Relationship between age of pregnant women with gestational diabetes mellitus and mode of delivery and neonatal Apgar score

BACKGROUND Gestational diabetes mellitus(GDM)refers to abnormal glucose tolerance during pregnancy,and it is often accompanied by obvious changes in glucose and lipid metabolism,and associated with adverse pregnancy outcomes.The incidence of fetal distress,polyhydramnios,puerperal infection,premature delivery,and macrosomia in pregnant women with GDM are higher than in those without GDM.AIM To analyze the relationship between age of pregnant women with GDM and mode of delivery and neonatal Apgar score.METHODS A total of 583 pregnant women with GDM who delivered in the Department of Obstetrics at our hospital between March 2019 and March 2022 were selected.Among them,377 aged<35 years were selected as the right age group and 206 aged>35 years were selected as the older group.The clinical data of the two groups were collected,and the relationship between age of the pregnant women with GDM and mode of delivery,maternal and neonatal outcomes,and neonatal Apgar score were compared.In the older group,159 women were classed as the adverse outcome group and 47 as the good outcome group according to whether they had adverse maternal and infant outcomes.The related factors of adverse maternal and infant outcomes were analyzed through logistic regression.RESULTS The number of women with assisted pregnancy,≤37 wk gestation,≥2 pregnancies,one or more deliveries,and no pre-pregnancy blood glucose screening in the older group were all higher than those in the right age group(P<0.05).The natural delivery rate in the right age group was 40.85%,which was higher than 22.33%in the older group(P<0.05).The cesarean section rate in the older group was 77.67%,which was higher than 59.15%in the right age group(P<0.05).The older group had a higher incidence of polyhydramnios and postpartum hemorrhage,and lower incidence of fetal distress than the right age group had(P<0.05).There was no significant difference in neonatal weight between the two groups(P>0.05).The right age group had higher Apgar scores at 1 and 5 min than the older group had(P<0.05).Significant differences existed between the poor and good outcome groups in age,education level,pregnancy mode,≤37 wk gestation,number of pregnancies,and premature rupture of membranes(P<0.05).Logistic regression showed that age,education level and premature rupture of membranes were all risk factors affecting the adverse outcomes of mothers and infants(P<0.05).CONCLUSION Delivery mode and Apgar score of pregnant women with GDM are related to age.Older age increases the adverse outcome of mothers and infants.

Exploration of the shared pathophysiological mechanisms of gestational diabetes and large for gestational age offspring

Gestational diabetes mellitus (GDM) and large for gestational age (LGA) offspring are two common pregnancy complications. Connections also exist between the two conditions, including mutual maternal risk factors for the conditions and an increased prevalence of LGA offspring amongst pregnancies affected by GDM. Thus, it is important to elucidate potential shared underlying mechanisms of both LGA and GDM. One potential mechanistic link relates to macronutrient metabolism. Indeed, derangement of carbohydrate and lipid metabolism is present in GDM, and maternal biomarkers of glucose and lipid control are associated with LGA neonates in such pregnancies. The aim of this paper is therefore to reflect on the existing nutritional guidelines for GDM in light of our understanding of the pathophysiological mechanisms of GDM and LGA offspring. Lifestyle modification is first line treatment for GDM, and while there is some promise that nutritional interventions may favourably impact outcomes, there is a lack of definitive evidence that changing the macronutrient composition of the diet reduces the incidence of either GDM or LGA offspring. The quality of the available evidence is a major issue, and rigorous trials are needed to inform evidence-based treatment guidelines.

Role of Ultrasonographic Measurement of Fetal Kidney Length in Determination of Gestational Age during Third Trimester of Pregnancy

Background: In routine ultrasonography, the ultrasonologist measures the bi-parietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) in estimating the gestational age (GA) and estimated date of delivery. However, as the pregnancy advances these parameters become increasingly unreliable in prediction of GA. Estimation of GA in late second and third trimester accurately still a problem till now. Fetal kidney has been shown a steady growth of 1.7 mm fortnightly (every 2 weeks) along pregnancy and is unaffected by growth abnormalities. Many studies have reported that fetal kidney length (FKL) correlates with the gestational age in late trimester very strong. The study aimed to assess the accuracy of the gestational age estimated by mean fetal kidney length compared to multiple growth parameters like BPD, HC, AC & FL in addition to the actual gestational age derived from the reliable last menstrual period. Methods: Cross sectional hospital based study, was conducted at ultrasound unit;department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University from the period of July 2018 to December 2018. A total number of 115 Pregnant women at their third trimester by reliable LMP attended antenatal care clinic at Ain-Shams University Hospital and consented to participate in this study. Every woman was subjected to: Expected date of delivery was calculated according to Naegle’s formula: Ultrasonography: Fetal biometry and estimated date of delivery (EDD) by assessment of BPD, HC, FL & AC. Expected fetal weight measured by Hadlock formula. Fetal lie and presentation. Exclusion of fetal anomalies. Measurement of both right & left fetal kidney length. Results: In this study, 255 participants were recruited and assessed for eligibility, 125 women were allocated to perform obstetric ultrasound just 115 completed and were included in the final analysis. The current study found that there was a highly significant positive correlation between gestational age (according to ultrasound parameters) and KL, BDP, HC, AC and FL but Kidney length was the most correlated parameter. Also this study found that there was significant positive correlation between gestational age (according to LMP) and gestational age estimated by BPD, HC, AC, FL and KL with the most significant positive correlation being with KL. Also this study found that there was no significant difference (matched) in KL and Gestational age compared to other parameters. This means that KL is the most accurate parameter for Estimating Gestational age, correlation between MKL and GA by LMP (r = 0.951, p = 0.000) the most significant correlation. In this study, no significant difference was found between gestational age estimated by KL and gestational age in all stages of pregnancy. This means that KL remains accurate as a predictor for gestational age regardless stage of pregnancy. Conclusion: Kidney length can be used as an individual parameter in estimating gestational age.

The Relation of Fetal Colon Diameter with Estimation of Gestational Age

Background: Conventional ultrasound dating is not very accurate after 34 weeks of gestation and has standard deviation of about 2 weeks. Objective: Verify whether fetal colon diameter can be used as a tool for estimating gestational age (GA) of fetuses between 34 to 40 weeks. Materials and Methods: This was a prospective cross-sectional study conducted at Obstetrics and Gynecology University Hospital, Damascus, Syria, during the period from September 2019-September 2020. The study enrolled 395 women with uncomplicated singleton pregnancies at 34 - 40 weeks of gestation. Fetal bi-parietal diameter, head circumference, abdominal circumference, and femoral lengths were assessed by ultrasound. In addition, descending colon diameter was assessed at the level of colonic haustra. The correlation between GA and colon diameter was assessed by the Pearson correlation test. Results: Significant correlation between fetal colon diameter and gestational age was observed P < 0.0001 (r = 0.852). In addition, a highly significant correlation between colon diameter and bi-parietal diameter, femoral length, head circumference and abdominal circumference were found with P values < 0.0001. The correlation between gestational age at 3rd trimester and colon diameter was significantly stronger than the correlation between gestational age and bi-parietal diameter, head circumference, and abdominal circumference. Whereas, no significant difference was found when comparing colon diameter and femoral lengths (P = 0.089). Conclusion: The present study suggested that colon diameter can be used for predicting third trimester gestational age.

Antenatal Corticosteroid Use and Perinatal Mortality According to Gestational Age among Preterm Singletons Born at 27 to 34 Weeks of Gestation in Hospitals in Tanzania

Background: Antenatal corticosteroid (ACS) treatment has been proven to decrease rates of adverse perinatal outcomes when administered to pregnant women at risk for preterm delivery. Given the uncertainty about the benefit of ACS according to gestational age, we aimed to examine whether there was any benefit of ACS on perinatal mortality and respiratory distress syndrome (RDS) according to different gestational ages at birth. Methods: Secondary analysis of data from an observational prospective chart review study was conducted in four hospitals located in the Mwanza region, Tanzania. The study population consisted of singleton infants delivered between 27 and 34 weeks of gestation between July 2019 and February 2020. Sociodemographic and medical data were recorded from participants’ medical records. Results: Over an eight-month period, 838 preterm singletons were delivered between 27 and 34 weeks of gestation. Three hundred and twelve (37.2%) pregnant women received at least one dose of ACS. Among infants exposed to ACS, perinatal mortality rates were significantly lower than those without exposure at the 27th week (27.8% vs 94.4%, P < 0.001), the 29th week (13.3% vs 51.4%, P = 0.012) and the 34th week (3.0% vs 18.2%, P < 0.001). Among infants exposed to ACS, the RDS rate was significantly lower than those without exposure only at the 32nd week (9.5% vs 25.0%, P = 0.039). Conclusion: Our findings add to the literature about the benefits of ACS for preterm infants of various gestational ages in low-resource settings. Compared to unexposed infants, those exposed to ACS and born at 27th and 34th weeks of gestation experienced lower rates of perinatal mortality. Future research, especially among infants born before the 27th week of pregnancy, is a priority.

Assessing gestational age of babies: Performance of obstetric ultrasound scan compared to that from the combination of Naegle’s rule and Dubowitz score in the 21st century

Background: Some researchers have suggested that when Naegle’s rule (NR) and Dubowitz score (DS) are combined, it could out-perform obstetric ultrasound scan (USS). Others still believe that obstetric USS alone is still effective relative to the combination of NR rule and DS in assessing the gestational age (GA) of babies. Objectives: To determine and compare the GA of babies using obstetric USS, NR and DS;and to provide relevant public health information on obstetric USS in the 21st century. Methods: Subjects were selected using systematic random sampling and the GA of babies was determined using obstetric USS, NR, and DS. Statistical package for social science (SPSS) statistical software version 16, Illinois, Chicago USA was used for all data analysis. Results: Eightyfive mother-baby pairs were studied. Forty-four babies (52%) were males and 41 (48%) females. Sixty four (75%) were term with a mean (SD) BW of 3.02 (0.59) at 95%CI (2.89 -?3.14) kg. The overall mean GA of the babies was 38.49 (2.89) at 95%CI (38.14 -?38.85) weeks. The mean GA using obstetric USS, NR and DS were 38.52 (1.98) at 95%CI (38.14 -?38.99), 38.09 (4.13) at 95%CI (37.20-?38.99) and 38.82 (2.02) at 95%CI (38.39 -?39.26), but comparison of these means was not significant (p = 0.256). Combined mean GA by NR and DS was 38.46 (3.26) at 95%CI (37.96 -?38.95). Comparing this mean with mean GA obtained by obstetric USS was also not significant (p = 0.885). Conclusion: The GA assessments by Obstetric USS, NR and DS were all reliable, and Obstetric USS performed effectively relative to combined NR and DS.

Growth Hormone Treatment, Cardiovascular Risk and Autonomic Maturation in Children and Adolescents with Growth Hormone Deficiency or Born Small for Gestational Age

Introduction: The impact of growth hormone therapy in children with short stature on cardiovascular prognosis seems to be unpredictable from big databases. The enhanced cardiovascular risk in this group of patients may be related to adverse autonomic imprinting by early life stress. Autonomic dysfunction and possible effects of growth hormone therapy on the autonomic nervous system can be measured easily by calculating heart rate variability (HRV) from Holter electrocardiogram monitoring. Methods: We performed HRV analysis prior to growth hormone therapy (N = 33), within the first year of growth hormone therapy between 4 and 10 years of age (N = 19), at least a further HRV measurement between 10 and 15 years (N = 30). Additional measurements were performed before and after cessation of growth hormone therapy (N = 14). Data were compared to untreated pediatric patients with short stature and to age matched healthy controls. Results: Untreated patients with short stature due to growth hormone deficiency or intrauterine growth restriction in early childhood have significantly increased heart rates most of all at night and concomitantly reduced global HRV indicated as Standard Deviation of Normal to Normal Intervals (SDNN). Growth hormone treated adolescents and the untreated patients with short stature show significantly elevated mean heart rates and concomitantly reduced vagus activities measured as reduced Route Mean Square Standard Deviation (RMSSD). After cessation of growth hormone treatment SDNN significantly increases and heart rate decreases to normal values in formerly treated patients with catch-up growth. Conclusion: There is a comparable autonomic dysfunction in treated and untreated children with short stature as an indicator for enhanced cardiovascular risk. After cessation of growth hormone therapy, we found a significant improvement of reduced HRV to normal values.

Accuracy of Trans-Cerebellar Diameter and Placental Thickness in Third Trimesteric Pregnant Women for Calculation of Gestational Age: A Cross Sectional Study

Background: Accurate determination of gestational age has become important for deciding the appropriate time for termination of the pregnancy as well as to monitor the fetal growth during the entire period of pregnancy. Objective: The aim of the study was to assess whether the trans-cerebellar diameter, placental thickness or combining both of them is more accurate for assessment of gestational age in the 3rd trimester of pregnancy. Patients and Methods: This is a cross sectional study conducted at outpatient Clinic and Obstetric ward, Ain Shams University Maternity Hospital, over a period of six months from March 2019 to September 2019. One hundred pregnant women were recruited according to inclusion criteria either from outpatient clinic or were admitted in obstetric ward Ain Shams Maternity Hospital to find out the most accurate fetal biometric measurement in the third trimester either trans-cerebellar diameter placental thickness or both compared to reliable LMP (last menstrual period) dates confirmed by crown rump length (CRL) in the first trimester. Results: Trans-cerebellar diameter mean ± SD was 46.0 ± 3.5 with range 38.2 - 51.7. The mean of placental thickness was 39.6 ± 7.1 with range 22.8 - 54.3. Placental thickness had highest determination (0.813) for last menstrual period followed by trans-cerebellar diameter (0.802). Combining trans-cerebellar diameter and placental thickness increased determination (0.902) for last menstrual period. Conclusion: Combined use of trans-cerebellar diameter and placental thickness in the third trimester of pregnancy is a reliable indicator for gestational age in women whose last menstrual period is unreliable or unknown, but placental thickness had higher accuracy than trans-cerebellar diameter.

Expectant Management of Preterm Ruptured Membranes before 34 Gestational Weeks at the University Hospital of Kinshasa, a Tertiary Referral Hospital in the Democratic Republic of Congo

Premature Rupture of Membranes (PROM) with the resulting prematurity remains a major public health issue in the Democratic Republic of Congo (DRC). This study aimed to assess expectant management of PPROM before 34 weeks at the university hospital of Kinshasa. We conducted a retrospective analysis of expectantly managed PROM before 34 weeks between January 2008 and December 2018. Maternal and fetal outcomes were collected, and all data were analyzed using the SPSS 23.0 software. Of the 113 patients included in the study, 2.6% were diagnosed with PROM before 34 weeks. We observed prolongation of the pregnancy duration;the median latency period was eight days, and the average gestational age at delivery of 32.85 ± 2.5 weeks. Chorioamnionitis (23%), severe oligoamnios (7%), and acute fetal distress (4%) were complications observed during the latency period. In the postpartum period, endometritis (6.2%), neonatal jaundice (39.8%), anemia (25.7%), ulcerative necrotizing enterocolitis (6.2%), cerebromeningeal hemorrhage (5.3%), and acute respiratory distress syndrome (4.4%) were complications observed. The risk of infection during the latency period was significantly associated with irregular (P = 0.045) or lack (P = 0.006) antenatal care (ANC) attendances and C-Reactive Protein (CRP) results 6 (P = 0.013). The risk of neonatal death was significantly associated to infection during the latency period (P = 0.011), irregular (P = 0.009) or lack of ANC (P = 0.000) attendances, Birth weight g (P = 0.039) as well as Gestational age at birth between 28 to 30 Weeks (S) (P = 0.021). These findings report first-time pregnancy outcomes related to the management of PPROM before 34 weeks in our setting. We found that the conservative attitude adopted allowed the prolongation of pregnancies, reducing the risks associated with prematurity. Nevertheless, attendance in good quality ANC could reduce the frequency of PROM and related adverse outcomes.

Gestational Diabetes Mellitus and Its Associated Risk Factors in Pregnant Women at Selected Health Facilities in Kigali City, Rwanda

Background: Gestational Diabetes Mellitus (GDM) is the most common complication of pregnancy that causes chronic hypertension, increased rate of cesarean delivery, fetal mortality and morbidity. Therefore, early diagnosis of GDM is vital to reduce maternal and fetal morbidity. Moreover, it can circumvent or procrastinate the onset of type 2 diabetes. Objectives: The main objective of this study was to determine the prevalence of GDM in pregnant women attending Kimironko, Kicukiro and Muhima Health Centres. The specific objectives were to determine the blood glucose during the second trimester in pregnant women aged between 21 and 45 years, to find out the frequencies of pregnant women presenting with GDM according to age and to assess some promising risk factors associated with GDM. Methods: A cross-sectional study was carried out at Kimironko, Kicukiro and Muhima Health centers using a sample size of 96 pregnant women. Blood glucose levels were measured using glucose oxidase method with a glucometer. Data were analyzed by using Microsoft Office Excel and SPSS version 20. Results: Out of 96 pregnant women who participated in the study, 8.3% were found to have GDM with the mean ± 2SD of 194.12 ± 25.53 mg/dl of their blood glucose results (Mean ± 2SD: A 95% level of confidence Intervals). The highest proportion of GDM was revealed in pregnant women aged between 26 - 30 years, representing a frequency of 5.2% whereas 2.1% of GDM was reflected in women aged between 21 - 25 years. The lowest proportion of GDM fell in age group of 31 - 35 years contributing to 1% of the total GDM. There were no cases of GDM in pregnant women in the 36 - 40 or 41 - 45 age groups. The mean ± 2SD of participant’s age groups was 27.12 ± 5.01 years. In addition, while obesity did not show to be associated with GDM, age and family history were found to be risk factors of GDM. Conclusion: The findings of this study revealed that the prevalence of GDM was 8.3% and the most affected pregnant women were in the age group of 26 - 30 years.

Characterization of Ga NAs/ Ga As and Ga In NAs/ Ga As Quantum Wells Grown by Plasma-Assisted Molecular Beam Epitaxy: Effects of Ion Damage

The effects of ion damage on Ga NAs/Ga As and Ga In NAs/Ga As quantum wells ( QWs) grown by plas- ma- assisted molecular beam epitaxy have been investigated. Itis found thation damage is a key factor affecting the quality of Ga NAs and Ga In NAs QWs. Obvious appearance of pendello¨ sung fringes in X- ray diffraction pattern and remarkable im provement in the optical properties of the samples grown with ion removal magnets are observed.By removing nitrogen ions,the PL intensity of the Ga In NAs QW is improved so as to be comparable with that of Ga In As QW. The stronger is the magnetic field,the m ore obvious the PL intensity im provement would be.

Maternal serum level of resistin is associated with risk for gestational diabetes mellitus:A meta-analysis

BACKGROUND Resistin is most likely involved in the pathogenesis of gestational diabetes mellitus(GDM), but the existing findings are inconsistent.AIM To review the literature investigating the associations of the risk of GDM with serum level of resistin.METHODS A systematic literature search was performed using MEDLINE, EMBASE, and Web of Science(all databases). This meta-analysis included eligible studies that:(1) investigated the relationship between the risk of GDM and serum resistin;(2)included GDM cases and controls without GDM;(3) diagnosed GDM according to the oral glucose-tolerance test;(4) were performed in humans;(5) were published as full text articles in English; and(6) provided data with median and quartile range, median and minimum and maximum values, or mean and standard deviation. The pooled standardized mean difference(SMD) and 95%confidence interval(CI) were calculated to estimate the association between the risk of GDM and serum resistin. To analyze the potential influences of need for insulin in GDM patients and gestational age at blood sampling, we performed a subgroup analysis. Meta-regression with restricted maximum likelihood estimation was performed to assess the potentially important covariate exerting substantial impact on between-study heterogeneity.RESULTS The meta-analysis for the association between serum resistin level and GDM risk included 18 studies(22 comparisons) with 1041 cases and 1292 controls. The total results showed that the risk of GDM was associated with higher serum resistin level(SMD = 0.250, 95%CI: 0.116, 0.384). The "after 28 wk" subgroup, "no need for insulin" subgroup, and "need for insulin" subgroup indicated that higher serum resistin level was related to GDM risk("after 28 wk" subgroup: SMD =0.394, 95%CI: 0.108, 0.680; "no need for insulin" subgroup: SMD = 0.177, 95%CI:0.018, 0.336; "need for insulin" subgroup: SMD = 0.403, 95%CI: 0.119, 0.687). The"before 14 wk" subgroup, "14-28 wk" subgroup, and "no information of need for insulin" subgroup showed a nonsignificant association between serum resistin level and GDM risk("before 14 wk" subgroup: SMD = 0.087, 95%CI:-0.055, 0.230;"14-28 wk" subgroup: SMD = 0.217, 95%CI:-0.003, 0.436; "no information of need for insulin" subgroup: SMD = 0.356, 95%CI:-0.143, 0.855). The postpartum subgroup included only one study and showed that higher serum resistin level was related to GDM risk(SMD = 0.571, 95%CI: 0.054, 1.087) The meta-regression revealed that no need for insulin in GDM patients, age distribution similar between cases and controls, and ELISA all had a significant impact on between-study heterogeneity.CONCLUSION This meta-analysis supports that the maternal serum resistin level is associated with GDM risk.

Tectonic Environments of the Yan-Liao Rift during Earth's Middle Age(1.7～0.75 Ga): Evidence from Mafic Dyke Swarms in Eastern Hebei, North China

During the past decade,generations of Precambrian mafic dykes/sills have been investigated and revealed in the North China Craton(NCC).Researchers identified more than 20 episodes of Precambrian dyke swarms,

Mafic, Ultramafic and Carbonatitic Dykes in the Southern Siberian Craton with Age of ca 1 Ga: Remnants of a New Large Igneous Province?

Virtual absence of igneous complexes with ages between1.8 Ga and 0.8 Ga in southern part of the Siberian Craton allowed to Galdkochub et al.(2010)to formulate a hypothesis of long magmatic quiescence.Most reliable

Association of interpregnancy interval and risk of adverse pregnancy outcomes in woman by different previous gestational ages

Background:With an increasing proportion of multiparas,proper interpregnancy intervals(IPIs)are urgently needed.However,the association between IPIs and adverse perinatal outcomes has always been debated.This study aimed to explore the association between IPIs and adverse outcomes in different fertility policy periods and for different previous gestational ages.Methods:We used individual data from China’s National Maternal Near Miss Surveillance System between 2014 and 2019.Multivariable Poisson models with restricted cubic splines were used.Each adverse outcome was analyzed separately in the overall model and stratified models.The stratified models included different categories of fertility policy periods(2014-2015,2016-2017,and 2018-2019)and infant gestational age in previous pregnancy(<28 weeks,28-36 weeks,and≥37 weeks).Results:There were 781,731 pregnancies enrolled in this study.A short IPI(≤6 months)was associated with an increased risk of preterm birth(OR[95%CI]:1.63[1.55,1.71]for vaginal delivery[VD]and 1.10[1.03,1.19]for cesarean section[CS]),low Apgar scores and small for gestational age(SGA),and a decreased risk of diabetes mellitus in pregnancy,preeclampsia or eclampsia,and gestational hypertension.A long IPI(≥60 months)was associated with an increased risk of preterm birth(OR[95%CI]:1.18[1.11,1.26]for VD and 1.39[1.32,1.47]for CS),placenta previa,postpartum hemorrhage,diabetes mellitus in pregnancy,preeclampsia or eclampsia,and gestational hypertension.Fertility policy changes had little effect on the association of IPIs and adverse maternal and neonatal outcomes.The estimated risk of preterm birth,low Apgar scores,SGA,diabetes mellitus in pregnancy,and gestational hypertension was more profound among women with previous term births than among those with preterm births or pregnancy loss.Conclusion:For pregnant women with shorter or longer IPIs,more targeted health care measures during pregnancy should be formulated according to infant gestational age in previous pregnancy.

Impact of Periconceptional Multi-micronutrient Supplementation on Gestation:A Population-based Study

Objective To examine the effect of periconceptional multi‐micronutrient supplementation on gestation and birth outcomes.Methods A population‐based community intervention program was conducted in 18 counties in China.Participants were divided into an intervention group,who received multi‐micronutrient supplementation from at least 3 months before pregnancy throughout the first trimester,and a control group.Pregnant women were followed up to record information about birth outcomes.Maternal socio‐economic characteristics and main birth outcomes were evaluated.Gestational age was further analyzed using survival analysis,to determine the time distribution of delivery.Results Periconceptional multi‐micronutrient supplementation was associated with higher birth weight,birth length and occipitofrontal head circumference,and with lower incidence rates for stillbirth,low birth weight,and preterm birth.Moreover,periconceptional multi‐micronutrient supplementation changed the time distribution of delivery,making the deliveries more clustered in the period between day 275 and day 295 of gestation.Conclusion Our study shows that periconceptional multi‐micronutrient supplementation is beneficial for fetal development and optimizes all measured aspects of health in neonates in socioeconomically disadvantaged areas in China.The change in time distribution of deliveries caused by multi‐micronutrient supplementation needs further clarification.

Age of onset of diabetes and all-cause mortality

Diabetes mellitus continues to present a large social,financial and health system burden across the world.The relationship between age of onset of the different types of diabetes and all-cause mortality is uncertain.In this review paper,the relationship between age of onset of the different types of diabetes and all-cause mortality will be reviewed and an update of the current evidence will be presented.There is strong evidence of the relationship between age of onset of type 2 diabetes mellitus(T2 DM) and all-cause mortality,good evidence of the relationship between age of onset of T1 DM and all-cause mortality and no evidence of the relationship between age of onset of gestational diabetes or prediabetes and all-cause mortality.Further research is needed to look at whether aggressive management of earlier onset of T2 DM can help to reduce premature mortality.

Peak systolic velocity Doppler of middle cerebral artery in small for gestational age （SGA） fetus

BACKGROUND： Small for gestational age （SGA） has high frequency which increases the risk of long-term adverse outcomes. Thus the aim of this study was to evaluate peak systolic velocity Doppler of middle cerebral artery （MCA） in SGA fetus in order to find appropriate method to diagnosis SGA sooner. MATERIALS and METHODS： This prospective longitudinal study was conducted on 90 pregnant women with a diagnosis of SGA fetus and 90 pregnant women with normal fetus. Then MCA and umbilical artery assessment were performed for all subjects and compared between two groups. RESULTS： Doppler assessment showed that umbilical artery PI was significantly higher in SGA group as compared to normal group （1.114-0.37 vs 0.984-0.18, P = 0.003）, while MCA PI was significantly lower in SGA group （1.77±0.44 vs 1.92±0.47, P = 0.028）. On the other hand, PSV did not differ between the groups （P = 0.592）. Moreover, we found that PSV was more in SGA group by grouping maternal age （〈 27 years） （P = 0.006）, and gestational age （〉 34 weeks） （P 〈 0.001）. CONCLUSION： The results of this study suggest that MCA PI decreased significantly in SGA fetuses, while UA PI increased in this group. Moreover, PSV increased in this group when evaluated in different subgroups （based on maternal age and gestational age）.

Trends in Triglyceride (Fat) Levels of Various Stages of Pregnancy in Nigerian Women

Background: In developing countries like Nigeria, with poor socio-economic, early marriage, poor acceptance of contraception, poor spacing of pregnancies, high fertility rate and poor maternal and child health indices, leading to poor maternal-child outcome. There is a need to investigate the pattern of serum lipid changes during pregnancy in Nigeria women as hyperlipidemia may lead to poor maternal outcome. Materials and methods: A total of one hundred and forty (140) subjects between the ages of 20 and 45 years with mean age 29.74 ± 6.5 years of the study population. Group 1: the control comprises of thirty-five (35) healthy non pregnant subjects with mean age of 26.84 ± 5.2 volunteers of Nigeria origin. Group 2: the test involved one hundred and five (105) apparently healthy pregnant Nigerian women sub-divided into three groups;X, Y and Z each made of thirty-five (35) subjects distributed into 1st, 2nd and 3rd trimester of pregnancy respectively. The TG assay was analyzed using enzymatic spectrophotometric method as described by Biosystems. Results: The result analysis showed a significant increase (p ≤ 0.05) in the TG level during the first trimester of pregnancy when compared with control as shown in Table 1. There was a significant increase (p ≤ 0.05) in the TG levels during the second trimester of pregnancy when compared with that of the control subjects. During the third trimester of pregnancy there was a significant increase in TG levels when compared with the control subjects. Conclusion: This work revealed that the most dramatic change in the lipid profile in normal pregnancy is serum hypertriglyceridemia, which may be as high as two-three folds in the third trimester over the levels in non pregnant subjects. The estimation of lipid profile is strongly recommended as part of the laboratory investigations during pregnancy. Since studies in recent past have incriminated abnormal lipid metabolism during pregnancy in the pathogenesis of atherosclerotic, ischemia heart disease, intrauterine growth disease, intrauterine growth retardation and hypertension.

Neonatal hemorrhage stroke and severe coagulopathy in a late preterm infant after receiving umbilical cord milking:A case report

BACKGROUND Umbilical cord milking(UCM)is an alternative placental transfusion method for delayed umbilical cord clamping in routine obstetric practice,allowing prompt resuscitation of an infant.Thus,UCM has been adopted at some tertiary neonatal centers for preterm infants to enhance placental-to-fetal transfusion.It is not suggested for babies less than 28 wk of gestational age because it is associated with severe brain hemorrhage.For late preterm or term infants who do not require resuscitation,cord management is recommended to increase iron levels and prevent the development of iron deficiency anemia,which is associated with impaired motor development,behavioral problems,and cognitive delays.Concerns remain about whether UCM increases the incidence of intraventricular hemorrhage.However,there are very few reports of late preterm infants presenting with neonatal hemorrhage stroke(NHS)and severe coagulopathy after receiving UCM.Here,we report a case of a late preterm infant born at 34 wk of gestation.She abruptly deteriorated,exhibiting signs and symptoms of NHS and severe coagulopathy after receiving UCM on the first day of life.CASE SUMMARY A female preterm infant born at 34 wk of gestation received UCM after birth.She was small for her gestational age and described as vigorous with Apgar scores of 9 and 10 at one minute and five minutes of life,respectively.After hospitalization in the neonatal intensive care unit,she showed hypoglycemia and metabolic acidosis.The baby was administered glucose and sodium bicarbonate infusions.Intramuscular vitamin K1 was also used to prevent vitamin K deficiency.The baby developed umbilical cord bleeding and gastric bleeding on day 1 of life;a physical examination showed bilateral conjunctival hemorrhage,and a blood test showed thrombocytopenia,prolonged prothrombin time,prolonged activated partial thromboplastin time,low fibrinogen,raised D-dimer levels and anemia.A subsequent cranial ultrasound and computed tomography scan showed a left parenchymal brain hemorrhage with extension into the ventricular and subarachnoid spaces.The patient was diagnosed with NHS in addition to disseminated intravascular coagulation(DIC).Fresh frozen plasma(FFP)and prothrombin complex concentrate were given for coagulopathy.Red blood cell and platelet transfusions were provided for thrombocytopenia and anemia.A bolus of midazolam,intravenous calcium and phenobarbital sodium were administered to control seizures.The baby’s clinical condition improved on day 5 of life,and the baby was hospitalized for 46 d and recovered well without seizure recurrence.Our case report suggests that preterm infants who receive UCM should undergo careful clinical assessment for intracranial hemorrhage,NHS and severe coagulopathy that may develop under certain circumstances.Supportive management,such as intensive care,FFP and blood transfusion,is recommended when the development of massive NHS and associated DIC is suspected.CONCLUSION Our case report suggests that for late preterm infants who are small for gestational age and who receive UCM for alternative placental transfusion,neonatal health care professionals should be cautious in assessing the development of NHS and severe coagulopathy.Neonatal health care professionals should also be more cautious in assessing the complications of late preterm infants after they receive UCM.