Since the implementation of the "universal two-child" policy, multiparous women has become the main labor and delivery population. Problems such as advanced maternal age, chronic comorbidities, obstetric complications and pregnancy after cesarean section have become increasingly prominent, bringing new challenges to obstetricians.

To analyze the current status of cesarean section in multiparous women under the new childbearing policy based on the revised Robson classification system, in order to provide data support for rational control of cesarean section rate, improvement of obstetric care.

A total of 19 170 women who delivered by cesarean section in the Tenth Affiliated Hospital, Southern Medical University from 2017 to 2020 were included and divided into the primipara group (n=5 630) and multiparous group (n=13 540). Maternal information including age, gravity, parity, previous deliveries, fetal position, pregnancy comorbidities and complications, maternal and fetal outcomes, was collected through the electronic medical records. The general information and maternal and neonatal outcomes of the two groups were compared. The revised Robson classification system was used to classify the parturients according to their obstetric characteristics (parity, fetal position, number of fetuses and gestational weeks of delivery). The distribution of parturients in the revised Robson classification system and the change of the proportion of parturients in each group with year were compared.

The proportion of pregnancy after cesarean section was as high as 81.4% (11 026/13 540). The age, gravity, parity, proportion of age ≥35 years and gestational diabetes mellitus of the multiparous group were higher than the primipara group (P<0.05). Based on the revised Robson classification system, R3 class (singleton cephalic position at ≥37 weeks' gestation with a history of at least 1 cesarean delivery) accounted for the highest proportion (50.4%, 9 668/19 170) in all cesarean section, followed by R1 class (singleton cephalic primiparous labor at≥37 weeks' gestation, spontaneous labor, induced labor, or cesarean section before labor) (20.8%, 3 993/19 170). In multiparous women, R3 class accounted for 71.4% (9 668/13 540). Analysis of the population characteristics of multiparous women found that the proportion of R3 class, which had the highest proportion, decreased from 73.5% to 67.1%, while the proportion of R2 class [transplants with singleton cephalic position at ≥37 weeks' gestation (without history of cesarean section), spontaneous labor, induced labor, or cesarean section before labor], and R8 class [all singleton cephalic positions at <37 weeks' gestation (including history of cesarean section) ] all increased. The 24-h postpartum hemorrhage and the proportion of blood transfusions were higher in the multiparous group than the primipara group, while length of hospital stay after surgery was lower than that in the primipara group (P<0.05). A total of 20 026 newborns were delivered by 19 170 women, including 6 077 primipara women and 13 949 multiparous women; the birth weight and 1-minute Apgar score of neonates in the multiparous group were higher than the primipara group, while the proportions of 1-minute ≤7 and neonatal transfers were lower than those in the primipara group (P<0.05). There was no significant difference in 5-minute Apgar score between the two groups (P>0.05) .

Advanced age and pregnancy after cesarean section are prominent features of multiparous women. Although the proportion of R3 class decreased by year, it is still the main population of cesarean section. In order to reduce cesarean section rate, it is necessary to effectively control the cesarean section of primipara women, and actively promote the vaginal trial of labor for women in R3 class. Meanwhile, the proportion of R2 and R8 in the multiparous women, which put forward new requirements for clinical practice of obstetrics.

With the mature application of assisted reproductive technologies, the incidence of multiple pregnancies has increased dramatically, and complications including premature labor, fetal malformations, preeclampsia, and gestational diabetes have also increased. Perinatal prognosis and fetal survival quality can be improved through fetal reduction. Selective fetal reduction in the first trimester may result in a better prognosis than selective fetal reduction in the second trimester, suggesting that early assessment of pregnancy outcome in early pregnancy will provide a significant improvement in maternal and fetal prognosis.

To explore the relationship of ultrasonographic soft markers in early pregnancy and twin-specific markers with the pregnancy outcome of double chorionic double amniotic sac twins (DCDA) .

Pregnant women and fetuses with DCDA twin pregnancies in early pregnancy (11-13⁺⁶ weeks) attending the Department of Ultrasound Medicine of Longgang District Maternity&Child Healthcare Hospital of Shenzhen City from May 2018 to May 2022 were retrospectively selected for the study. The detection rates of ultrasonographic soft markers and twin-specific markers in DCDA twin pregnancies in early pregnancy and their association with adverse pregnancy outcomes. Ultrasonographic soft markers included thickened nuchal translucency (NT), choroid plexus cyst, nasal bone dysplasia, ventricular punctate strong echo, tricuspid regurgitation, absence or inversion of ductus venosus A wave, intestinal echo enhancement, mild dilatation of the renal pelvis, single umbilical artery and right subclavian artery vagus. Twin-specific markers included differences in twin crown-rump length (CRL), twin NT, and twin umbilical cord insertion (UCI). Adverse pregnancy outcomes included miscarriage, stillbirth, neonatal death, structural abnormalities, and genetic abnormalities, with the addition of positive weight gain (≥25% difference in twin weights) as a specific adverse pregnancy outcome. Logistic regression analysis was used to explore the correlation of ultrasonographic soft markers and twin-specific markers of DCDA twin pregnancies in early pregnancy with adverse fetal pregnancy outcomes.

Finally, 418 cases pregnant women of DCDA twin pregnancies in the first trimester were included, of which 342 cases (81.82%) had normal pregnancy outcomes and 76 cases (18.18%) had adverse pregnancy outcomes. The total detection rate of positive ultrasonographic soft markers in twin pregnancies in the first trimester was 10.53% (53/418) ; a total of 61 ultrasonographic soft markers were detected in 53 fetuses with positive ultrasonographic soft markers, and the top three detection rates were NT thickening in 6.94% (29/418), choroid plexus cyst in 2.39% (10/418) and nasal bone dysplasia in 1.67% (7/418). The incidence rate of adverse pregnancy outcomes for fetuses with positive ultrasonographic soft markers was 30.19% (16/53), and the incidence rate of adverse pregnancy outcomes for fetuses with negative ultrasonographic soft markers was 16.44% (60/365) ; the incidence rate of adverse pregnancy outcomes for fetuses with positive ultrasonographic soft markers in the first trimester was higher than fetuses with negative ultrasonographic soft markers (χ²=5.882, P=0.015). Binary Logistic regression analysis results showed that a twin CRL difference≥15% was a risk factor for adverse pregnancy outcomes in twin pregnancy (OR=9.955, 95%CI=1.882-52.662, P=0.007), and a positive twin UCI difference was a risk factor for positive fetal weight in twin pregnancy (OR=3.733, 95%CI=1.300-10.720, P=0.014). The total detection rate of positive twin-specific markers in fetuses with twin pregnancies in early pregnancy was 27.27% (114/418), including 12 cases with a twin CRL difference≥15% and a negative twin UCI difference, 100 cases with a twin CRL difference<15% and a positive twin UCI difference, and 2 cases with a twin CRL difference≥15% and a positive twin UCI difference. The total detection rate of fetuses with ultrasonographic soft markers but positive twin-specific markers in early pregnancy was 25.12% (105/418). The incidence of adverse pregnancy outcomes and positive weight gain among fetuses with negative ultrasound soft markers but positive twin-specific markers was 27.6% (29/105), and the incidence of adverse pregnancy outcomes among fetuses with negative ultrasound soft markers alone was 16.4% (60/365). The incidence of adverse pregnancy outcomes and positive weight gain in fetuses with negative ultrasonographic soft markers but positive twin-specific markers in early pregnancy was higher than the incidence of adverse pregnancy outcomes in fetuses with negative ultrasonographic soft markers alone (χ²=6.641, P=0.010). The total detection rate of positive ultrasonographic soft markers combined with positive twin-specific markers in fetuses with twin pregnancies in early pregnancy was 2.15% (9/418), and the incidence of adverse pregnancy outcomes combined with positive weight gain in fetuses with positive ultrasonographic soft markers combined with positive twin-specific markers was 44.4% (4/9), and the incidence of adverse pregnancy outcomes in fetuses with positive ultrasonographic soft markers alone was 30.2% (16/53). There was no statistically significant difference in the incidence of adverse pregnancy outcomes combined with positive weight gain in fetuses with positive ultrasonographic soft markers combined with positive twin-specific markers compared with the incidence of adverse pregnancy outcomes in fetuses with positive ultrasonographic soft markers alone (χ²=0.212, P=0.645). The results of multivariate Logistic regression analysis showed that NT thickening (OR=2.576, 95%CI=1.146-5.791, P=0.022), twin-fetal CRL difference≥15% (OR=13.167, 95%CI=3.595-48.229, P<0.001), and positive twin-fetal UCI difference (OR=2.369, 95%CI=1.049-5.348, P=0.038) were risk factors for adverse fetal pregnancy outcome and positive weight gain in DCDA twin pregnancies in early pregnancy.

NT thickening, twin-fetal CRL difference≥15%, and positive twin-fetal UCI difference may be risk factors for adverse fetal pregnancy outcomes and positive weight gain in DCDA twin pregnancies in early pregnancy. The fetus with positive ultrasonographic soft markers or positive twin-specific markers should be vigilant, and comprehensive evaluation and close follow-up should be carried out.

The disorder of serum uric acid metabolism during pregnancy is associated with adverse pregnancy outcomes, while few studies have analyzed and compared the correlation of serum uric acid and serum uric acid/creatinine ratio levels with adverse pregnancy outcomes.

To explore the correlation of serum uric acid and serum uric acid/creatinine ratio levels with adverse pregnancy outcomes in late pregnancy.

A total of 743 pregnant women with singleton live births who were routinely examined and delivered at Nanjing Drum Tower Hospital from 2015 to 2022 were selected . Based on the occurrence of adverse pregnancy outcomes, pregnant women were divided into normal group (344 cases) and adverse outcome group (399 cases) . Serum uric acid and serum uric acid/creatinine ratio were divided into three levels by quartiles, respectively, including Q1 (serum uric acid<257 μmol/L) , Q2 (serum uric acid 257-359 μmol/L) , Q3 (serum uric acid>359 μmol/L) and q1 (serum uric acid/creatinine ratio<5.88) , q2 (serum uric acid/creatinine ratio 5.88-7.94) , q3 (serum uric acid/creatinine ratio>7.94) . According to the median age of pregnant women, they were divided into the age subgroup<30 years old (341 cases) and age subgroup≥ 30 years old (402 cases) . Based on previous pregnancies and deliveries, they were divided into the primiparous subgroup (539 cases) and multiparous subgroup (194 cases) . The correlation of serum uric acid and serum uric acid/creatinine ratio levels with adverse pregnancy outcomes was analyzed by using multivariate Logistic regression.

Pregnant women in adverse outcomes group were older with higher levels of BMI, serum uric acid, serum uric acid/creatinine ratio and triglycerides than those in the normal group (P<0.05) . After adjustment for confounders, the multivariate Logistic regression results of the effect of serum uric acid and serum uric acid/creatinine ratio on adverse pregnancy outcomes showed that, compared to Q1 serum uric acid level, the risk of preeclampsia (AOR=4.41, 95%CI=2.16-8.99) and intrauterine growth restriction (AOR=3.59, 95%CI=1.08-11.96) increased at Q3 serum uric acid level (P<0.05) ; compared to q1 serum uric acid/creatinine ratio level, the risk of preeclampsia (AOR=2.33, 95%CI=1.13-4.79; AOR=3.56, 95%CI=1.68-7.56) increased at q2 and q3 serum uric acid/creatinine ratio levels. Compared to q1 serum uric acid/creatinine ratio level, the risk of preterm labor (AOR=2.76, 95%CI=1.33-5.71) and intrauterine growth restriction (AOR=5.15, 95%CI=1.39-19.14) increased, while the risk of macrosomia (AOR=0.43, 95%CI=0.19-0.98) and large for gestational age (AOR=0.38, 95%CI=0.15-0.96) decreased (P<0.05) . The results of the effect of serum uric acid and serum uric acid/creatinine ratio on preeclampsia and preterm labor in different age subgroups showed that, compared to Q1 serum uric acid level, the risk of preeclampsia increased in both age subgroups at Q3 serum uric acid level (P<0.05) ; compared to q1 serum uric acid/creatinine ratio level, the risk of preeclampsia increased among women aged≥30 years at q2 and q3 serum uric acid/creatinine ratio level (P<0.05) . The results of the effect of serum uric acid and serum uric acid/creatinine ratio on preeclampsia and preterm labor in different pregnancies and deliveries subgroups showed that compared to Q1 serum uric acid level, the risk of preeclampsia increased at Q3 serum uric acid level among primiparous women (P<0.05) ; compared to q1 serum uric acid/creatinine ratio level, the risk of preeclampsia increased at q2 and q3 serum uric acid/creatinine ratio level among primiparous women, as well as the risk of preterm birth at q3 serum uric acid/creatinine ratio level among primiparous women (P<0.05) .

Elevated levels of serum uric acid and serum uric acid/creatinine ratio were associated with the risk of preeclampsia and intrauterine growth restriction, in which preeclampsia mainly occurred in pregnant women aged≥30 years or primiparous women. The risk of preterm labor was increased at high levels of serum uric acid/creatinine ratio, primarily in primiparous women. Serum uric acid/creatinine ratio predicted more adverse pregnancy outcomes than serum uric acid.

Intrapartum fever is a common clinical manifestation in obstetrics, which increases the rates of cesarean section, vaginal instrumental delivery and neonatal asphyxia. The influencing factors of intrapartum fever include pregnancy comorbidities and complications, labor induction duration, labor analgesia, trial delivery time, temperature of delivery room, and number of pelvic examination. These factors can exist independently or be causal. Is it true that the higher maximum body temperature correlates with worse maternal and neonatal outcomes in women with intrapartum fever? The study on it is useful to guide the clinical prognosis and management strategies of pregnant women with intrapartum fever.

To investigate the effect of intrapartum fever and its severity on maternal and fetal outcomes during trial delivery of full-term singleton primipara.

A total of 994 full-term singleton primiparas who delivered in 2019 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University and diagnosed with intrapartum fever during labor were included as fever group, the full-term singleton primiparas without intrapartum fever who met the criteria were enrolled in a 1∶1 ratio as the control group during the same period. The general situation, complications, labor induction, delivery mode, and maternal and infant outcomes were compared between the fever group and control group. The fever group was further divided into 4 subgroups according to the degree of body temperature at delivery, including 142 cases in subgroup 1 with temperature of 37.3 to <37.5℃, 600 cases in subgroup 2 with temperature of 37.5 to <38 ℃, 213 cases in subgroup 3 with temperature of 38.0 to <38.5 ℃, 39 cases in subgroup 4 with temperature ≥38.5 ℃. General information, obstetric complications, labor induction, delivery mode, and maternal and fetal outcomes of the four subgroups were compared and analyzed.

A total of 994 cases were included in the fever group and 987 cases in the control group. The proportions of labor induction and induced labor≥3 days in the fever group were higher than those in the control group (P<0.05) . The incidence of premature membrane rupture, gestational hypertension and gestational diabetes in the fever group was higher than the control group (P<0.05) . The rates of cesarean section, puerperal infection, neonatal asphyxia, amniotic fluid contamination neonatal NICU transfer in the fever group were higher than those in the control group (P<0.05) . There was no statistically significant difference between the two groups in terms of neonatal body mass (P>0.05) . There was no statistically significant difference in the rates of labor induction, proportion of induced labor≥3 days and incidence of premature rupture of fetal membranes, gestational hypertension and gestational diabetes among the subgroups (P>0.05) . The differences were not statistically significant when comparing the rates of cesarean delivery, puerperal infection, neonatal asphyxia, amniotic fluid contamination and neonatal NICU transfer among the subgroups (P>0.05) .

The incidence of maternal complications, labor induction, cesarean section, puerperal infection and neonatal asphyxia increased in patients with fever during labor, the severity of fever was not related to the mode of delivery and maternal and infant outcomes.

Elevated dyslipidemia during pregnancy can adversely affect maternal and child health. It not only increases the risk of preeclampsia, gestational diabetes mellitus (GDM) , hypertriglyceridemic pancreatitis, late abortion, premature delivery and macrosomia, but also significantly increases the risk of postnatal cardiovascular disease.

To analyze the distributional characteristics of dyslipidemia in the first, second and third trimesters of pregnancy and the predictive value of early lipid levels for dyslipidemia in the second and third trimesters of pregnancy.

This was a single-center retrospective study, which included singleton pregnant women who were enrolled in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2018 to June 2019 for obstetrics checkups until delivery. Clinical data and lipid data [total cholesterol (TC) , triacylglycerol (TG) , low-density lipoprotein cholesterol (LDL-C) , and high-density lipoprotein cholesterol (HDL-C) ] were collected in the first, second and third trimesters of pregnancy. The reference range of lipids in department of obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University was used as the diagnostic standard for dyslipidemia, including high total cholesterolemia, high triacylglycerolemia, low HDL-cholesterolemia and high LDL-cholesterolemia. The correlation between lipid levels in the first trimester of pregnancy and dyslipidemia in the second and third trimesters of pregnancy was analyzed by using binary Logistic regression, and the receiver operating characteristics (ROC) curves of the subjects were plotted to obtain the area under ROC curve (AUC) , to evaluate the predictive value of the lipid levels in the first trimester of pregnancy for dyslipidemia in the second and third trimesters of pregnancy, and to determine the optimal cut-off value according to the sensitivity and specificity.

A total of 8 511 singleton pregnant women were included in the study, with an average age of (31.7±3.9) years and an average pre-pregnancy BMI of (21.7±3.2) kg/m². Among them, 988 (11.6%) were of low pre-pregnancy body mass, 5 568 (65.4%) were of normal pre-pregnancy body mass, 1 271 (14.9%) were overweight, 366 (4.3%) were obese, 1 415 (16.7%) were with GDM, and 650 (7.6%) were with hypertensive disorders of pregnancy (HDP) . The levels of TC, TG and LDL-C in the second and third trimesters of pregnancy were higher than those in the first trimester of pregnancy (P<0.05) . The level of HDL-C in the third trimester of pregnancy was higher than that in the first trimester of pregnancy, but lower than that in the second trimester of pregnancy (P<0.05) . The prevalence of dyslipidemia in the first trimester of pregnancy was 23.4% (1 990/8 511) , and the prevalence of dyslipidemia in the second and third trimesters of pregnancy was lower than that in the first trimester of pregnancy (P<0.05) . The prevalence of dyslipidemia in overweight and obese pregnant women in the first trimester of pregnancy was higher than that in pregnant women with normal pre-pregnancy body mass, but there was no statistical difference in the prevalence of dyslipidemia in the third trimester of pregnancy (P>0.05) . The prevalence of dyslipidemia in first and second trimesters of pregnancy in the GDM group was higher than that in the non-GDM group, and the prevalence of dyslipidemia in first, second and third trimesters of pregnancy in HDP group was higher than the non-HDP group (P<0.05) . After excluding pregnancy comorbidities and complications that may affect blood lipids, the optimal cut-off values for predicting dyslipidemia in the second trimester of pregnancy were TC of 4.485 mmol/L (AUC=0.854) , TG of 1.325 mmo/L (AUC=0.864) , HDL-C of 1.275 mmol/L (AUC=0.908) , and LDL-C of 2.265 mmol/L (AUC=0.823) , respectively; the optimal cut-off values for predicting dyslipidemia in the third trimester of pregnancy were TC of 4.485 mmol/L (AUC=0.809) , TG of 1.145 mmol/L (AUC=0.833) , HDL-C of 1.285 mmol/L (AUC=0.851) , LDL-C of 2.195 mmol/L (AUC=0.766) .

The prevalence of dyslipidemia did not increase during pregnancy. There were significant differences in the prevalence of dyslipidemia during pregnancy among pregnant women with different pre-pregnancy BMI, between GDM and non-GDM pregnant women, between HDP and non-HDP pregnant women, respectively. The blood lipid level in the first trimester was helpful to predict the occurrence of dyslipidemia in the second and third trimesters of pregnancy.

The development of maternal and child health requires reducing urban-rural, regional and group disparities in the health of women and children. Focusing on the quality of life of maternal women in rural areas and other low-income areas is of great significance to improve the inequalities in maternal and child health.

To analyze the current situation of maternal quality of life during pregnancy and its influencing factors in rural China.

From September 2018 to September 2019, a total of 3 329 pregnant women were selected from 6 county-level medical institutions in Shanxi Province, Sichuan Province and Yunnan Province (Zhaoyang District People's Hospital, Yiliang County People's Hospital, Pingchang County Maternal and Child Health Care Hospital, Yingshan County Maternal and Child Health Care Hospital, Ziyang County Maternal and Child Health Care Hospital, and Hanyin County Maternal and Child Health Care Hospital) as the research objects to collect basic information of pregnant women. WHOQOL-BREF scale was used to investigate the quality of life of pregnant women. Multiple linear regression analysis was used to explore the influencing factors of each dimension of the quality of life score.

A total of 3 294 questionnaires were included, with a valid questionnaire rate of 98.94%. The average WHOQOL-BREF score of pregnant women was (81.99±11.01) points, and the social relation score was the highest among the 4 dimensions [ (69.13±12.46) points] , followed by the psychological dimension score [ (66.99±12.59) points] , physiological dimension score [ (65.40±12.62) points] , environmental dimension score [ (65.02±12.11) points] . Stratified comparison results showed that there were statistically significant differences in the scores of physiological dimension, psychological dimension, social relation dimension and environmental dimension among pregnant women of different ages, total annual income levels, places of residence, education levels and occupations (P<0.05) . The difference was statistically significant in psychological dimension score when comparing pregnant women with different preconception BMI (P<0.05) . There were significant differences in the scores of psychological dimension and environmental dimension of pregnant women with weight gain during different gestation periods (P<0.05) . The scores of psychological dimension, social relation dimension and environmental dimension of pregnant women with different medical insurance types were compared, and the differences were statistically significant (P<0.05) . The score of environmental dimension of parturients was significantly lower than that of parturients (P<0.05) . The scores of physiological dimension, psychological dimension and environmental dimension of pregnant women with exercise habit were higher than those of pregnant women without exercise habit, and the difference was statistically significant (P<0.05) . The results of multiple linear regression analysis showed that age, exercise habit, education level and occupation were the influencing factors of physiological dimension score (P<0.05) . Age, pre-pregnancy BMI, family history, exercise habits, education level and medical insurance type were the influencing factors of psychological dimension score (P<0.05) . Age and exercise habit were the influencing factors of social relation dimension score (P<0.05) . Family history, weight gain during pregnancy, exercise habits, residence type, occupation, total annual income level and medical insurance type were the influencing factors of environmental dimension score (P<0.05) .

There is still much room for improvement in the quality of life of pregnant women in rural areas of China. In addition to individual factors such as age, parity, social factors such as place of residence and health insurance coverage are also significant influencing factors, improvement from the social perspective remains a priority for maternal and child health care in the future.

It is of great importance to standardize labor management for ensuring maternal and neonatal safety. Since the publication of the new stage of labor, the definition of prolonged labor has not been emphasized and it is recommended to minimize interventions during labor, therefore, the number of pregnant women with labor over 24 h is increased compared to the previous.

To analyze the risk factors and maternal and neonatal outcomes of pregnant women with labor over 24 h and discuss the labor management under the new stage of labor.

The clinical data of pregnant women received maternity examination and delivered at Department of Obstetrics, the First Affiliated Hospital with Nanjing Medical University from January to December 2022 were collected in the retrospective study. A total of 40 single birth pregnant women with normal fetal position and prolonged total labor (more than 24 h) were selected as the observational group, and 95 single birth pregnant women with normal fetal position and normal total labor (less than 24 h) were selected as the control group. The age, BMI, gestational age of delivery, gestational diabetes, gestational hypertension, neonatal body mass, labor condition, analgesic delivery rate and delivery intervention rate of the two groups were compared. Multivariate Logistic regression analysis was used to explore the risk factors for total labor over 24 h. The maternal and neonatal outcomes including intrapartum fever, amniotic fluid contamination, mediolateral episiotomy, vaginal instrumental delivery, cervical laceration, postpartum hemorrhage, manual removal of placenta, fetal distress, neonatal asphyxia and referral to neonatal intensive care unit (NICU) were compared to screen the risk factors and analyse the maternal and neonatal outcomes of pregnant women with labor over 24 h.

There were no significant differences in age, BMI, gestational age of delivery, gestational hypertension, gestational diabetes mellitus and neonate body mass between the two groups (P>0.05). The first stage of labor, second stage of labor and total labor were longer and the rates of labor analgesia and labor intervention were higher in the observational group than the control group (P<0.05). Multivariate Logistic regression analysis showed that labor analgesia and intervention were not risk factor for total labor over 24 h (P>0.05). There were no significant differences in the incidence of postpartum hemorrhage, vaginal instrumental delivery and fetal distress between the two groups (P>0.05) ; the incidence of intrapartum fever, amniotic fluid contamination, mediolateral episiotomy, vaginal instrumental delivery, cervical laceration and referral to NICU in the observational group was higher than the control group (P<0.05) ; no neonatal asphyxia occurred in both groups.

The rates of labor analgesia and labor intervention were significantly increased in pregnant women with total labor over 24 h due to prolonged labor. Although prolonged labor does not increase the incidence of postpartum hemorrhage, manual removal of placenta and neonatal asphyxia, it increases the incidence of intrapartum fever, amniotic fluid contamination, mediolateral episiotomy, vaginal instrumental delivery, cervical laceration and fetal distress. Obstetricians and gynecologists should pay attention to the adverse maternal and neonatal outcomes caused by prolonged labor and individualized management of labor.

Adequate gestational weight gain (GWG) is critical for maternal and child health. The Institute of Medicine (IOM) standard has long been adopted in clinical practice to guide GWG in China. Since October 2022, China has officially promulgated and adopted the Standard of Recommendation for Weight Gain during Pregnancy Period (WS/T 801-2022) (herein after referred to as SRWGPP) to guide GWG.

To compare the distribution of GWG recommended by the SRWGPP and IOM used for Chinese singleton pregnant women and associated adverse pregnancy outcomes, providing clinical evidence for further application of the SRWGPP.

The data of this study were from a prospective cohort study involving singleton pregnant women who gave birth in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from May 2020 to September 2021 and participated in the Beijing Birth Cohort Study (registration number: ChiCTR220058395) . Baseline information was collected from the participants, and the incidence of pregnancy complications and outcomes was obtained from the clinical health record system. We compared the distribution of GWG of the participants based on the criteria by the SRWGPP and the IOM guidelines. Then we divided the participants into five groups: insufficient weight gain (IOM+IW) , insufficient weight gain+appropriate weight gain (IOM+IW+AW) , appropriate weight gain (IOM+AW) , appropriate weight gain+ excessive weight gain (IOM+AW+EW) , and excessive weight gain (IOM+EW) . The risk of adverse pregnancy outcomes〔large for gestational age (LGA) , small for gestational age (SGA) , macrosomia, low birth weight, and preterm birth〕 was analyzed after adjusting for confounding factors.

A total of 11 839 singleton pregnant women were included. The proportions of women with insufficient, appropriate, and excessive GWG were 36.7% (4 339/11 839) , 38.9% (4 601/11 839) , and 24.5% (2 899/11 839) , respectively, according to the IOM standard, and were 16.2% (1 913/11 839) , 45.0% (5 332/11 839) , and 38.8% (4 594/11 839) , respectively, according to the SRWGPP. The proportions of pregnant women in groups of IOM+IW, IOM+IW+AW, IOM+AW, IOM+AW+EW and IOM+EW were 16.2% (1 913/11 839) , 20.5% (2 426/11 839) , 24.6% (2 907/11 839) , 14.3% (1 694/11 839) and 24.5% (2 899/11 839) , respectively. The results from multivariate Logistic regression analysis showed that the risk of overall adverse pregnancy outcomes in IOM+AW+EW group was higher than that in IOM+AW group〔aOR=1.23, 95%CI (1.07, 1.41) , P<0.05〕. There was no difference in the risk of overall adverse pregnancy outcomes between IOM+IW+AW group and IOM+AW group〔aOR=1.02, 95%CI (0.89, 1.16) , P<0.05〕. The risk of LGA, macrosomia, cesarean section, or the overall adverse pregnancy outcomes was higher in IOM+EW group than that in IOM+AW group either in the first or second trimesters (P<0.05) .

The adoption of the SRWGPP will allow more pregnant women to meet the appropriate range for GWG, and their pregnancy outcomes will be better than those using the IOM standard. Therefore, the SRWGPP is more applicable to Chinese pregnant women for pregnancy weight management. Especially, it is critical to avoid excessive GWG in the first and second trimesters.

Gestational diabetes mellitus (GDM) is a common complication during pregnancy. However, the adherence to individualized medical nutrition therapy (IMNT) alone among GDM women is poor and the impact of group cognitive behavioral therapy (GCBT) on their pregnancy outcomes remains unclear.

To examine the impact of GCBT on the pregnancy outcomes of women with GDM, and to provide reference for improving pregnancy outcomes and developing effective gestational diabetes management programme.

A total of 878 pregnant women with GDM who delivered and received IMNT in our hospital from 2020 to 2021 were retrospectively selected as the study subjects and divided into the observation group including 141 pregnant women with GDM who received GCBT and the control group including 737 pregnant women with GDM who did not receive GCBT. The differences in pregnancy outcomes of pregnant women with GDM between the two groups before and after propensity score matching were analyzed.

There were 134 pregnant women with GDM in the observation group and 256 pregnant women with GDM in the control group after 1∶2 propensity score matching. The proportion of pregnant women with GDM who gained normal weight in the observation group (50.7%, 68/134) was higher than that in the control group (37.5%, 96/256) (P<0.05) . The gestational weeks of delivery of pregnant women with GDM in the observation group (39.0±1.1) were longer than those in the control group (38.5±1.7) (P<0.05) . Additionally, the proportions of preterm infants (3.7%) , macrosomia (1.5%) , and low birth weight infants (2.2%) were lower than those in the control group (10.5%, 5.9%, and 9.0%, respectively) (P<0.05) .

GCBT can help reduce the risk of the delivery of preterm infants, low birth weight infants, and macrosomia in pregnant women with GDM, providing a reference for the establishment of a multidisciplinary management model for GDM.

Macrosomia is not only harmful to the pregnant women and newborns, but also to the long-term metabolic health of the offspring. Maternal body mass is closely associated with pregnancy outcomes, overweight and obese pregnant women are often associated with dyslipidemia, while elevated blood lipid levels during pregnancy can affect the intrauterine environment and neonatal birth weight has not been investigated.

To analyze the association between blood lipid levels and macrosomia in pregnant women with different pre-pregnancy (BMI) .

A total of 5 287 singleton pregnant women who were registered at department of obstetrics of Beijing Obstetrics and Gynecology Hospital, Capital Medical University until delivery from January 2018 to June 2019 and met the inclusion and exclusion criteria were included in the single-center retrospective study, and divided into low-body-mass pregnant women with a non-macrosomia group (group A, n=731) and with a macrosomia group (group B, n=27) , normal-body-mass pregnant women with a non-macrosomia group (group C, n=3 539) and with a macrosomia group (group D, n=243) , overweight and obese pregnant women with a non-macrosomia group (group E, n=675) and with a macrosomia group (group F, n=72) according to maternal pre-pregnancy BMI and neonatal birth weight. Relevant clinical and laboratory data of pregnant women were collected for statistical analysis. Binary Logistic regression analysis was used to explore the association between blood lipid levels and macrosomia in pregnant women with different pre-pregnancy BMI.

The level of high-density lipoprotein cholesterol (HDL-C) in the third trimester of pregnancy in group B was lower than group A (P<0.05) . The levels of total cholesterol (TC) in the first trimester and triglyceride (TG) in the third trimester in group D were higher than group C (P<0.05) , while the levels of HDL-C in the second and third trimesters were lower than group C (P<0.05) . The TG levels in the first, second and third trimesters of pregnancy in group F were higher than group E (P<0.05) , while HDL-C levels in the second and third trimesters were lower than group E (P<0.05) . Binary Logistic regression analysis showed that HDL-C level in the third trimester〔OR=0.256, 95%CI (0.075, 0.871) 〕 was the influencing factor of macrosomia in low body mass pre-pregnancy women (P<0.05) . HDL-C levels in the second and third trimesters〔OR=0.661, 95%CI (0.450, 0.971) ; OR=0.406, 95%CI (0.271, 0.610) 〕 were the influencing factors of macrosomia in normal body mass pre-pregnancy women (P<0.05) . TG levels in the first, second and third trimesters〔OR=1.546, 95%CI (1.070, 2.234) ; OR=1.399, 95%CI (1.019, 1.758) ; OR=1.289, 95%CI (1.072, 1.550) 〕 were the influencing factors of macrosomia in overweight and obese pre-pregnancy women (P<0.05) .

For pre-pregnancy women with low and normal body mass, low HDL-C level during pregnancy is associated with an increased risk for macrosomia, while for overweight and obese pre-pregnancy women, high TG level during pregnancy is associated with an increased risk of macrosomia. For pregnant women with large fetuses or high risk of macrosomia during maternal examination, it is necessary to emphasize the detection and control of blood lipid levels.

The incidence of gestational diabetes mellitus (GDM) remains high, and it is prevalent all over the world. The incidence of GDM in China is up to 14.8%. Intrauterine hyperglycemia during pregnancy is a severe threat to maternal and neonatal health.

The aim of this study was to evaluate the effect of mindfulness-based complementary and alternative therapy for GDM.

This study selected 64 pregnant women with GDM undergoing routine outpatient prenatal examination in Changsha Central Hospital by using convenience sampling from March to December 2021. These patients were randomly assigned into the intervention group (n=31) and the control group (n=33) . The control group received routine psychologicalgcare, nutritional guidance and exercise guidance. The intervention group received 8 weeks of mindfulness-based complementary and alternative therapy on the basis of routine psychological care. This study collected the baseline characteristics and compared the blood sugar and inflammatory biomarkers and adipokines, followed-up neonatal outcomes (birth weight, random blood sugar) .

The fasting blood sugar level, 1-hour blood sugar, 2-hour blood sugar and the expression of interleukin-6, interleukin-8, tumor necrosis factor-α and vaspin were lower than those of the control group (P<0.05) . After the intervention, the fasting blood sugar, 1-hour blood sugar, 2-hour blood sugar, and the expression of interleukin-6, interleukin-8, tumor necrosis factor-α and vaspin in the experiment group were lower than those before the intervention (P<0.05) . The pre-delivey weight, pre-delivery BMI, gestational weight gain, pre-delivey HbA_1c, birth weight of newborns of pregnant women with GDM in the intervention group were lower than those of the control group (P<0.05) , and the random blood sugar of the intervention group was higher than that of the control group (P<0.05) .

The 8 weeks of mindfulness-based complementary and alternative therapy reduced body mass index, effectively controlled blood sugar, reduced expression of inflammatory biomarkers and adipokines, and reduced the risk of neonatal hypoglycemia.

The total gestational weight gain is closely related to the gestational week at delivery. Choosing the gestational weight gain rate (GWGR) as a indicator can reduce the interference of gestational week on the results. Currently, available recommendations regarding GWGR are controversial. Few studies have explored the correlation between GWGR in second and third trimesters and delivery outcomes in women with gestational diabetes mellitus (GDM) .

To investigate the association of GWGR in second and third trimesters with pregnancy complications and delivery outcomes in women with GDM.

A total of 370 women with GDM were selected, who had an experience of undergoing delivery in Hangzhou Women's Hospital from March to December 2018, and were included in the Hangzhou Maternal and Offspring Health Cohort Study (clinical trial registration number: ChiCTR1900026149) . According to GWGR in second and third trimesters recommended by the Weight Monitoring and Evaluation during Pregnancy Period of Chinese Women published by the Chinese Nutrition Society in 2021, the subjects were divided into insufficient GWGR group (n=115) , normal GWGR group (n=152) and excessive GWGR group (n=103) . We analyzed the incidence of pregnancy complications and delivery outcomes of the three groups.

Logistic regression analysis demonstrated that excessive GWGR in second and third trimesters was associated with an increased risk of hypertensive disorders of pregnancy〔OR=2.661, 95%CI (1.291, 9.460) 〕, gestational hypothyroidism〔OR=2.288, 95%CI (1.090, 4.805) 〕, gestational hyperlipidemia〔OR=2.085, 95%CI (1.656, 6.630) 〕 and macrosomia〔OR=4.591, 95%CI (1.238, 17.031) 〕 (P<0.05) , and a decreased risk of preterm neonate〔OR=0.117, 95%CI (0.014, 0.959) 〕 (P<0.05) .

Abnormal weight gain in pregnant women is common. Excessive GWGR in second and third trimesters may increase the risk of hypertensive disorders of pregnancy, gestational hypothyroidism, hyperlipidemia and macrosomia, and decrease the risk of preterm neonate in women with GDM.

Due to possible neglect of elevated fasting glucose, poor intra-pregnancy glycemic control may occur in gestational diabetes mellitus (GDM) women with isolated fasting hyperglycemia, but whether it is related to adverse pregnancy outcomes, and associated factors need to be evaluated further.

To explore the prevalence of adverse pregnancy outcomes in GDM with simple isolated fasting hyperglycemia and its influencing factors.

A total of 411 GDM patients with isolated fasting hyperglycemia who had prenatal examination in Northwest Women and Children's Hospital between June 2020 and March 2021 were selected, and followed up until delivery. Clinical data and pregnancy outcomes (normal and adverse) were collected. Multivariate Logistic regression was used to examine the factors associated with adverse pregnancy outcomes.

Among the 411 cases, 245 received standardized glycemic management, 157 (38.2%) of whom achieved adequate glycemic control, but other 88 cases (21.4%) still had poor glycemic control; the other 166 cases (40.4%) did not receive standardized blood glucose management. Three hundred and twenty-three (78.6%) patients had adverse pregnancy outcomes, and other 88 (21.4%) had normal pregnancy outcomes. Patients with normal and adverse pregnancy outcomes had statistically significant differences in mean maternal age, prevalence of pre-pregnancy maternal obesity, intra-pregnancy glycemic management, mean fasting glucose, one- and two-hour plasma glucose level during the OGTT, prevalence of HbA_1c≥5.5%, serum total protein, serum albumin, prevalence of hypoproteinemia and the AUC of the time-blood glucose curve of the OGTT (P<0.05) . Multivariate Logistic regression analysis showed that pre-pregnancy maternal overweight or obesity〔OR=2.89, 95%CI (1.45, 5.78) , P=0.003〕, intra-pregnancy glycemic management 〔poor glycemic control: OR=3.64, 95%CI (1.64, 8.06) , P=0.001; non-management: OR=3.46, 95%CI (1.91, 6.25) , P<0.001〕, prenatal HbA_1c〔OR=2.38, 95%CI (1.06, 5.34) , P=0.035〕, hypoproteinemia〔OR=2.25, 95%CI (1.15, 4.41) , P=0.018〕, and elevated AUC of the time-blood glucose curve of the OGTT〔OR=1.23, 95%CI (1.03, 1.47) , P=0.024〕 were associated with increased risk of adverse pregnancy outcomes.

Pre-pregnancy maternal overweight or obesity, uncontrolled or non-management of blood glucose during pregnancy, high prenatal HbA_1c values, hypoproteinemia, and high AUC of the time-blood glucose curve of the OGTT may be high risk factors for adverse outcomes in GDM with isolated fasting hyperglycemia. To improve the rate of normal maternal and neonatal outcomes, clinical guidance should be given to pregnant women to maintain a normal pre-pregnancy weight and to standardizedly manage the blood glucose.

Birth weight is closely related to individual health. Low birth weight is a high-risk factor for early neonatal death. Macrosomia is associated with higher risk of maternal and infant complications and various chronic diseases in adulthood. Therefore, it is very important to identify the influencing factors of neonatal birth weight.

To investigate the relationship between maternal intestinal flora and neonatal birth weight.

Participants were 516 singleton mothers and their babies〔24 with low birth weight (LW group) , 479 with normal birth weight (NW group) and 13 with macrosomia (OW group) 〕 delivered at term in Guangzhou Women and Children's Medical Center from January to September 2017. Maternal intestinal flora and clinical laboratory test parameters were collected, and the composition and diversity of intestinal flora were analyzed using QIIME. LEfSe analysis was used to compare the relative abundance of intestinal flora at the genus level of the mothers of three groups of babies to identify the flora with significant intergroup differences. MaAslin was used to assess associations of maternal laboratory test parameters and microbial genera. The Boruta was used to build models for predicting three types of neonatal birth weight using maternal laboratory test parameters and intestinal flora OTUs, to assess the association of maternal intestinal floras and neonatal birth weight.

The analysis of maternal intestinal floras showed that the abundance of Firmicutes was the highest at the phylum level, and Faecalibacterium was significantly enriched at the genus level. There were no significant differences in Simpson's Diversity Index and Shannon Diversity Index at the phylum level across the maternal intestinal floras of three groups of babies (P>0.05) . LEfSe analysis found that compared with intestinal flora of mothers of LW group, the intestinal flora of mothers of NW group showed significantly enriched Streptococcus and Roseburia (P<0.05) , and significantly reduced abundance of Bacillaceae, Raphanus, Methanosphaera, Barnesiella and Paraprevotella (P<0.05) , while the intestinal flora of mothers of OW group demonstrated significantly enriched Closrtidiaceae and Alistipes as well as significantly reduced abundance of Barnesiella (P<0.05) . Compared with intestinal flora of mothers of NW group, the intestinal flora of mothers of OW group indicated significantly enriched Megamonas, Coprococcus, Veillonellaceae, cc-115, Closrtidiaceae and Alistipes, and significantly reduced abundance of Blautia and Eggerthella (P<0.05) . The area under ROC curve (AUC value) based on laboratory test parameter OTUs model and intestinal flora OTUs model was 0.62 and 0.77, respectively, in discriminating LW from NW, and was 0.65, and 0.78 respectively, in discriminating OW from NW.

Neonatal birth weight varied by the features of maternal intestinal floras. The OTUs model based on maternal intestinal flora could distinguish the neonatal birth weight. Maternal intestinal flora may be a good predictor of neonatal birth weight.

The correct reference range for maternal thyroid function during pregnancy is essential for making an accurate diagnosis of thyroid disease and delivering proper interventions in pregnant women. But there is still no universal standard for this in women with a twin pregnancy.

To determine a rational reference range for maternal thyroid function during twin pregnancies.

Healthy pregnant women who underwent antenatal examination in Obstetric Clinic, Beijing Friendship Hospital, Capital Medical University from January 2009 to September 2019 were retrospectively selected, including 352 with a twin pregnancy (twin group) , and 988 with a singleton pregnancy (singleton group) . Clinical and laboratory data were collected. The lower and upper limits for determining normal maternal thyroid function during twin pregnancies were the 2.5 (P_2.5) and 97.5 (P_97.5) percentiles of TSH and FT₄. Clinical hyperthyroidism was defined as TSH<P_{2.5 (total TSH)} and FT₄>P_{97.5 (total FT4)} . Clinical hypothyroidism was defined as TSH>P_{97.5 (total TSH)} and FT₄<P_{2.5 (total FT4)} . Subclinical hypothyroidism was diagnosed by TSH>P_97.5 and P_2.5≤FT₄≤P_97.5. Low T₄ syndrome was diagnosed by P_{2.5 (total TSH)} ≤TSH≤P_{97.5 (total TSH)} and FT₄<P_{2.5 (total FT4)} . FT₄ and TSH levels in the early, middle and late pregnancy were compared between singleton and twin groups. Prevalence of thyroid function abnormalities in the early, middle and late pregnancy was in twin group was recorded and analyzed.

Three hundred and fifty-two pregnant women with a twin pregnancy and 988 with a singleton pregnancy were finally included. The average FT₄ level in the twin group was higher than that of the singleton group regardless of the stage of pregnancy (P<0.05) . The average TSH level in the twin group was lower in the early pregnancy, but was higher in late pregnancy compared with that of singleton group (P<0.05) . For maternal thyroid function during a twin pregnancy, the determined normal FT₄ in the early, middle and late pregnancy expressed as median and interquartile range M (P_2.5, P_97.5) was 〔11.84 (7.95, 26.73) 〕, 〔8.24 (5.53, 18.58) 〕, 〔8.37 (5.80, 15.79) 〕pmol/L, respectively, and the determined normal TSH in the three stages of pregnancy was〔0.67 (0.03, 3.99) 〕, 〔1.44 (0.06, 4.79) 〕, 〔2.43 (0.41, 6.92) 〕mU/L, respectively. In the twin group, the prevalence of hyperthyroidism, clinical hypothyroidism, subclinical hypothyroidism, and low T₄ syndrome was 0, 0.28% (1/352) , 4.83% (17/352) and 3.98% (14/352) , respectively, by the above-mentioned criteria for diagnosing thyroid disease in a twin pregnancy, and that of the four diseases was 8.24% (29/352) , 0, 15.91% (56/352) and 1.99% (7/352) , respectively, by the criteria for diagnosing thyroid disease in a singleton pregnancy.

In this study, the recommended reference ranges of FT₄ in the early, middle and late stages of pregnancy were 7.95-26.73, 5.53-18.58 and 5.80-15.79 pmol/L, respectively, and the reference ranges of TSH were 0.03-3.99, 0.06-4.79 and 0.41-6.92 mU/L, respectively. Based on the FT₄ and TSH standards of the pregnant women with twin pregnancies obtained in our laboratory as the reference standards, the incidence of thyroid dysfunction detected in the pregnant women with twin pregnancies is low, which is consistent with relevant literature reports. The FT₄ and TSH standard range of single pregnancy obtained in our laboratory may lead to overdiagnosis of hyperthyroidism and subclinical hypothyroidism in pregnant women of twin pregnancy. So it is necessary to establish specific reference intervals for pregnant women with twin pregnancies based on the FT₄ and TSH standard ranges obtained in our laboratory.

Stubbornly high pregnancy prevalence in adolescent females worldwide, results in numerous adverse pregnancy outcomes, causing wide public concern. Thereby, it is pressing to study the pregnancy characteristics, adverse pregnancy outcomes and associated factors in adolescent primiparous females.

To examine adverse pregnancy outcomes and related factors in adolescent primiparous females via comparing pregnancy outcomes of them with those of emerging and early adult females.

Primiparous females (n=12 222, <35 year old) with ≥28 weeks of gestation were recruited from Ningbo Women and Children's Hospital during 2019—2020, including 210 aged 13-19 (adolescent group) , 1 729 aged 20-24 (adult group 1) , and 10 283 aged 25-34 (adult group 2) . Data were collected for maternal demographics, pregnancy complications, comorbidities, delivery course and adverse fetal outcomes. The associations of age, marital status, education background, rural or urban living, income, body mass index (BMI) with adverse maternal and fetal outcomes were analyzed.

Adolescent primiparas had higher proportions of individuals with unmarried status, junior high school or lower education level, rural living, and an unstable income, as well as less mean prenatal care visits than the other two groups (P<0.05) . Moreover, adolescent primiparas also had higher rates of placental abruption, maternal anemia, vaginal delivery, perineal laceration, premature labor, (very) low-birth-weight infant, and stillbirth (P<0.05) . Multivariate Logistic regression analysis demonstrated that in adolescent primiparas, 13-24 years, unmarried and BMI<18.5 kg/m² were associated with lower risk of gestational diabetes (P<0.05) ; gravida≥3 and BMI≥28 kg/m² were risk factors for gestational diabetes (P<0.05) ; 13-24 years, unmarried, unstable income and BMI≥28 kg/m² were risk factors for vaginitis (P<0.05) ; 13-19 year-old, unmarried, junior high school or lower education level and unstable income were risk factors for placental abruption (P<0.05) ; gravida≥3 was the risk factor for placenta previa (P<0.05) ; 13-24 years, unmarried, junior high school or lower education level, rural living and unstable income were risk factors for maternal anemia (P<0.05) ; BMI≥28.0 kg/m² was associated with lower risk of maternal anemia (P<0.05) . Further analysis showed that 13-24 years, unmarried, junior high school or lower education level, rural living and BMI<18.5 kg/m², were associated with higher possibility of having vaginal delivery (P<0.05) , whereas gravida≥3 was associated with higher possibility of having cesarean section (P<0.05) . Aged 13-19 years, unmarried, junior high school or lower education level, unstable income, gravida≥3, and BMI<18.5 kg/m² or ≥28.0 kg/m² were risk factors for premature labor (P<0.05) . Aged 13-19 year-old, unmarried, junior high school or lower education level, rural living, unstable income, gravida≥3, and BMI<18.5 kg/m² were risk factors for (very) low-birth-weight infants (P<0.05) . 20-24 year-old was associated with lower risk of fetal distress (P<0.05) . 13-19 year-old and unmarried were risk factors for stillbirth (P<0.05) . 13-24 years, junior high school or lower education level, rural living, unstable income, and gravida≥3 were risk factors for neonatal asphyxia (P<0.05) .

Adolescent primiparous females were featured by high rates of having unmarried status, rural living, an unstable income, low education level, fewer prenatal care visits, and adverse pregnancy outcomes. Younger age, unmarried, poor socioeconomic status, higher number of pregnancies, and excessive low or high BMI were risk factors for adverse pregnancy outcomes in this group. Healthcare specialists should schedule prenatal examinations for these people based on the high risk factors accordingly. And government at all levels and affiliated adolescent institutions should offer appropriate social and economic support for teenage mothers to reduce adverse pregnancy outcomes.

Severe preeclampsia can progress to eclampsia and threaten the life safety of mothers and infants, while intestinal flora composition changes may be involved in the occurrence and development of preeclampsia, but there is no clear evidence.

To investigate the relationship between intestinal flora differences and the incidence of preeclampsia in pregnant women in the early and middle stages of pregnancy.

A total of 455 pregnant women recruited from the Department of Obstetrics, the Second Affiliated Hospital of Guilin Medical University from January 2019 to January 2021 who met the requirements were selected. Pregnant women diagnosed with preeclampsia after 20 weeks of gestation were classified as preeclampsia group (n=32) , and pregnant women without preeclampsia were classified as non-preeclampsia group (n=423) . The clinical data of pregnant women were collected, and fecal samples were collected in the early (≤12⁺⁶ weeks) and middle stages of pregnancy (13~27⁺⁶ weeks) for bioinformatics analysis of intestinal flora, and the relationship between bioinformatics and the incidence of preeclampsia was analyzed.

There were statistically significant differences in age, Shannon index and Simpson index in early pregnancy between preeclampsia group and non-preeclampsia group (P<0.05) . Logistic regression analysis showed that age≥35 years old〔OR=1.894, 95%CI (1.432, 2.369) 〕, low Shannon index in early pregnancy〔OR=0.709, 95%CI (0.465, 0.921) 〕 and low Simpson index in early pregnancy〔OR=0.612, 95%CI (0.354, 0.893) 〕 were independent risk factors for preeclampsia (P<0.05) . ROC curve showed that the optimal cut-off value and AUC of Shannon index for predicting the incidence of preeclampsia in pregnant women in early pregnancy were 6.255 and 0.745〔95%CI (0.652, 0.838) 〕, with the corresponding sensitivity and specificity of 76.58% and 60.00%, respectively. The Simpson index in early pregnancy predicted the onset of preeclampsia with the best truncation value of 0.945 and AUC of 0.724〔95%CI (0.623, 0.826) 〕, and the corresponding sensitivity and specificity were 62.90% and 60.61%, respectively.

Decreased Shannon index and Simpson index of fecal intestinal flora in early pregnancy in early pregnancy are independent risk factors for the occurrence of preeclampsia in pregnant women, and have early predictive value for the onset of preeclampsia.

Delayed onset of lactogenesis (DOL) is an important cause of failed lactation. Excessive gestational weight gain and postpartum depression will increase the risk of DOL, but appropriate physical activity (PA) during pregnancy may effectively prevent excessive gestational weight gain, improve postpartum negative mood, benefiting breastfeeding. However, the relationship between PA during pregnancy and DOL is still unclear.

To investigate the PA level in the third trimester and its association with DOL, providing a basis for early prevention of DOL and ensuring breastfeeding success.

A prospective study design was adopted. Participants were women in their third trimester who underwent prenatal examination and later delivery in the 901 Hospital, Joint Logistic Support Force of the Chinese People's Liberation Army, from December 2020 to August 2021. General information (including demographic and obstetric data) , PA and sedentary behaviour time (evaluated by the International Physical Activity Questionnaire-Short Form) , postpartum depression (evaluated by the Edinburgh Postnatal Depression Scale) , and DOL were investigated and collected. Unconditional Logistic regression analysis was used to explore the relationship between PA level in the third trimester and DOL.

A total of 261 cases were selected, and 247 of them (94.7%) who returned responsive questionnaires were finally enrolled. The prevalence of DOL was 27.9% (69/247) . Respondents with and without DOL had significant differences in gestational weight gain, depression prevalence, and prevalence of infant formula feeding within 48 hours after delivery (P<0.1) . The prevalence of having appropriate and inappropriate PA in the third trimester was 73.3% (181/247) and 26.7% (66/247) , respectively. The prevalence of duration of sedentariness ≥6.5 h/d was 15.8% (39/247) . Respondents with DOL had lower prevalence of having appropriate PA, and higher prevalence of duration of sedentariness ≥6.5 h/d than did those without (P<0.05) . Unconditional Logistic regression analysis showed that inappropriate PA level 〔OR=0.421, 95%CI (0.223, 0.797) 〕 and longer duration of sedentariness ≥6.5 h/d〔OR=0.193, 95%CI (0.090, 0.414) 〕 in the third trimester were associated with increased risk of DOL (P<0.05) .

Inappropriately increasing the level of PA during pregnancy and reducing the duration of sedentariness per day could reduce the risk of DOL and effectively improve the rate of successful breastfeeding.

With the rapid development of economy and the change of fertility concept in modern population, the number of advanced maternal age is increasing year by year. Compared with appropriate maternal age, advanced maternal age is more likely to suffer from depressive symptoms due to personal, family, work, and other reasons.

To systematically evaluate the detection rate of postpartum depression in advanced maternal age (≥35 years at delivery) in China to provide relevant evidence for early prevention and intervention.

CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, Embase, and Web of Science were searched for articles on the detection rate of postpartum depression in advanced maternal age in China by combining subject terms and free terms from inception to July 2023. The process of literature screening, data extraction and quality assessment were carried out by two researchers independently. Stata 16.0 software was used for data analysis.

A total of 21 studies were included, with a total sample size of 5 163. The results of Meta-analysis showed that the overall detection rate of postpartum depression in advanced maternal age in China was 20.0% (95%CI=17.4%-22.6%). The subgroup analysis revealed that the detection rate of postpartum depression was 19.5% (95%CI=13.8%-25.3%) in women < 40 years old, 40.3% (95%CI=11.4%-69.3%) in women ≥ 40 years old, 19.7% (95%CI=11.7%-27.7%) in women with high school education level or higher, 30.7% (95%CI=19.1%-42.3%) in women with high school education level or lower, 21.1% (95%CI=14.4%-27.9%) in primipara, 16.2% (95%CI=12.9%-19.6%) in multipara, 16.4% (95%CI=12.2%-20.6%) in natural childbirth, 27.8% (95%CI=20.9%-34.8%) in cesarean section, 20.7% (95%CI=15.6%-25.8%) in women with male newborn and 27.3% (95%CI=20.5%-34.0%) in women with female newborn; there were 38.7% (95%CI=22.6%-54.8%) women with pregnancy complications, 11.7% (95%CI=7.6%-15.8%) women without pregnancy complications, 29.5% (95%CI=17.9%-41.1%) women with adverse pregnancy and childbirth history, 27.7% (95%CI=16.6%-38.8%) women without adverse pregnancy and childbirth history, 18.0% (95%CI=16.5%-19.4%) published the year before 2020, 19.5% (95%CI=18.0%-21.0%) published the year after 2020, 20.4% (95%CI=18.2%-22.6%) in the north and 18.2% (95%CI=17.0%-19.4%) in the south, 20.0% (95%CI=18.5%-21.5%) in the Edinburgh Postnatal Depression Scale (EPDS) score ≥ 13 and 16.9% (95%CI=15.2%-18.5%) in the EPDS score ≥ 10. The Egger's test (t=1.76, P=0.095) and the Begg's test (Z=1.48, P=0.147) indicated no significant publication bias.

The detection rate of postpartum depression is higher for advanced maternal age in China, including women ≥ 40 years old, with high school education level or lower, primipara, cesarean section, female newborn, pregnancy complications and adverse pregnancy and childbirth history, publish year after 2020, areas of the north, EPDS score ≥ 13, attention should be paid to the psychological status of advanced maternal age, and corresponding prevention and intervention measures should be formulated.