Objective To explore the interactions between pre-pregnancy body mass index(BMI) and age on offspring neuropsychological development from 1 to 24 months in China.Methods In this birth cohort study, a total of 2,253 mo...Objective To explore the interactions between pre-pregnancy body mass index(BMI) and age on offspring neuropsychological development from 1 to 24 months in China.Methods In this birth cohort study, a total of 2,253 mother-child pairs were enrolled in Tianjin, China,between July 2015 and May 2018. The China Developmental Scale for Children was used to assess developmental quotient(DQ) of children aged from 1 to 24 months.Results Mixed-models analysis revealed significant age × pre-pregnancy BMI interactions for total DQ and five neurobehavioral domains(gross motor, fine motor, adaptive, language, and social;P < 0.001).Age × pre-pregnancy BMI ≥ 25 kg/m^2 was associated with a negative effect on total DQ and five neurobehavioral domains, as compared to pre-pregnancy BMI < 25 kg/m^2(P < 0.01). Multiple comparisons showed pre-pregnancy BMI ≥ 25 kg/m^2 of mothers had a positive effect on child total DQ at the age of 1 month but a negative effect at 24 months(P < 0.05).Conclusions This study supported the age × pre-pregnancy BMI interaction on offspring neuropsychological development. It also revealed a short-term positive impact of high pre-pregnancy BMI on neuropsychological development at 1 month of age, but a long-term negative effect(from 1 to24 months).展开更多
The 7-valent pneumococcal conjugate vaccine (PCV) was introduced in Uruguay in March 2008. In April 2010, it was replaced by PCV13. Surveillance of both vaccines was performed on hospitalized children with consolidate...The 7-valent pneumococcal conjugate vaccine (PCV) was introduced in Uruguay in March 2008. In April 2010, it was replaced by PCV13. Surveillance of both vaccines was performed on hospitalized children with consolidated pneumonia. The effect of different number of vaccine doses was evaluated in 2008 and 2010 birth cohorts vaccinated with PCV7 and PCV13 respectively. The study aims to estimate the effects of PCV7 and PCV13 different number of doses on consolidated pneumonia, through the study of hospitalized children from 2008 and 2010 birth cohorts. Vaccination records of every child were available providing precise vaccination data;therefore a new approach was used to estimate PCVs effect. Incidence rate was calculated for each year of the study and for the different number of vaccine doses used each year. Exposure was calculated as person per year and rate ratio values determined the decrease of consolidated pneumonias. This decrease in percentage was estimated as the difference between the incidence with no vaccine and the incidence of every one of the doses. Incidence rate ratio revealed significant values for the three vaccine doses of PCVs for both cohorts. Upon comparing incidences, significant reduction percentages of consolidated pneumonia admissions were found. The reduction percentage of consolidated pneumonia for fully vaccinated (3 doses) patients was 69.3% and 84.6 % for PCV7 and PCV13, respectively. These results confirm that PCV7 and PCV13 are highly effective for reducing pediatric hospitalizations due to consolidated pneumonia, as reported by other national publications and demonstrated by international researchers.展开更多
Background:The role of inflammation in the development of gestational diabetes mellitus(GDM)has recently become a focus of research.The systemic immune-inflammation index(SII)and systemic inflammation response index(S...Background:The role of inflammation in the development of gestational diabetes mellitus(GDM)has recently become a focus of research.The systemic immune-inflammation index(SII)and systemic inflammation response index(SIRI),novel indices,reflect the body’s chronic immune-inflammatory state.This study aimed to investigate the associations between the SII or SIRI and GDM.Methods:A prospective birth cohort study was conducted at Beijing Obstetrics and Gynecology Hospital from February 2018 to December 2020,recruiting participants in their first trimester of pregnancy.Baseline SII and SIRI values were derived from routine clinical blood results,calculated as follows:SII=neutrophil(Neut)count×platelet(PLT)count/lymphocyte(Lymph)count,SIRI=Neut count×monocyte(Mono)count/Lymph count,with participants being grouped by quartiles of their SII or SIRI values.Participants were followed up for GDM with a 75-g,2-h oral glucose tolerance test(OGTT)at 24-28 weeks of gestation using the glucose thresholds of the International Association of Diabetes and Pregnancy Study Groups(IADPSG).Logistic regression was used to analyze the odds ratios(ORs)(95%confidence intervals[CIs])for the the associations between SII,SIRI,and the risk of GDM.Results:Among the 28,124 women included in the study,the average age was 31.8±3.8 years,and 15.76%(4432/28,124)developed GDM.Higher SII and SIRI quartiles were correlated with increased GDM rates,with rates ranging from 12.26%(862/7031)in the lowest quartile to 20.10%(1413/7031)in the highest quartile for the SII(P_(trend)<0.001)and 11.92-19.31%for the SIRI(P_(trend)<0.001).The ORs(95%CIs)of the second,third,and fourth SII quartiles were 1.09(0.98-1.21),1.21(1.09-1.34),and 1.39(1.26-1.54),respectively.The SIRI findings paralleled the SII outcomes.For the second through fourth quartiles,the ORs(95%CIs)were 1.24(1.12-1.38),1.41(1.27-1.57),and 1.64(1.48-1.82),respectively.These associations were maintained in subgroup and sensitivity analyses.Conclusion:The SII and SIRI are potential independent risk factors contributing to the onset of GDM.展开更多
Introduction:Eliminating hepatitis B virus(HBV)as a major public health threat is a global health priority that requires cost-effective screening strategies.This study evaluated the cost-effectiveness of sequential bi...Introduction:Eliminating hepatitis B virus(HBV)as a major public health threat is a global health priority that requires cost-effective screening strategies.This study evaluated the cost-effectiveness of sequential birth cohort HBV screening strategies in China.Methods:Using a Markov model,we compared five screening strategies with current practice,calculating HBV-related deaths averted,qualityadjusted life years(QALYs)gained,and incremental cost-effectiveness ratios(ICER).One-way deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the results.Results:The sequential birth cohort screening strategy(Sequential Screening 1:screening the 1991–2000 cohort in 2025–2026,the 1971–1990 cohort in 2027–2028,and the 1951–1970 cohort in 2029–2030)was the most cost-effective,with an ICER of 58,523 Chinese Yuan(CNY)per QALY at a willingness-to-pay threshold of three times the percapita Gross Domestic Product(GDP).An alternative strategy that prioritized the 1951–1970 cohort in 2025–2026 averted the most HBV-related deaths(approximately 3.44 million)and gained 24.9 million QALYs,with an ICER of 60,113 CNY per QALY,also showing cost-effectiveness.Discussion:Our findings support sequential birth cohort screening as an optimal and innovative approach to achieving the WHO HBV elimination targets,offering evidence-informed guidance for policymakers to optimize screening programs and resource allocation.展开更多
Objective Toinvestigate theepidemiological characteristics and morbidity trends of hypertensive disorders of pregnancy(HDP)in Shenzhen,China.Methods This study was a cross-sectional study.Data were based on the Shenzh...Objective Toinvestigate theepidemiological characteristics and morbidity trends of hypertensive disorders of pregnancy(HDP)in Shenzhen,China.Methods This study was a cross-sectional study.Data were based on the Shenzhen Birth Cohort.Pregnant women who gave birth from January 1,2018 to March 31,2023 were included.Incidence and change trends of HDP and its different pathological types were analyzed.The enrolled pregnant women were divided into the HDP group and the non-HDP group according to whether HDP occurred.General clinical data and pregnancy outcomes were collected from both groups.The incidence of adverse pregnancy outcomes among pregnant women with different pathological types of HDP was analyzed,and subgroup analyses were performed based on age and body mass index(BMI).Results A total of 90117 pregnant women were enrolled,aged(31.6±4.4)years.There were 4117 cases in the HDP group and 86000 in the non-HDP group.The overall incidence of HDP in the whole study population was 4.57%(4117/90117).From 2018—2023,the incidence of HDP in Shenzhen showed an increasing trend year by year,from 2.88%(523/18155)to 7.04%(271/3851).Specifically,the incidence of gestational hypertension increased from 0.93%(168/18155)to3.09%(119/3851),the incidence of preeclampsia-eclampsia increased from 1.78%(323/18155)to3.17%(122/3851),the incidence of chronic hypertension increased from 0.01%(1/18155)to 0.42%(16/3851),and the incidence of chronic hypertension with superimposed preeclampsia increased from 0.17%(31/18155)to 0.36%(14/3851).The age((32.8±4.8)years vs.(31.5±4.3)years,P<0.05)and BMI in the first trimester((23.37±3.77)kg/m^(2)vs.(21.35±2.91)kg/m^(2),P<0.05)of HDP group were higher than those of the non-HDP group.Subgroup analysis showed that the incidence of HDP in pregnant women aged≥50.0 years was the highest in all age subgroups(42.86%(6/14)).The incidence of HDP in pregnant women with BMI≥30.0 kg/m^(2)in the first trimester was the highest among all BMI subgroups(20.44%(241/1179)).The proportions of preterm birth,gestational diabetes,fetal growth restriction,small for gestational age,placental abruption,and late abortion in HDP group were 30.82%(1269/4117),30.46%(1254/4117),6.80%(280/4117),4.86%(200/4117),3.59%(148/4117),and 0.80%(33/4117),respectively.Conclusion The incidence of HDP among pregnant women has been increased year by year in Shenzhen,China.With the increase in age and BMI during early pregnancy,the incidence of HDP shows an overall upward trend.展开更多
Background The first five years of life are sensitive periods for neurodevelopment.Poor maternal metrics of cardiovascular health may influence offspring neurodevelopment.Previous studies focused only on one or two me...Background The first five years of life are sensitive periods for neurodevelopment.Poor maternal metrics of cardiovascular health may influence offspring neurodevelopment.Previous studies focused only on one or two metrics,or different time window.This study is aimed to investigate the effects of combined cardiovascular health metric exposure during pregnancy on the neurodevelopment of offspring during crucial periods. Methods A total of 1007 mother-child pairs recruited from 2013 to 2016 from the Shanghai Birth Cohort were included.Five maternal cardiovascular health metrics at 28 weeks of gestation were collected.Offspring neurodevelopment at 2-3 years and 4-5 years was evaluated with the Bayley-Ⅲ and Wechsler preschool and primary scale of intelligence,fourth edition(WPPSI-Ⅳ),respectively. Results After adjusting for confounders,the scores for cognition and language at 2-3 years significantly increased by 1.63[95%confidence interval(CI)0.42-2.83,P=0.008]and 0.84(95%CI 0.005-1.67,P=0.049)per one-point higher mater-nal cardiovascular health score,respectively.After false discovery rate adjustment,the associations were preserved in the cognitive domain.Similarly,each one-point higher maternal cardiovascular health score was associated with an increase of 0.92(95%CI 0.16-1.68,P=0.018)and 0.71(95%CI 0.01-1.40,P=0.047)in the visual space index and working memory index scores at 4-5 years,respectively,but with an false discovery rate-adjusted P>0.05;in the sex-stratified analysis,the visual space index scores significantly increased(β=1.47,95%CI 0.38-2.56,P=0.009),regardless of false discovery rate correction.In addition,each one-point higher maternal cardiovascular health score reduced the relative risk of suboptimal development in the visual space index domain by 0.83(95%CI 0.70-0.99;P=0.041)in female offspring despite the non-significant after false discovery rate adjustment. Conclusions Our study provides novel evidence that maternal cardiovascular health during pregnancy is associated with offspring neurodevelopment within the first five years of life and that female offspring appear to derive greater benefit from higher maternal cardiovascular health scores.The potential role of maternal cardiovascular health in identifying risk of neurodevelopmental delay in clinical practice needs to be further explored.展开更多
Background Birth weight is a strong determinant of infant short-and long-term health outcomes.Family socioeconomic position(SEP)is usually positively associated with birth weight.Whether this association extends to ab...Background Birth weight is a strong determinant of infant short-and long-term health outcomes.Family socioeconomic position(SEP)is usually positively associated with birth weight.Whether this association extends to abnormal birth weight or there exists potential mediator is unclear.Methods We analyzed data from 14,984 mother-infant dyads from the Born in Guangzhou Cohort Study.We used multi-variable logistic regression to assess the associations of a composite family SEP score quartile with macrosomia and low birth weight(LBW),and examined the potential mediation effect of maternal pre-pregnancy body mass index(BMI)using causal mediation analysis.Results The prevalence of macrosomia and LBW was 2.62%(n=392)and 4.26%(n=638).Higher family SEP was associated with a higher risk of macrosomia(OR 1.30,95%CI 0.93-1.82;OR 1.53,95%CI 1.11-2.11;and OR 1.59,95%CI 1.15-2.20 for the 2nd,3rd,and 4th SEP quartile respectively)and a lower risk of LBW(OR 0.69,95%CI 0.55-0.86;OR 0.76,95%CI 0.61-0.94;and OR 0.61,95%CI 0.48-0.77 for the 2nd,3rd,and 4th SEP quartile respectively),compared to the 1st SEP quartile.We found that pre-pregnancy BMI did not mediate the associations of SEP with macrosomia and LBW.Conclusions Socioeconomic disparities in fetal macrosomia and LBW exist in Southern China.Whether the results can be applied to other populations should be further investigated.展开更多
Background Prenatal bisphenol exposure has been reported to be associated with lower birth weight and obesity-related indicators in early childhood.These findings warrant an investigation of the relationship between p...Background Prenatal bisphenol exposure has been reported to be associated with lower birth weight and obesity-related indicators in early childhood.These findings warrant an investigation of the relationship between prenatal bisphenol exposure and the dynamic growth of offspring.This study aimed to evaluate the relationship of maternal bisphenol concentration in urine with the body mass index(BMI)growth trajectory of children aged up to two years and to identify the critical exposure periods.Methods A total of 826 mother–offspring pairs were recruited from Wuhan Children’s Hospital between November 2013 and March 2015.Maternal urine samples collected during the first,second,and third trimesters were analyzed for bisphenol A(BPA),bisphenol S,and bisphenol F(BPF)concentrations.Measurements of length and weight were taken at 0,1,3,6,8,12,18,and 24 months.Children's BMI was standardized using the World Health Organization reference,and group-based trajectory modeling was used to identify BMI growth trajectories.The associations between prenatal bisphenol exposure and BMI growth trajectory patterns were assessed using multinomial logistic regression models.Results The BMI growth trajectories of the 826 children were categorized into four patterns:low-stable(n=134,16.2%),low-increasing(n=142,17.2%),moderate-stable(n=350,42.4%),and moderate-increasing(n=200,24.2%).After adjusting for potential confounders,we observed that prenatal exposure to BPA during the second trimester[odds ratio(OR)=2.20,95%confidence interval(CI)=1.09–4.43]and BPF during the third trimester(OR=3.28,95%CI=1.55–6.95)at the highest quartile concentration were associated with an increased likelihood of the low-increasing BMI trajectory.Furthermore,in the subgroup analysis by infant sex,the positive association between the highest quartile of prenatal average urinary BPF concentration during the whole pregnancy and the low-increasing BMI trajectory was found only in girls(OR=2.82,95%CI=1.04–7.68).Conclusion Our study findings suggest that prenatal exposure to BPA and BPF(a commonly used substitute for BPA)is associated with BMI growth trajectories in offspring during the first two years,increasing the likelihood of the low-increasing pattern.展开更多
Chronic hepatitis C infection in the USA is a highly morbid condition and current guidelines recommend one-time screening among the birth cohort(1945-1965).Understand-ing strategies to optimize screening can help info...Chronic hepatitis C infection in the USA is a highly morbid condition and current guidelines recommend one-time screening among the birth cohort(1945-1965).Understand-ing strategies to optimize screening can help inform future hepatitis C virus(HCV)screening guidelines.A focused literature search was performed using PubMed and manual abstract review from major hepatology conferences over the past 2 years.The search strategy involved using Medical Subject Headings terms for hepatitis C,screening,birth cohort,baby boomers,and 1945-1965.The review was limited to data from the USA.A total of 327 articles were identified and 36 abstracts were included,with studies published between 2012-2019.Strategies including clinician education,electronic medical record alerts,reflex HCV RNA testing,point-of-care testing,multisite(outpatient,inpatient,emergency department,endoscopy suite)initiatives,direct patient solicitation,and utilization of non-physician providers have increased HCV screening rates.However,broad imple-mentation remains less than optimal.Barriers include lack of patient acceptance to screening and engagement in the HCV care cascade.The Veterans Affairs Healthcare System has achieved higher birth cohort screening rates through an integrated approach requiring high-level engagement by leadership and institutional commitment.Multiple strategies for increasing birth cohort screening have been successful,but overall rates of HCV screening remain low.These strat-egies can inform public health efforts to implement emerging national recommendations for expansion of HCV screening to all U.S.adults age 18 or older.展开更多
ABSTRACT:Antibiotic exposure during pregnancy may affect the neurodevelopment of children,but biomonitoring-based population studies on this class of new pollutants are lacking.We conducted a prospective birth cohort ...ABSTRACT:Antibiotic exposure during pregnancy may affect the neurodevelopment of children,but biomonitoring-based population studies on this class of new pollutants are lacking.We conducted a prospective birth cohort study of 2860 mother−child pairs,measured the urinary concentrations of 41 antibiotics and their two metabolites over three trimesters,and assessed children’s autism spectrum disorder(ASD)symptoms at 3 years of age.We examined the associations between prenatal antibiotic exposure and children’s ASD symptoms.The least absolute shrinkage and selection operator regression screened for Tetracycline and Ofloxacin as important predictors of ASD symptoms.Modified Poisson regression models revealed that maternal Tetracycline exposure throughout pregnancy increased the risk of ASD symptoms(RR:1.66,95%CI:1.14,2.40).Maternal Tetracycline exposure during the first(RR:1.74,95%CI:1.13,2.68)and third trimesters(RR:1.86,95%CI:1.16,3.00)increased the risk of ASD symptoms in boys,and Ofloxacin exposure during the first trimester(RR:1.47,95%CI:1.07,2.02)increased the risk of ASD symptoms in girls.No dose-dependent relationships between prenatal antibiotic exposure and ASD symptoms were validated by restricted cubic splines.Prenatal exposure to Tetracycline and Ofloxacin may increase the risk of ASD symptoms in children,and the first and third trimesters might be the key windows.展开更多
目的使用河北省营养项目人群数据,探讨母亲孕期空气颗粒物(PM)暴露对新生儿体格发育状况指标的影响,并评估不同颗粒物暴露的滞后效应以确定敏感时间窗。方法本研究基于河北孕期营养干预项目数据,纳入14148对母婴数据,通过China High Air...目的使用河北省营养项目人群数据,探讨母亲孕期空气颗粒物(PM)暴露对新生儿体格发育状况指标的影响,并评估不同颗粒物暴露的滞后效应以确定敏感时间窗。方法本研究基于河北孕期营养干预项目数据,纳入14148对母婴数据,通过China High Air Pollutants(CHAP)数据库获取1 km×1 km分辨率的月均PM浓度,结合孕妇居住地址和孕周估算孕早期、孕中期、孕晚期及全孕期的PM暴露水平。新生儿体格发育状况指标根据中国标准按照不同孕周和性别标准化为Z评分。采用多元线性回归模型分析不同PM暴露与新生儿体格发育状况指标的关联,并通过分布滞后线性模型评估不同妊娠阶段的滞后效应,明确敏感时间窗。结果全孕期每增加10μg/m 3的PM 2.5、PM 10和PM_(2.5-10)暴露分别使出生体重Z评分下降0.03(95%CI:-0.04,-0.02)、0.03(95%CI:-0.04,-0.02)和0.10(95%CI:-0.12,-0.08);出生身长和头围Z评分亦呈负相关,且PM_(2.5-10)的影响最显著。分布滞后线性模型结果显示,孕早期和孕晚期为新生儿出生体重和身长的关键敏感窗口,出生头围的敏感期主要集中在孕早期。结论孕期PM暴露与新生儿体格发育状况呈显著负相关,PM_(2.5-10)的效应最为突出。孕早期和孕晚期暴露为胎儿体格发育影响的关键窗口期。本研究为空气污染防控政策及孕期健康干预提供了重要的科学依据。展开更多
目的 评估孕期居住地周边绿地暴露与低出生体重(low birth weight,LBW,出生体重<2 500 g)风险的关联。方法 本研究为回顾性队列研究,基于既有多中心母婴队列数据库(重庆、贵阳、成都、连云港)开展二次分析。回顾性纳入2023年12月—2...目的 评估孕期居住地周边绿地暴露与低出生体重(low birth weight,LBW,出生体重<2 500 g)风险的关联。方法 本研究为回顾性队列研究,基于既有多中心母婴队列数据库(重庆、贵阳、成都、连云港)开展二次分析。回顾性纳入2023年12月—2024年12月在四中心分娩并符合纳排标准的单胎妊娠孕妇,提取其孕期及分娩相关资料,并采用MODIS MOD13Q1估计居住地500 m缓冲区归一化植被指数均值(normalized difference vegetation index mean within 500 m buffer,NDVImean-500 m)与增强型植被指数均值(enhanced vegetation index mean within 500 m buffer,EVImean-500 m)。以LBW为二分类结局,采用Logistic回归评估NDVI/EVI(每增加0.1单位)与LBW风险的关联,并构建限制性立方样条(restricted cubic spline,RCS)评估剂量―反应关系。多因素模型(Model 2)调整高龄(≥35岁)、受教育程度、孕前体重指数(body mass index,BMI)分组与产次。另在Model 2基础上开展“附加调整孕周(<37周)”及“足月限制(≥37周)”敏感性分析。结果 共纳入单胎孕妇5 397例,其中LBW 147例,发生率为2.72%(95%CI:2.32%~3.19%)。在完全调整模型中,EVImean-500 m每增加0.1单位与LBW风险降低相关(OR=0.488,95%CI:0.405~0.587,P<0.001),NDVImean-500 m结果一致(OR=0.690,95%CI:0.587~0.810,P<0.001)。RCS分析显示,2个指标总体关联均显著(P<0.001);EVI提示非线性(P<0.001),NDVI未见显著非线性(P=0.095)。附加调整孕周及足月限制后,关联方向与主分析一致。结论 在单胎妊娠样本中,孕期居住地周边绿地暴露水平与LBW风险降低相关,并呈现剂量―反应特征。鉴于观察性研究可能存在残余混杂与暴露错分,结果应谨慎解释为相关性发现,尚需进一步研究验证其因果关系与作用路径。展开更多
基金supported by a grant from the National Natural Science Foundation of China [No.81472967 and No.81602849]Young Elite Scientists Sponsorship Program by CAST [No.2017QNRC001]
文摘Objective To explore the interactions between pre-pregnancy body mass index(BMI) and age on offspring neuropsychological development from 1 to 24 months in China.Methods In this birth cohort study, a total of 2,253 mother-child pairs were enrolled in Tianjin, China,between July 2015 and May 2018. The China Developmental Scale for Children was used to assess developmental quotient(DQ) of children aged from 1 to 24 months.Results Mixed-models analysis revealed significant age × pre-pregnancy BMI interactions for total DQ and five neurobehavioral domains(gross motor, fine motor, adaptive, language, and social;P < 0.001).Age × pre-pregnancy BMI ≥ 25 kg/m^2 was associated with a negative effect on total DQ and five neurobehavioral domains, as compared to pre-pregnancy BMI < 25 kg/m^2(P < 0.01). Multiple comparisons showed pre-pregnancy BMI ≥ 25 kg/m^2 of mothers had a positive effect on child total DQ at the age of 1 month but a negative effect at 24 months(P < 0.05).Conclusions This study supported the age × pre-pregnancy BMI interaction on offspring neuropsychological development. It also revealed a short-term positive impact of high pre-pregnancy BMI on neuropsychological development at 1 month of age, but a long-term negative effect(from 1 to24 months).
文摘The 7-valent pneumococcal conjugate vaccine (PCV) was introduced in Uruguay in March 2008. In April 2010, it was replaced by PCV13. Surveillance of both vaccines was performed on hospitalized children with consolidated pneumonia. The effect of different number of vaccine doses was evaluated in 2008 and 2010 birth cohorts vaccinated with PCV7 and PCV13 respectively. The study aims to estimate the effects of PCV7 and PCV13 different number of doses on consolidated pneumonia, through the study of hospitalized children from 2008 and 2010 birth cohorts. Vaccination records of every child were available providing precise vaccination data;therefore a new approach was used to estimate PCVs effect. Incidence rate was calculated for each year of the study and for the different number of vaccine doses used each year. Exposure was calculated as person per year and rate ratio values determined the decrease of consolidated pneumonias. This decrease in percentage was estimated as the difference between the incidence with no vaccine and the incidence of every one of the doses. Incidence rate ratio revealed significant values for the three vaccine doses of PCVs for both cohorts. Upon comparing incidences, significant reduction percentages of consolidated pneumonia admissions were found. The reduction percentage of consolidated pneumonia for fully vaccinated (3 doses) patients was 69.3% and 84.6 % for PCV7 and PCV13, respectively. These results confirm that PCV7 and PCV13 are highly effective for reducing pediatric hospitalizations due to consolidated pneumonia, as reported by other national publications and demonstrated by international researchers.
基金supported by the Capital’s Funds for Health Improvement and Research(No.2024-2G-2118)the National Key Research and Development Program of China(No.2016YFC1000100)+2 种基金the Leading Talents in the Construction Project of High Level Public Health Technical Talents in Beijing(No.20221003)the“Green Seedling”Youth Program by the Beijing Hospitals Authority(No.QML20231402)the Young Elite Scientist Sponsorship Program by the Beijing Association for Science and Technology(No.BYESS2022200).
文摘Background:The role of inflammation in the development of gestational diabetes mellitus(GDM)has recently become a focus of research.The systemic immune-inflammation index(SII)and systemic inflammation response index(SIRI),novel indices,reflect the body’s chronic immune-inflammatory state.This study aimed to investigate the associations between the SII or SIRI and GDM.Methods:A prospective birth cohort study was conducted at Beijing Obstetrics and Gynecology Hospital from February 2018 to December 2020,recruiting participants in their first trimester of pregnancy.Baseline SII and SIRI values were derived from routine clinical blood results,calculated as follows:SII=neutrophil(Neut)count×platelet(PLT)count/lymphocyte(Lymph)count,SIRI=Neut count×monocyte(Mono)count/Lymph count,with participants being grouped by quartiles of their SII or SIRI values.Participants were followed up for GDM with a 75-g,2-h oral glucose tolerance test(OGTT)at 24-28 weeks of gestation using the glucose thresholds of the International Association of Diabetes and Pregnancy Study Groups(IADPSG).Logistic regression was used to analyze the odds ratios(ORs)(95%confidence intervals[CIs])for the the associations between SII,SIRI,and the risk of GDM.Results:Among the 28,124 women included in the study,the average age was 31.8±3.8 years,and 15.76%(4432/28,124)developed GDM.Higher SII and SIRI quartiles were correlated with increased GDM rates,with rates ranging from 12.26%(862/7031)in the lowest quartile to 20.10%(1413/7031)in the highest quartile for the SII(P_(trend)<0.001)and 11.92-19.31%for the SIRI(P_(trend)<0.001).The ORs(95%CIs)of the second,third,and fourth SII quartiles were 1.09(0.98-1.21),1.21(1.09-1.34),and 1.39(1.26-1.54),respectively.The SIRI findings paralleled the SII outcomes.For the second through fourth quartiles,the ORs(95%CIs)were 1.24(1.12-1.38),1.41(1.27-1.57),and 1.64(1.48-1.82),respectively.These associations were maintained in subgroup and sensitivity analyses.Conclusion:The SII and SIRI are potential independent risk factors contributing to the onset of GDM.
文摘Introduction:Eliminating hepatitis B virus(HBV)as a major public health threat is a global health priority that requires cost-effective screening strategies.This study evaluated the cost-effectiveness of sequential birth cohort HBV screening strategies in China.Methods:Using a Markov model,we compared five screening strategies with current practice,calculating HBV-related deaths averted,qualityadjusted life years(QALYs)gained,and incremental cost-effectiveness ratios(ICER).One-way deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the results.Results:The sequential birth cohort screening strategy(Sequential Screening 1:screening the 1991–2000 cohort in 2025–2026,the 1971–1990 cohort in 2027–2028,and the 1951–1970 cohort in 2029–2030)was the most cost-effective,with an ICER of 58,523 Chinese Yuan(CNY)per QALY at a willingness-to-pay threshold of three times the percapita Gross Domestic Product(GDP).An alternative strategy that prioritized the 1951–1970 cohort in 2025–2026 averted the most HBV-related deaths(approximately 3.44 million)and gained 24.9 million QALYs,with an ICER of 60,113 CNY per QALY,also showing cost-effectiveness.Discussion:Our findings support sequential birth cohort screening as an optimal and innovative approach to achieving the WHO HBV elimination targets,offering evidence-informed guidance for policymakers to optimize screening programs and resource allocation.
文摘Objective Toinvestigate theepidemiological characteristics and morbidity trends of hypertensive disorders of pregnancy(HDP)in Shenzhen,China.Methods This study was a cross-sectional study.Data were based on the Shenzhen Birth Cohort.Pregnant women who gave birth from January 1,2018 to March 31,2023 were included.Incidence and change trends of HDP and its different pathological types were analyzed.The enrolled pregnant women were divided into the HDP group and the non-HDP group according to whether HDP occurred.General clinical data and pregnancy outcomes were collected from both groups.The incidence of adverse pregnancy outcomes among pregnant women with different pathological types of HDP was analyzed,and subgroup analyses were performed based on age and body mass index(BMI).Results A total of 90117 pregnant women were enrolled,aged(31.6±4.4)years.There were 4117 cases in the HDP group and 86000 in the non-HDP group.The overall incidence of HDP in the whole study population was 4.57%(4117/90117).From 2018—2023,the incidence of HDP in Shenzhen showed an increasing trend year by year,from 2.88%(523/18155)to 7.04%(271/3851).Specifically,the incidence of gestational hypertension increased from 0.93%(168/18155)to3.09%(119/3851),the incidence of preeclampsia-eclampsia increased from 1.78%(323/18155)to3.17%(122/3851),the incidence of chronic hypertension increased from 0.01%(1/18155)to 0.42%(16/3851),and the incidence of chronic hypertension with superimposed preeclampsia increased from 0.17%(31/18155)to 0.36%(14/3851).The age((32.8±4.8)years vs.(31.5±4.3)years,P<0.05)and BMI in the first trimester((23.37±3.77)kg/m^(2)vs.(21.35±2.91)kg/m^(2),P<0.05)of HDP group were higher than those of the non-HDP group.Subgroup analysis showed that the incidence of HDP in pregnant women aged≥50.0 years was the highest in all age subgroups(42.86%(6/14)).The incidence of HDP in pregnant women with BMI≥30.0 kg/m^(2)in the first trimester was the highest among all BMI subgroups(20.44%(241/1179)).The proportions of preterm birth,gestational diabetes,fetal growth restriction,small for gestational age,placental abruption,and late abortion in HDP group were 30.82%(1269/4117),30.46%(1254/4117),6.80%(280/4117),4.86%(200/4117),3.59%(148/4117),and 0.80%(33/4117),respectively.Conclusion The incidence of HDP among pregnant women has been increased year by year in Shenzhen,China.With the increase in age and BMI during early pregnancy,the incidence of HDP shows an overall upward trend.
基金supported by the National Key Research and Development Program of China(No.2022YFC2705200)the High-level Medical Introduction Teams in Fujian Province(No.RT2022-022)+5 种基金the Clinical Research Center of ADHD affiliated with Pediatrics College,Shanghai Jiao Tong University School of Medicine(No.ELYZX202207)the Clinical Research Center for Pediatric Neurodevelopmental Disease of Fujian Province(No.2022Y2016)the Shanghai Municipal Education Commission-Gaofeng Clinical Medical Grant Support(No.20152234)funded by the Shanghai Key Laboratory of Child Brain and Development(No.24dz2260100)Shanghai Municipal Health Commission(No.2020CXJQ01)Early Life Plan Program of Xinhua Hospital,Shanghai Jiao Tong University School of Medicine.
文摘Background The first five years of life are sensitive periods for neurodevelopment.Poor maternal metrics of cardiovascular health may influence offspring neurodevelopment.Previous studies focused only on one or two metrics,or different time window.This study is aimed to investigate the effects of combined cardiovascular health metric exposure during pregnancy on the neurodevelopment of offspring during crucial periods. Methods A total of 1007 mother-child pairs recruited from 2013 to 2016 from the Shanghai Birth Cohort were included.Five maternal cardiovascular health metrics at 28 weeks of gestation were collected.Offspring neurodevelopment at 2-3 years and 4-5 years was evaluated with the Bayley-Ⅲ and Wechsler preschool and primary scale of intelligence,fourth edition(WPPSI-Ⅳ),respectively. Results After adjusting for confounders,the scores for cognition and language at 2-3 years significantly increased by 1.63[95%confidence interval(CI)0.42-2.83,P=0.008]and 0.84(95%CI 0.005-1.67,P=0.049)per one-point higher mater-nal cardiovascular health score,respectively.After false discovery rate adjustment,the associations were preserved in the cognitive domain.Similarly,each one-point higher maternal cardiovascular health score was associated with an increase of 0.92(95%CI 0.16-1.68,P=0.018)and 0.71(95%CI 0.01-1.40,P=0.047)in the visual space index and working memory index scores at 4-5 years,respectively,but with an false discovery rate-adjusted P>0.05;in the sex-stratified analysis,the visual space index scores significantly increased(β=1.47,95%CI 0.38-2.56,P=0.009),regardless of false discovery rate correction.In addition,each one-point higher maternal cardiovascular health score reduced the relative risk of suboptimal development in the visual space index domain by 0.83(95%CI 0.70-0.99;P=0.041)in female offspring despite the non-significant after false discovery rate adjustment. Conclusions Our study provides novel evidence that maternal cardiovascular health during pregnancy is associated with offspring neurodevelopment within the first five years of life and that female offspring appear to derive greater benefit from higher maternal cardiovascular health scores.The potential role of maternal cardiovascular health in identifying risk of neurodevelopmental delay in clinical practice needs to be further explored.
基金supported by National Natural Science Foundation of China(Grant Numbers 81673181,81703244,and 81803251).
文摘Background Birth weight is a strong determinant of infant short-and long-term health outcomes.Family socioeconomic position(SEP)is usually positively associated with birth weight.Whether this association extends to abnormal birth weight or there exists potential mediator is unclear.Methods We analyzed data from 14,984 mother-infant dyads from the Born in Guangzhou Cohort Study.We used multi-variable logistic regression to assess the associations of a composite family SEP score quartile with macrosomia and low birth weight(LBW),and examined the potential mediation effect of maternal pre-pregnancy body mass index(BMI)using causal mediation analysis.Results The prevalence of macrosomia and LBW was 2.62%(n=392)and 4.26%(n=638).Higher family SEP was associated with a higher risk of macrosomia(OR 1.30,95%CI 0.93-1.82;OR 1.53,95%CI 1.11-2.11;and OR 1.59,95%CI 1.15-2.20 for the 2nd,3rd,and 4th SEP quartile respectively)and a lower risk of LBW(OR 0.69,95%CI 0.55-0.86;OR 0.76,95%CI 0.61-0.94;and OR 0.61,95%CI 0.48-0.77 for the 2nd,3rd,and 4th SEP quartile respectively),compared to the 1st SEP quartile.We found that pre-pregnancy BMI did not mediate the associations of SEP with macrosomia and LBW.Conclusions Socioeconomic disparities in fetal macrosomia and LBW exist in Southern China.Whether the results can be applied to other populations should be further investigated.
基金supported by the National Natural Science Foundation of China(81903331 and 82073660)Open Project of Key Laboratory of Environment and Health,Ministry of Education(2022GWKFJJ05).
文摘Background Prenatal bisphenol exposure has been reported to be associated with lower birth weight and obesity-related indicators in early childhood.These findings warrant an investigation of the relationship between prenatal bisphenol exposure and the dynamic growth of offspring.This study aimed to evaluate the relationship of maternal bisphenol concentration in urine with the body mass index(BMI)growth trajectory of children aged up to two years and to identify the critical exposure periods.Methods A total of 826 mother–offspring pairs were recruited from Wuhan Children’s Hospital between November 2013 and March 2015.Maternal urine samples collected during the first,second,and third trimesters were analyzed for bisphenol A(BPA),bisphenol S,and bisphenol F(BPF)concentrations.Measurements of length and weight were taken at 0,1,3,6,8,12,18,and 24 months.Children's BMI was standardized using the World Health Organization reference,and group-based trajectory modeling was used to identify BMI growth trajectories.The associations between prenatal bisphenol exposure and BMI growth trajectory patterns were assessed using multinomial logistic regression models.Results The BMI growth trajectories of the 826 children were categorized into four patterns:low-stable(n=134,16.2%),low-increasing(n=142,17.2%),moderate-stable(n=350,42.4%),and moderate-increasing(n=200,24.2%).After adjusting for potential confounders,we observed that prenatal exposure to BPA during the second trimester[odds ratio(OR)=2.20,95%confidence interval(CI)=1.09–4.43]and BPF during the third trimester(OR=3.28,95%CI=1.55–6.95)at the highest quartile concentration were associated with an increased likelihood of the low-increasing BMI trajectory.Furthermore,in the subgroup analysis by infant sex,the positive association between the highest quartile of prenatal average urinary BPF concentration during the whole pregnancy and the low-increasing BMI trajectory was found only in girls(OR=2.82,95%CI=1.04–7.68).Conclusion Our study findings suggest that prenatal exposure to BPA and BPF(a commonly used substitute for BPA)is associated with BMI growth trajectories in offspring during the first two years,increasing the likelihood of the low-increasing pattern.
文摘Chronic hepatitis C infection in the USA is a highly morbid condition and current guidelines recommend one-time screening among the birth cohort(1945-1965).Understand-ing strategies to optimize screening can help inform future hepatitis C virus(HCV)screening guidelines.A focused literature search was performed using PubMed and manual abstract review from major hepatology conferences over the past 2 years.The search strategy involved using Medical Subject Headings terms for hepatitis C,screening,birth cohort,baby boomers,and 1945-1965.The review was limited to data from the USA.A total of 327 articles were identified and 36 abstracts were included,with studies published between 2012-2019.Strategies including clinician education,electronic medical record alerts,reflex HCV RNA testing,point-of-care testing,multisite(outpatient,inpatient,emergency department,endoscopy suite)initiatives,direct patient solicitation,and utilization of non-physician providers have increased HCV screening rates.However,broad imple-mentation remains less than optimal.Barriers include lack of patient acceptance to screening and engagement in the HCV care cascade.The Veterans Affairs Healthcare System has achieved higher birth cohort screening rates through an integrated approach requiring high-level engagement by leadership and institutional commitment.Multiple strategies for increasing birth cohort screening have been successful,but overall rates of HCV screening remain low.These strat-egies can inform public health efforts to implement emerging national recommendations for expansion of HCV screening to all U.S.adults age 18 or older.
基金supported by the National Natural Science Foundation of China(NSCF-82204053)the University Natural Foundation of Anhui Educational Committee(KJ2021A0222)+1 种基金the National Key Research and Development Program of China(2016YFC1000204-2)the Discipline Construction Project of School of Public Health,Anhui Medical University(0301001872).
文摘ABSTRACT:Antibiotic exposure during pregnancy may affect the neurodevelopment of children,but biomonitoring-based population studies on this class of new pollutants are lacking.We conducted a prospective birth cohort study of 2860 mother−child pairs,measured the urinary concentrations of 41 antibiotics and their two metabolites over three trimesters,and assessed children’s autism spectrum disorder(ASD)symptoms at 3 years of age.We examined the associations between prenatal antibiotic exposure and children’s ASD symptoms.The least absolute shrinkage and selection operator regression screened for Tetracycline and Ofloxacin as important predictors of ASD symptoms.Modified Poisson regression models revealed that maternal Tetracycline exposure throughout pregnancy increased the risk of ASD symptoms(RR:1.66,95%CI:1.14,2.40).Maternal Tetracycline exposure during the first(RR:1.74,95%CI:1.13,2.68)and third trimesters(RR:1.86,95%CI:1.16,3.00)increased the risk of ASD symptoms in boys,and Ofloxacin exposure during the first trimester(RR:1.47,95%CI:1.07,2.02)increased the risk of ASD symptoms in girls.No dose-dependent relationships between prenatal antibiotic exposure and ASD symptoms were validated by restricted cubic splines.Prenatal exposure to Tetracycline and Ofloxacin may increase the risk of ASD symptoms in children,and the first and third trimesters might be the key windows.
文摘目的使用河北省营养项目人群数据,探讨母亲孕期空气颗粒物(PM)暴露对新生儿体格发育状况指标的影响,并评估不同颗粒物暴露的滞后效应以确定敏感时间窗。方法本研究基于河北孕期营养干预项目数据,纳入14148对母婴数据,通过China High Air Pollutants(CHAP)数据库获取1 km×1 km分辨率的月均PM浓度,结合孕妇居住地址和孕周估算孕早期、孕中期、孕晚期及全孕期的PM暴露水平。新生儿体格发育状况指标根据中国标准按照不同孕周和性别标准化为Z评分。采用多元线性回归模型分析不同PM暴露与新生儿体格发育状况指标的关联,并通过分布滞后线性模型评估不同妊娠阶段的滞后效应,明确敏感时间窗。结果全孕期每增加10μg/m 3的PM 2.5、PM 10和PM_(2.5-10)暴露分别使出生体重Z评分下降0.03(95%CI:-0.04,-0.02)、0.03(95%CI:-0.04,-0.02)和0.10(95%CI:-0.12,-0.08);出生身长和头围Z评分亦呈负相关,且PM_(2.5-10)的影响最显著。分布滞后线性模型结果显示,孕早期和孕晚期为新生儿出生体重和身长的关键敏感窗口,出生头围的敏感期主要集中在孕早期。结论孕期PM暴露与新生儿体格发育状况呈显著负相关,PM_(2.5-10)的效应最为突出。孕早期和孕晚期暴露为胎儿体格发育影响的关键窗口期。本研究为空气污染防控政策及孕期健康干预提供了重要的科学依据。
文摘目的 评估孕期居住地周边绿地暴露与低出生体重(low birth weight,LBW,出生体重<2 500 g)风险的关联。方法 本研究为回顾性队列研究,基于既有多中心母婴队列数据库(重庆、贵阳、成都、连云港)开展二次分析。回顾性纳入2023年12月—2024年12月在四中心分娩并符合纳排标准的单胎妊娠孕妇,提取其孕期及分娩相关资料,并采用MODIS MOD13Q1估计居住地500 m缓冲区归一化植被指数均值(normalized difference vegetation index mean within 500 m buffer,NDVImean-500 m)与增强型植被指数均值(enhanced vegetation index mean within 500 m buffer,EVImean-500 m)。以LBW为二分类结局,采用Logistic回归评估NDVI/EVI(每增加0.1单位)与LBW风险的关联,并构建限制性立方样条(restricted cubic spline,RCS)评估剂量―反应关系。多因素模型(Model 2)调整高龄(≥35岁)、受教育程度、孕前体重指数(body mass index,BMI)分组与产次。另在Model 2基础上开展“附加调整孕周(<37周)”及“足月限制(≥37周)”敏感性分析。结果 共纳入单胎孕妇5 397例,其中LBW 147例,发生率为2.72%(95%CI:2.32%~3.19%)。在完全调整模型中,EVImean-500 m每增加0.1单位与LBW风险降低相关(OR=0.488,95%CI:0.405~0.587,P<0.001),NDVImean-500 m结果一致(OR=0.690,95%CI:0.587~0.810,P<0.001)。RCS分析显示,2个指标总体关联均显著(P<0.001);EVI提示非线性(P<0.001),NDVI未见显著非线性(P=0.095)。附加调整孕周及足月限制后,关联方向与主分析一致。结论 在单胎妊娠样本中,孕期居住地周边绿地暴露水平与LBW风险降低相关,并呈现剂量―反应特征。鉴于观察性研究可能存在残余混杂与暴露错分,结果应谨慎解释为相关性发现,尚需进一步研究验证其因果关系与作用路径。
