes in Chinese nulliparous women, indicating that an appropriate GWG rate during pregnancy is necessary for neonatal health. [ABSTRACT FROM AUTHOR]

Objective: Although eating disorders in pregnancy have been studied extensively, little research attention has been given to disordered eating. The objectives of the present study were to determine the prevalence and levels of disordered eating in the perinatal period, and to identify risk factors and adverse outcomes of disordered eating during pregnancy. Method: A prospective longitudinal design with a quantitative approach was adopted. A consecutive sample of 1,470 Chinese pregnant women from hospitals in Hong Kong was assessed using standardized instruments at five time points from the first trimester to 6 months postpartum. Results: The levels of disordered eating changed significantly across trimesters. Higher levels of disordered eating in pregnancy were significantly associated with higher levels of disordered eating at 6 weeks and 6 months postpartum, greater anxiety and depressive symptoms, lower 1‐min Apgar scores, and abnormal birth weight. Discussion: The present study pointed to the need for more research and clinical attention to antenatal disordered eating given that it is associated with anxiety, depression, postpartum disordered eating and obstetric outcomes. [ABSTRACT FROM AUTHOR]

Objective. To examine if patients with PM/DM are at higher risk of complicated pregnancies. Methods. In a retrospective cohort in a large tertiary centre in North China, the outcomes of 144 pregnancies were evaluated in 62 women with PM/DM. Generalized linear mixed effect models were fitted to assess the effect of pregnancy occurring after disease on pregnancy outcomes including preterm birth (PTB), abortion (spontaneous or induced) and normal delivery. Adjustment for confounding factors including parity, maternal age and pregnancy-disease interval were achieved with a multivariable model. Results. For women who became pregnant after disease onset, there was significantly higher risk of either PTB or spontaneous abortion (adjusted odds ratio, OR= 9.36, 95% CI: 1.10, 79.88; P = 0.041). The odds increase was more prominent if PM/DM was also active during pregnancy (adjusted OR= 435.35, 95% CI: 5.32, 35628.18; P = 0.007). Disease flare upon conception was observed in 4 of 22 post-PM/DM pregnancies (P = 0.125), and responded well to steroids and IVIG but resulted in PTB or spontaneous abortion. Conclusion. PM/DM, [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate associations between pre-pregnancy body mass index (BMI) and adverse pregnancy outcomes among Chinese pregnant women. A prospective population-based cohort study was performed using data collected as part of the China-Anhui Birth Cohort Study or C-ABCS. A total of 13,121 pregnant women who received the first prenatal visit were enrolled from November 2008 to October 2010. Logistic regression analysis was used to calculate associations between pre-pregnancy BMI and pregnancy outcomes. Results indicated that the increased pre-pregnancy BMI was associated with a number of adverse pregnancy outcomes such as hypertensive disorder (adjusted relative risk (ARR) 2.3, 95% confidence interval [CI] 1.5–3.6), gestational diabetes (ARR 3.5, 95% CI 2.3–5.2), caesarean delivery (ARR 2.0, 95% CI 1.6–2.4), and medically indicated preterm delivery (ARR 1.8, 95% CI 1.1–2.9). Women with pre-pregnancy BMI above the normal range pose an increased risk of adverse pregnancy outcomes. [ABSTRACT FROM PUBLISHER]

Taking folic acid (FA) supplements reduces the risks of neural tube defects (NTDs) in early pregnancy. Obstetricians and specialists in women's health play important roles in promoting FA intake. However, surveys on their knowledge of, attitudes toward, and behavior regarding giving FA to pregnant women are limited. A cross-sectional study was conducted with 5,860 obstetricians and specialists in women's health using a self-administered questionnaire to collect information on participants' demographic characteristics and their knowledge of and attitudes toward and practices related to taking FA supplements. Chi-square analysis was used for rate comparison while logistic regression analysis was performed to predict influencing factors. For items on knowledge about FA and taking FA supplements the overall correct response rate was 60.3% (24,235/40,173). Questions about related practices and attitudes were correctly answered for the most part (more than 90%), but participants were less likely to follow the practice of prescribing FA tablets to women planning a pregnancy while working (77.2%). Statistical analysis indicated that the "Level of facility where the participant works" and "Rate of correct responses on a test of knowledge" were the main factors affecting participants' recommendation to take FA while "Job title", "Amount of professional work experience", and "Rate of correct responses on a test of knowledge" were the main factors affecting participants' prescription of FA. In conclusion, participants had a good deal of knowledge about NTDs and FA but the lack of some knowledge possibly led to the relatively low rate of correct behaviors. Therefore, educating obstetricians and specialists in women's health in this regard is crucial. [ABSTRACT FROM AUTHOR]

Abstract: Toxic heavy metals are released to the environment constantly from unregulated electronic waste (e-waste) recycling in Guiyu, China, and thus may contribute to the elevation of lead and other heavy metals levels in placenta. We aimed to investigate concentrations of heavy metals, including lead (Pb), cadmium (Cd), chromium (Cr), and nickel (Ni) in placenta from Guiyu and compared them with those from a control area where no e-waste processing occurs. Two hundred and twenty human placentas were collected from Guiyu (n =101) and the control area (n =119). The placenta concentrations of Pb, Cd, Cr, and Ni (PCPb, PCCd, PCCr, and PCNi) were determined by graphite furnace atomic absorption spectrometry (GFAAS). Risk factors of high exposure and correlation with adverse pregnancy outcomes were analyzed using Spearman correlation analyses. PCPb from Guiyu ranged from 6.51 to 3465.16ng/g with a median of 301.43ng/g, whereas PCPb from the control area ranged from 4.53 to 3176.12ng/g with a median of 165.82ng/g (P =0.010). We also observed that in Guiyu, 41.6% of women (42/101) had PCPb>500ng/gwt (wet weight), compared with 24.4% of women (29/119) in the control area (P =0.006). No significant differences of PCCd and PCCr were found between the two groups. In contrast, PCNi was higher in samples from the control area (median 14.30, range 1.76–593.70ng/g) than in Guiyu samples (median 7.64, range 1.19–1108.99ng/g) (P =0.000), and a negative correlation between PCNi and gestational age was found in this study (P =0.017). Spearman correlation analyses showed that there was correlation between PCPb and residence in e-waste recycling area. Environmental pollution, resulted from unregulated e-waste recycling activities, may contribute to elevated PCPb in neonates born in Guiyu and threaten their health. [Copyright &y& Elsevier]

Maternal anaemia is a common pregnancy complication in developing countries; however, its epidemiology remains largely unexplored in China. This study was designed to explore the epidemiology and risk factors of anaemia during pregnancy. A prospective cohort study was conducted, using data from a population-based pregnancy-monitoring system in 13 counties in East China (1993–96). Women who delivered singleton infants at 20–44 weeks with at least one haemoglobin assessment during pregnancy were included ( n = 164 667). The prevalence of anaemia (haemoglobin < 10 g/dL) during pregnancy as well as in each trimester was estimated. Multivariable log-binomial regression models were used to evaluate risk factors. The overall prevalence of anaemia in pregnancy was 32.6%, with substantial variations across trimesters (11.2%, 20.1% and 26.2% in the 1st, 2nd and 3rd trimesters respectively). Risk factors for anaemia included older maternal age, education below junior high school (prevalence rate ratio [RR] 1.10, 95% confidence interval [CI] 1.08, 1.12), farming occupation (1.05, 95% CI 1.03, 1.06), and mild pregnancy-induced hypertension (PIH) (RR 1.09, 95% CI 1.05, 1.13) and severe PIH (RR 1.13, 95% CI 1.06, 1.19). Peri-conception folic acid use was associated with a reduced risk for anaemia in the 1st trimester (RR 0.75, 95% CI 0.72, 0.78). Initiating prenatal care after the 1st trimester was associated with increased risk of anaemia in the 2nd and 3rd trimesters. Our study found anaemia during pregnancy is highly prevalent in this indigenous Chinese population. The risk increases with the severity of hypertensive disorders. Folic acid supplementation during the peri-conception period is associated with reduced risk of 1st trimester anaemia. [ABSTRACT FROM AUTHOR]

Background: The prevalence of obesity and excessive gestational weight gain (GWG) has been increasing worldwide. The aims of this study were to evaluate associations of prepregnancy body mass index (BMI) and rate of GWG in the 2nd and 3rd trimesters with pregnancy outcomes in Chinese urban women, and to examine the dose-response relationship between rate of GWG and pregnancy outcomes. Methods: A retrospective analysis included 8926 women who delivered live singletons at ≥28 weeks of gestation between June 2012 and March 2013 among Chinese urban women. BMI was classified into underweight (BMI < 18.5 kg/m2), normal weight (18.5 kg/m2 ≤ BMI < 24 kg/m2), overweight (24 kg/m2 ≤ BMI < 28 kg/m2) and obese (BMI ≥ 28 kg/m2) according to the Chinese standard. Rate of GWG in the 2nd and 3rd trimesters was classified as insufficient, adequate and excessive if it was below, within, or above the 2009 IOM guidelines (0.44–0.58 kg/w [underweight], 0.35–0.50 kg/w [normal], 0.23–0.33 kg/w [overweight], and 0.17–0.27 kg/w [obese]). Logistic regression models and restricted cubic spline analyses were used to assess the association of prepregnancy BMI and rate of GWG with cesarean delivery, preterm birth, small-for-gestational age (SGA) and large-for-gestational age (LGA). Results: 22.6 and 50.0% of women had insufficient and excessive rate of GWG, respectively. After adjustment for potential confounders, prepregnancy underweight was associated with increased risk of SGA (OR = 1.71, 95% CI: 1.40–2.09), while both overweight and obesity were associated with higher risk of cesarean delivery (overweight: OR [95% CI] = 1.80 [1.56–2.08]; obese: 2.34 [1.69–3.24]) and LGA (overweight: 1.75 [1.44–2.13]; obese: 2.48 [1.71–3.60]). Both insufficient (OR = 1.34, 95% CI: 1.08–1.65) and excessive rates of GWG (OR = 1.44, 95% CI: 1.20–1.73) were associated with higher risk of preterm birth. Insufficient rate of GWG was associated with increased odds of SGA (OR = 1.49, 95% CI: 1.16–1.82), while excessive rate of GWG was associated with higher risk for cesarean delivery (OR = 1.22, 95% CI: 1.10–1.35) and LGA (OR = 1.58, 95% CI: 1.33–1.87). Additionally, there were significant nonlinear associations between rate of GWG and preterm birth (U-shaped, P for nonlinear < 0.001). Conclusions: Prepregnancy overweight, obesity and underweight, and insufficient and excessive rate of GWG were associated with increased risk of pregnancy outcomes in Chinese urban women. [ABSTRACT FROM AUTHOR]