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Background: Labor represents a period of significant physical activity. Inefficient energy supply may delay labor process and even lead to cesarean delivery. Herein we investigated whether ingestion of a carbohydrate-rich beverage could reduce cesarean delivery in laboring women with epidural analgesia. Methods: This multicenter randomized trial was conducted in obstetrician-led maternity units of nine tertiary hospitals in China. Primigravidae with single term cephalic pregnancy who were preparing for vaginal birth under epidural analgesia were randomized to intake a carbohydrate-rich beverage or commercially available low-carbohydrate beverages during labor. The primary outcome was the rate of cesarean delivery. Secondary outcomes included maternal feeling of hunger, assessed with an 11-point scale where 0 indicated no hunger and 10 the most severe hunger, and maternal and neonatal blood glucose after childbirth. Results: Between 17 January 2018 and 20 July 2018, 2008 women were enrolled and randomized, 1953 were included in the intention-to-treat analysis. The rate of cesarean delivery did not differ between the two groups (11.3% [111/982] with carbohydrate-rich beverage vs. 10.9% [106/971] with low-carbohydrate beverages; relative risk 1.04, 95% CI 0.81 to 1.33; p = 0.79). Women in the carbohydrate-rich beverage group had lower subjective hunger score (median 3 [interquartile range 2 to 5] vs. 4 [2 to 6]; median difference − 1; 95% CI − 1 to 0; p < 0.01); their neonates had less hypoglycemia (1.0% [10/968] vs. 2.3% [22/956]; relative risk 0.45; 95% CI 0.21 to 0.94; p = 0.03) when compared with those in the low-carbohydrate beverage group. They also had higher rates of maternal hyperglycemia (6.9% [67/965] vs. 1.9% [18/953]; p < 0.01) and neonatal hyperglycemia (9.2% [89/968] vs. 5.8% [55/956]; p < 0.01), but none required special treatment. Conclusions: For laboring primigravidae with epidural analgesia, ingestion of a carbohydrate-rich beverage compared with low-carbohydrate beverages did not reduce cesarean delivery, but relieved maternal hunger and reduced neonatal hypoglycemia at the expense of increased hyperglycemia of both mothers and neonates. Optimal rate of carbohydrate supplementation remains to be determined. Trial registration: www.chictr.org.cn; identifier: ChiCTR-IOR-17011994; registered on 14 July 2017. [ABSTRACT FROM AUTHOR]

The main geological landform in southwest China is karst, and hydrological resources in the region are rich. The water resources in this region cannot be efficiently and rationally used due to the complex topography and difficulty in developing water resources, which has led to problems such as desertification and soil erosion. The most typical area of karst landforms is in Guizhou Province. A water management method for an interconnected river system network is proposed, taking Guiyang as an example. This study provides a foundation for China’s South-to-North Water Diversion Project and can improve socioeconomic conditions in China. [ABSTRACT FROM AUTHOR]

The water footprint theory was used to analyze the agricultural water footprint (AWF) and its spatiotemporal characteristics in the Hexi corridor, Northwest of China from 2002 to 2017. The AWF increased during 2002–2017. Meanwhile, the water footprint of cash crops rapidly increased from 10.08 billion m3 to 100.94 billion m3; however, the water footprint of grain production increased slowly and remained relatively stable. There were great differences in the water footprint of various agricultural products in twenty counties in the Hexi corridor. Furthermore, this study explored the equilibrium relationship between the gross domestic product (GDP), population, grain yield, fertilization, urbanization rate, and AWF using the Panel Pool Mean Group and autoregressive distributive lag (PMG/ARDL) model. Our findings demonstrated that economic growth, grain yield, and fertilization had a significant positive relationship with AWF, and population and the urbanization rate had a negative long-run but non-significant relationship with AWF. The panel causality analysis showed a one-way causal relationship between the AWF with population and urbanization rate. The grain yield, the rate of urbanization, and fertilization in the Hexi corridor need further improvements to ensure the sustainable development of water resources. • Significant spatial-temporal variation of the AWF in the Hexi Corridor, China. • The ARDL model was creatively introduced to explore the driving factors of AWF. • The structure of the AWF has changed significantly. • Economic and social factors as key drivers of AWF change. [ABSTRACT FROM AUTHOR]

Objective: To estimate the risk of adverse maternal and perinatal outcomes in women with different pre-pregnancy body mass index (BMI).Methods: We conducted a cohort study with 14 451 singleton pregnancies in 15 medical centers in Beijing between 20 June 2013 and 30 November 2013 using cluster random sampling. We divided participants into four groups based on pre-pregnancy BMI: Group A (underweight): BMI < 18.5 kg/m(2), Group B (normal): 18.5-23.9 kg/m(2), Group C (overweight): 24-27.9 kg/m(2), Group D (obesity): ≥28 kg/m(2). We used multivariate analysis to evaluate the association of the risk of adverse pregnancy outcomes and pre-pregnancy BMI.Results: The prevalence of maternal overweight and obesity was 14.82% (2142/14 451) and 4.71% (680/14 451) in the study population, respectively. Higher pre-pregnancy BMI is associated with higher prevalence of gestational diabetes (GDM), macrosomia, Cesarean section (C-section), preeclampsia and postpartum hemorrhage. Pre-pregnancy overweight or obesity increases the risk of adverse pregnancy outcomes, regardless of GDM status.Conclusions: Pre-pregnancy overweight or obesity is associated with increased risk of adverse pregnancy outcomes. Nutrition counseling is recommended before pregnancy in women who have overweight or obesity. [ABSTRACT FROM AUTHOR]

The diagnostic criteria of gestational diabetes mellitus has being changed continuously. Based on the hyperglycemia and adverse pregnancy outcome study, most international academic organizations including World Health Orgnization and Ministry Heath of China published new criteria, while there are still some arguments. After introduced the development of the diagnostic criteria and risk factors, the article presented the study of metformin in gestational diabetes the offspring followup and proposed to adopt comprehensive intervention to face the challenges to our clinical management in China [ABSTRACT FROM AUTHOR]

Background: The relationship between thyroid nodules (TNs) and adiposity is controversial. This paper describes a cross-sectional investigation performed to determine the existence of any such relationship. To assess adiposity, body mass index (BMI) and visceral fat area (VFA) were utilized. Methods: Between January 1, 2017 and March 3, 2019. Three thousand five hundred thirty four healthy people were examined using thyroid ultrasonography, visceral fat and anthropometric measurements, laboratory tests and questionnaire interview. Binary logistic regression analyses were used. Results: Of the 3534 healthy subjects, 58.69% (2074/3534) of the subjects had TNs. A total of 55.91% (1976/3534) had BMI ≥ 25 kg/m2 and 39.67% (1402/3534) had VFA ≥ 100 cm2. After adjustment to address confounders, BMI-based overweight and obesity levels only correlated with higher risk TNs when used as a continuous variable (OR = 1.031, 95% CI: 1.008–1.055, P = 0.008), while VFA was both a continuous variable (OR = 1.003, 95% CI: 1.000–1.005, P = 0.034) and a categorical variable (OR = 1.198, 95% CI: 1.014–1.417, P = 0.034) associated with significantly elevated risk of TNs. Analyzing the subgroups, BMI ≥ 25 kg/m2 (OR = 1.500, 95% CI: 1.110–2.026, P = 0.008) was significantly correlated with TN risk in individuals with TG ≥ 1.7 mmol/L. VFA ≥ 100 cm2 correlated with the TN risk irrespective of age (< 50 years: OR = 1.374, 95% CI: 1.109–1.703, P = 0.004; ≥ 50 years: OR = 1.367, 95% CI: 1.063–1.759, P = 0.015) and in the following subgroups: women (OR = 4.575, 95% CI: 2.558–8.181, P = 0.000), FBG ≥ 6.1 mmol/L (OR = 1.522, 95% CI: 1.048–2.209, P = 0.027), and TG ≥ 1.7 mmol/L (OR = 1.414, 95% CI: 1.088–1.838, P = 0.010). Conclusions: Adiposity correlates with TNs. To assess TN risk in Chinese individuals, VFA is better than BMI. [ABSTRACT FROM AUTHOR]

Objective: To identify the association of the glucokinase gene (GCK) rs4607517 polymorphism with gestational diabetes mellitus (GDM) and determine whether sweets consumption could interact with the polymorphism on GDM in Chinese women., Design: We conducted a case-control study at a hospital including 1015 participants (562 GDM cases and 453 controls). We collected the data of pre-pregnancy BMI, sweets consumption and performed genotyping of the GCK rs4607517 polymorphism. Logistic regression was performed to test the association between the rs4607517 polymorphism and GDM, and the stratified analyses by sweets consumption were conducted, using an additive genetic model., Setting: A case-control study of women at a hospital in Beijing, China., Participants: One thousand and fifteen Chinese women., Results: The GCK rs4607517 A allele was significantly associated with GDM (OR 1·35, 95 % CI 1·03, 1·77; P = 0·028). Furthermore, stratified analyses showed that the A allele increased the risk of GDM only in women who had a habitual consumption of sweet foods (sweets consumption ≥ once per week) (OR 1·61, 95 % CI 1·17, 2·21; P = 0·003). Significant interaction on GDM was found between the rs4607517 A allele and sweets consumption (P = 0·004)., Conclusions: This study for the first time reported the interaction between the GCK rs4607517 polymorphism and sweets consumption on GDM. The results provided novel evidence for risk assessment and personalised prevention of GDM.

The gestational diabetes mellitus (GDM) diagnostic criteria recommended by the International Association of Diabetes and Pregnancy Study Group (IADPSG) were established based on the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study and have been the most commonly used criteria for determining GDM worldwide. Although individuals from mainland China were not included in the HAPO study, the IADPSG criteria have been used in China since 2011. However, the appropriateness of the criteria for evaluating maternal postpartum outcomes in mainland China are unknown. We conducted this study to determine whether the IADPSG criteria are appropriate for Chinese patients for evaluating long-term maternal postpartum outcomes.Eighty-four patients who were diagnosed with hyperglycemia during pregnancy and had delivery in Peking University First Hospital from February 2007 to December 2009 were enrolled in the study. For patients in Group A, GDM was diagnosed using both the National Diabetes Data Group (NDDG) and the IADPSG criteria, while patients in Group B, gestational impaired glucose tolerance (GIGT) was diagnosed using the NDDG criteria while GDM was diagnosed based on the IADPSG criteria. Anthropometric data, glucose metabolism, lipid profiles, β cell function, and insulin resistance index were evaluated and compared to baseline after 5- to 6-year postpartum period.Patients in group A had significantly higher oral glucose tolerance test (OGTT) fasting, 2-hour and 3-hour plasma glucose levels compared to patients in group B at 24 to 28 weeks of gestation (P < .05). No significant differences were observed between the groups for anthropometric data, postpartum abnormal glucose metabolism (50.91% vs 44.83%, P = .596), type 2 diabetes mellitus (T2DM) (16.36% vs 3.45%, P = .167), lipid profiles, β cell function (homeostasis model assessment β-cell function index (HOMA-β) 1.04 vs 0.99, P = .935) and insulin resistance (homeostasis model assessment insulin resistance index (HOMA-IR) 2.01 vs 1.69, P = .583).Patients diagnosed with GDM using either the NDDG or IADPSG criteria had abnormal glucose levels and lipid metabolism after delivery. Patients with mild hyperglycemia had similar postpartum β-cell functional impairment and insulin resistance to those with moderate hyperglycemia during pregnancy. Hence, with respect to maternal long-term postpartum outcomes, the IADPSG diagnostic criteria for GDM could be appropriate for patients in mainland China.

Objective: To evaluate the usefulness of a fasting plasma glucose (FPG) at 24-28 weeks' gestation to screen for gestational diabetes mellitus (GDM)., Research Design and Methods: The medical records and results of a 75-g 2-h oral glucose tolerance test (OGTT) of 24,854 pregnant women without known pre-GDM attending prenatal clinics in 15 hospitals in China were examined., Results: FPG cutoff value of 5.1 mmol/L identified 3,149 (12.1%) pregnant women with GDM. FPG cutoff value of 4.4 mmol/L ruled out GDM in 15,369 (38.2%) women. With use of this cutoff point, 12.2% of patients with mild GDM will be missed. The positive predictive value is 0.322, and the negative predictive value is 0.928., Conclusions: FPG at 24-28 weeks' gestation could be used as a screening test to identify GDM patients in low-resource regions. Women with an FPG between ≥4.4 and ≤5.0 mmol/L would require a 75-g OGTT to diagnose GDM. This would help to avoid approximately one-half (50.3%) of the formal 75-g OGTTs in China.

Objective: To evaluate the value of fasting plasma glucose (FPG) value in the first prenatal visit to diagnose gestational diabetes mellitus (GDM)., Research Design and Methods: Medical records of 17,186 pregnant women attending prenatal clinics in 13 hospitals in China, including the Peking University First Hospital (PUFH), were examined. Patients with pre-GDM were excluded; data for FPG at the first prenatal visit and one-step GDM screening with 75-g oral glucose tolerance test (OGTT) performed between 24 and 28 weeks of gestation were collected and analyzed., Results: The median ± SD FPG value was 4.58 ± 0.437. FPG decreased with increasing gestational age. FPG level at the first prenatal visit was strongly correlated with GDM diagnosed at 24-28 gestational weeks (χ(2) = 959.3, P < 0.001). The incidences of GDM were 37.0, 52.7, and 66.2%, respectively, for women with FPG at the first prenatal visit between 5.10 and 5.59, 5.60 and 6.09, and 6.10-6.99 mmol/L. The data of PUFH were not statistically different from other hospitals., Conclusions: Pregnant women (6.10 ≤ FPG < 7.00 mmol/L) should be considered and treated as GDM to improve outcomes; for women with FPG between 5.10 and 6.09 mmol/L, nutrition and exercise advice should be provided. An OGTT should be performed at 24-28 weeks to confirm or rule out GDM. Based on our data, we cannot support an FPG value ≥5.10 mmol/L at the first prenatal visit as the criterion for diagnosis of GDM.

Objective: To study newborns weight in singleton term births and the association between newborns birth weight and mode of delivery in 3 hospitals., Methods: From Jan. 2005 to Dec. 2009, 13 963 singleton term live neonates born in the Department of Obstetrics and Gynecology of Peking University First Hospital (PU group), 6519 neonates in Affiliated Hospital of Binzhou Medical College (BMC group,) and 8725 neonates in Miyun Hospital Affiliated to Capital Medical University, Yanjing Medical College (MYC group) were enrolled in this retrospective study. The newborns weight and the rate of macrosomia was calculated and compared. Those newborns from PU group and MYC group were divided into 2288 neonates at macrosomia group and 20 400 neonates at non-macrosomia group, their mode of deliveries were analyzed., Results: (1) The mean neonatal birth weight were (3386 ± 414) g at PU group, (3389 ± 446) g at BMC group and (3445 ± 449) g at MYC group. Neonates born weight in MYC was significantly higher than those from in PU group and BMC group (P = 0.000). Neonates born weight in BMC showed higher than those in PU group, which did not reached statistical difference (P = 0.638). (2) The incidence of macrosomia were 7.935% (1108/13 963) in PU group, 9.802% (639/6519) in BMU group and 13.524% (1180/8725) in MYU group. The incidence of macrosomia in MYC group was higher than those in PU and BMC group, the incidence of macrosomia in BMC group was higher than that in PU group, which reached statistically difference (P = 0.000). (3)The proportion of cesarean delivery were 75.306% (1723/2288) at macrosomia group, 50.765% (10 356/20 400) at non-macrosomia group, which showed statistical difference (P = 0.000)., Conclusions: (1) The difference of newborns birth weight existed in different administrative level hospital. (2) The risk of cesarean delivery due to macrosomia is higher than that of non-macrosomia. (3) Obstetricians should pay more attention to nutrition in gestation period to lessen the incidence of macrosomia and cesarean section.

Objective: To study whether the current Institute of Medicine (IOM) pregnancy weight gain recommendations vary by pre-pregnancy body mass index (BMI) was suitable to Chinese people., Methods: A study was conducted on 4736 term singleton live birth gravidas, who were diagnosed normal glucose metabolism and delivered in Peking University First Hospital in 2005 and 2009, by reviewing the medical records. Based on the pre-pregnant BMI, the selected cases were divided into 3 groups: low body mass group (BMI < 18.5 kg/m(2), n = 465), normal body mass group (BMI 18.5 - 24.9 kg/m(2), n = 3549), over body mass group (BMI ≥ 25 kg/m(2), n = 722). All the cases were divided into 3 subgroups based on pregnancy weight gain as below, within, and above the IOM recommendations in each pre-pregnant BMI group. Totally 4736 newborns were divided by birth weight into 3 groups: normal birth weight group (weight 2500 - 4000 g, n = 4339), macrosomia group (weight ≥ 4000 g, n = 359) and low birth weight group (weight < 2500 g, n = 38). The difference of age, gestational age, pre-pregnant weight, pre-pregnant BMI and history of delivery of cases between 2005 and 2009 were analyzed. The difference of pregnancy outcome of women whose gestational weight gain was below, within, and above the IOM recommendations was analyzed., Results: (1) Compared to mothers with pregnancy weight gain within IOM recommendations in low body mass group, risk of low birth weight in offspring was elevated tendency with pregnancy weight gain below IOM recommendations (OR = 3.71, 95%CI: 0.97 - 14.12, P = 0.055). (2) In normal body mass group, compared to women with pregnancy weight gain within IOM recommendations, risk of macrosomia in offspring was elevated with pregnancy weight gain above IOM recommendations (OR = 2.14, 95%CI: 1.62 - 2.83, P < 0.01). (3) In over body mass group, compared to women with pregnancy weight gain within IOM recommendations, risk of macrosomia in offspring was elevated (OR = 3.25, 95%CI: 1.65 - 6.39, P = 0.001) and risk of hypertensive disorders complicating pregnancy was high (OR = 1.79, 95%CI: 1.04 - 3.09, P = 0.037) in women with pregnancy weight gain above IOM recommendations., Conclusion: The current IOM pregnancy weight gain recommendations vary by pre-pregnancy BMI may be suitable to Chinese people.

Objective: To investigate the relationship between gestational hyperglycemia and adverse pregnancy outcomes and find out the optimum diagnostic criteria of gestational diabetes mellitus in China., Methods: A retrospective population-based study of 14 593 pregnant women, who delivered between Jan.2005 and Dec.2009 and accepted the gestational diabetes mellitus (GDM) screening and diagnosis was performed. The prevalence of gestational hyperglycemia according to different criteria was calculated, and the incidence of adverse pregnant outcomes relation to gestational hyperglycemia according to different criteria was analyzed., Results: (1) According to National Diabetes Data Group (NDDG) criteria and International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, the prevalence of gestational hyperglycemia that intervention required was 8.9% (1293/14 593) and 14.7% (2138/14 593) respectively; the prevalence of gestational hyperglycemia differed significantly between NDDG and IADPSG criteria (P < 0.05). (2) The prevalence of macrosomia, large for gestational ages (LGA), cesarean section, preterm birth and neonatal hypoglycemia etc would increase in gestational glucose metabolic disorders according to any criteria. The prevalence of the complications in gestational hyperglycemia according to NDDG criteria, IADPSG criteria and the patients with normal glucose metabolism is as follows, macrosomia: 8.4% (108/1293), 11.3% (241/2138) and 6.7% (835/12 403); LGA: 9.7% (125/1293), 11.7% (250/2138) and 5.5% (687/12 403); cesarean section: 59.0% (763/1293), 60.4% (1291/2138) and 51.6% (6397/12 403); preterm birth: 11.4% (147/1293), 9.5% (203/2138) and 6.3% (777/12 403); neonatal hypoglycemia: 2.6% (33/1293), 2.2% (46/2138) and 0.7% (89/12 403).(3) About 71.3% (922/1293) of the gestational hyperglycemia according to NDDG criteria could be well control only by diet control., Conclusion: The prevalence of perinatal complications would increase in gestational hyperglycemia that achieved IADPSG criteria without intervention, so IADPSG criteria is reasonable in China.

Objective: This study investigated the prevalence of fecal incontinence (FI) and urinary incontinence (UI) in primiparous postpartum Chinese women., Study Design: Questionnaires about FI and UI symptoms were completed via telephone interviews conducted within 6 months postpartum., Results: A total of 1889 primiparous postpartum women were asked to participate in this investigation. Only 13 (0.69%) of them had FI within 6 months after parturition, including loss of flatus in six women (0.32%), loss of solid stool in one (0.05%), loss of liquid stool in two (0.11%) and fecal urgency in four (0.21%). Bivariate logistic regression analysis showed that FI was significantly associated with forceps delivery OR=37.91 (95% CI 4.20-342.18, P=0.001) and medio-lateral episiotomy OR=11.79 (95% CI 1.47-94.46, P=0.02). The prevalence of UI, stress urinary incontinence (SUI), urge urinary incontinence (UUI) and mixed urinary incontinence (MUI) was 9.9% (186), 8.0% (151), 1.0% (18) and 0.9% (17), respectively. Multinomial logistic regression analysis found that SUI prevalence was related to age OR=1.08 (95% CI 1.04-1.12, P=0.000), maternal weight OR=1.04 (95% CI 1.02-1.06, P=0.001), neonate head circumference OR=1.17 (95% CI 1.01-1.36, P=0.043), spontaneous labor OR=5.42 (95% CI 2.60-11.32, P=0.000), forceps delivery OR=7.0 (95% CI 2.40-20.41, P=0.000), and medio-lateral episiotomy OR=5.24 (95% CI 3.15-8.72, P=0.000)., Conclusions: 1. FI and UI prevalence was lower in our department than reported in previous studies in other areas. 2. Vaginal delivery has a risk impact on women's FI and UI, especially forceps delivery and medio-lateral episiotomy. 3. Maternal age, weight, newborn head circumference, spontaneous vaginal delivery, forceps delivery, and medio-lateral episiotomy increase the risk of UI., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

The possibility of the 2 h oral glucose tolerance test (OGTT) as an alternative to the 3 h OGTT was investigated based on data from a national survey on pregnancy-associated diabetes. Data were retrieved from 4179 pregnant women who had OGTT performed after an abnormal 50 g glucose challenge test (GCT). All of the 4 glucose levels during their OGTT were collected and analyzed. According to American Diabetes Association (ADA) gestational diabetes mellitus (GDM) diagnostic criteria, among the 4179 pregnant women who required OGTT, 3429 (82.1%) were normal and 750 (17.9%) were diagnosed as GDM. If the 3rd h glucose levels were omitted from OGTT, 79 cases of GDM (10.5%) would be overlooked. No trend was shown where women with more risk factors were more likely to be overlooked if the 3rd h test was omitted (χ2 for trend=0.038, P>0.05). No significant differences were found in the rate of cesarean section (CS), preterm births or macrosomia between the 79 cases and those with normal OGTT results and in the gestational weeks when OGTT was performed. It shows that in order to diagnose one woman with GDM, another 52 pregnant women would have an innocent 3rd h glucose test. Omission of the 3rd h glucose test in OGTT might be reasonable due to its convenience, better compliance and a small number of possibly miss-diagnosed cases, and their pregnancy outcomes have no significant difference from those of normal pregnant women.

Objective: To investigate the incidence and relevant information of preterm birth and the outcomes of preterm infants delivered at various gestational weeks and for different causes., Methods: Totally 955 women, who ended their pregnancies before term, and 1066 neonates of the previous mothers were enrolled in this survey, among 15,197 deliveries at Peking University First Hospital, Beijing Gynecological and Obstetric Hospital, Women's and Children's Hospital of Haidian District and Peking University Third Hospital, respectively, from December 1(st), 2006 to May 31(st), 2007., Results: (1) Incidence of preterm birth: the overall incidence of preterm birth of the 4 hospitals was 6.3% (955/15 197), and it was 8.1% (125/1549) in Peking University First Hospital, 13.1% (150/1142), which was the highest (P < 0.01), in Peking University Third Hospital, 5.5% (369/6656) in Beijing Gynecological and Obstetric Hospital and 34.0% (311/5850) in Women's and Children's Hospital of Haidian District. The preterm birth rate at the two comprehensive hospitals was significantly higher than that of the two specialized hospitals [10.2% (275/2691) vs 5.4% (680/12 506), P < 0.01]. (2) Gestational weeks at delivery: the incidence of preterm birth before 34 weeks was 28.5% (272/954) and the number changed to 71.5% (682/954) for those preterm deliveries after 34 weeks. However, this number varied among the 4 hospitals. Peking University First Hospital had the highest incidence of preterm birth before 34 weeks (P < 0.05), and the lowest was found in Women's and Children's Hospital of Haidian District (P < 0.01), but no difference was found between Peking University Third Hospital and Beijing Gynecological and Obstetric Hospital. (3) Etiology of preterm birth: preterm premature rupture of membranes (PPROM) accounted for the most proportion of all preterm birth cases, followed by iatrogenic preterm birth and spontaneous preterm birth. But the causes of preterm birth in the 4 hospitals were different. Peking University Third Hospital had a higher incidence of iatrogenic preterm birth than the others (P < 0.01), and Peking University First Hospital had a higher incidence of preterm birth caused by PPROM and lower incidence of spontaneous preterm birth. The first four reasons of iatrogenic preterm birth were preeclampsia (143, 42.0%), fetal distress (58, 17.1%), placenta previa (43, 12.6%) and placenta abruption (33, 9.7%). (4) Neonatal outcomes in different hospitals: the neonatal outcomes were quite different among the 4 hospitals due to different causes and different delivery weeks. The highest neonatal mortality rate was found in Beijing Gynecological and Obstetric Hospital (5.4%, 22/408) compared to that in Women's and Children's Hospital of Haidian District (1.3%, 4/320) and Peking University Third Hospital (0.6%, 1/170) (P < 0.01), but without any difference when compared to that in Peking University First Hospital (2.4%, 3/124) (P > 0.05). (5) Neonatal outcomes at different gestational age: the recovery rate of preterm infants delivered at < 32 weeks was lower than those delivered > or = 32 weeks (P < 0.01), and this number rose to 99.6% in those delivered > or = 34 weeks. More infants delivered < 32 weeks were given up for treatment or died during the perinatal period than those delivered > or = 32 weeks, with the neonatal mortality rate of 22.1% for those delivered at < 32 weeks and only 0.3% for those delivered at > or = 34 weeks (P < 0.01). (6) Neonatal outcomes for various causes: the premature neonatal mortality rate for iatrogenic preterm births was higher than that of PPROM (4.9% vs 1.6%, P < 0.05). But the neonatal recovery rates were similar among the PPROM, spontaneous and iatrogenic preterm birth group (P > 0.05)., Conclusions: Preterm birth is associated with high perinatal mortality rate, especially for those delivered before 32 weeks which would be highlighted in prevention. Reduction of the iatrogenic preterm birth, combined with proper prevention of PPROM, is an important issue in decreasing the prevalence of preterm birth.

Objective: To understand the current status and clinical relevance of early (<24 weeks) glucose challenge test (GCT) in pregnant women with risk factors of gestational diabetes mellitus (GDM) in China., Methods: Data from the survey of incidence of GDM in China were re-analyzed. The incidence of abnormal glucose metabolisms and the rate of early GCT in all women were calculated according to different numbers of risk factors. Sixteen risk factors were included in the survey. However, 4 independent risk factors were considered separately in this re-analysis. The ADA criteria for GDM diagnosis were applied., Results: A total of 16 286 pregnant women were included in this analysis and 64.3% (10 468) presented with at least one risk factor. The incidence of GDM became elevated with the increasing number of risk factors (P < 0.001). Early GCT was performed in 1687 (16.1%) pregnant women and the early detected GDMs only accounted for 11.9% of all GDMs among those with at least one risk factor. Among those who had early GCT, the GDM diagnosis rate increased with the number of risk factors (P < 0.001). Previous analysis in this survey identified 4 independent risk factors for GDM among 16 risk factors: BMI > or = 24, age over 30 years old, family history of DM and southerners. Similar analysis was performed according to the above 4 risk factors and similar results were found as those found for 16 risk factors. No significant difference was found in the GDM and GIGT incidence between the two analyses in those with at least one risk factor., Conclusion: Early GCT is necessary for pregnant women with risk factors of GDM, but the screening rate in China is low. GCT should be repeated for those women with risk factors of GDM and normal GCT at early screening.

Objective: To investigate the incidence of glucose metabolism disorder during pregnancy and establish the diagnosis criteria for gestational diabetes mellitus (GDM) among Chinese patients., Method: A prospective population-based study of 16 286 pregnant women, who received 50 g glucose challenge test (GCT) for the first time between Apr 1, 2006 and Sept 30, 2006, was performed throughout 18 cities in China., Results: According to national diabetes data group (NDDG) criteria, the overall incidence of GDM and glucose impaired glucose tolerance (GIGT) was 2.763% (450/16 286) and 3.862% (629/16 286), respectively; it changed to 5.078% (827/16 286) and 5.268% (858/16 286) when using American diabetes association (ADA) criteria. If the women who had 2 or more abnormal oral glucose tolerance test (OGTT) values meeting or exceeding ADA criteria was classified as group 1, and the women who had one or more meeting or exceeding NDDG criteria was group 2, the ratio of women who met both the criteria of ADA and NDDG in group 1 was 94.2%. The 95%CI of normal glucose when using ADA criteria were fasting glucose 5.3 mmol/L, 1 hour 10.4 mmol/L, 2 hour 8.7 mmol/L, 3 hour 7.7 mmol/L, which is close to ADA criteria., Conclusions: ADA criterion is more suitable for Chinese patients. According to NDDG criteria, it is reasonable to treat the patient with 1 or more abnormal OGTT values, and if choosing ADA criteria, 2 or more abnormal OGTT values is more reasonable.

In China many women in labor are young primigravidas whose fear of labor pain leads them to request cesarean deliveries. While the rate of cesarean deliveries has reached 50% in many hospitals, less than 1% of women in labor are given neuraxial analgesia. The necessary equipment is seldom available in China and many physicians have misconceptions about the risks associated with neuraxial analgesia, which are low with the ultra-low-dosages used today. However, attitudes have begun to change. Meetings held in China have brought together Chinese physicians and world experts on the various epidural and combined spinal-epidural techniques. Thanks to the information and support provided at these meetings clinical trials were carried out, more than 5000 women benefited from labor analgesia, and publications appeared in Chinese journals. An effective, safe, and cost-effective way to provide analgesia to women in labor may slow the increase in cesarean delivery rates across China and improve women's health in general.

Objective: Alport syndrome (AS) is a progressive renal disease characterized by hematuria and progressive renal failure. X-linked dominance is the major inheritance form of the syndrome, accounting for almost 80% of the cases, caused by mutations in COL4A5 genes. There is currently no effective treatment that has been shown to favorably affect the outcome of AS, so early diagnosis and even prenatal diagnosis is very important., Methods: In this study mutation of COL4A5 was detected by amplifying the entire coding sequence mRNA of peripheral blood lymphocytes using nested PCR in two Chinese X-linked dominant Alport syndrome (XLAS) families, then the first prenatal diagnosis of XLAS in China was performed. Mutation analysis of the fetus was performed on both cDNA-based level and DNA-based level of amniocytes. Fetus sex was determined by PCR amplification of SRY as well as karyotypes analysis. Maternal cells contamination was excluded by linkage analysis., Results: There was a deletion mutation in the proband of the first family, 2696 - 2705 del gtatgatggg in the 32 exon of COL4A5, but the mother did not carry the mutation (de novo). There was a G to A substitution at position 4271 in exon 46 of COL4A5 gene (c.G4271A) in the second family, the mother also carried this mutation. After genetic counselling, only the second family accepted prenatal diagnosis. Both amniocytes cDNA level and amniocytes genomic DNA level based prenatal diagnosis showed that the fetus did not carry the same mutation as the mother. PCR amplification of SRY and karyotypes analysis showed a male fetus. Linkage analysis of X chromosome polymorphic microsatellite markers showed that there was no MCC in amniocytes., Conclusion: Both cDNA level and DNA level analysis could enhance the accuracy and reliability of prenatal diagnosis. PCR amplification of SRY was faster than karyotypes analysis in the fetal sex determination. Linkage analysis was useful in the detection of maternal cells contamination in amniocytes.

Objective: To analyze the pregnant outcome of women with chronic hypertension, and to investigate the high risk factors associated with harmful maternal and perinatal prognosis., Methods: Of the 14 127 deliveries in Peking University First Hospital from Jan 2001 to Dec 2005, 121 pregnant women with chronic hypertension were identified and divided into two groups: chronic hypertension with and without preeclampsia (group PE, 64 cases; group N-PE, 57 cases). The maternal and perinatal outcomes of the two groups and the high risk factors for adverse maternal and perinatal prognosis were analyzed., Results: (1) The incidence of pregnancy with chronic hypertension was 0.86% (121/14 127). (2) The incidences of placental abruption, pulmonary edema and retinopathy in groups PE and N-PE were 16% (10/64) vs 2% (1/57), 11% (7/64) vs 0 and 41% (26/64) vs 16% (9/57, P < 0.05). (3) Preterm birth rate and preterm birth rate before 32 weeks in groups PE and N-PE were 55% (35/64) vs 16% (9/57) and 27% (17/64) vs 2% (1/57, P < 0.01). (4) The rate of small for gestational age in groups PE and N-PE was 31% (20/64) vs 7% (4/57, P < 0.01). (5) The perinatal mortality and newborn intensive care unit (NICU) admission rate in groups PE and N-PE were 11% (7/64) vs 0 and 33% (21/64) vs 5% (3/57, P < 0.01). (6) Chronic hypertension history > or = 4 years, no systemic therapy, irregular perinatal care and preeclampsia history were high risk factors of preeclampsia superimposed on chronic hypertension (P < 0.05). Chronic hypertension history > or = 4 years was the only independent risk factor by multiple factors logistic regression analysis (P < 0.05)., Conclusions: Maternal and perinatal morbidity and mortality are higher in chronic hypertension with preeclampsia than without preeclampsia. Hypertension history for at least 4 years is an independent risk factor.

Objective: To understand the incidence of abnormal glucose metabolism during pregnancy and the maternal and neonatal outcomes after standard management., Methods: A retrospective study of maternal and neonatal outcomes was conducted in 1490 pregnant women who were diagnosed and treated for abnormal glucose metabolism and delivered in the Department of Obstetrics and Gynecology of First Hospital of Peking University from Jan 1995 to Dec 2004 by reviewing the medical records. The selected cases consisted of 79 women with diabetes mellitus (DM group), 777 with gestational diabetes mellitus (GDM group), including 355 cases of A1, 316 with A2 and 106 cases unclassified, and 634 with gestational impaired glucose test (GIGT group). Maternal and fetal outcomes were analysed in comparison with the controls of 19 013 pregnant women with normal glucose metabolism who delivered during the same period., Results: (1) The total incidence of gestational abnormal glucose metabolism was 7.3% and increased gradually from 1995 to 2004. The first stage, from Jan 1995 to Dec 1999, saw a slow increase in the incidence [4.3% (376/8739)]; the second stage, from Jan 2000 to Dec 2001, showed a fast increasing trend. The average incidence was 10.8% (445/4133). The incidence in the third stage kept stable at 8.9% (678/7640) from Jan 2002 to Dec 2004. (2) The incidence of macrosomia, preeclampsia and preterm birth were 12.1% (180/1490), 9.5% (141/1490) and 9.4% (140/1490), which were significantly higher than those women with normal glucose metabolism (P < 0.01). A significant difference was found in the incidence of preeclampsia, preterm birth, intrauterine infection, polyhydramnios and ketonuria among the three groups (P < 0.05), but not in the incidence of macrosomia (P > 0.05). (3) The perinatal mortality rate (PMR) of abnormal glucose metabolism group was 1.19% (18/1513) which was significantly higher in the DM group (4.93%) than GDM (1.14%) and GIGT groups (0.78%, P < 0.01), while the incidence of neonatal asphyxia, hypoglycemia, malformation and admission to NICU in the DM group were all higher than GDM and GIGT groups (P < 0.01). (4) NRDS was found in 9 cases among 1505 neonates (0.6%) and all were delivered preterm., Conclusions: (1) The incidence of gestational abnormal glucose metabolism is increasing and the screening and diagnosis of diabetes in pregnancy should be strengthened. (2) Macrosomia, preeclampsia and preterm birth remain the first three common complications even after standardized glycemic management, but the maternal and neonatal complications are reduced in the GIGT group except for macrosomia. Those women in the DM group has a higher rate of maternal and neonatal complications than those in GDM and GIGT groups, so management in these patients should be strengthened. (3) NRDS is no longer a primary neonatal complication provided proper management is performed.

Objective: To evaluate whether incidence of 50 g glucose challenge test (GCT) and 75 g oral glucose tolerance test (OGTT) is higher in pregnant women with vulvovaginal candidiasis (VVC)., Methods: A retrospective study of pregnant women with IGGT or GDM who delivered at Peking University First Hospital from Jan 1, 2004 to June 30, 2005 was conducted. The prevalence of VVC and re-infected vulvovaginal candidiasis (RVVC) were determined, and blood glucose concentrations of GGT and OGTT in VVC, RVVC and NVVC groups were compared., Results: Four hundred and one pregnant women were recruited, of whom 51 had VVC, and 16 had RVVC. The prevalence of VVC was greater among GDM women than among IGGT women (P = 0.014). Glucose concentrations were higher in VVC cases than in NVVC cases at GCT [(9.6 +/- 2.0) vs (9.3 +/- 1.6) mmol/L], OGTT 0 hour [(5.4 +/- 1.1) vs (5.3 +/- 0.9) mmol/L], 1 hour [(11.1 +/- 1.7) vs (11.0 +/- 1.5) mmol/L], 2 hours [(9.4 +/- 1.8) vs (9.2 +/- 1.6) mmol/L], however, there were no statistical differences (P > 0.05). Glucose concentrations were higher in RVVC cases than in NVVC cases at GCT [(10.4 +/- 1.2) vs (9.3 +/- 1.6) mmol/L]; OGTT 0 hour [(5.3 +/- 0.6) vs (5.3 +/- 0.9) mmol/L], 1 hour [(11.4 +/- 1.0) vs (11.0 +/- 1.5) mmol/L]; 2 hours [(9.4 +/- 1.4) vs (9.2 +/- 1.6) mmol/L], but there were no statistical differences (P > 0.05)., Conclusion: The incidence of VVC is higher in pregnant women with GDM than in pregnant women with GIGT, however, GCT, and OGTT show no statistical differences between women with VVC and those without VVC.

Objective: To investigate the relationship between the polymorphism of site rs228648 in urotensin II gene and the genetic susceptibility to gestational diabetes mellitus in northern Chinese women., Methods: Genotyping was conducted to investigate the polymorphism of site rs228648 (G-A) in urotensin II gene among 70 unrelated gestational diabetes mellitus (GDM) subjects and 70 normal controls. DNA samples isolated from leucocyte of the control and study groups were analyzed for single-nucleotide polymorphisms of the urotensin II gene at positions rs228648 using polymerase chain reaction and restriction analysis., Results: (1) The distribution of genotype frequencies of site rs228648 accorded with Hardy-Weinberg's equation law, being colony representative. (2) The frequency of G allele of site rs228648 was 70.7% in GDM group, significantly higher than that in the control group (57.9%, P < 0.05); and the frequency of A allele of site rs228648 was 29.3% in GDM group, significantly lower than that in the control group (42.1%, P < 0.05). There was no significant difference in the frequency of G/G genotype between GDM group and control group (52.9% vs 41.4%, P > 0.05). (3) Women in control group were more likely to be homozygous for the allele A of site rs228648 than women with GDM. The frequency of A/A genotype of rs228648 was negatively correlated with GDM group. By the logistic procedure, after adjustment by age and gestational weeks, the odds ratio was 0.312, and Wald Confidence Limites were 0.108 to 0.900 (P = 0.031)., Conclusion: Urotensin II gene may contribute to the genetic susceptibility to gestational diabetes mellitus in northern Chinese population. G allele of site rs228648 is related to GDM possibly, and that homozygosis A of site rs228648 is likely to be an important protecting factor for GDM.

Objective: Severe preeclampsia, and hemolysis, elevated liver enzymes, and low platelet syndrome (HELLP) are serious complications of pregnancy, and evidence suggests a genetic basis for these conditions. A G1528C mutation in the alpha-subunit of the mitochondrial trifunctional protein (MTP) gene has been identified in association with these conditions. The aim of this study is to explore the carrier rate of the G1528C mutation in the MTP gene in pregnant women with severe preeclampsia, HELLP syndrome and in their newborns, as well as in a normal pregnant population, so as to determine its association with maternal liver disease among women in Beijing., Methods: A multicenter, prospective, case control study was carried out. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to screen the G1528C mutations in the MTP gene. One hundred and forty cord blood samples from cases with severe preeclampsia (n = 130) and HELLP syndrome (n = 10) were collected. Ninety maternal peripheral blood samples among them (84 from severe preeclampsia and 6 from HELLP syndrome) were also collected for screening the common disease-causing mutation in Caucasians. Five hundred and sixty cord blood samples and 90 maternal peripheral blood samples obtained from normal pregnant women served as controls., Results: The G1528C mutations in the MTP gene were not found in samples from women with severe preeclampsia and their newborns, from women with HELLP syndrome and their new borns, as well as in samples from the normal pregnant women and their new borns., Conclusions: The common disease-causing mutation of G1528C in MTP gene in Caucasians is probably not a common mutation in Chinese Han people in Beijing. Further study is needed to expand the sample size among HELLP syndrome and maternal liver diseases in Chinese population.

Objective: To explore the carrier rate of G1528C mutation in alpha-subunit gene of MTP in Chinese newborns., Methods: 1 200 cases of cord blood samples were taken in pregnant women with Han nationality in Chinese. PCR-RFLP analysis was conducted for detection of G1528C mutation., Results: No. G1528C mutations in LCHAD gene were found in these study subjects., Conclusion: G1528C is probably not the common prevalent mutation in MTP gene in Chinese. Different prevalent mutation between Chinese and Western white people needs further study.