In rural areas, the self-management levels of pregnant women not only remain generally low but also vary significantly among individuals, thereby necessitating a detailed investigation into their behavioral patterns to facilitate their classification into distinct groups.

This analysis explores the types and characteristics of self-management among pregnant women in rural areas to provide references for devising targeted management strategies.

From January to August 2023, a convenience sampling method was employed to select pregnant women from Suihua City and Daqing City in Heilongjiang Province, and Changchun City in Jilin Province. Surveys were conducted using a general data questionnaire, a self-management scale for pregnant women, a general self-efficacy scale, an internal motivation scale, and a prenatal care knowledge scale. Cluster analysis was performed using SPSS 25.0 to classify the subjects into different types based on their self-management traits and compare their general characteristics.

A total of 481 questionnaires were distributed, and 470 valid questionnaires were retrieved, with a valid questionnaire recovery rate of 97.7%. It was found that the total score for self-management behaviors among the surveyed rural pregnant women stood at (70.2±16.4). Four distinct types were identified through optimal clustering: typeⅠ, characterized by low awareness non-participants (25.3%, n=119) ; typeⅡ, those who engage through guided cooperation (29.4%, n=138) ; typeⅢ, those under supervised directive (18.7%, n=88) ; and typeⅣ, proactive participants (26.6%, n=125). Noteworthy were the significant statistical differences that emerged across such variables as educational backgrounds, occupations, annual incomes, number of pregnancies, gestational weeks, whether pregnancies were planned, histories of chronic diseases, and complications during pregnancy among the four types (P<0.05). Furthermore, the comparison of scores across different self-management dimensions revealed significant statistical differences, with adherence to medical advice scoring the highest and fetal monitoring behavior scoring the lowest (P<0.05) .

The four types of self-management among rural pregnant women, identified based on differentiated characteristics in prenatal care knowledge, self-efficacy, and behavioral motivation, exhibit a high degree of heterogeneity. Type Ⅰ, characterized by low awareness non-participants, faces the dual challenge of inadequate knowledge reserves and lack of behavioral motivation. Type Ⅱ, those who engage through guided cooperation, is marked by low self-efficacy but good compliance with external guidance. TypeⅢ, those under supervised directive, lacks intrinsic motivation and relies heavily on external supervision for regulating self-management behaviors. Type Ⅳ, proactive participants, represents the most optimal group, possessing strong prenatal care knowledge, high self-efficacy, and effective self-management behaviors. Therefore, in clinical practice, targeted intervention strategies can be developed according to each type, in order to further enhance the self-management capabilities of rural pregnant women and optimize prenatal care services.

Despite ongoing adjustments and optimizations to fertility policies, deficiencies persist in contraceptive service provision for pregnant and postpartum women, potentially increasing the risk of unintended and short-interval pregnancies. Currently, contraceptive decision-making is largely concentrated in the postpartum period, with relatively delayed timing, whereas prenatal contraceptive decision-making remains insufficiently addressed.

To investigate maternal preferences and associated factors regarding the three contraceptive decision-making models—physician-led, patient-led, and shared decision-making—with a particular focus on their needs for postpartum contraceptive decision-making during the prenatal period.

A cross-sectional survey was conducted among women aged 18-45 years who delivered healthy live births between January and July 2023 at Wuzhong People's Hospital and Yinchuan Maternal and Child Health Hospital and attended postpartum follow-up visits at (42±7) days. The questionnaire gathered information on participants' demographic characteristics, the current status of prenatal contraceptive decision-making services, postpartum contraceptive practices, and contraceptive decision-making preferences. Maternal contraceptive decision-making preferences were assessed using the Problem Solving Decision-making (PSDM) Scale. Multiple Logistic regression analyses were performed to identify factors influencing maternal preferences for contraceptive decision-making.

In this study, a total of 650 questionnaires were collected. After excluding 34 due to duplicate data and significant missing values, 616 valid questionnaires were included in the final analysis. Among these, 612 postpartum women (99.4%) had not received any antenatal contraceptive decision-making services, while only 4 (0.6%) had. Of the 4 women who received such services, 1 relied on doctor- (or nurse-) led decision-making, while 3 preferred autonomous decision-making. A total of 533 (86.5%) participants expressed a need for shared decision-making regarding postpartum contraception during the prenatal period, and 545 (88.5%) were willing to receive shared decision-making services for postpartum contraception before delivery. Multiple Logistic regression analysis indicated that, compared with a preference for autonomous decision-making, acceptance of postpartum shared decision-making services was a significant factor influencing the preference for shared decision-making (OR=0.231, 95%CI=0.062-0.864, P<0.05) .

Maternal acceptance of the shared decision-making model for contraception is relatively high, yet the actual receipt of related services remains low. Efforts should be made to enhance pregnant and postpartum women's awareness of and participation in shared decision-making during the prenatal period, promoting the integration of prenatal and postpartum contraceptive services to further safeguard maternal and infant health.

Depression and anxiety are among the most frequently observed adverse emotional states in pregnant women. The inadequacy of mental health services and the paucity of external support often result in the psychological well-being of rural expectant mothers being overlooked, thereby exerting a profound impact on both maternal and neonatal health.

This study, adopting a socio-ecological framework, explores the emotional regulation experiences of rural pregnant women in China, aiming to furnish empirical insights that may inform early intervention strategies for primary healthcare practitioners.

A purposive sampling strategy was utilized to recruit rural pregnant women exhibiting negative emotional experiences from villages under the jurisdiction of Anda City, Suihua, Heilongjiang Province, and Honggang District, Daqing, Heilongjiang Province, during the period spanning October 1 to December 1, 2023. Participants were enlisted through outreach medical consultations and maternal health record registration conducted by higher-tier maternal and child health institutions. Semi-structured interviews were employed for data collection, with information gathered via audio recordings and subsequently transcribed verbatim. The collected data underwent rigorous analysis through Colaizzi's descriptive phenomenological framework, executed by two independent coders.

A total of 13 participants were incorporated into the study. Through meticulous examination of the interview data, three principal themes and eleven subordinate sub-themes were delineated: (1) Microsystemic level: the ramifications of somatic symptoms, amplified anxieties regarding childbirth, perturbations in self-perception, and substantive alterations in lifestyle. (2) Mesosystemic level: the precipitous escalation in child-rearing expenditures, pronounced familial discord, and a dearth of peer support mechanisms. (3) Macrosystemic level: suboptimal healthcare encounters, insufficiencies in informational support, structural disequilibrium between service provision and demand, and intensifying societal pressures.

The emotional adversities confronted by rural pregnant women emanate from a constellation of interwoven determinants. Mitigating these psychological challenges necessitates a holistic and stratified approach that engages the expectant mothers themselves, their familial environments, and the grassroots medical infrastructure. Recognizing and refining the emotional regulation experiences of rural pregnant women through empirically substantiated, tailored interventions is paramount. Such efforts are pivotal in augmenting their emotional resilience and, consequently, advancing maternal and neonatal health outcomes.

Hypertensive disorders of pregnancy (HDP) is one of the most common complications of pregnancy and one of the leading causes of maternal mortality worldwide. In 2023, the Society of Obstetricians of Australia and New Zealand released the A Summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand Hypertension in Pregnancy Guideline. This article interprets its key contents and proposes suggestions on non-drug intervention measures and refined management processes for HDP in China, in order to provide a new basis for the management of HDP in China.

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.

Psychological birth trauma is closely related to maternal mental health, so identifying and evaluating the effectiveness of interventions are extremely important. There are many assessment tools for psychological birth trauma, but there is a lack of research evaluating the quality for them.

To systematically review the methodological quality and measurement properties of assessment tools of psychological birth trauma, so as to provide a reference for subsequent research.

PubMed, Web of Science, CINAHL, APA psycArticles, Embase, CNKI, Wanfang, VIP and CBM databases were searched on assessment tools of psychological birth trauma from the date of library construction to November 6, 2023. Literature screening, extraction and evaluation were conducted independently by 2 researchers and cross-checked.

Six literature involving six assessment tools for psychological birth trauma were included: the Birth Trauma Perception Assessment Scale (BTPS), the Maternal Childbirth Trauma Scale (MCTS), the Chinese version of the Traumatic Childbirth Perception Scale (TCPS-C), the Birth Trauma Scale (BTS), the Traumatic Childbirth Perception Scale (TCPS), and the Childbirth Trauma Index (CTI). None of assessment tools reported measurement error, cross-cultural validity, hypothesis testing, and responsiveness; In terms of content validity was "adequate" for the MCTS, TCPS-C, BTS, and TCPS, "uncertain" for the BTPS, and not reported for the "CTI"; In terms of structural validity, TCPS-C was "adequate", the remaining scales were "uncertain"; In terms of internal consistency, MCTS was "inadequate", the remaining scales were "adequate"; In terms of stability, BTPS, MCTS, and TCPS-C were "adequate", the remaining scales were "not mentioned". Ultimately, the recommendation grade for TCPS-C, BTS, and TCPS were A, and for BTPS, MCTS, and CTI were B.

TCPS-C, BTS and TCPS are valid assessment tools and can be provisionally recommended. However, their measurement properties and methodological quality are still inadequate, and this aspect can be further studied and continuously optimized in the future to improve the scientific and accuracy of the assessment tools and promote the development of related fields.

Postpartum depression may occur not only in the mother but also in spouses, which affects their quality of life, increases the social and family economic burden, and is not conducive to the growth and development of the child. Therefore, it is important to identify the factors that influence its occurrence at an early stage.

To clarify the incidence of postpartum depression in Chinese maternal spouses through meta-analysis.

A computerized search was performed for cohort studies, case-control studies, and cross-sectional studies on the incidence of postpartum depression in Chinese maternal spouses in the databases of CNKI, Wanfang Data, VIP, CBM, PubMed, Web of Science, CINAHL, Embase, and Cochrane Library, with the time of search being from the establishment of the databases to March 2024. The search was conducted from the time of database construction to 2024-03-19. Two researchers independently screened the literature, and the included studies were subjected to data extraction, literature quality assessment, and meta-analysis by Stata 14.0 software.

39 papers were finally included, with a total sample size of 12 162 cases. Meta-analysis results showed that the prevalence of postpartum depression among maternal spouses in China was 14% (95%CI=12%-17%). The results of subgroup analysis showed that the incidence of postpartum depression in spouses was 17% (95%CI=13%-22%) within 1 month postpartum and 13% (95%CI=10%-15%) within 1 month-1 year postpartum; the incidence was 17% (95%CI=11%-23%) in inland areas and 13% (95%CI=11%-16%) in coastal regions; the measurement tool EPDS showed an incidence of 13% (95%CI=11%-16%) for spouses in studies using the EPDS and 18% (95%CI=10%-29%) for other study instruments; the incidence of postpartum depression was 15% (95%CI=11%-21%) for spouses of primiparous women and 14% (95%CI=11%-18%) for spouses of multiparous mothers. For the year of publication, the incidence was 16% (95%CI=10%-22%) for studies published from 2007 to 2016 and 14% (95%CI=12%-16%) for studies published from 2017 to 2023. Sensitivity analyses were performed by excluding literature one by one, and the combined effect sizes did not change significantly, suggesting that the meta-merged results were relatively robust. The distribution of each study point on both sides of the funnel plot was symmetrical, and the results of Egger's test showed t=1.79, P=0.082, suggesting that there was no significant publication bias.

The incidence of postpartum depression in Chinese maternal spouses is high, with an overall incidence of 14%, of which the incidence is as high as 17% within 1 month postpartum. Early screening and prevention should be emphasized.

Perinatal depression, which affects both maternal and child health, is a significant public health issue that requires urgent and effective management. Since 2021, Shenzhen has been promoting city-wide perinatal depression screening and intervention using a mobile healthcare platform.

This study utilises routine data from the Shenzhen perinatal depression screening and intervention programme to assess the impact of the mobile platform on programme implementation and identify the most prominent implementation bottlenecks.

This retrospective study included pregnant and postpartum women who delivered in one of Shenzhen's 82 midwifery institutions across 10 districts between June 2020 and May 2022. Eligible participants were divided into two groups: the routine service group (delivered between June 2020 and May 2021) and the mobile platform group (delivered between June 2021 and May 2022) . Depression screening rates, screening positive rates, referral rates, and intervention rates during early pregnancy, mid-pregnancy, late pregnancy, and postpartum were observe.

A total of 311 719 pregnant and postpartum women were included in the study, of which 166 832 were in the routine service group and 144 887 in the mobile platform group. Screening rates, referral rates, and intervention rates in all stages of pregnancy and postpartum were significantly higher in the mobile platform group than in the routine service group (P<0.05) . Screening positive rates in early and mid-pregnancy were higher in the mobile platform group (P<0.05) , while rates in late pregnancy and postpartum were lower than in the routine service group (P<0.05) .

The mobile platform offers an effective tool for routine perinatal depression management. However, the low intervention rate among screening-positive women represents the most prominent implementation bottleneck. Future research should focus on optimising platform functionality, identifying the most effective combination of intervention measures, enhancing health education, and developing innovative, sustainable, and widely applicable implementation strategies.

Protecting female fertility stands as a central goal and vision in a fertility-friendly society, and fallopian tube recanalization offers the possibility of pregnancy for patients with tubal infertility.

This study aims to accurately identify the influencing factors affecting successful pregnancy after fallopian tube recanalization and explore the application of the random forest algorithm in screening and predicting pregnancy influencing factors in such patients.

The study collected and analyzed data from 170 patients who underwent laparoscopic combined with hysteroscopic fallopian tube recanalization at Capital Medical University Affiliated Beijing Shijitan Hospital between 2016 and 2018. Based on whether the patients achieved successful natural pregnancy within 2 years after the surgery, they were divided into the pregnancy and non-pregnancy groups. Using the R software, a random forest model for predicting pregnancy risk after tube recanalization was established on the training data set (108 cases, 63.2% of cases, extracted via Bootstrap method), and its prediction accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) were evaluated on the verification data set.

The study comprised 82 cases in the pregnancy group and 88 in the non-pregnancy group, with a spontaneous pregnancy rate of 48.2% post-surgery. The random forest algorithm, trained on the training set, demonstrated robust predictive capability upon validation, with an accuracy of 87.1%, sensitivity of 93.1%, specificity of 81.8%, positive predictive value of 81.8%, negative predictive value of 93.1%, and an AUC of 0.921. The random forest algorithm was employed to rank the importance of factors influencing pregnancy following fallopian tube recanalization by using variable importance scores. The analysis identified the top three significant predictor variables: duration of infertility, history of previous pregnancies, and patient age.

The random forest algorithm emerges as a viable tool for predicting factors influencing pregnancy after fallopian tube recanalization. The predictive model, predicated on infertility duration, history of prior pregnancies, and age, exhibits notable discrimination and accuracy. Early identification of key factors post-recanalization allows for timely and effective interventions. We recommend that patients presenting risk factors consider utilizing assisted reproductive technology to improve pregnancy rates.

Limited research currently exists on the relationship between remnant cholesterol (RC) and maternal depression as well as pregnancy stress.

To explore the relationship between factors such as RC and maternal depression and pregnancy stress in the second trimester, providing a scientific foundation for clinical identification and intervention strategies.

Pregnant women in early pregnancy (6 to 13⁺⁶ weeks of gestation) who attended regular prenatal check-ups at the Obstetrics Department of the Second Affiliated Hospital of Xinjiang Medical University from June 2020 to April 2024 were recruited as study participants. A longitudinal study design was adopted to collect baseline data and blood lipid indicators of pregnant women, followed up until the second trimester, and used the Edinburgh Postpartum Depression Scale (EPDS) and Pregnancy Pressure Scale (PPS) to evaluate the depression and stress of pregnant women. Multi-factor Logistic regression analysis was used to construct a prediction model for maternal depression and pregnancy stress. In order to further determine the factors that have the greatest impact on the outcome, the random forest (RF) algorithm was used to build the model again, and the SHAP tool was used to visually analyze the RF model results.

This study followed 403 pregnant women from the first trimester to the second trimester, with 323 valid responses collected, resulting in a follow-up loss rate of 19.9%. After excluding inaccurate baseline data, 279 pregnant women were included in the final analysis. Results indicated that the incidence of depression was 38.7% (108/279), and the incidence of pregnancy stress was 20.8% (58/279). RC levels were significantly higher in pregnant women with depression and pregnancy stress than in those without (P<0.05). Multivariate Logistic regression identified pregnancy planning (OR=0.441, 95%CI=0.251-0.775), breakfast frequency (OR=5.086, 95%CI=2.105-12.270), and RC (OR=2.759, 95%CI=1.157-6.580) as significant factors influencing depression during the second trimester (P<0.05). Additionally, taking a midday rest (OR=0.513, 95%CI=0.276-0.953) and RC (OR=3.747, 95%CI=1.519-9.246) were significant factors associated with pregnancy stress (P<0.05). The SHAP analysis indicated that RC was the most influential factor affecting maternal depression and pregnancy stress in the second trimester.

Elevated RC levels may increase the risk of depression and stress-related events in pregnant women during the second trimester. Future research involving larger cohort studies or clinical trials is necessary to confirm these findings and elucidate causal relationships.

Thyroid hormones are very important for normal growth and development of fetus. Hypothyroidism during pregnancy and Graves' hyperthyroidism in pregnancy are well-known risk factors for small for gestational age (SGA). However, the influence of isolated maternal hypothyroxinemia (IMH) in the first trimester during pregnancy on birthweight is less analyzed and controversial.

To examine the correlation of IMH in the first trimester during pregnancy with birthweight.

This was a retrospective cohort study involving singleton pregnant women with medical files and receiving prenatal examination, delivery or termination of pregnancy in the Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2016 to October 2020. According to the 2.5th and 97.5th percentiles of free thyroxine (FT₄) and thyroid stimulating hormone (TSH), participants were assigned into IMH group (n=344) and control group (n=19 426). Binary Logistic regression was used to analyze the correlation of IMH in the first trimester during pregnancy with birthweight. Then according to the pre-pregnancy body mass index (PPBMI), participants were assigned into the overweight/obesity group (PPBMI≥24.0 kg/m², 69 cases in IMH group and 3 376 cases in control group) and non-overweight/obesity group (PPBMI<24.0 kg/m², 275 cases in IMH group and 16 050 cases in control group). The pregnancy outcomes of different groups were compared and the relationship between IMH and pregnancy outcomes was compared.

The results of multivariate Logistic regression analysis showed that, the incidence of macrosomia and large for gestational age (LGA) in the IMH group was 1.627 times (OR=1.627, 95%CI=1.103-2.399, P=0.014) and 1.681 times higher than the control group (OR= 1.681, 95%CI=1.288-2.196, P<0.001), respectively. However, there were no significant differences in the incidences of low birth weight (LBW) and SGA between the two groups (P>0.05). Among participants with PPBMI<24.0 kg/m² (non-overweight/obesity group), the incidence of macrosomia and LGA in the IMH group was 2.021 times (OR=2.021, 95%CI=1.320-3.093, P=0.001) and 1.788 times (OR=1.788, 95%CI=1.322-2.418, P<0.001) higher than the control group, respectively. Among participants with PPBMI≥24.0 kg/m² (overweight/obesity group), there were no significant differences in the incidences of macrosomia, LBW, LGA and SGA between the two groups (P>0.05) .

IMH in the first trimester increases the risks of macrosomia and LGA during pregnancy, especially in pre-pregnancy non-overweight/obese women. Among pre-pregnancy overweight /obese women, IMH in the first trimester does not increase the risks of macrosomia and LGA. However, the incidences of LBW and SGA are comparable in the total cohort, women with pre-pregnancy overweight/obese or those without pre-pregnancy overweight/obese.

Gestational diabetes mellitus (GDM) is closely related to the short-term and long-term health outcomes of the mothers and offspring. Pre-pregnancy BMI is strongly associated with GDM, nevertheless, it does not distinguish between body fat content and fat distribution. Only using it to assess obesity is flawed. Normal weight obesity (normal BMI but body fat percentage above 30%) and normal weight with central obesity (normal BMI but visceral fat area above 80 cm²) show different degree of metabolic dysregulation. However, those population are usually overlooked in clinical practice and there is a paucity of research on those population and GDM.

To explore the correlation between body composition in early pregnancy and GDM in a population of normal pre-pregnancy BMI, and to investigate the relationship between fat distribution and GDM.

We performed a study that included 1 938 singleton pregnant women registered in the obstetric out-patient clinic of Beijing Obstetrics and Gynecology Hospital, Capital Medical University from October 2018 to October 2022. They voluntarily underwent nutritional assessment in early pregnancy and had regular pregnancy check-ups until 24-28 weeks of gestation, who underwent body composition testing in early pregnancy (6-16 weeks) and oral glucose tolerance test (OGTT) at 24-28 weeks. According to the OGTT results, the study population were divided into the GDM group (n=382) and the normal group (n=1 556). We estimated the relationship between body composition and fat distribution with GDM in early pregnancy with binary Logistic regression.

Body fat mass (BFM), visceral fat area (VFA), percentage body fat (PBF), and fat mass index (FMI) in the GDM group were higher than in the normal group (P<0.05). BFM, VFA, PBF, FMI (OR=1.044, 95%CI=1.012-1.078; OR=1.007, 95%CI=1.002-1.012; OR=1.041, 95%CI=1.012-1.070; OR=1.138, 95%CI=1.043-1.241) (P<0.05) and central obesity (VFA≥80 cm²) (OR=1.396, 95%CI=1.101-1.770, P<0.05) associated with a significant increased risk for GDM with binary Logistic regression analysis. Spearman rank correlation analysis showed that BFM, VFA, PBF, FMI and blood glucose of the OGTT test were positively correlated (P<0.05) .

Among normal pre-pregnancy BMI women, BFM, VFA, PBF, and FMI in early pregnancy were the risk factors of GDM. Central obesity (VFA≥ 80 cm²) could independently predict the development of GDM. It is necessary to pay attention to fat distribution during pregnancy check-ups and to strengthen the pregnancy management for central obesity women.

Given the increased risk of adverse pregnancy outcomes in pregnant women with type 2 diabetes, in addition to glycemic control, it is crucial to understand the relationship between gestational weight gain and adverse pregnancy outcomes.

To investigate the gestational weight gain in pregnant women with type 2 diabetes and its relationship with pregnancy outcomes.

A retrospective analysis was conducted on 691 cases of pregnant women with type 2 diabetes who underwent prenatal care and delivery at Beijing Obstetrics and Gynecology Hospital, Capital Medical University, from 2012 to 2020. According to the Chinese "Standard of Recommendation for Weight Gain during Pregnancy Period", the participants were categorized into the inadequate weight gain group (n=143), appropriate weight gain group (n=289), and excessive weight gain group (n=259). The gestational weight gain characteristics, maternal outcomes, and neonatal outcomes were compared among the three groups. Multivariate Logistic regression analysis was employed to explore the impact of gestational weight gain on pregnancy outcomes.

The results of multivariate Logistic regression analysis showed that compared to the appropriate weight gain group, the excessive weight gain group had increased risks of cesarean section (aOR=1.626, 95%CI=1.110-2.382), preeclampsia (aOR=1.997, 95%CI=1.071-3.677), macrosomia (aOR=1.948, 95%CI=1.175-3.230), and large for gestational age (LGA) (aOR=2.090, 95%CI=1.321-3.306), while reducing the rate of vaginal delivery (aOR=0.617, 95%CI=0.415-0.918). The inadequate weight gain group was associated with a reduced risk of delivering LGA (aOR=0.497, 95%CI=0.255-0.970), with no impact on small for gestational age (SGA) (P>0.05). Further stratified analysis revealed that excessive weight gain group with pre-pregnancy BMI≥24.0 kg/m² increased the risks of cesarean section, preeclampsia, LGA [aOR and 95%CI were 1.673 (1.082-2.587), 1.961 (1.022-3.761), 2.031 (1.221-3.379), respectively], while reducing the rate of vaginal delivery (aOR=0.589, 95%CI=0.372-0.933). The inadequate weight gain group with pre-pregnancy BMI≥24.0 kg/m² showed a decreased risk of delivering LGA (aOR=0.487, 95%CI=0.237-0.999). Excessive weight gain during early, middle, and late pregnancy was identified as a risk factor for macrosomia [aOR and 95%CI were 1.07 (1.00-1.15), 1.16 (1.03-1.31), and 1.16 (1.06-1.27), respectively] and LGA [aOR and 95%CI were 1.08 (1.01-1.16), 1.13 (1.02-1.26), and 1.16 (1.07-1.26), respectively]. Excessive weight gain during late pregnancy was associated with gestational hypertension and preeclampsia (aOR=1.13, 95%CI=1.02-1.24; aOR=1.14, 95%CI=1.03-1.26), while excessive weight gain during middle and late pregnancy was a risk factor for cesarean section (aOR=1.11, 95%CI=1.02-1.21; aOR=1.09, 95%CI=1.02-1.17) .

Excessive gestational weight gain increases the risk of adverse pregnancy outcomes such as LGA, macrosomia, preeclampsia, and cesarean section in women with type 2 diabetes during pregnancy. Inadequate gestational weight gain reduces the risk of LGA, but does not increase the risk of SGA. There is a clear correlation between gestational weight gain during different stages of pregnancy and adverse pregnancy outcomes. Therefore, optimizing blood glucose levels during pregnancy in patients with type 2 diabetes should be accompanied by enhanced education and interventions on weight gain management from preconception and early pregnancy stages.

Hypertensive disorders of pregnancy (HDP) is one of the leading causes of maternal and perinatal mortality worldwide, with increasing incidence and mortality year by year. In 2023, the U.S. Preventive Services Task Force (USPSTF) updated the recommendation statement on screening for hypertensive disorders of pregnancy by evaluating the latest research evidence and analyzing the benefits and harms of screening for HDP. The recommendation, compared with the 2017 version, further affirms the importance of blood pressure measurement in screening for HDP, affirms substantial net benefit, and recommends blood pressure measurement throughout pregnancy to screen for HDP. This article explores and analyzes the key points of this recommendation based on the RIGHT statement for introductions and interpretations of guidelines in Chinese (RIGHT for INT) and its implications for guiding general practitioners in China.

Gestational diabetes mellitus (GDM) is a common complication of pregnancy, and previous studies have shown that pregnant women with GDM have a higher risk of developing infectious diseases of the reproductive tract than healthy pregnant women, but relevant cohort studies are rare.

To investigate the variation characteristics of vaginal microbiota in pregnant women with GDM at different gestational weeks, to compare the differences of vaginal microbiota between GDM and non-GDM women, and to observe the effects of vaginal microbiota changes on pregnancy outcomes.

In this study, we used a consecutive sampling method to recruit pregnant women who established their records and regulated health care at Daxing Teaching Hospital of Capital Medical University from March 2022 to March 2023. They underwent 75 g oral glucose tolerance test (OGTT) at 24-28 weeks of gestation to diagnose GDM. The GDM group was matched 1∶1 with the non-GDM group using propensity score matching method (PSM). Sample of vaginal secretions were collected at 24-28 weeks (stage A), 32-35 weeks (stage B) and 37-40 weeks (stage C) for three vaginal microecological examination, respectively. Based on the results, participants were further divided into the GDM normal vaginal flora subgroup, GDM abnormal vaginal flora subgroup, non-GDM normal vaginal flora subgroup and non-GDM abnormal vaginal flora subgroup, and were followed up until 7 d after delivery to assess pregnancy outcome.

A total of 426 participants were initially enrolled in this study, and GDM occurred in 141 cases. After PSM mathing, the GDM and non-GDM groups were successfully matched in 122 pairs. In this study, because 9 women with GDM and 5 women without GDM had preterm birth (<37 weeks of gestation), 113 women with GDM and 117 women without GDM ended up in stage C. The proportion of the dominant vaginal flora of Lactobacillus was higher in stage A than in stage C. Moreover, the vaginal pH, the incidence of vaginal flora abnormalities, and the incidence of BV and VVC were lower than those in stage C (P<0.05). The proportion of dominant bacteria as Lactobacillus in the GDM group was higher than that in the non-GDM group, and the incidence of abnormal vaginal flora and VVC was lower than that in the non-GDM group in stage A (P<0.05). In contrast, the proportion of the dominant bacterium Lactobacillus was lower in the GDM group than in the non-GDM group, and the incidence of abnormal vaginal flora was higher than in the non-GDM in stage C (P<0.05). The incidence of adverse pregnancy outcomes was higher in the GDM abnormal vaginal flora subgroup (n=65) than in the GDM normal vaginal flora subgroup (n=57) (P<0.05). In more details, the risk of adverse pregnancy outcomes in the GDM abnormal vaginal flora group was 1.830 times higher than that in the GDM normal vaginal flora group (RR=1.830, 95%CI=1.293-2.590, P<0.001) .

Compared with non-GDM pregnant women, GDM pregnant women had a lower incidence of vaginal flora abnormalities at 24-28 weeks of gestation and an increased risk of vaginal flora abnormalities after 37 weeks of gestation. GDM pregnant women with abnormal flora have higher risk of adverse pregnancy outcomes, so we recommend enhanced testing and management of vaginal microecology during pregnancy.

Chromosomal abnormalities are one of the common causes of birth defects, and karyotype analysis is still an important method for prenatal diagnosis of chromosomal abnormalities as well as an effective way to prevent and control birth defects. However, karyotype analysis, especially chromosomal image segmentation and classification mainly depends on manual work at present, which is laborious and time-consuming. As an emerging approach to karyotype analysis, it is of great significance to investigate the application value of artificial intelligence (AI) in prenatal chromosomal karyotype diagnosis.

To investigate the application effect and clinical value of AI in prenatal karyotype diagnosis.

A total of 1 000 pregnant women who received interventional prenatal diagnosis and karyotype analysis of amniotic fluid cells in the department of medical genetics and prenatal diagnosis of Wuxi Maternity and Child Health Care Hospital between 2020 and 2022 were selected as the study subjects. The karyotype analysis of all cases was performed using two-line mode, the results of the AI reading were reviewed by one geneticist in the first line, and another geneticist analyzed the karyotypes by Ikaros karyotype analysis workstation in the second line, the diagnostic results and time were recorded respectively. The final diagnosis of the samples were based on the manual review of the first line and the manual reading of the second line.

Among the 1 000 amniotic fluid samples, 735 cases were diagnosed as normal karyotype, 233 cases as aneuploidy, 0 case as structural abnormality and 32 cases as mosaicism by AI. The numbers of normal karyotype, aneuploidy, structural abnormality and mosaicism assessed by AI-assisted geneticist were 689, 233, 45 and 33, which were completely consistent with those evaluated by geneticist using Ikaros system. Compared with AI-assisted geneticist, AI-based diagnosis had strong consistency (Kappa=0.895, 95%CI=0.866-0.924, P<0.01). The diagnostic accuracy, sensitivity and positive predictive value of AI-based diagnosis was 95.4%, 95.4% and 100.0%, respectively, among which the normal karyotype, aneuploidy, structural abnormality and mosaicism were detected with a sensitivity of 100.0%, 100.0%, 0 and 97.0%, and the positive predictive value of 100.0%, 100.0%, 0 and 100.0%. The average diagnostic time of AI was shorter than that of AI-assisted geneticist and Ikaros-assisted geneticist (P<0.001), and AI-assisted geneticist took less time on average to diagnose than the Ikaros-assisted geneticist (P<0.001) .

AI-assisted karyotype analysis of amniotic fluid cells has a high degree of automation, but its ability to recognize chromosomal structural abnormalities needs to be improved. It is suggested that AI be combined with the geneticist for karyotype analysis in clinical application to ensure the quality of prenatal diagnosis and improve efficiency.

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.

The current classification of cesarean scar pregnancy (CSP) is only based on the ultrasonic characteristics. At present, there is a lack of analysis and summarization of the clinical characteristics of different types of CSP cases under this classification criteria.

To investigate the clinical characteristics and management variance of different types of CSP.

A total of 862 patients with CSP admitted to the Department of Obstetrics and Gynecology, Peking University Third Hospital from July 2014 to June 2022 were enrolled and divided into the type Ⅰ, type Ⅱ and type Ⅲ groups. The clinical characteristics and indicators of diagnosis and treatment were analyzed retrospectively.

Among the total CSP patients, 36.5% (315/862) were typeⅠ, 53.1% (458/862) were typeⅡ, and 10.3% (89/862) were type Ⅲ. The incidence of abdominal pain was 24.2% (209/862) and vaginal bleeding was 65.0% (560/862) in CSP patients. There was no statistically significant difference in the age, history of pregnancy and childbirth, and proportion of previous uterine cavity surgery among the three groups of patients (P>0.05). There was no significant difference in abdominal pain (P=0.261) and vaginal bleeding (P=0.062) among the three groups. In typeⅢ patients, the average gestational age was 55 (46, 64) days, the average diameter of gestational mass was 29.6 (19.1, 43.3) mm, and the serum β-HCG level was 60 673 (17 164, 122 203) mU/mL at diagnosis. The proportion of patients who needed adjuvant pharmacologic embryocidal therapy, laparoscopic surgery and uterine artery occlusion was 27% (24/89), 33.7% (30/89) and 32.6% (29/89), respectively. The operation duration was 101 (67, 125) min, the hospitalization duration was 4 (3, 7) days, and the treatment cost was 11 933.7 (8 760.7, 15 250.6) CNY for typeⅢpatients. The accumulated bleeding volume within 24 hours after surgery, the proportion of patients with perioperative bleeding≥200 mL and requiring blood transfusion was 24.7% (22/89) and 7.9% (7/89) in typeⅢ patients, respectively, which were higher than the other two groups (P<0.001). The incidence of persistent CSP was 3.1% (27/862) in all patients, and there was no significant difference among the three groups (χ²=3.353, P=0.187) .

There is no significant difference in age, maternal history, gravidity and parity, and clinical characteristics such as abdominal pain and vaginal bleeding in patients with different types of CSP. The treatment of typeⅠand typeⅡpatients is less invasive and consumes less medical resources, while typeⅢpatients consume more medical resources and have high requirements for multidisciplinary team and individualized management. The prognosis of all three types of patients is ideal after standardized management.

Due to economic development changes in domestic fertility policy, the incidence of acute pancreatitis in pregnancy (APIP) has been gradually increasing. The clinical characteristics of APIP of different etiologies are different, and there may be significant differences in the prognosis for mothers and infants, but previous studies on this are relatively few.

To analyze the clinical characteristics and maternal and neonatal outcomes in pregnancy complicated with acute pancreatitis patients of different etiologies.

A total of 48 inpatients with APIP in Beijing Friendship Hospital, Capital Medical University from 2016 to 2022 were collected, which were divided into the biliary group (n=27) and hyperlipidemic group (n=21). The laboratory indicators and maternal and infant outcomes in the two groups were compared.

The biliary group had a longer time of onset to visit, a smaller gestational week at admission, more previous pregnancies, and lower percentage of diarrhea and cessation of defecation than the hyperlipidemic group (P<0.05). There was no statistically significant difference in severity between the two groups of patients (P=0.912). The levels of hemoglobin, platelets, C-reactive protein, cholesterol, and triacylglycerol in the biliary group were lower than those in the hyperlipidemia group, while the levels of total bilirubin, direct bilirubin, alanine transaminase, alkaline phosphatase, glutamyltranspeptidase, creatinine, calcium, sodium, amylase, and N-terminal brain natriuretic peptide precursor were higher than those in the hyperlipidemia group (P<0.05). The gestational week at delivery of the biliary group was shorter than the hyperlipidemia group (P<0.05). There was no statistically significant difference in premature delivery rate, cesarean section rate, and artificial intervention termination of pregnancy rate between the biliary group and hyperlipidemia group (P>0.05). The birth weight of the biliary group was smaller than the hyperlipidemia group, while the birth length was shorter than the hyperlipidemia group. The incidence of neonatal jaundice, respiratory distress, and ventilator-assisted breathing was higher than the hyperlipidemia group (P<0.05) .

Biliary diseases are still the first cause of APIP patients, which can significantly shorten the maternal gestational week, cause low fetal body mass, increase the incidence of pathological jaundice, respiratory distress, and ventilator-assisted breathing in the fetus, leading to a more severe prognosis for the fetus.

Pregnant women with gestational diabetes mellitus (GDM) are often comorbid with hypertensive disorders of pregnancy (HDP), which can severely impact pregnancy health and delivery outcomes. The relationship between gut microbiota and pregnancy health has received increasing attention, but its association with concurrent HDP in GDM remains to be investigated.

To explore the association between gut microbiota characteristics and concurrent HDP in GDM patients.

The 204 patients with GDM who underwent prenatal examination at the Hangzhou Women's Hospital from August 2019 to January 2020 were selected as the study subjects. Pregnant women diagnosed with GDM only were categorized as the GDM group (n=181), while those concurrently diagnosed with GDM and HDP were categorized as the GDM with concurrent HDP group (n=23). Clinical data and inflammation detection markers of the enrolled pregnant women were collected, and fecal samples of the same period were retained for gut microbiota 16S rDNA amplicon sequencing analysis. LEfSe analysis was used to compare microbiota composition between the two groups at the phylum, family and genus levels, and to identify distinct bacterial enrichments. Logistic regression analysis was performed to identify gut microbiota characteristics associated with concurrent HDP in GDM. Spearman's rank correlation analysis was performed to explore the association between gut microbiota and inflammatory markers.

No significant differences were found in overall gut microbiota composition and relative abundances of major phyla between the two groups (P>0.05). LEfSe analysis on family level showed that the Veillonellaceae family was enriched in the GDM with concurrent HDP group (P<0.05), while Mollicutes RF39 unclassified family and Lachnospiraceae were depleted (P<0.05). At the genus level, Dialister, Intestinibacter, Eubacterium and Parasutterella were enriched in the GDM with concurrent HDP group (P<0.05), whereas [Eubacterium] xylanophilum group, Ruminiclostridium 6, Mollicutes RF39 unclassified genus and Lachnospiraceae unclassified genus were enriched in the GDM group (P<0.05). Logistic regression analysis results showed increased abundances of Veillonellaceae (OR=1.06, 95%CI=1.01-1.11), Dialister (OR=1.26, 95%CI=1.10-1.45) and Intestinibacter (OR=2.07, 95%CI=1.12-3.84) were independent risk factors for concurrent HDP in GDM (P<0.05), while increased Lachnospiraceae was a protective factor (P<0.05). Spearman's rank correlation analysis results showed Veillonellaceae was positively correlated with the proportion of monocytes (r_s=0.149, P<0.05) ; Dialister was positively correlated with leukocyte count, eosinophil leukocyte, and eosinophil count (r_s=0.151, 0.163, 0.171, P<0.05) .

Increased abundances of Veillonellaceae, Dialister and Intestinibacter are independent risk factors for concurrent HDP in GDM pregnant women, while increased abundance of Lachnospiraceae unclassified genus is a protective factor. Veillonellaceae and Dialister are positively correlated with multiple inflammatory markers. Gut microbiota may be an important risk factor for concurrent HDP in GDM.

Postpartum depression (PPD) is one of the most common health problems among postpartum women worldwide, and it is also the most disabling disorder in reproductive period of women, which has a negative impact on the physical and mental health of mothers, infants and their families.

To analyze the causes of PPD, validate or revise the previous theoretical hypothesis "self-interpersonal model of PPD from the perspective of role transition", and provide intervention targets for the construction of effective prevention programs.

Using the explanatory case study method, based on the previous theoretical hypothesis, 15 women who experienced PPD symptoms and underwent routine postpartum checkups in the postpartum rehabilitation clinic of Obstetrics and Gynaecology Hospital of Fudan University from November 2022 to January 2023 were selected as the cases using the theoretical sampling method and following the "replication logic", who were interviewed by face-to-face, semi-structured in-depth personal interviews. Max QDA 2022 qualitative data analysis software was used to summarize the textual information, analytical method of constructive interpretation was used to analyze the results of each case in comparison to the previous theoretical hypotheses.

The causes of maternal PPD symptoms in this study did not go beyond the self and interpersonal aspects of the previous theoretical hypotheses and could be further summarized as four types of stressors, including "cannot take care of oneself" "cannot take care of the baby" "cannot manage the relationship with spouse" "cannot manage relationships with significant others".

The previous theoretical hypothesis of the "self-interpersonal model of PPD from the perspective of role transition" has been validated and concretized, in view of this, the four types of stressors can be used as targets for the development of PPD prevention programs to prevent PPD in the future.

As an objective index to evaluate chronic stress, allostatic load (AL) is associated with adverse pregnancy outcomes. At present, there are few longitudinal studies to analyze the influencing factors of AL among pregnant women.

To investigate the status of AL and its influencing factors in pregnant women at different trimesters.

This study was designed as a prospective study. Questionnaire survey, physical examination and laboratory examination were administered to 152 women in the first (≤14 weeks), second (23-27 weeks) and third (30-34 weeks) trimesters of pregnancy collected in the obstetrics outpatient clinics of the 901 Hospital, Joint Logistic Support Force of the Chinese People's Liberation Army, Jin'an Maternal and Child Health Care Hospital from November 2021 to November 2022 by using convenience sampling method. The Edinburgh Postpartum Depression Scale (EPDS) was used to assess the depression during pregnancy. Referring to previous studies, the relevant assessment indexes of metabolic system, cardiovascular system, and immune system were used to calculate the total score of AL, and AL≥3 score was used as a criterion for determining high AL level at different trimesters of pregnancy. Multivariate Logistic regression analysis was used to explore the influencing factors of AL in the first, second and third trimesters.

Among 152 pregnant women, the mean total AL score was (2.06±1.68), (2.07±1.84) and (2.07±1.68) in the first, second and third trimesters; 52 (34.2%), 54 (35.5%) and 50 (32.9%) women were in high level of AL (total score of AL≥3) in the first, second and third trimesters. The results of multivariate Logistic regression analysis showed that occupations {business service employees〔OR=0.229, 95%CI (0.062, 0.845), P=0.027〕, office staff〔OR=0.164, 95%CI (0.051, 0.528), P=0.002〕, professional and technical personnel〔OR=0.278, 95%CI (0.099, 0.784), P=0.015〕}, unemployment〔OR=5.516, 95%CI (1.044, 29.144), P=0.044〕and depression〔OR=6.241, 95%CI (1.403, 27.757), P=0.016〕were the influencing factors of AL in the first trimester. Age〔OR=1.098, 95%CI (1.002, 1.202), P=0.045〕and AL in the first trimester〔OR=9.965, 95%CI (4.402, 22.561), P<0.001〕were the influencing factors of AL in the second trimester. Sleep duration in the third trimester〔≥9 h/d: OR=0.176, 95%CI (0.044, 0.703), P=0.014〕, AL in the first trimester〔OR=4.697, 95%CI (1.852, 11.908), P<0.001〕and AL in the second trimester〔OR=9.426, 95%CI (3.728, 23.834), P<0.001〕 were the influencing factors of AL in the third trimester.

More than 30% of women are at high levels of AL at different trimesters and the influencing factors of AL at different trimesters are different. Occupation, unemployment status, and depression are the influencing factors of AL in the first trimester; age and AL in the first trimester are the influencing factors of AL in the second trimester; sleep duration in the third trimester and AL in the first and second trimesters are the influencing factors of AL in the third trimester.