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Objective: Ferritin levels are well known to be associated with gestational diabetes mellitus (GDM). However, the association of the combination of ferritin and triglyceride (TG) levels in early mid‐pregnancy with GDM has not been studied in depth. We investigated the independent and combined relationships of plasma ferritin and TG concentrations with the risk of GDM as well as the mediation effect of TG on ferritin. Methods: We analysed 2071 pregnant women from the Tongji Maternal and Child Health Cohort who had their plasma ferritin and TG concentrations measured at 11–20 weeks of gestation. Associations between ferritin and TG concentrations and GDM risk were estimated using multivariable logistic regression models. Youden's index was calculated to find the cut‐off values of ferritin and TG by ROC curve analysis. The mediation effect of the TG concentration on the ferritin level with GDM risk was explored by a mediation analysis. Results: A total of 264 (12.3%) participants developed GDM. The median and IQR of ferritin was 53.9 (30.5–92.7) ng/mL. After adjusting for potential confounders, the relative risks (RRs) and 95% confidence intervals of GDM were 2.19 (1.42, 3.39) for ferritin and 2.02 (1.37, 2.97) for TG. The adjusted RR for combination was 2.40 (1.62, 3.55). Moreover, we found that the TG concentration mediated 15.0% of the total effect of the ferritin concentration on the risk of GDM. Conclusions: Women with a combination of both high plasma ferritin (˃55.7 ng/mL) and high TG (˃1.9 mmoL/L) were at the highest risk of GDM. Additionally, we have revealed for the first time that an elevated maternal TG concentration in early pregnancy mediates the relationship between ferritin concentration and GDM risk. Trial registration: This trial is registered at https://ClinicalTrials.gov as NCT03099837. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between patterns of gestational weight gain (GWG) and allergic diseases in offspring. Design: Prospective cohort study. Setting: Prenatal clinics in Wuhan, China. Population: A cohort of 2546 mother and offspring pairs were enrolled before 16 weeks of gestation and followed up to 24 months postpartum. Methods: Maternal body weights were measured regularly during pregnancy, and their GWG patterns were estimated using the growth mixture model. Robust Poisson models were used to evaluate relative risk (RR) and 95% CI after multivariable adjustment. Main outcome measures: Offspring atopic allergy and allergic contact dermatitis were defined according to a physician's diagnosis reported by the mother, and food allergy was reported by the mother. Results: Three GWG patterns were identified: 18.1% (461) of the women were described as pattern 1, characterised by rapid GWG earlier in pregnancy; 56.6% (1442) of the women were described as pattern 2, with steady GWG throughout pregnancy; and 25.3% (643) of the women was described as pattern 3, with rapid GWG later in pregnancy. By the age of 24 months, 360 (14.1%), 109 (4.3%) and 757 (29.7%) offspring had atopic allergy, allergic contact dermatitis or food allergy, respectively. Compared with women in GWG pattern 2, the RRs (95% CIs) among women in pattern 1 were 0.74 (0.55–0.99) for atopic allergy, 0.64 (0.36–1.15) for allergic contact dermatitis and 0.95 (0.81–1.12) for food allergy. Conclusions: Maternal GWG pattern characterised by rapid GWG earlier in pregnancy was associated with a lower risk of atopic allergy in offspring. [ABSTRACT FROM AUTHOR]

We used two a priori diet scores [Mediterranean diet (aMed) and Diet Balance Index (DBI)] and two a posteriori approaches [principal components analysis (PCA) and reduced-rank regression (RRR)] to examine the association of maternal dietary patterns with risk of gestational diabetes mellitus (GDM) and blood glucose among 2202 pregnant women in the Tongji Birth Cohort. Compared to the highest quartile of the aMed and legumes-vegetables-fruits (derived by PCA) scores, the fasting blood glucose (FBG) levels were higher in the lower quartiles (p-trend < 0.05). Lower scores of the meats-eggs-dairy (derived by PCA) and eggs-fish patterns (derived by RRR; characterised by higher intakes of freshwater fish, eggs, and lower intakes of leafy and cruciferous vegetables and fruits) were associated with decreased FBG levels (p-trend < 0.05). Similarities were found across approaches that some dietary patterns were associated with FBG, but not with postprandial glucose and GDM risk. [ABSTRACT FROM AUTHOR]

Maternal gestational weight gain (GWG) is an important determinant of infant birth weight, and having adequate total GWG has been widely recommended. However, the association of timing of GWG with birth weight remains controversial. We aimed to evaluate this association, especially among women with adequate total GWG. In a prospective cohort study, pregnant women's weight was routinely measured during pregnancy, and their GWG was calculated for the ten intervals: the first 13, 14–18, 19–23, 24–28, 29–30, 31–32, 33–34, 35–36, 37–38 and 39–40 weeks. Birth weight was measured, and small-for-gestational-age (SGA) and large-for-gestational-age were assessed. Generalized linear and Poisson models were used to evaluate the associations of GWG with birth weight and its outcomes after multivariate adjustment, respectively. Of the 5049 women, increased GWG in the first 30 weeks was associated with increased birth weight for male infants, and increased GWG in the first 28 weeks was associated with increased birth weight for females. Among 1713 women with adequate total GWG, increased GWG percent between 14 and 23 weeks was associated with increased birth weight. Moreover, inadequate GWG between 14 and 23 weeks, compared with the adequate GWG, was associated with an increased risk of SGA (43 (13·7 %) v. 42 (7·2 %); relative risk 1·83, 95 % CI 1·21, 2·76). Timing of GWG may influence infant birth weight differentially, and women with inadequate GWG between 14 and 23 weeks may be at higher risk of delivering SGA infants, despite having adequate total GWG. [ABSTRACT FROM AUTHOR]

Purpose: To assess the association between vitamin D (VD) supplementation and the risk of lower respiratory tract infection (LRTI) among infants. Methods: This is a nested case–control study from an ongoing prospective birth cohort in Wuhan from 2013. Cases were subjects free of neonatal pneumonia but later developed LRTI during infancy, who were matched with five randomly selected controls by infant sex, birth year, and birth season. We included 190 cases and 950 controls in the final analysis. The primary outcome was the first LRTI incident and the exposure was VD supplementation from birth to the index endpoint. The association between VD supplementation and LRTI risk was assessed using the Cox proportional-hazards regression model. Results: Infants taking supplements had a 59% relative reduction in the hazard ratio of LRTI (HR = 0.41; 95% CI 0.26, 0.64) compared to those not supplemented. There was a linear relationship between LRTI risk and VD supplementation within range of 0–603 IU/day: for each 100 IU per day increment in VD supplementation, infants experienced a 21% lower risk of developing LRTI (adjusted HR: 0.79; 95% CI 0.71, 0.89). The linear relationship was stably observed in the sensitivity analyses as well. Conclusions: VD supplementation was associated with the reduced risk of LRTI throughout infancy, and the optimal supplementation dose for infants may be beyond the current recommendation. [ABSTRACT FROM AUTHOR]

The high overall plant-based diet index (PDI) is considered to protect against type 2 diabetes in the general population. However, whether the PDI affects gestational diabetes mellitus (GDM) risk among pregnant women is still unclear. We evaluated the association between PDI and GDM risk based on a Chinese large prospective cohort – the Tongji Maternal and Child Health Cohort. Dietary data were collected at 13–28 weeks of pregnancy by a validated semi-quantitative FFQ. The PDI was obtained by assigning plant food groups positive scores while assigning animal food groups reverse scores. GDM was diagnosed by a 75 g 2-h oral glucose tolerance test at 24–28 weeks of gestation. Logistic regression models were fitted to estimate OR of GDM, with associated 95 % CI, comparing women in different PDI quartiles. Among the total 2099 participants, 169 (8·1 %) were diagnosed with GDM. The PDI ranged from 21·0 to 52·0 with a median of 36·0 (interquartile range (IQR) 33·0–39·0). After adjusting for social-demographic characteristics and lifestyle factors etc., the participants with the highest quartile of PDI were associated with 57 % reduced odds of GDM compared with women in the lowest quartile of PDI (adjusted OR 0·43; 95 % CI 0·24, 0·77; Pfor trend = 0·005). An IQR increment in PDI was associated with 29 % decreased odds of GDM (adjusted OR 0·71; 95 % CI 0·56, 0·90). Findings suggest that adopting a plant-based diet during pregnancy could reduce GDM risk among Chinese women, which may be valuable for dietary counselling during pregnancy. [ABSTRACT FROM AUTHOR]

Background The association between iron supplementation and gestational diabetes mellitus (GDM) is still inconclusive, and this association has not been extensively studied in relation to plasma ferritin in the early second trimester. Objectives We aimed to prospectively examine the independent and combined associations of plasma ferritin concentrations and iron supplement use with GDM. Methods We studied 2117 women from the Tongji Maternal and Child Health Cohort in Wuhan, China. Plasma ferritin around 16 weeks' gestation was measured by ELISA kits and information on iron supplement use was collected by questionnaires. GDM was diagnosed by a 75-g oral-glucose-tolerance test (OGTT) at 24–28 weeks' gestation. A log-Poisson regression model was used to estimate the RR of GDM associated with plasma ferritin and iron supplementation. Results The median and IQR of plasma ferritin was 52.1 (29.6–89.9) ng/mL, and 863 (40.8%) participants reported use of iron supplements during the second trimester. A total of 219 (10.3%) participants developed GDM. Adjusted RRs (95% CIs) for GDM across increasing quartiles of plasma ferritin were 1.00 (reference), 2.14 (1.37, 3.34), 2.03 (1.30, 3.19), and 2.72 (1.76, 4.21), respectively. After adjustment, supplemental iron ≥60 mg/d during the second trimester was associated with an increased risk of GDM compared with nonusers (RR: 1.37; 95% CI: 1.02, 1.84). Conclusions Both elevated plasma ferritin concentrations in the early second trimester and use of ≥60 mg/d of supplemental iron during pregnancy are independently associated with increased risk of GDM. Further clinical trials with precision nutrition approaches considering both baseline iron status and supplement use are needed to evaluate the benefits and risks of iron supplementation during pregnancy. [ABSTRACT FROM AUTHOR]

We aimed to assess protein nutrition status during pregnancy by maternal plasma total protein (MTP) levels in urban pregnant women and to explore the association between the trimester‐specific MTP levels and risk of preterm birth (PTB). A prospective design was conducted in 3,382 mother‐newborn pairs with the second‐trimester maternal MTP information and in 3,478 mother‐newborn pairs with the third‐trimester MTP information. Multiple Cox proportional hazard regression and multiple linear regression were used to analyse the associations between MTP levels and PTB risk as well as gestational duration, respectively. Nearly all the second‐trimester MTP levels were within the clinical reference range, but more than 40% of the third‐trimester MTP levels were less than the lower limit of normal. No significant association was found between the second‐trimester MTP level and PTB risk. However, the adjusted hazard ratios (HRs) of PTB across increasing quartiles of the third‐trimester MTP levels were 1.00 (reference), 0.59 (0.36, 0.95), 0.35 (0.20, 0.60), and 0.32 (0.19, 0.53) (pfor trend < 0.001), respectively. Each standard deviations increment of the third‐trimester MTP was associated with increase of 0.13 weeks in gestational duration. Moreover, stratified analyses showed that the effects of third‐trimester MTP on PTB risk and gestational duration were stronger in pregnant women carrying female offspring than those carrying male offspring (pfor interaction < 0.05). The third‐trimester MTP level was inversely associated with PTB risk and was positively associated with gestational duration. Improving third‐trimester MTP level may be helpful for preventing PTB. [ABSTRACT FROM AUTHOR]

Investigators in previous studies have drawn inconsistent conclusions regarding the relationship between relatively low exposure to fine particulate matter (particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5)) and risk of gestational diabetes mellitus (GDM), while the association between high PM2.5 exposure and GDM risk has not been well studied. We investigated the association of high PM2.5 exposure during pregnancy with blood glucose levels and GDM risk in Chinese women. The present study was conducted from August 2013 to May 2016 among 3,967 pregnant women in the Tongji Maternal and Child Health Cohort in Wuhan, China. PM2.5 exposure during pregnancy for each participant was estimated by means of land-use regression models. An interquartile-range increase in PM2.5 exposure (33.84 μg/m3 for trimester 1 and 33.23 μg/m3 for trimester 2) was associated with 36% (95% confidence interval (CI): 1.15, 1.61) and 23% (95% CI: 1.01, 1.50) increased odds of GDM during trimester 1 and trimester 2, respectively. An interquartile-range increment of PM2.5 exposure during trimester 1 increased 1-hour and 2-hour blood glucose levels by 1.40% (95% CI: 0.42, 2.37) and 1.82% (95% CI: 0.98, 2.66), respectively. The same increment of PM2.5 exposure during trimester 2 increased fasting glucose level by 0.85% (95% CI: 0.41, 1.29). Our findings suggest that high PM2.5 exposure during pregnancy increases blood glucose levels and GDM risk in Chinese women. [ABSTRACT FROM AUTHOR]

Vitamin D deficiency has been reported to be associated with respiratory tract infection (RTI). However, evidence regarding the effects of vitamin D supplementation on susceptibility of infants to RTI is limited. In this prospective birth cohort study, we examined whether vitamin D supplementation reduced RTI risk in 2,244 infants completing the follow‐up from birth to 6 months of age. The outcome endpoint was the first episode of paediatrician‐diagnosed RTI or 6 months of age when no RTI event occurred. Infants receiving vitamin D supplements at a daily dose of 400–600 IU from birth to the outcome endpoint were defined as vitamin D supplementation and divided into four groups according to the average frequency of supplementation: 0, 1–2, 3–4, and 5–7 days/week. We evaluated the relationship between vitamin D supplementation and time to the first episode of RTI with Kaplan–Meier plots. The associations of vitamin D supplementation with infant RTI, lower RTI (LRTI), and RTI‐related hospitalization were assessed using modified Poisson regression. The median time to first RTI episode was 60 days after birth (95% CI [60, 90]) for infants without supplementation and longer than 6 months of age for infants with supplementation (p <.001). We observed inverse trends between supplementation frequency and risk of RTI, LRTI, and RTI‐related hospitalization (p for trend <.001), with the risk ratios in the 5–7 days/week supplementation group of 0.46 (95% CI [0.41, 0.50]), 0.17 (95% CI [0.13, 0.24]), and 0.18 (95% CI [0.12, 0.27]), respectively. These associations were significant and consistent in a subgroup analysis stratified by infant feeding. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding has many established health benefits to both babies and mothers. There is limited evidence on the association between delayed lactogenesis and breastfeeding practices.Objective: We assessed the association between delayed lactogenesis and breastfeeding practices in women initiating breastfeeding.Design: We used data from a prospective cohort study in Wuhan, China, which enrolled pregnant women at 8-16 weeks of gestation and followed up to postpartum. Women were included who had a singleton live birth, initiated breastfeeding, and provided information on infant feeding. Maternal lactogenesis status was assessed by face-to-face interview at day 4 postpartum. Breastfeeding practices (full breastfeeding and/or any breastfeeding) were queried by telephone interview at 3, 6, and 12 mo postpartum. Poisson regression and Cox regression were used to identify the association between delayed lactogenesis and breastfeeding practices.Results: Delayed lactogenesis was reported by 17.9% of the 2877 participants. After adjusting for potential confounders, when compared with timely lactogenesis, delayed lactogenesis was significantly associated with higher risk of inability to sustain full breastfeeding at 3 mo postpartum (RR: 1.24, 95% CI: 1.10, 1.39) and 6 mo postpartum (RR: 1.14, 95% CI: 1.04, 1.24). Delayed lactogenesis was also significantly associated with early termination of any breastfeeding (HR: 1.15, 95% CI: 1.01, 1.30) in the adjusted model. In a combined analysis, women with higher gestational weight gain (GWG, ≥16 kg for underweight and normal weight, 15 kg for overweight/obesity) and who subsequently experienced delayed lactogenesis had the highest risk of ending any breastfeeding earlier (adjusted HR: 1.32, 95% CI: 1.11, 1.55) compared with those who gained less GWG and experienced timely lactogenesis.Conclusions: This study shows that delayed lactogenesis was associated with low rate of full breastfeeding and shorter duration of any breastfeeding. Greater efforts to promote breastfeeding should be targeted towards women with delayed lactogenesis. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether increased carotenoids intake was associated with reduced risk of gestational diabetes mellitus (GDM). We performed a cross-sectional analysis using data from Tongji Maternal and Child Health Cohort study. The dietary carotenoids intake of 1978 pregnant women was assessed using a researcher-administered FFQ before undertaking an oral glucose tolerance test at 24–28 weeks. Multivariate logistic and linear regression analyses were used to obtain the effect estimates. Participants in the highest quartile of lycopene intake showed a lower risk of GDM (OR 0·50; 95 % CI 0·29, 0·86; P for trend = 0·007) compared with those in the lowest quartile; each 1 mg increase in lycopene consumption was associated with a 5 % (95 % CI 0·91, 0·99; P for trend = 0·020) decrease in GDM risk. No significant association was found between α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin intake and GDM risk. Multiple linear regression analysis suggested an inverse association between lycopene intake and fasting blood glucose (FBG) (P for trend < 0·001); each 1 mg increase in lycopene intake was associated with 0·005 (95 % CI 0·002, 0·007; P for trend < 0·001) mmol/l decrease in FBG. Interaction analysis indicated consistent effect on each age or pre-BMI subgroup; however, a stronger protective effect of lycopene intake against GDM was observed among primigravid women (OR 0·20; 95 % CI 0·07, 0·55 in the highest v. the lowest quartile of intake; P for interaction = 0·036). In conclusion, dietary lycopene intake was mainly assumed via reducing FBG to decrease GDM risk, and the protection was relatively increased among primigravid women. [ABSTRACT FROM AUTHOR]

Maternal dietary patterns and macronutrients intake have been shown to affect the development of gestational diabetes mellitus (GDM), but the findings are inconsistent. We aimed to identify maternal dietary patterns and examine their associations with GDM risk, and to evaluate the contributions of macronutrients intake to these associations. We included 2755 Chinese pregnant women from the Tongji Maternal and Child Health Cohort. Dietary intakes were assessed using a validated semi-quantitative FFQ 2 weeks before the diagnosis of GDM. GDM (n 248) was diagnosed based on the results of a 75-g, 2-h oral glucose tolerance test at 24–28 weeks gestation. We derived five different dietary patterns from a principal component analysis. The results showed that high fish–meat–eggs scores, which were positively related to protein intake and inversely related to carbohydrate intake, were associated with a higher risk of GDM (adjusted OR for quartile 4 v. quartile 1: 1·83; 95 % CI 1·21, 2·79; P trend=0·007) and higher plasma glucose levels. In contrast, high rice–wheat–fruits scores, which were positively related to carbohydrate intake and inversely related to protein intake, were associated with lower risk of GDM (adjusted OR for quartile 3 v. quartile 1: 0·54; 95 % CI 0·36, 0·83; P trend=0·010) and lower plasma glucose levels. In addition, dietary protein and carbohydrate intake significantly contributed to the associations between dietary patterns and GDM risk or glucose levels. These findings suggest that a dietary pattern characterised by high protein and low carbohydrate intake in pregnancy was associated with a higher risk of GDM, which may provide important clues for dietary guidance during pregnancy to prevent GDM. [ABSTRACT FROM AUTHOR]

Background: Maternal iodine status has been suggested to affect birth outcomes. Few studies have focused on its effects on fetal growth during pregnancy.Objective: This study aimed to assess maternal iodine status during early pregnancy and further examine the relation between maternal iodine status and fetal growth.Methods: A total of 2087 singleton-pregnant women participating in the Tongji Maternal and Child Health Cohort study were involved. Urinary iodine concentration (UIC) and creatinine concentration were measured in spot urine samples collected in early pregnancy (<20 wk of gestation). Fetal head circumference (HC), femur length (FL), and estimated fetal weight (EFW) were evaluated by ultrasonography in each trimester. A multiple linear regression model was used to examine the association of iodine status with fetal growth characteristics, and a mixed-effects model was used to assess longitudinal effect.Results: The median UIC and iodine-to-creatinine (I/Cr) ratio were 178 μg/L and 234 μg/g, respectively. The prevalence of insufficient iodine status (I/Cr ratio <150 μg/g) was 19.8%(n = 414), of adequate iodine status (150-249 μg/g) was 34.8% (n = 726), of iodine status above the requirements (250-499 μg/g) was 32.1% (n = 669), and of excessive iodine status (≥500 μg/g) was 13.3% (n = 278). Maternal iodine insufficiency was inversely associated with fetal FL in the second and third trimesters. In stratified analysis, significant interactions were found between maternal iodine status and age as well as parity (all P < 0.05). The longitudinal analyses showed negative associations of maternal insufficient, more than adequate, or excessive iodine status with fetal growth during pregnancy (all P < 0.05).Conclusions: In central China, maternal iodine insufficiency and excess coexisted during early pregnancy and they both adversely affected fetal growth. There is an urgent need for ongoing monitoring of iodine status among vulnerable pregnant women in order to optimize iodine nutrition during pregnancy. [ABSTRACT FROM AUTHOR]

Adrenomedullin (ADM) is thought to play a significant role in regulating insulin secretion and glucose metabolism. However, studies on the relationship between ADM and gestational diabetes mellitus (GDM) are limited. We hypothesized that a higher serum ADM concentration would be associated with an increased risk of GDM. Therefore, a nested case-control study of 65 GDM cases and 130 prepregnancy body mass index, age, parity, and gestational age of blood collection-matched controls was conducted to prospectively evaluate the association between circulating ADM concentrations in early pregnancy and the risk of GDM in pregnant women based on the Tongji Birth Cohort. Serum ADM concentrations in the GDM group were higher than those in the control group (2125.04 ± 644.97 vs 1880.76 ± 581.13 pg/mL) (P =.008). Serum ADM concentration was positively associated with the risk of developing GDM (P trend <.05). The adjusted odds ratio (OR) comparing the highest tertile of ADM with the lowest was 2.74 (95% CI, 1.17-6.43). The risk of GDM increased by 49% (OR, 1.49; 95% CI, 1.05-2.12) for each SD increment of serum ADM. Moreover, serum ADM concentration was positively correlated with circulating total cholesterol (r = 0.204), triglycerides (r = 0.197), and systolic blood pressure (r = 0.173), but negatively correlated with circulating high-density lipoprotein cholesterol concentration (r = –0.176). Pregnant women with higher serum ADM concentrations have a markedly increased risk of developing GDM. Further studies are warranted to explore the possible thresholds of ADM that increase the risk of GDM and to confirm and elucidate the underlying mechanisms. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: To investigate the association of the maternal serum albumin (MAlb) level with fetal growth and fetal growth restriction (FGR) risk in term-born singletons.Design: Prospective cohort study.Setting: Four hospital maternity units of the Tongji Maternal and Child Health Cohort study initiated from September 2013 to April 2016 at Wuhan City, in central China.Patient(s): A total of 3,065 mother-offspring pairs.Intervention(s): None.Main Outcome Measure(s): Fetal growth was evaluated by birth weight (BW) and birth length. Fetal growth restriction was defined as BW below the 10th percentile.Result(s): All MAlb levels were within the upper limit of normal. After adjustment for liver function parameters, inflammatory indicators, and others, a reverse U-shaped relationship between MAlb and fetal growth was observed. Specifically, BW increased significantly with an increasing MAlb level when the MAlb level was <36.1 g/L (per g/L: β = 36.8; 95% CI, 0.8, 72.7) but decreased with increasing the MAlb level when the MAlb level was >36.1 g/L (per g/L: β = -15.1; 95% CI, -21.2, -8.9). There was a similar association between MAlb and birth length. Furthermore, the adjusted odd ratios of FGR across increasing tertiles of the MAlb levels were 1.0 (reference), 1.1 (0.7, 1.8), and 1.7 (1.0, 2.6).Conclusion(s): There was a reverse U-shaped association between MAlb and fetal growth. A higher MAlb level was associated with an increased risk of FGR.Clinical Trial Registration Number: NCT03099837. [ABSTRACT FROM AUTHOR]

Objectives: To examine the relationship between poor sleep quality during pregnancy and the risk of gestational diabetes mellitus (GDM).Methods: A total of 4066 singleton pregnant women from the Tongji Maternal and Child Health Cohort (TMCHC) without overt diabetes before pregnancy were analyzed. Sleep quality and duration during early pregnancy were self-reported by enrolled women at their first antenatal care visit before 16 weeks of gestation. Gestational diabetes mellitus (GDM) was assessed with a 75-g, 2-h oral glucose tolerance test at 24-28 weeks of gestation. Information about self-reported sleep quality and duration in mid-pregnancy were also collected at this time. Odds ratios (OR) and 95% CIs were calculated by multivariable logistic regression models, and adjusted for potential confounders to estimate the effect of poor sleep quality and the interaction between sleep quality and duration on the development of GDM. Stratified analyses were performed according to age, parity, family history of diabetes and napping.Results: A total of 335 (8.2%) participants were diagnosed with GDM. Poor sleep quality was reported in 259 (6.4%) women during early pregnancy and 248 (6.1%) in mid-pregnancy. The risk of GDM was increased in women with poor sleep quality during early pregnancy (OR 1.77, 95% CI 1.20-2.61). No association was found between poor sleep quality during mid-pregnancy and the risk of GDM. The risk of GDM was highest in women with poor sleep and longer nighttime sleep duration during early pregnancy (OR 2.27, 95% CI 1.20-4.29) when compared with those who reported good sleep and 7.0-8.5 h of sleep duration per night. Stratified analysis found that the association between poor sleep quality in early pregnancy and the risk of GDM was stronger among women aged ≥30 years (OR 2.35, 95% CI 1.35-4.09) and those with a family history of diabetes (OR 4.02, 95% CI 1.54-10.48).Conclusions: Poor sleep quality during early pregnancy was associated with an increased risk of GDM. Screening for and treating sleep problems in early pregnancy could potentially reduce the risk of GDM. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association between sleep duration in early pregnancy and fetal growth in a prospective cohort study of 3567 Chinese women.Methods: Pregnant women at 8-16 weeks of gestation were interviewed using a semi-quantitative questionnaire to assess sleep duration. Birth weight and birth length were measured by a midwife in the delivery room at birth; low birth weight (LBW) was defined as birth weight <2500 g and small for gestational age (SGA) was defined as <10th customized centile.Results: The average age of participants was 28.21 ± 3.38 years old. The mean sleep duration was 8.39 ± 1.13 h/day. A total of 1290 women sleeping ≥9 h/day, 1563 sleeping 8 to <9 h/day, 550 sleeping 7 to <8 h/day, and 164 sleeping <7 h/day. Compared to the sleeping 8 to <9 h/day group, birth length and birth weight of the sleeping <7 h/day group decreased by 2.42 mm (95% CI: -4.27, -0.58, p = 0.010) and 42.70 g (95% CI: -103.02, 17.62, p = 0.165), respectively; and risk of LBW and SGA of the sleeping <7 h/day group increased by 83% (95% CI: 0.59, 5.73, p = 0.297) and 56% (95% CI: 0.84, 2.92, p = 0.159), respectively; birth length of the sleeping <7 h/day group was decreased more in male babies, and among mothers without a midday napping habit or with a history of abortion (all p for interaction <0.05).Conclusions: Shorter sleep duration in early pregnancy was associated with birth length. Our findings indicate that midday napping may be a protective factor for birth length among pregnant women with shorter sleep duration. [ABSTRACT FROM AUTHOR]

The association between the age at introduction of complementary feeding and the risk of overweight or obesity during childhood has been hotly debated, but the result remains uncertain. This meta-analysis of prospective cohort studies attempted to evaluate this association, as well as provide evidence for infant feeding recommendations. The PubMed, Embase, and Cochrane databases were systematically searched for relevant original articles published prior to March 1, 2015 that met predefined inclusion criteria. The pooled relative risks (RRs) and corresponding 95% confidence intervals (CIs) were calculated using fix-effect or random-effect models, which were chosen based on heterogeneity among studies. Ten articles consisting of 13 studies, where 8 measured being overweight as an outcome and 5 measured being obese, were included in this meta-analysis. There were a total of 63,605 participants and 11,900 incident cases in the overweight studies, and 56,136 individuals and 3246 incident cases in the obese studies. The pooled results revealed that introducing complementary foods before 4 months of age compared to at 4 to 6 months was associated with an increased risk of being overweight (RR, 1.18; 95% CI, 1.06-1.31) or obese (RR, 1.33; 95% CI, 1.07-1.64) during childhood. No significant relationship was observed between delaying introduction of complementary foods after 6 months of age, and being overweight (RR, 1.01; 95% CI, 0.90-1.13) or obese (RR, 1.02; 95% CI, 0.91-1.14) during childhood. The results of this study suggest that the introduction of complementary foods to infants before 4 months of age should be avoided to protect against childhood obesity. [ABSTRACT FROM AUTHOR]