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Background Growth chart is a valuable clinical tool to monitor the growth and nutritional status of children. A growth chart widely used in China is based on the merged data sets of national surveys in 2005. We aimed to establish an up-to-date, complete growth curve for urban Chinese children and adolescents with a full range of ages. Methods Using data collected in a large-scale, cross-sectional study (Prevalence and Risk factors for Obesity and Diabetes in Youth (PRODY), 2017–2019), we analyzed 201,098 urban children aged 3 to 18 years from 11 provinces, autonomous regions, and municipalities that are geographically representative of China. All participants underwent physical examinations. Sex-specific percentiles of height-for-age and weight-for-age were constructed by Generalized Additive Models for Location Scale and Shape (GAMLSS) model. We also compared the median values of height-for-age or weight-for-age between our growth chart and the established growth reference using Welch-Satterthwaite T-Test. Results Consistent with the established growth reference, we observed that the P50 percentile of height-for-age reached plateaus at the age of 15 years (172 cm) and 14 years (160 cm) for boys and girls, respectively. In addition, boys aged 10 ~ 14 years and girls aged 10 ~ 12 years exhibited the most dramatic weight difference compared to those of other age groups (19.5 kg and 10.3 kg, respectively). However, our growth chart had higher median values of weight-for-age and height-for-age than the established growth reference with mean increases in weight-for-age of 1.36 kg and 1.17 kg for boys and girls, respectively, and in height-for-age of 2.9 cm and 2.6 cm for boys and girls, respectively. Conclusions Our updated growth chart can serve as a reliable reference to assess the growth and nutritional status in urban Chinese children throughout the entire childhood.

To investigate the association of chronic hypertension, gestational hypertension, and preeclampsia diseases with infant growth in the first 36 months of life, we conducted a retrospective birth cohort of 31,734 children born in Zhoushan Maternal and Child Care Hospital between January 2001 and May 2018. Birthweight, gestational age, and infant growth (weight, height, weight/height-for-age Z score, the weight gain during childhood) were the main outcomes. The associations of chronic hypertension, gestational hypertension, and preeclampsia diseases with birth outcomes and infant growth at children's age of 3, 6, 12, 18, and 24 months were analyzed by multivariable regression models. Gestational hypertension, preeclampsia diseases, and chronic hypertension were significantly associated with lower birthweight and shorter gestational age. Both gestational hypertension and preeclampsia diseases were respectively inversely associated with weight, weight-for-age Z score, height, and height-for-age Z score of children in the whole sample and sub-sample data analysis from birth to the age of 36 months, although correction for birthweight rendered the associations nonsignificant. No significant association of gestational hypertension, preeclampsia diseases, and chronic hypertension with weight gain was found. Conclusion: The inverse associations of gestational hypertension and preeclampsia diseases with infant growth in early childhood were mainly mediated by the effect of gestational hypertension and preeclampsia diseases on lower birthweight. What is Known: • Hypertensive disorders of pregnancy are associated with increased risk of adverse birth outcomes. What is New: • Both gestational hypertension and preeclampsia were respectively inversely associated with physical development of offspring from birth to the age of 36 months. • Lower birthweight might be the mediator of the inverse associations of gestational hypertension and preeclampsia diseases with infant growth in early childhood.

We aimed to investigate the association of maternal nausea and vomiting during pregnancy (NVP) with infant growth in the first 24 months of life and compare the effect of fetal gender. This prospective cohort study was conducted in Zhoushan Maternal and Child Health Hospital, Zhejiang, from 2011 to 2018. 1942 pairs of singleton newborns and their mothers were selected as participants. Main outcomes were gestational weight gain (GWG), birth outcomes (birthweight and gestational age) and infant growth [weight, height, weight/height-for-age Z score (WAZ/HAZ), the weight gain during childhood]. The associations of NVP with birth outcomes and infant growth at children’s age of 1, 3, 6, 12, 18, and 24 months were analyzed by multivariable regression models. Of the 1942 women, 1395 had NVP at first trimester (T1) and among them, 210 still experienced NVP at second trimester (T2). Compared with women without NVP, women experienced severe NVP at T1 were related with lower total GWG. Mild and moderate NVP at T1 were negatively associated with lower birthweight among women with male infants. Female infants exposed to maternal NVP at T1, especially for severe degree, were showed greater weight, WAZ, height, HAZ, and weight gain after 1 year old (at age of 12, 18, 24 months). No association between maternal NVP and infant growth was observed among male infants. Exposure to NVP at T1 was, respectively, associated with lower GWG. Favorable influence of NVP at T1 on infant growth was observed among female offspring.

Objective: We aimed to explore the effect of single nucleotide polymorphism (SNP) in the genes of the vitamin D (VitD) metabolic pathway and its interaction with VitD level during pregnancy on the development of hypertensive disorders of pregnancy (HDP). Methods: The study was conducted in the Zhoushan Maternal and Child Health Care Hospital, China, from August 2011 to May 2018. The SNPs in VitD metabolic pathway-related genes were genotyped. Plasma 25-hydroxyvitamin vitamin D (25(OH)D) levels was measured at first (T1), second (T2), and third (T3) trimesters. The information of systolic blood pressure (SBP) and diastolic blood pressure (DBP), and the diagnosis of HDP were extracted from the electronic medical record system. Multivariable linear and logistic regression models and crossover analysis were applied. Results: The prospective cohort study included 3699 pregnant women, of which 105 (2.85%) were diagnosed with HDP. After adjusting for potential confounders, VitD deficiency at T2, as well as the change of 25(OH)D level between T1 and T2, were negatively associated with DBP at T2 and T3, but not HDP. Polymorphisms in CYP24A1, GC, and LRP2 genes were associated with blood pressure and HDP. In addition, VitD interacted with CYP24A1, GC, and VDR genes’ polymorphisms on blood pressure. Furthermore, participants with polymorphisms in CYP24A1-rs2248137, LRP2-rs2389557, and LRP2-rs4667591 and who had VitD deficiency at T2 showed an increased risk of HDP. Conclusions: The individual and interactive association between VitD deficiency during pregnancy and SNPs in the genes of the VitD metabolic pathway on blood pressure and HDP were identified.

A prime–boost strategy of COVID-19 vaccines brings hope to limit the spread of SARS-CoV-2, while the immunogenicity of the vaccines is waning over time. Whether a booster dose of vaccine is needed has become a widely controversial issue. However, no published meta-analysis has focused on the issue. Therefore, this study assessed the immunogenicity and safety of the different combinations of prime–boost vaccinations. Electronic databases including PubMed, the Cochrane Library, Embase, medRxiv, Wanfang and CNKI were used to retrieve the original studies. A total of 28 studies, 9 combinations of prime–boost vaccinations and 5870 subjects were included in the meta-analysis, and random effect models were used to estimate pooled immunogenicity and safety. The immunity against COVID-19 after the prime vaccination waned over time, especially in the populations primed with inactivated vaccines, in which the seropositive rate of antibodies was only 28% (95% CI: 17–40%). Booster vaccination could significantly increase the antibody responses, and heterologous immunization was more effective than homologous immunization (neutralization titers: 1.65 vs. 1.27; anti-RBD IgG: 1.85 vs. 1.15); in particular, the combination of inactivated–mRNA vaccines had the highest antibody responses (neutralization titers: MRAW = 3.64, 95% CI: 3.54–3.74; anti-RBD IgG: 3.73, 95% CI: 3.59–3.87). Moreover, compared with the initial two doses of vaccines, a booster dose did not induce additional or severe adverse events. The administration of the booster dose effectively recalled specific immune responses to SARS-CoV-2 and increased antibody levels, especially in heterologous immunization. Considering the long-term immunogenicity and vaccine equity, we suggest that now, only individuals primed with inactivated vaccines require a booster dose.

We described the changing patterns of depression and anxiety status in different trimesters among Chinese pregnant women, and identified the modified form of SDS/SAS for pregnant women and assessed its reliability and validity.Changing patterns of depression/ anxiety status in different trimesters were described. The modified form of SDS/SAS was identified for pregnant women. Cohen's Kappa to measure agreement with SDS/SAS, and the ROC analysis was performed to assess its validity.The SDS score in 1st trimester was higher than 2nd and 3rd trimester; there was no significant difference between SDS score in 2nd and 3rd trimester. Modified form of SDS evaluated the depression; the areas under the curve (AUC) in testing group were up to 0.988, 0.989 and 0.992 for 1st, 2nd and 3rd trimester, respectively. Modified form of SAS evaluated the anxiety, the AUC in testing group were up to 0.987, 0.985, 0.987 for 1st, 2nd and 3rd trimester, respectively.Pregnant women had higher severity of depression and anxiety status in 1st trimester than that in 2nd and 3rd trimester. The modified form of SDS/SAS may be more brief and suitable to assess the depression and anxiety status in pregnant women.KEY POINTSPregnant women had a higher severity of depression and anxiety status in the 1st trimester than that in the 2nd and 3rd trimester.The present study suggests that prenatal depression and anxiety status are prevalent in Chinese pregnant women.Prevention or treatments focus on high-score items of SDS and SAS would be beneficial for rectifying prenatal depression and anxiety.

OBJECTIVE We aimed to describe the feature and the trajectory of blood pressure (BP) among pregnant women with onset of gestational hypertension. METHODS This epidemiology cohort study of pregnant women enrolled in Zhoushan, Zhejiang, included 4050 participants from the Zhoushan Pregnant Women Cohort. Each participant contributed up to eight serial perinatal visits of BP measurements from 2001 to 2018. Segmented mixed models were utilized to identify the dramatic change points in the relationship of BP elevation and gestational week among pregnant women with onset of gestational hypertension. RESULTS Despite of in which gestational week gestational hypertension developed, the SBP and DBP levels of pregnant women in each gestational hypertension category maintained the stable and normal levels (SBP

Importance Obesity is a public health challenge in China, but the geographical profiles of overweight and obesity among Chinese children are limited. Objective To examine regional disparities in the prevalence of obesity among the heterogeneous population of Chinese children and adolescents to provide a more accurate profile of obesity among children in China. Design, setting, and participants The Prevalence and Risk Factors for Obesity and Diabetes in Youth (PRODY) study was a cross-sectional survey study conducted from January 1, 2017, to December 31, 2019, among 201 098 children aged 3 to 18 years from 11 provinces, autonomous regions, and municipalities that produced a sample of Chinese children with a full range of ages and wide geographical coverage using a multistage, stratified, cluster-sampling design. Exposures Five regions geographically representative of China (northern, eastern, southern, western, and central). Main outcomes and measures The body weights and heights of all participants were measured. Multilevel, multinomial logistic regression models were used to estimate the prevalence of overweight and obesity. Results Among 201 098 healthy children (105 875 boys [52.6%]; mean [SD] age, 9.8 [3.8] years) from eastern, southern, northern, central, and western China, the highest obesity prevalence was estimated for children aged 8 to 13 years in northern China (from 18.8% [95% CI, 16.2%-21.7%] to 23.6% [95% CI, 20.5%-26.9%]) and for boys aged 3 to 6 years in western China (from 18.1% [95% CI, 10.4%-29.4%] to 28.6% [95% CI, 14.3%-49.0%]). Boys had a higher prevalence than girls of obesity only in eastern and northern China, with a mean difference in prevalence of 4.6% (95% CI, 3.8%-5.4%) and 7.6% (95% CI, 6.5%-8.6%), respectively. Conclusions and relevance In this survey study, substantial geographic disparities in the prevalence of obesity and overweight were found among the heterogeneous population of Chinese children. The results suggest that special attention should be paid to vulnerable children and that regionally adapted interventions are needed to efficiently mitigate obesity in children.

Optimal doses of vitamin D (VitD) supplement in different populations are unclear. We aim to evaluate the relationship between VitD supplementation and post-intervention serum 25-hydroxyvitamin D [25(OH)D] concentration, to provide a recommended dosage of VitD for achieving an optimal 25(OH)D concentration for different populations. Literature search was conducted in Embase, etc. Randomized controlled trials about VitD supplemental intakes and their effect on 25(OH)D concentration were enrolled. The effect on 25(OH)D concentration between different supplementation doses in each population group was compared by meta-analysis. Multivariate meta-regression model is utilized to establish reference intake dosage of VitD. A total of 136 articles were included about children (3–17 years), adults (18–64 years), postmenopausal women, the elderly ( >64 years), pregnant, or lactating women. Overall, intervention groups obtained higher 25(OH)D concentration than controls and there was obvious dose–response effect between intake dose and 25(OH)D concentration. Baseline 25(OH)D concentration and age were significant indicators for 25(OH)D concentration. To reach sufficient 25(OH)D concentration (75 nmol/L), the recommended VitD supplemental intakes was 1340 and 2250 IU/day for children and pregnant women, 2519 and 797 IU/day for European adults aged 18–64 and 65–85 years, 729, 2026, and 1229 IU/day for adults in North America, Asia and Middle East and Africa, respectively. Regional- and age-specific recommended dosages of VitD supplements for population to achieve optimal 25(OH)D concentrations have been suggested.

A number of SARS-CoV-2 variants that have evolved to have significant immune escape have emerged worldwide since the COVID-19 outbreak. The efficacy of prime vaccination is waning with the evolution of SARS-CoV-2, and the necessity of booster doses is more and more prominent. Therefore, this study aimed to compare the neutralization activity against the wild type and variants (Beta, Delta, and Omicron) in different prime–boost vaccination regimens. Electronic databases including PubMed, the Cochrane Library, Embase, medRxiv, Wanfang and CNKI were used to retrieve original studies. A total of 16 studies, 9 prime–boost vaccination regimes, and 3134 subjects were included in the meta-analysis and random effect models were used to estimate pooled neutralization titers. The neutralization activity against SARS-CoV-2 showed a significant decline with the evolution of the virus, especially in the populations primed with inactivated vaccines. For homologous immunization, only the populations boosted with mRNA vaccines consistently had a significant rise in neutralization titers (Beta: MD = 0.97; Delta: MD = 1.33; Omicron: MD = 0.74). While the heterologous immunization was more effective, the increment of neutralization titers against wild type, Beta, Delta and Omicron was 1.65 (95% CI: 1.32–1.96), 1.03 (95% CI: 0.53–1.54), 1.46 (95% CI: 1.07–1.85) and 1.15 (95% CI: 0.68–1.61), respectively. With the evolution of SARS-CoV-2, the effectiveness of prime immunization is waning. Although the administration of the booster dose could ameliorate the neutralization titers, homologous immunization regimens were gradually losing their effectiveness. Therefore, a heterologous booster dose is required, especially in populations primed with inactivated vaccines.

Maternal hemoglobin (Hb) is related to nutritional status, which affects neonatal birth weight. However, it is very common for maternal Hb to fluctuate during pregnancy. To evaluate the associations of maternal Hb in different time points and its changes during pregnancy with neonatal birth weight, small for gestational age (SGA)/low birth weight (LBW) and large for gestational age (LGA)/macrosomia, we conducted this study by using data from the Electronic Medical Record System (EMRS) database of Zhoushan Maternal and Child Care Hospital in Zhejiang province, China. The pregnancy was divided into five periods: first, early-second, mediate-second, late-second, early-third and late-third trimesters; we further calculated the maternal Hb changes during pregnancy. Overall, the socio-demographic characteristics, health-related information and childbirth-related information of 24,183 mother–infant pairs were obtained. The average Hb concentration during the different periods were 123.95 ± 10.14, 117.95 ± 9.84, 114.31 ± 9.03, 113.26 ± 8.82, 113.29 ± 8.68 and 115.01 ± 8.85 g/L, respectively. Significant dose–response relationships between maternal Hb and birth weight were observed in the first, late-second and later trimesters (p non-linear < 0.05). Maternal Hb < 100 g/L was related to a high risk of LGA/macrosomia in the late-second (OR: 1.47, 95% CI: 1.18, 1.83) and later trimesters; additionally, high maternal Hb (>140 g/L) increased the risk of SGA/LBW in the first (OR: 1.26, 95% CI: 1.01, 1.57) and late-third trimesters (OR: 1.96, 95% CI: 1.20, 3.18). In addition, the increase in maternal Hb from the late-second to late-third trimesters had a positive correlation with SGA/LBW. In conclusion, maternal Hb markedly fluctuated during pregnancy; the negative dose–response association of maternal Hb in the late-second and third trimesters, and Hb change during pregnancy with neonatal birth weight outcomes were observed, respectively. Furthermore, the phenomenon of high Hb in the first trimester and after the late-second trimester and the increase of maternal Hb from the late-second to late-third trimesters more significantly increasing the risk of SGA/LBW should especially be given more attention. Its biological mechanism needs to be further explored.

To explore the relationship between vitamin D pathway genes, gene-environment interactions and vitamin D level among southeast Chinese pregnant women.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.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.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.

Background: Evidence on amount and mode of physical activity (PA) is optimum for human health is limited. We aimed to determine the optimum amount and mode of PA in association with mortality. Methods: The data of this study was from the US National Institutes of Health–AARP Diet and Health Study from 1995 to 2011. PA was acquired using a self-report questionnaire. We used restricted cubic splines to fit PA time and amount for Cox proportional hazards of mortality. Cox proportional hazards regression was used to generate multivariable-adjusted hazard ratio (HR) and 95%CI of mortality. Results: 266,072 participants were included in this study. During a median follow-up of 7.12 years, there were 36,006 deaths from all cause. Anyway, compared with participants without PA, those with any amount of PA had lower risk of all-cause mortality; furthermore, the risk of all-cause mortality decreased rapidly until around 15.0 hours or 50.0 MET-hours per week of total PA, but the sharply decreasing trend of all-cause mortality risk was changed to slightly decreasing trend while time or amount of all PA increased. Similar trends were also observed in participants with light, moderate and vigorous PA, respectively. Compared participants without PA, those with the combination of 0.1 ~5.0 hours per week light PA, ≥5.0 hours per week moderate PA and ≥1.3 hours per week vigorous PA had relatively lowest risk not only for all-cause mortality, but also for cancer-cause, cardiovascular disease-cause, respiratory disease-cause and diabetes-cause mortality. Conclusions: This study found that any amount and intensity of PA certainly benefited on lowering mortality among all populations with different characteristics, and based on input-output ratio, up to 15.0 hours or 50.0 MET-hours per week of PA is optimal. The mode of combined light, moderate and vigorous PA is recommended. Funding: This study was funded by Chinese National Natural Science Foundation (81973055), Major research and development projects of Zhejiang science and Technology Department (2018C03010) and the Fundamental Research Funds for the Central Universities. Declaration of Interest: There was no conflict of interest. Ethical Approval: The NIH-AARP study was approved by the Special Studies Institutional Review Board of the National Cancer Institute, and all participants gave written informed consent.

Background: Geographical profiles of overweight and obesity in China are limited. We aimed to compare region-specific prevalences of overweight and obesity for Chinese children with a full range of ages and to describe the distribution of potential risk factors.Methods: We analyzed data from Prevalence and Risk factors for Obesity and Diabetes in Youth (PRODY) study, which was a cross-sectional survey of children aged 3-18 years from 11 provinces, autonomous regions, and municipalities that are geographically representative of western, southern, eastern, northern and central China. All participants underwent physical examinations, and their parents or caregivers completed online, self-administered questionnaires. We used multilevel logistic regression models to estimate prevalences of overweight and obesity and to assess related risk factors across sexes, age groups and regions. Findings: Between January 2017 and December 2019, 200,937 children in the PRODY study were included in our analysis. We found that children aged 8-13 years in northern China and children aged 3-5 years in western China were heavily burdened with overweight and obesity. In northern China the obesity prevalences peaked at 31·0% for boys and at 18·8% for girls, while in western China the prevalences of overweight and obesity peaked at 39·0% and 26·0%, respectively. Boys were vulnerable to overweight and obesity throughout all ages and regions (except western China). In addition, risk factors for overweight and obesity varied across ages, sexes and regions. Early-life factors (breast-feeding duration) and lifestyle factors (daily screen time, sleep time and exercise frequency) were the most important, modifiable factors for obesity control. Parental factors (parent’s overweight, socioeconomic characteristics and education status) had noteworthy impacts on their offspring’s overweight and obesity. Interpretation: The age- and sex-specific prevalences of overweight and obesity in Chinese children vary geographically; therefore, modifications of the major risk factors for the prevention and treatment of overweight and obesity should take age, sex and regional characteristics into consideration. Special attention should be paid to the most vulnerable children, and targeted interventions are urgently needed to mitigate the obesity burden in such a vast country. Funding: National Key RD National Natural Science Foundation of China; Zhejiang Provincial Key Science and Technology Project; Key Disciplines of Medicine; Fundamental Research Funds for the Central Universities. Declaration of Interest: We declare no competing interests. Ethical Approval: The study protocol was approved by the ethics review committee of The Children’s Hospital of the Zhejiang University (Approval Number:2016-JRB-018) and the cooperating institutions.

Summary Background & aims This study aims to explore the associations of vitamin D (VD) metabolic pathway gene with 25(OH)D level in pregnant women and the interactions of SNP with season and VD supplement. Methods A total of 2658 pregnant women were selected from Zhoushan Pregnant Women Cohort study. Gestational 25(OH)D level and single nucleotide polymorphism (SNP) of VD metabolic pathway gene were detected. Multilinear regression models were used to estimate associations of SNPs with gestational 25(OH)D levels. Stratified analyses were performed to test the interactions of SNP with season and VD supplements. Results The mutations of rs2298849 and rs7041 on the GC gene were respectively associated with higher 25(OH)D in the first and third trimester; the mutations of seven SNPs (rs1155563, rs16846876, rs17467825, rs2282679, rs2298850, rs3755967, and rs4588) on the GC gene were respectively associated with lower 25(OH)D both in the first and third trimester, and lower changes in 25(OH)D during late pregnancy. The mutations of above seven SNPs, except for rs1155563, were also respectively associated with lower 25(OH)D in the second trimester, but to a lesser extent; Besides, pregnant women with mutation on CYP24A1-rs2209314 had a higher increment in 25(OH)D than their counterparts in the second trimester. The increasing dose effect of Gc isoform on 25(OH)D was observed. The associations of GC and LRP2 genes with 25(OH)D modified by season and VD supplements. Conclusions The polymorphisms of VD metabolic pathway gene were associated with gestational 25(OH)D, and the associations differ by seasons and VD supplements. Gc isoform exerted a profound influence on gestational 25(OH)D.

Hemoglobin (Hb) measurement is a conventional test during perinatal visits. Hb concentration is related to iron supplement. However, studies focusing on Hb levels, iron supplement, and pregnancy outcomes are scarce. This study aimed to determine whether Hb levels and iron supplement were associated with the risk of gestational diabetes mellitus (GDM).A running hospital-based cohort was conducted from August, 2011. The demographic data and medical information were collected individually through questionnaires and patient medical records. Multiple linear regression was applied for the association between Hb levels, iron supplement, and blood glucose. Multiple logistic regression was used for evaluating odds ratios between Hb levels, iron supplement, and GDM.Hb levels during first (T1) and second trimester (T2) of pregnancy were significantly and positively associated with blood glucose and GDM risk. After adjusting for age, prepregnancy body mass index, and other risk factors, pregnant women with Hb ≥ 11 g/dL and iron supplement had higher postprandial blood glucose at 1 hour (Hb ≥ 11 g/dL in T2 and iron supplement in T1: β = 0.860，P =0.001; Hb ≥ 11 g/dL in T2 and iron supplement in T2: β = 0.960，P 0.001; Hb ≥ 11 g/dL in T1 and iron supplement in T2: β = 1.133, P = 0.033) and GDM risks (odds ratio [OR] = 1.53, 95% confidence interval [CI]: 1.05-2.24; OR = 1.92, 95% CI: 1.13-3.35; OR = 2.15, 95% CI: 1.07-4.34, respectively), compared with those with Hb 11 g/dL and without iron supplement.High Hb concentration and iron supplements without anemia increased postprandial blood glucose and risks for GDM. It indicates that pregnant women with good Hb levels should not be advised to take iron supplements during pregnancy.背景: 血红蛋白(Hemoglobin, Hb)测定是孕期的常规检查, Hb浓度与铁的补充有关。然而, 有关Hb水平、铁补充和妊娠结局的研究很少。本研究旨在探索Hb水平和铁补充剂是否与妊娠糖尿病(Gestational diabetes, GDM)的发生风险有关。 方法: 2011年8月开始以医院为基础建立动态队列研究。通过问卷调查和电子医疗系统收集社会人口学特征和医疗信息等。采用多元线性回归分析Hb、补铁和血糖的关系；采用多元logistic回归估计Hb、补铁对GDM的比值比。 结果: 孕早期和孕中期的Hb水平均与血糖值以及GDM发生风险呈正相关。调整年龄、孕前BMI等因素后, 与Hb11g/dL并且不补铁相比, Hb≥11g/dL且补铁的孕妇餐后1小时血糖较高(孕中期Hb≥11g/dL且孕早期补铁: β=0.860, P0.001；孕中期Hb≥11g/dL且孕中期补铁:β= 0.960, P0.001；孕早期Hb≥11g/dL且孕中期补铁:: β=1.133, P= 0.033), GDM的患病风险也更高(OR=1.53, 95%CI: 1.05-2.24; OR= 1.92,95% CI: 1.13-3.3; OR=2.15, 95%CI: 1.07-4.34)。 结论: 血红蛋白较高的非贫血孕妇补铁会增加餐后血糖水平且增加GDM的患病风险。提示在血红蛋白水平较高的孕妇中不建议进行孕期补铁。.

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 (β = 99.5 g, P = 0.0002), gestational age-specific Z-score of birth weight (β = 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 (β = 161.4 g, P = 0.0192), gestational age-specific Z-score of birth weight (β = 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 (β = 125.8 g, P = 0.0010), gestational age-specific Z-score of birth weight (β = 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.

Background and aims To investigate the effects of serum uric acid (SUA) level and its fluctuation on renal dysfunction in gout patients. Methods and results Data on gout patients was collected from Huzhou city electronic medical record system data sharing platform, and information about relevant diagnoses, prescriptions, biochemical indexes and imaging characteristics was extracted. The gout patients with baseline normal renal function were enrolled in this analysis, and the estimated glomerular filtration rate (eGFR) Conclusion Regardless of the baseline SUA level, SUA >10 mg/dL was a significant risk factor for renal dysfunction. SUA between 6 and 10 mg/dL was a potential risk factor for renal dysfunction. No significant correlation of SUA fluctuation and renal function was found.

To investigate the association of VitD with GDM, and examine the potential modifying effect of prepregnancy BMI in Chinese pregnant women.3318 pregnant women underwent oral glucose tolerance test (OGTT) were selected from Zhoushan Pregnant Women Cohort. Plasma VitD levels were measured in the first (T1) and/or second trimester (T2). Multiple linear and logistic regression models were used for evaluating the association of VitD with GDM.Prepregnancy BMI was positively associated with all three time-point glucose of OGTT. 25(OH)D level in T1 (β = -0.003) and T2 (β = -0.004), and its change from T1 to T2 (β = -0.004) were significantly and inversely associated with fasting blood glucose (FBG) of OGTT, but not 1-h and 2-h postload blood glucose of OGTT, respectively. The negative associations of VitD and FBG were stronger among overweight/obese women. VitD deficiency (25(OH)D20 ng/ml) in T2 was associated with an increased risk of GDM with increased FBG, GDM subtype 1 (OR: 2.10) and subtype 3 (OR: 2.19). Moreover, prepregnancy BMI modified this effect on GDM subtype 1 (BMI24: OR = 1.42; BMI ≥ 24: OR = 9.61, P for interaction = 0.002). Lower VitD increment from T1 to T2 was associated with a higher risk for GDM among overweight/obese women. Additionally, GDM prevalence fluctuated with the season, i.e. lower in summer/fall and higher in winter/spring.Maternal VitD deficiency was associated with a higher risk of GDM subtype with increased FBG, and the risk is much greater among overweight/obesity women. The lower the VitD increment during pregnancy, the greater the risk of GDM, especially in overweight/obesity women. Furthermore, seasonal variation of GDM may be exhibited as a critical confounder in the association of VitD and GDM.

Little is known about variation of vitamin D (VD) status during pregnancy among Chinese women. This study is to assess the change of VD status during pregnancy and its influencing factors among Chinese women.A running cohort study has being conducted in southeast China. The pregnant women were interviewed and the peripheral blood samples were collected at the first (T1), second (T2) and third trimester (T3), respectively. 25(OH)DThere were 4368 pregnant women enrolled in the current study. The 25(OH)D concentration increased notably with gestational week. The average plasma 25(OH)D concentration in T1, T2 and T3 was 18.94 ± 8.74, 23.05 ± 11.15, and 24.65 ± 11.59 ng/mL, respectively. Correspondingly, VD deficiency (25(OH)D 20 ng/mL) rate was 65.26%, 33.56% and 32.12%. In T1 phase, higher pre-pregnancy BMI, more parity, sampling in summer/autumn were related to higher 25(OH)D level, and similar patterns were observed in T2 and T3 phase. There was positive dose-response effect between VD supplement frequency and 25(OH)D concentration during pregnancy, adjusting for potential confounders (T1: β(SE) = 3.907 (0.319), P 0.001; T2: β(SE) = 2.780 (0.805), P 0.001; T3: β(SE) = 3.640 (1.057), P = 0.006). Not surprisingly, supplementing VD 3 times/week reduced the risk of VD deficiency during pregnancy significantly, compared to without VD supplement (T1: OR = 0.30, 95% CI: 0.24-0.37; T2: 0.56, 0.38-0.82; T3: 0.67, 0.44-0.96).VD level increased with gestational week among Chinese pregnant women. High frequency of VD supplement during pregnancy is an effective way to reduce risk of VD deficiency, especially among the pregnant women with younger age, low prepregnancy BMI and primipara, and during winter and spring season.

Optimal doses of vitamin D (VitD) supplement in different populations are unclear. We aim to evaluate the relationship between VitD supplementation and post-intervention serum 25-hydroxyvitamin D [25(OH)D] concentration, to provide a recommended dosage of VitD for achieving an optimal 25(OH)D concentration for different populations.Literature search was conducted in Embase, etc. Randomized controlled trials about VitD supplemental intakes and their effect on 25(OH)D concentration were enrolled. The effect on 25(OH)D concentration between different supplementation doses in each population group was compared by meta-analysis. Multivariate meta-regression model is utilized to establish reference intake dosage of VitD.A total of 136 articles were included about children (3-17 years), adults (18-64 years), postmenopausal women, the elderly ( 64 years), pregnant, or lactating women. Overall, intervention groups obtained higher 25(OH)D concentration than controls and there was obvious dose-response effect between intake dose and 25(OH)D concentration. Baseline 25(OH)D concentration and age were significant indicators for 25(OH)D concentration. To reach sufficient 25(OH)D concentration (75 nmol/L), the recommended VitD supplemental intakes was 1340 and 2250 IU/day for children and pregnant women, 2519 and 797 IU/day for European adults aged 18-64 and 65-85 years, 729, 2026, and 1229 IU/day for adults in North America, Asia and Middle East and Africa, respectively.Regional- and age-specific recommended dosages of VitD supplements for population to achieve optimal 25(OH)D concentrations have been suggested.

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.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.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.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.

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. 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. 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. 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.

AIM The objective of the study is to explore the relationship between the dietary diversity score (DDS) and anxiety and depression of perinatal women. METHODS The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and the dietary recall questionnaire were used to measure the status of depression, anxiety and dietary diversity at T1 (first trimester), T2 (second trimester), T3 (third trimester) and T4 (post-partum). The association of dietary diversity and food groups with depression and anxiety status were estimated by linear and logistic regression models. RESULTS The prevalence of depression and anxiety status were the highest at T1, which were 35.58% and 22.57%, respectively. Cross-sectional and longitudinal association of DDS with SDS and SAS was estimated by ordinary or multilevel linear or logistic model. In the cross-sectional analysis, high dietary status (>6) was negatively associated with depression status [T1: OR (95% CI) = 0.56 (0.46, 0.69); T2: 0.55 (0.36, 0.84); T3: 0.45 (0.31, 0.65); T4: 0.58 (0.34, 0.99)] and anxiety status [T1: OR (95% CI) = 0.70 (0.56, 0.88); T2: 0.42 (0.27, 0.65)]. In the longitudinal analysis, it was demonstrated that the DDS level was negatively associated with SDS [β(se) = -0.99 (0.09), P =

The objective of the study is to explore the relationship between the dietary diversity score (DDS) and anxiety and depression of perinatal women.The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and the dietary recall questionnaire were used to measure the status of depression, anxiety and dietary diversity at T1 (first trimester), T2 (second trimester), T3 (third trimester) and T4 (post-partum). The association of dietary diversity and food groups with depression and anxiety status were estimated by linear and logistic regression models.The prevalence of depression and anxiety status were the highest at T1, which were 35.58% and 22.57%, respectively. Cross-sectional and longitudinal association of DDS with SDS and SAS was estimated by ordinary or multilevel linear or logistic model. In the cross-sectional analysis, high dietary status (6) was negatively associated with depression status [T1: OR (95% CI) = 0.56 (0.46, 0.69); T2: 0.55 (0.36, 0.84); T3: 0.45 (0.31, 0.65); T4: 0.58 (0.34, 0.99)] and anxiety status [T1: OR (95% CI) = 0.70 (0.56, 0.88); T2: 0.42 (0.27, 0.65)]. In the longitudinal analysis, it was demonstrated that the DDS level was negatively associated with SDS [β(se) = -0.99 (0.09), P = 0.0001] and SAS scores [β(se) = -0.37 (0.08), P = 0.0001] throughout pregnancy. There was a negative relationship between some food groups and SDS or SAS scores at different periods.A negative relationship between DDS and depression as well as anxiety was found among prenatal and post-partum women.

Background Pregnancy is a critical time of altered metabolic function and changed lipid profiles. Maternal hyperlipidemia has been shown to be associated with maternal and offspring adverse outcomes, yet no consistence reference values for lipids exist in pregnancy period, and there are no recommended lipid levels for Chinese pregnant women. The object of this study was to describe lipid levels during pregnancy and establish the reference ranges of lipids in Chinese pregnant women. Methods In total, 14,739 pregnant females and 183,787 non-pregnant females who underwent measurement of serum lipids were taken as parent dataset. For controlling confounding from age and BMI, a 1:1 matched pair analysis was used to compare the difference in lipid levels between pregnant and non-pregnant females. Pairs were matched by BMI (± 1 kg/m2) and age (± 1 year). Multi-index method was used to determine reference ranges in healthy pregnant women with normal pre-pregnancy BMI. Results Concentrations of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were higher in pregnant women compared to non-pregnant women. With pregnancy development, TC, TG, and HDL-C increased from 1st trimester to 2nd and 3rd trimesters, and LDL-C decreased in the third trimester. The reference ranges were recommended as the levels of TC no greater than 9.02 mmol/L, TG no greater than 5.88 mmol/L; HDL-C no less than 1.03 mmol/L and LDL-C no greater than 5.65 mmol/L. Conclusion Obvious higher lipid concentrations were observed during pregnancy compared to non-pregnant females. Hence, reference ranges of lipid profiles from the general population are not appropriate for pregnant women. Furthermore, this study provided reference ranges of lipid profiles for Chinese pregnant women.