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Air pollution is widely acknowledged as a significant risk factor for human health, especially reproductive health. Nevertheless, many studies have disregarded the potentially mixed effects of air pollutants on reproductive outcomes. We performed a retrospective cohort study involving 8048 women with 9445 cycles undergoing In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI) in China, from 2017 to 2021. A land-use random forest model was applied to estimate daily residential exposure to air pollutants, including sulfur dioxide (SO 2), nitrogen dioxide (NO 2), carbon monoxide (CO), ozone (O 3), and fine particulate matter (PM 2.5). Individual and joint associations between air pollutants and oocyte-related outcomes of ART were evaluated. In 90 days prior to oocyte pick-up to oocyte pick-up (period A), NO 2 , O 3 and CO was negatively associated with total oocyte yield. In the 90 days prior to oocyte pick-up to start of gonadotropin medication (Gn start, period B), there was a negative dose-dependent association of exposure to five air pollutants with total oocyte yield and mature oocyte yield. In Qgcomp analysis, increasing the multiple air pollutants mixtures by one quartile was related to reducing the number of oocyte pick-ups by −2.00 % (95 %CI: −2.78 %, −1.22 %) in period A, −2.62 % (95 %CI: −3.40 %, −1.84 %) in period B, and −0.98 % (95 %CI: −1.75 %, −0.21 %) in period C. During period B, a 1-unit increase in the WQS index of multiple air pollutants exposure was associated with fewer number of total oocyte (−1.27 %, 95 %CI: −2.16 %, −0.36 %) and mature oocyte (−1.42 %, 95 %CI: −2.41 %, −0.43 %). O 3 and NO 2 were major contributors with adverse effects on the mixed associations. Additionally, period B appears to be the susceptible window. Our study implies that exposure to air pollution adversely affects oocyte-related outcomes, which raises concerns about the potential adverse impact of air pollution on women's reproductive health. [Display omitted] • A LURF model was used to evaluate air pollution among women underwent ART. • The mixture effect of air pollutants on early ART outcomes was assessed. • The higher exposure level of air pollutants, fewer number of oocytes retrieved. [ABSTRACT FROM AUTHOR]

Mulches combined with drip irrigation techniques have been widely applied in China for higher yield and water use efficiency (WUE). To develop an efficient strategy that can improve maize yield and save water in the North China Plain (NCP), we conducted a two-year field experiment, using transparent plastic film mulching (T), black plastic film mulching (B), and straw mulching (S) and non-mulching (N) for spring maize in 2019 and summer maize in 2020, and high drip irrigation amount (H) and low drip irrigation amount (L) were also considered in 2019. We mainly studied the effects of mulches on soil water content, soil temperature, crop growth rate, grain yield, and water use efficiency (WUE). The results indicated that T and B treatment increased soil water content (SWC) and topsoil temperature. The T treatment promoted the growth rate significantly more than N treatment, by 27.7–43.4% at the early stage in two years. The grain yield under TH treatment was significantly (p < 0.05) higher than that of other treatments, by 9.8–17.4% for spring maize in 2019, and significantly (p < 0.05) higher under both TH and BH than under NH, by 8.9% and 4.7% for summer maize in 2020. There was a significant quadratic parabola relationship between ET and grain yield in 2019, and the correlation between SEAT of 0–10 cm soil depth with grain yield or with biomass was positive. These results indicate that the transparent plastic film with high drip irrigation amount treatment (TH) can be recommended for spring maize, and both transparent and black film mulch treatments (TH and BH) can be recommended for summer maize in the NCP. [ABSTRACT FROM AUTHOR]

Since the 90s, tourism-induced landscape change has become a widespread phenomenon for villages outside major Chinese metropolises. Focusing on Zhangjiazha Village of central China, this study applies mixed methods to examine tourism-induced changes in landscape morphology, function, and structure. Results indicate that while Zhangjiazha's tourism development has improved rural road quality, living conditions, and land-use efficiency, it has induced negative changes in landscape morphology and traditional lifestyles. Study conclusions are vital for understanding the widespread impacts of tourism village restructuring, highlighting consideration of resident interests / well-being as crucial for sustainable land conversion and resettlement along China's rural-urban fringe. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore the influence of maternal folate and vitamin B12 (B12) status during pregnancy on the incidence of low birthweight (LBW) infants. Methods: A total of 6203 eligible women registered in seven hospitals in southern China, and 230 cases with singleton live births and 382 controls were matched for further analyses. The concentrations of serum folate and B12 were detected with chemiluminescence microparticle immunoassay on ARCHITECT i2000‐1. Conditional logistic regression was used to evaluate the effects of folate and B12 levels on LBW. Results: Maternal serum folate levels increased basically with increasing the period of folic acid supplementation (P trend <0.001). Moreover, maternal serum folate and B12 levels gradually decreased with the increase of gestational age (P < 0.001). Conditional logistic regressions analysis results showed increased odds ratios (OR) for LBW from the fourth to first folate quartiles (P trend <0.01) in the second trimester. Compared with the women in the highest quartile, those in the lowest quartile of serum folate in the second trimester were found with higher risk of LBW (adjusted OR = 1.67, 95% confidence interval [CI]: 1.02–2.73). However, no significant association was observed between serum folate and LBW in the first trimester or third trimester. In addition, serum B12 exhibited no significant association with LBW. Conclusions: Low serum folate levels in the second trimester significantly increases the risk of LBW amongst Chinese women with singleton pregnancies. [ABSTRACT FROM AUTHOR]

This paper investigates the urban redevelopment process under the ‘three old redevelopment’ policy in Guangzhou, China from 2009 to 2014. It highlights strongly shared interests between stakeholders’ institutions that match the core mechanism of the urban regime approach. The fragmented authoritarianism model is used to explain the origins of such regimes, using concepts such as institutional obstacles and small opportunities. In addition, comparisons are made between three types of places (the ‘three olds’ of towns, factories and village) that experience specific institutional difficulties. Through the ‘three old redevelopment’ policy, selective regimes are emerging in diverse ways to form new informal coalitions and realise potential land values, depending on the place and context in which it is applied. These selectivities can be explained by the analysis of a bias institutional ensemble which privileges some projects and some actors more than others in the ‘three old redevelopment’. [ABSTRACT FROM AUTHOR]

Osteoporosis has become a major health problem in older women. Previous studies have linked individual metals exposure with osteoporosis, but combined effects remain inconclusive. We aimed to explore the individual and combined association between multiple metals mixture and osteoporosis risk in older Chinese women. A total of 2297 older women (aged ≥60) from the Hongshuihe region of Guangxi, southern China included. We measured 22 blood metal levels through inductively coupled plasma mass spectrometry. And osteoporosis was defined as a T score ≤ −2.5. The least absolute shrinkage and selection operator (LASSO) penalized regression, and Bayesian kernel machine regression (BKMR) models were performed to explore the association between blood metals and osteoporosis risk. Of 2297 older women, there were 829 osteoporosis and 1468 non-osteoporosis participants. The median age was 71 and 68 years old in the osteoporosis and the non-osteoporosis group, respectively. In the single-metal model, rubidium and vanadium were negatively associated with osteoporosis (P for trend = 0.02 and 0.002, respectively), and lead presented the reverse trend (P for trend = 0.01). The LASSO penalized regression model selected nine metals (calcium, cadmium, cobalt, lead, magnesium, rubidium, strontium, vanadium and zinc), which were included in the subsequent analysis. And the multiple-metal model presented a consistent trend with the single-metal model using the selected metals. Furthermore, we performed BKMR to explore the combined effect, and found an overall negative effect between metals mixture and osteoporosis risk when all the metals were fixed at 50th, and rubidium and vanadium were the main contributors. In addition, blood Rb and V were significantly negatively related to OP risk with other metals at different levels (25th, 50th and 75th percentiles). The study suggests metal mixture exposure and osteoporosis risk in older Chinese women, and further studies need to be conducted. [Display omitted] • Exposure to lead could increase the risk of osteoporosis in older women. • Rubidium and vanadium were negatively associated with osteoporosis in older women. • There was negative overall effect between nine metal mixture and osteoporosis risk. • Blood rubidium and vanadium dominated the overall effect. [ABSTRACT FROM AUTHOR]

• Long-term exposure to PM 2.5 was positively associated with an increased risk of type 2 diabetes. • Long-term exposure to PM 2.5 may promote the development of arthritis in type 2 diabetes patients. • Quantitatively, 13.54% of type 2 diabetes and 18.54% of arthritis (in type 2 diabetes patients) were attributable to long-term exposure to PM 2.5 in China. • Women, older people, rural residents, and southern residents may be more susceptible to PM 2.5 for developing type 2 diabetes as well as complication of arthritis. It remains unclear whether type 2 diabetes and the complication of arthritis are causally related to the PM 2.5 pollutant. Therefore, we aimed to investigate the associations of long-term PM 2.5 exposure with type 2 diabetes and with arthritis in type 2 diabetes patients. This study used data from the China Health and Retirement Longitudinal Survey (CHARLS) implemented during 2011–2018. The associations were analyzed by Cox proportional hazards regression models, and the population-attributable fraction (PAF) was calculated to assess the burden of type 2 diabetes and arthritis-attributable to PM 2.5. A total of 21,075 participants were finally included, with 19,121 analyzed for PM 2.5 and type 2 diabetes risk and 12,427 analyzed for PM 2.5 and arthritis risk, of which 1,382 with newly-diagnosed type 2 diabetes and 1,328 with arthritis during the follow-up. Overall, each 10 μg/m3 increment in PM 2.5 concentration was significantly associated with an increase in the risk of type 2 diabetes (HR = 1.26, 95 %CI1.22 to 1.31), and the PAF of type 2 diabetes attributable to PM 2.5 was 13.54 %. In type 2 diabetes patients, each 10 μg/m3 increment in PM 2.5 exposure was associated with an increase in arthritis (HR = 1.42, 95 %CI: 1.28 to 1.57), and the association was significantly greater than that (H = 1.23, 95 %CI: 1.19 to 1.28) in adults without type 2 diabetes. The PAFs of arthritis-attributable to PM 2.5 in participants with and without type 2 diabetes were 18.54 % and 10.69 %, respectively. Long-term exposure to PM 2.5 may increase the risk of type 2 diabetes and make type 2 diabetes patients susceptible to arthritis. [ABSTRACT FROM AUTHOR]

Abstract Background Low birth weight infants (LBW) are at risk of chronic diseases in later life due to the disorder of energy metabolism during pregnancy. Osteocalcin (OC) has been identified as a hormone that regulate energy metabolism. However, few studies have researched on the associations between maternal serum OC levels and low birth weight infants. Objections To examine the associations between maternal serum OC concentrations and LBW. Methods This was a nested case-control study involving a total of 230 pregnant women delivering LBW and 382 control pregnant women (matched for infant gender, gestational age at blood draw, region of Maternity and Child Healthcare Hospital and maternal age in 1: (1–2) ratio). One serum sample was collected from each pregnant woman at 5–35 weeks' gestation. Pregnant women were divided into 3 groups (1st, 2nd and 3rd trimester group). There were 60 and 142 and 28 pregnant women delivering LBW in the first, second and third trimester, respectively. Similarly, there were 101 and 233 and 48 controls in the first, second and third trimester, respectively. Maternal serum OC and 25(OH)D concentrations were categorized into low and high levels, the low level used as reference in analyses. Binary logistic regression model was used to compute odd radio (ORs) for LBW according to levels of maternal serum OC and 25(OH)D. Results Compared with the subjects in low level in first trimester, LBW was two times as likely to occur among pregnancy women with high serum OC concentrations (OR = 2.04, 95%CI:1.05–3.96). After adjusted for confounding factors, a significant positive relationship still existed (adjusted ORs = 2.29, 95%CI: 1.11–4.72). In second trimester, women in high level of serum OC had nearly 1.6 times the risk of delivering LBW infants as those in the low level (OR = 1.55, 95%CI: 1.01–2.37). After adjusted for confounding factors, the ORs increased (ORs = 1.59, 95%CI:1.03–2.45). No significant associations were found between maternal serum OC levels and LBW in third trimester. In addition, there were no associations between maternal 25(OH)D concentrations and LBW during pregnancy. Conclusion High maternal serum OC levels in the first or the second trimester during pregnancy may be associated with the risk of LBW. Highlights • Our study first shows the association between maternal serum osteocalcin concentrations during pregnancy and low birth weight. • Our study first reveals that elevated maternal serum OC levels were significantly associated with the risk of low birth weight. [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]

Cataract is one key cause of visual disability and blindness. Ambient particulate matter is more likely to increase cataract risk due to eye continuous exposure to the environment. However, less is known about whether long-term exposure to particulate matter 2.5 (PM 2.5 ) is related to age-related cataracts. We conducted a population-based study among 22,298 adults from two multicenter cohort studies [China Family Panel Studies (CFPS) and Chinese Longitudinal Healthy Longevity Survey (CLHLS)]. The associations between PM 2.5 and age-related cataracts were analyzed by Cox proportional hazard regression models, which were also stratified according to demographic characteristics. The restricted cubic spline (RCS) model was used to explore the dose-response relationships between PM 2.5 and age-related cataracts. The population attributable fraction (PAF) was calculated to assess the burden of age-related cataracts that can be attributed to PM 2.5 . In the final analysis, 1897 participants reported age-related cataracts during follow-up. Long-term exposure to PM 2.5 was associated with age-related cataracts, with HRs of 1.165 (1.130, 1.201), 1.138 (1.103, 1.173), and 1.091 (1.057, 1.126) for per 10 μg/m 3 increase at one-, two-, and three-year before the end of follow-up, respectively. Furthermore, associations between PM 2.5 and age-related cataracts were also demonstrated in RCS models. The PAF of age-related cataracts to PM 2.5 in the total participants was 24.63%. Our research found that long-term exposure to PM 2.5 may increase the risk of age-related cataracts, and age-related cataracts should be considered as an important public health issue due to air pollution.

Phthalates have been shown to have adverse effects on neurodevelopment, which may be gender-specific. However, the association between prenatal mixed exposure to phthalates and children's neurodevelopment remains inconsistent. We measured 15 prenatal serum phthalate levels and evaluated children's neurodevelopmental indicators using Gesell Developmental Schedule (GDS) (n = 750). Generalized linear regression was fitted to examine the association. Among boys, mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP) had adverse effects on gross motor [odds ratio (OR): 7.38, 95% confidence interval (CI):1.42, 38.46]. For gross motor in boys, joint effect was discovered between mono-2-ethylhexyl phthalate (MEHP) and MEHHP. Moreover, synergistic effects were found for MEHP with vanadium and cadmium, and antagonistic effects for MEHP with magnesium, calcium, titanium, iron, copper, selenium, rubidium, and strontium. We did not find statistically significant relationships in girls. In the 1st trimester, adverse effects were identified between mono-2-ethyl-5-oxoyhexyl phthalate (MEOHP) and adaptation (P = 0.024), and monomethyl phthalate (MMP) with social area (P = 0.017). In the 2nd trimester, MEHHP had adverse effects on social area (P = 0.035). In summary, we found boys may be more vulnerable to the neurotoxicity than girls in gross motor, and we also discovered the detrimental effects of phthalates on children's neurodevelopment in the 1st and 2nd trimesters. Therefore, the supplementation of appropriate elements in the 1st and 2nd trimesters may help reduce the adverse effects of phthalates on children's neurodevelopment, especially among boys., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Impaired neurodevelopment of children has become a growing public concern; however, the associations between metals exposure and neurocognitive function have remained largely unknown., Objectives: We systematically evaluated the associations of multiple metals exposure during pregnancy and childhood on the neurodevelopment of children aged 2-3 years., Methods: We measured 22 metals in the serum and urine among703 mother-child pairs from the Guangxi Birth Cohort Study. The neurocognitive development of children was assessed by the Gesell Development Diagnosis Scale (GDDS; Chinese version). Multiple linear regression models were used to evaluate the relationship between the metals (selected by elastic net regression) and the outcomes. The Bayesian kernel machine regression (BKMR) was used to evaluate the possible joint effect between the multiple metal mixture and the outcomes., Results: Prenatal aluminum (Al) exposure was negatively associated with the fine motor developmental quotient (DQ) (β = -1.545, 95%CI: 2.231, -0.859), adaption DQ (β = -1.182, 95%CI: 1.632, -0.732), language DQ (β = -1.284, 95% CI: 1.758, -0.809), and social DQ (β = -1.729, 95% CI: 2.406, -1.052) in the multi-metal model. Prenatal cadmium (Cd) exposure was negatively associated with gross motor DQ (β = -2.524, 95% CI: 4.060, -0.988), while postpartum Cd exposure was negatively associated with language DQ (β = -1.678, 95% CI: 3.227, -0.129). In stratified analyses, infants of different sexes had different sensitivities to metal exposure, and neurobehavioral development was more significantly affected by metal exposure in the first and second trimester. BKMR analysis revealed a negative joint effect of the Al, Cd, and selenium (Se) on the language DQ score; postpartum Cd exposure played a major role in this relationship., Conclusion: Prenatal exposure to Al, Ba, Cd, molybdenum (Mo), lead (Pb), antimony (Sb), and strontium (Sr), and postpartum exposure to cobalt (Co), Cd, stannum (Sn), iron (Fe), nickel (Ni), and Se are associated with neurological development of infants. The first and second trimester might be the most sensitive period when metal exposure affects neurodevelopment., (Copyright © 2021. Published by Elsevier Inc.)

Aims: Iron supplementation has been recommended for healthy pregnancy, but concerns have been raised regarding the potential adverse effects. We sought to examine the impact of periconceptional iron supplement use on subsequent gestational diabetes mellitus (GDM) risk., Methods: Participants (N = 5101) with information on periconceptional micronutrient supplementation and diagnosis of GDM were involved. Information on iron supplementation and general characteristics were collected at enrollment and follow-up visits. GDM was diagnosed by oral glucose tolerance tests (OGTT) conducted at 24-28 weeks of gestation. Robust Poisson regression model was used to estimate the relative risks (RRs) and 95% confidence intervals (CI) for the effect of iron supplement use on GDM., Results: 10.5% of the participants were diagnosed with GDM and the incidence was significantly higher in users with iron >30 mg/d for more than 3 months (Iron >30-L) than in nonusers. Adjusted RRs (95% CI) were 1.53 (1.21, 1.93) in Iron >30-L group, 1.14 (0.80, 1.61) in users with iron >30 mg/d for<3 months (Iron > 30-S) and 1.15 (0.86, 1.54) in users with iron ≤30 mg/d for any duration (Iron ≤30) respectively, compared to nonusers. This link in Iron >30-L group was even stronger (adjusted RR: 1.70, 95% CI: 1.25, 2.31) when restricting the analysis among primiparous and iron-replete participants without family history of diabetes. There were no significant differences in birth outcomes among groups., Conclusions: Periconceptional iron supplementation >30 mg/d for long-term was associated with increased GDM risk. The need and safety of prophylactic iron supplement in iron-replete pregnant women should be reconsidered., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Previous studies have reported metals exposure contribute to the change of fasting blood glucose (FBG) level. However, the roles of reproductive hormones in their associations have not been fully elucidated. The aim of the study is to investigate the associations of multiple serum metals with reproductive hormones, and to further explore potential roles of reproductive hormones in relationships between metals exposure and FBG level. A total of 1911 Chinese Han men were analyzed by a cross-sectional study. We measured serum levels of 22 metals by inductively coupled plasma mass spectrometer (ICP-MS). FBG, total testosterone (TT), estradiol (E2), follicle stimulating hormone (FSH), and sex hormone-binding globulin (SHBG) levels were determined. Least absolute shrinkage and selection operator (LASSO) regression models were conducted to select important metals, and restricted cubic spline models were then used to estimate dose-response relationships between selected metals and reproductive hormones. We also conducted mediation analyses to evaluate whether reproductive hormones played mediating roles in the associations between metals and FBG. We found significant inverse dose-dependent trends of copper, tin and zinc with E2; zinc with SHBG; copper and nickel with TT, while significant positive dose-dependent trend of iron with E2, respectively. Moreover, approximately inverted U-shaped associations existed between lead and SHBG, iron and TT. In addition, E2, SHBG and TT were negatively associated with FBG level. In mediation analyses, the association of copper with FBG was mediated by E2 and TT, with a mediation ratio of 10.4% and 22.1%, respectively. Furthermore, E2 and SHBG mediated the relationship of zinc with FBG, with a mediation ratio of 7.8% and 14.5%, respectively. E2 mediated 11.5% of positive relationship between tin with FBG. Our study suggested that the associations of metals exposure with FBG may be mediated by reproductive hormones., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Studies with multi-pollutant approach on the relationships between multiple metals and fasting plasma glucose (FPG) are limited. Few studies are available on the potential sex-specific associations between metal exposures and glucose metabolism. We explored the associations between 22 plasma metals and FPG level among the 769 participants from the manganese-exposed workers healthy cohort in China. We applied a sparse partial least squares (sPLS) regression followed by ordinary least-squares regression to evaluate multi-pollutant association. Bayesian kernel machine regression (BKMR) model was used to deal with metal mixtures and evaluate their joint effects on FPG level. In the sPLS model, negative associations on FPG levels were observed for plasma iron (belta = -0.066), cobalt (belta = -0.075), barium (belta = -0.109), and positive associations for strontium (belta = 0.082), and selenium (belta = 0.057) in men, which overlapped with the results among the overall participants. Among women, plasma copper (belta = 0.112) and antimony (belta = 0.137) were positively associated with elevated FPG level. Plasma magnesium was negatively associated with FPG level in both sexes (belta = -0.071 in men and belta = -0.144 in women). The results of overlapped for plasma magnesium was selected as the significant contributor to decreasing FPG level in the multi-pollutant, single-metal, and multi-metal models. BKMR model showed a significantly negative over-all effect of six metal mixtures (magnesium, iron, cobalt, selenium, strontium and barium) on FPG level among the overall participants from all the metals fixed at 50th percentile. In summary, our findings underline the probable role of metals in glucose homeostasis with potential sex-dependent heterogeneities, and suggest more researches are needed to explore the sex-specific associations of metal exposures with risk of diabetes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Compliance with dietary guidelines among pregnant women can positively influence not only their own health but also the health of their babies. Measuring the compliance requires professional skills in nutrition and dietary counseling. In China, few simple and effective techniques assess dietary quality among pregnant women, especially in rural areas. We aimed to establish a new simple and effective assessment technique, the "Chinese Dietary Guidelines Compliance Index for Pregnant Women (CDGCI-PW)" and assess the association between maternal dietary compliance and risks of pregnancy complications., Methods: The CDGCI-PW consists of 13 main components which were based on the 2016 edition of the Chinese dietary guidelines for pregnant women. Each component was assigned a different score range, and the overall score ranged from 0 to 100 points. The Tongji Maternal and Child Health Cohort study (from September 2013 to May 2016) was a prospective cohort study designed to examine maternal dietary and lifestyle effects on the health of pregnant women and their offspring. The maternal diet during the second trimester was compared with the corresponding recommended intake of the Chinese balanced dietary pagoda for pregnant women to verify their compliance with dietary guidelines. The association between maternal dietary quality and risks of pregnancy complications was estimated by regression analysis. Receiver operating characteristic (ROC) curves were constructed to identify the optimal cut-off values of CDGCI-PW for gestational hypertension and gestational diabetes mellitus (GDM)., Results: Among the 2708 pregnant women, 1489 were eventually followed up. The mean CDGCI-PW score was 74.1 (standard deviation (SD) 7.5) in the second trimester. The majority of foods showed the following trend: the higher the CDGCI-PW score, the higher the proportion of pregnant women who reported food intake within the recommended range. Moreover, a higher maternal CDGCI-PW score was significantly associated with lower risks of gestational hypertension [odds ratio (OR) (95% confidence interval [(CI): 0.30 (0.20, 0.37)] and GDM [OR (95% CI): 0.38 (0.31, 0.48)]. The optimal CDGCI-PW cut-off value for gestational hypertension was ≥68.5 (sensitivity 82%; specificity: 61%; area under the ROC curve, AUC = 0.743), and the optimal CDGCI-PW cut-off score for GDM was ≥75.5 (sensitivity 43%; specificity: 81%; area under the ROC curve, AUC = 0.714)., Conclusions: The CDGCI-PW is a simple and useful technique that assesses maternal diet quality during pregnancy, while adherence to the CDGCI-PW is associated with a lower risk of gestational hypertension and GDM.

Background: Human are widely exposed to multiple metals, some of which have suspected reproductive toxicity, but no human studies have investigated the developmental effects of prenatal metal exposure., Objectives: We aimed to evaluate the associations between prenatal multiple metal exposure and reproductive development in boys at 2-3 years using multi-pollutant approach., Methods: This prospective study used data of 564 mother-child pairs recruited from the Guangxi Birth Cohort Study. Twenty serum metal concentrations were measured. Least absolute shrinkage and selection operator (LASSO) penalized regression was used to identify independent associations between prenatal multiple metal exposure and testicular volume (TV), and anogenital distance (AGD). Adjusted estimates were then obtained using multiple linear regression analysis, and the regression tree method was used to explore the interactions., Results: Boys in the highest quartile of prenatal lead exposure had a 0.064 mL (95% CI: -0.124, -0.004) smaller ln-transformed TV, 0.060 cm (95% CI: -0.110, -0.011) shorter ln-transformed anopenile distance (AGDap), and 0.115 cm (95% CI: -0.190, -0.039) shorter ln-transformed anoscrotal distance (AGDas) than boys in the lowest quartile (all Ptrend < 0.05). Chromium was inversely with ln-transformed AGDap (β = -0.078, 95% CI: -0.127, -0.030) and ln-transformed AGDas (β = -0.113, 95% CI: -0.188, -0.038), while stibium was positivity associated with ln-transformed AGDap (β = 0.091, 95% CI: 0.046, 0.136) and strontium was positivity associated with ln-transformed AGDas (β = 0.120, 95% CI: 0.051, 0.189) (all Ptrend < 0.05). And the critical window of vulnerability may be the late pregnancy (the second and third trimester). Moreover, we detected interaction effects between lead, chromium and stibium on AGDap; lead, chromium and strontium on AGDas., Conclusions: The results suggest that prenatal exposure to lead, chromium, stibium and strontium may affect TV and/or AGD in infant boys. Potential mechanisms for the complex metal interactive effects during vulnerable periods are worthy of further investigation., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Manganese (Mn) ions play a crucial role in the immune response. The immunotoxicity of Mn is rarely reported compared with the neurotoxicity of Mn., Objectives: The purpose of this study was to investigate the associations between chronic Mn exposure and immunological parameters in occupational Mn-exposed workers., Methods: A total of 538 workers were selected from the follow-up of manganese-exposed workers healthy cohort (MEWHC) in 2017. We divided the workers into the low-exposure group and the high-exposure group by the cutoff of the manganese-time weighted average (Mn-TWA) setting at 0.15 mg/m 3 . We examined serum immunological parameters by the immunoturbidimetric method and leukocyte counts and ratios in blood routine. Then we used the generalized linear model analyses and spline analyses to explore the associations between external exposure of Mn and multiple immunological parameters adjusted for variables. Based on the epidemiological analyses, we used Elisa (enzyme-linked immune sorbent assay) to detect plasma complement C3 of Mn-exposed rats., Results: In male workers, the mean value of complement C3 was 1.20 ± 0.16 g/L in the high-exposure group, which was significantly lower as compared to the low-exposure group (1.25 ± 0.18 g/L, P = 0.023). The generalize linear models' analyses showed that complement C3 value had a significantly negative association with external exposure of Mn included adjustment for variables (β = -0.04, P = 0.035). Moreover, in male rats, the high-exposure group also had a lower level of complement C3 compared with the low-exposure group (P < 0.001). None significant association was observed in immunological parameters among female workers and rats (all P > 0.05)., Conclusions: Mn exposure from inhalable dust was associated with decreased complement C3 among occupationally Mn-exposed male individuals but not in female workers, which was further confirmed by the rat model. Further research into the possible mechanism of C3 reduction is needed in the future., Competing Interests: Declaration of Competing Interest The authors declare no competing financial interests., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Background: Currently, there are many studies researched the associations between maternal serum inflammatory indicators (i.e. ferritin, C-reactive protein [CRP], C3 and C4) and preterm birth (PTB). The results, however, are inconsistent. Therefore, the aim of this study was to estimate the relationship between maternal serum inflammatory indicators and PTB in a nested case-control (NCC)study., Methods: A NCC study was conducted by Guangxi Birth Cohort Study which enrolled a total of 6203 pregnant women between 5 0/7 and 34 6/7 weeks of gestational age (wGA) from six cities in China between 2015 and 2016. There were 206women who delivered preterm (< 37 0/7 wGA), and 412 women who delivered term birth, those women were matched by maternal age, birth place, gender of infants, and wGA at blood collection. The inflammatory indicators were quantified by immunoturbidimetric methods., Results: Highest quartile concentrations of all inflammatory indicators were determined versus median. After adjusting for maternal age, high levels of CRP (CRP > 16.60 mg/L) are related to the risk of PTB (OR = 2.16, 95% CI: 1.02-4.56, p = 0.044) in the first trimester. The association of C3 was extremely related to those who delivered PTB (OR = 2.53, 95% CI: 1.14-5.64, p = 0.023) in the first trimester. Moreover, no significant associations were found in C4 (p = 0.079) and ferritin (p = 0.067) between PTB., Conclusions: Elevated concentrations of CRP and C3 in the first trimester were associated with increased risk of PTB. Inflammatory indicators may act a pivotal part in early diagnosis and prognosis of PTB.

Background & Aims: Oxidative stress has been implicated in the pathogenesis of gestational diabetes mellitus (GDM). Vitamin C as natural antioxidant may help to increase the body's antioxidant capacity. The study is aimed to determine whether vitamin C intake during pregnancy is associated with lower risk of GDM., Methods: Women with singleton pregnancy and without any history of diabetes were drawn from the ongoing Tongji Maternal and Child Health Cohort (TMCHC). Oral glucose tolerance tests (OGTT) were conducted during weeks 24-28 of gestation to screen for GDM. A validated food frequency questionnaire (FFQ) was used to assess dietary intake during mid pregnancy. Use of multivitamins and specific supplements of vitamin C was assessed by questionnaires. Odds ratios (ORs) of GDM risk were calculated by logistic regression models, adjusted for potential confounders., Results: 344 (11.4%) of the 3009 women were diagnosed with GDM. Dietary vitamin C intake was inversely associated with the risk of GDM. Women with above adequate dietary vitamin C intake (more than 200 mg/day) experienced lower odds of GDM (OR 0.68, 95% CI: 0.49-0.95) than those with adequate intake (115-200 mg/day). There was no association between the total consumption of vitamin C and the risk of GDM (OR 1.04, 95% CI: 0.71-1.53)., Conclusion: This data suggests that higher dietary consumption of vitamin C during pregnancy is independently associated with lower odds of GDM. Above 200 mg/day of dietary vitamin C intake may help reduce the odds of GDM. However, no such association between total vitamin C intake and the risk of GDM was found. Hence, sufficient vegetables and fruits rich in vitamin C should be recommended to protect pregnant women from developing gestational diabetes., (Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objective: To examine optimal gestational weight gain(GWG) for Chinese pregnant women., Methods: A total of 6998 women with singleton and term pregnancy recruited to the Tongji Maternal and Child Health Cohort during January 2013 to May 2016 in Wuhan, Hubei were included. Information on sociodemographic, medical and family history of disease was obtained by questionnaire, body weight and height were measured at the first antenatal care during 8-16 weeks of gestation. Prenatal weight of mothers were measured, and gestational week, mode of delivery, pregnancy complications, gender of newborn, birth weight and length were collected from medical records after delivery. Restricted cubic spline was used to model nonlinear relationships between GWG and the occurrence of small for gestational age(SGA), large for gestational age(LGA), low birth weight(LBW), macrosomia, cesarean, gestational hypertension(GH)and gestational diabetes mellitus(GDM), respectively. The GWG of the lowest risks for adverse pregnant outcomes was regarded as optimal GWG recommended by Tongji(TJ) for pregnant women. The P25-P75 of GWG was defined as the optimal GWG recommended by percentile method. Logistic regression was used to analyze the effect of excessive or insufficient GWG on adverse pregnancy outcomes, while the recommendations of TJ and percentile method were used as references, respectively., Results: (1) The GWG with lower risk of adverse pregnant outcomes based on pre-gravid body mass index(BMI) are 12. 0-17. 0 kg for underweight, 9. 0-14. 0 kg for normal weight and 7. 0-11. 0 kg for overweight, respectively, which are defined as TJ recommendations. The recommended GWG by percentile method are 14. 0-19. 0 kg for underweight, 13. 0-19. 0 kg for normal weight, 10. 8-18. 0 kg for overweight and 9. 0-15. 8 kg for obesity, respectively. (2) Compared to women gain within the TJ recommendations, OR of LGA is 2. 94(95%CI 2. 31-3. 73), macrosomia is 3. 13(95%CI 2. 38-4. 13), cesarean is 1. 53(95%CI 1. 38-1. 71) and GH is 2. 18(95%CI 1. 50-3. 17) for those with excessive GWG, OR of SGA is 1. 82(95%CI 1. 32-2. 53) for those who gain less. The corresponding ORs according to percentile method are 2. 11(95%CI 1. 76-2. 54) for LGA, 2. 16(95%CI 1. 76-2. 65) for macrosomia, 1. 53(95%CI 1. 36-1. 72) for cesarean, 1. 39(95%CI 1. 02-1. 90) for GH and 1. 60(95%CI 1. 29-1. 99) for SGA, respectively., Conclusion: The optimal GWG of Chinese pregnant women recommended by the study are 12. 0-17. 0 kg for pre-gravid underweight women, 9. 0-14. 0 kg for normal weight women and 7. 0-11. 0 kg for overweight, respectively.

The study aimed to investigate the associations between maternal lifestyles and antenatal stress and anxiety. 1491 pregnant women were drawn from the Guangxi birth cohort study (GBCS). A base line questionnaire was used to collect demographic information and maternal lifestyles. The Pregnancy Stress Rating Scale (PSRS) and Self-Rating Anxiety Scale (SAS) were used to assess prenatal stress and anxiety, respectively. Regression analyses identified the relationship between maternal lifestyles and prenatal stress and anxiety: (1) Hours of phone use per day was positively correlated to prenatal stress and anxiety and increased with stress and anxiety levels (all P trend < 0.05). In addition, not having baby at home was positively correlated to prenatal stress. (2) Self-reported sleep quality was negative with prenatal stress and anxiety, and decreased with stress and anxiety levels (all P trend < 0.01). Moreover, not frequent cooking was negatively correlated to prenatal stress and having pets was negatively correlated to prenatal anxiety (P < 0.05). However, having pets was not correlated to prenatal stress (P > 0.05). Our results showed that adverse lifestyles increase the risk of antenatal stress and anxiety, a regular routine and a variety of enjoyable activities decreases the risk of prenatal stress and anxiety.

Objective: To examine the expression of transforming growth factor 1(TGF-β1) and bone morphogenetic protein-9 (BMP-9) in human nonunion tissues, and to evaluate the clinical significance.
 Methods: The number of hypertrophic nonunion tissue samples and atrophic nonunion tissue samples were collected from Department of Orthopedics, the Second Xiangya Hospital of Central South University and Suzhou Kowloon Hospital Affiliated to School of Medicine of Shanghai Jiao Tong University between 2010 and 2014. Semi-quantification of SP immunohistochemical method and pathological image analysis software IPP6.0 were used to analyze the expression of TGF-β1 and BMP-9. Nonunion type, patients' age and nonunion time were statistical analyzed.
 Results: The absorbance values of TGF-β1 and BMP-9 in the hypertrophic nonunion tissues were 0.3236±0.0390 and 0.1337±0.0400, respectively; while the absorbance values ofTGF-β1 and BMP-9 in the atrophic nonunion tissues were 0.3191±0.0369 and 0.1373±0.0423, respectively, with no significant difference between the two types of tissues (both P>0.05). There was also no significant difference in patients' age and bone nonunion time between them (all P>0.05).
 Conclusion: There is no significant difference in osteogenic potential between the hypertrophic nonunion tissues and the atrophic nonunion tissues.

Background & Aims: Gestational diabetes mellitus is associated with adverse short- and long-term consequences for both the mother and the offspring. To examine the relationship between the rates of gestational weight gain (RGWG) during early and mid-pregnancy and the risk of gestational diabetes mellitus (GDM)., Methods: 2090 singleton pregnant women from the Tongji Maternal and Child Health Cohort (TMCHC) without overt diabetes before pregnancy were analyzed in our study. Gestational weight were measured regularly in every antenatal visit. Gestational diabetes mellitus was assessed with the 75-g, 2-h oral glucose tolerance test at 24-28 weeks of gestation. Multivariable logistic regression was performed to estimate effect of RGWG on GDM., Results: A total of 8.3% (n = 173) of pregnant women were diagnosed with GDM. Women with elevated rate of gestational weight gain prior to glucose screening test (RGWG-PG) increased the risk of GDM (adjusted p-trend = 0.004; odds ratios (OR) 1.64, 95% confidence intervals (CI) 1.01-2.68 and OR 2.30,95% CI 1.44-3.66 for 0.297-0.384 kg/wk and 0.385 kg/wk or more vs. 0.213 kg/wk or less, respectively). Women with greater rate of gestational weight gain in the first trimester (RGWG-F) increased the risk of GDM (adjusted p-trend = 0.048; OR 1.83, 95% CI 1.14-2.94 and OR 1.76, 95% CI 1.10-2.83 for 0.086-0.200 kg/wk and 0.201 kg/wk or more vs. -0.025 kg/wk or less, respectively). The rate of gestational weight gain in the second trimester (RGWG-S) was significantly associated with GDM only among women with RGWG-F more than 0.086 kg/wk (adjusted p-trend = 0.035; OR 2.04, 95% CI 1.16-3.59 for 0.658 kg/wk or more vs. 0.418 kg/wk or less)., Conclusions: Greater early pregnancy weight gain are associated with increased risk of GDM. Elevated weight gain in mid-pregnancy increased the risk of GDM only among pregnant women with greater weight gain in the first trimester., (Copyright © 2017 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Bilirubin concentrations have been recently reported to be negatively associated with type 2 diabetes mellitus. We examined the association between bilirubin concentrations and gestational diabetes mellitus. In a prospective cohort study, 2969 pregnant women were recruited prior to 16 weeks of gestation and were followed up until delivery. The value of bilirubin was tested and oral glucose tolerance test was conducted to screen gestational diabetes mellitus. The relationship between serum bilirubin concentration and gestational weeks was studied by two-piecewise linear regression. A subsample of 1135 participants with serum bilirubin test during 16-18 weeks gestation was conducted to research the association between serum bilirubin levels and risk of gestational diabetes mellitus by logistic regression. Gestational diabetes mellitus developed in 8.5 % of the participants (223 of 2969). Two-piecewise linear regression analyses demonstrated that the levels of bilirubin decreased with gestational week up to the turning point 23 and after that point, levels of bilirubin were increased slightly. In multiple logistic regression analysis, the relative risk of developing gestational diabetes mellitus was lower in the highest tertile of direct bilirubin than that in the lowest tertile (RR 0.60; 95 % CI, 0.35-0.89). The results suggested that women with higher serum direct bilirubin levels during the second trimester of pregnancy have lower risk for development of gestational diabetes mellitus.

Objectives: Several studies have investigated the association between serum uric acid (SUA) and the risks of coronary artery disease (CAD) but have yielded inconsistent results. The aim of this study was to assess whether there is an independent association of SUA with all-cause and cardiovascular disease (CVD) mortality in Chinese patients with CAD., Methods: A prospective cohort study of 1,799 patients was conducted. Cox regression models were used to estimate the association of SUA with the risk of death., Results: During a median follow-up of 3.9 years, 177 deaths were recorded and 126 of these were due to CVD. Patients in the highest SUA quartile had a 2.43-fold risk of all-cause mortality and a 2.44-fold risk of CVD mortality compared with those in the lowest quartile. In the subpopulation analysis, the association between SUA and mortality remained similar when participants were stratified by age, gender, body mass index and type of CAD. In contrast, we found a significant interaction with estimated glomerular filtration rate (eGFR). There was a stronger association between SUA and the risk of all-cause and CVD mortality among patients with an eGFR ≥60 ml/min/1.73 m2, but no significant association was found in the population with an eGFR <60 ml/min/1.73 m2., Conclusions: Elevated SUA levels were positively associated with an increased risk of all-cause and CVD mortality among CAD patients., (© 2016 S. Karger AG, Basel.)