The association between maternal folic acid (FA) supplementation and childhood cerebral palsy (CP) remains inconsistent. The specific role of continuous periconceptional supplementation and potential modifications by parental health are unclear. We conducted a case-control study in Shanghai (2017-2018) including 102 children with CP and 403 controls. Maternal FA use (continuous: pre-conception through first trimester) and parental health data were collected via questionnaire. Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) for the associations were estimated using logistic regression, with adjustment for covariates. Continuous FA supplementation was less common among case mothers than controls (17.65% vs. 38.46%). Compared to continuous use, partial supplementation (adjusted OR = 3.79, 95% CI: 2.00-7.17) and no supplementation (adjusted OR = 2.64, 95% CI: 1.20-5.84) were associated with higher CP odds. These associations remained when restricting to confirmed CP cases. Continuous maternal FA supplementation appeared to attenuate the elevated CP odds linked to parental metabolic disorders or maternal genital tract infections/inflammation. Continuous periconceptional FA supplementation is associated with reduced odds of CP in offspring, with parental health potentially modifying this relationship. Further studies are needed to confirm these findings.

This study investigated the association between handgrip strength (HGS) asymmetry and weakness with cognitive function and depressive symptoms among 920 community-dwelling adults aged above 60 years in suburban Shanghai. Participants were selected using a multistage cluster-stratified sampling approach. Assessments included HGS measured with a dynamometer, the Montreal Cognitive Assessment (MoCA) for cognition, and the Geriatric Depression Scale (GDS) for depressive symptoms. Restricted cubic splines revealed a positive association between dominant HGS and MoCA scores, indicating better cognitive performance, and a negative association with GDS scores, suggesting fewer depressive symptoms. The association between the HGS ratio and MoCA scores and the HGS ratio and GDS scores varied by sex. Women with HGS weakness alone (odds ratio (OR) = 2.00, 95% confidence interval (CI) = 1.17–3.37), asymmetry alone (OR = 1.93, 95% CI = 1.14–3.29), or weakness and asymmetry together (OR = 2.57, 95% CI = 1.48–4.46) had a significantly increased risk of cognitive impairment. However, no such associations observed in men. These findings suggest that HGS weakness and asymmetrical HGS may be associated with a higher risk of cognitive decline and depressive symptoms, particularly in women. This study emphasizes the need for sex-specific assessments and prevention strategies to address cognitive and mental health issues among older adults.

Taste preference drives food selection, acceptance, or rejection and influences nutritional status and body mass index. Nevertheless, there are few reports concerning pregnant women. Mala flavor, characterized by its "numbing" and "spicy" sensations, is a distinctive taste of Sichuan cuisine, created by the combination of Chinese prickly ash and chili peppers. We conducted a cohort study in Chongqing, China to analyze the impact of Mala flavor, on excessive gestational weight gain (GWG). The study included 495 pregnant women aged 20-45 years, without chronic diseases, who conceived naturally and had single pregnancies from May 2021 to November 2022. Demographic information and pregnancy outcomes were collected during the second trimester and post-delivery, respectively. Food intake and taste preferences, including fatty, salty, and Mala flavors, were assessed during the third trimester. Latent Profile Analysis revealed three dietary patterns: "high-carbohydrate diet" (HCD), "low-carbohydrate diet" (LND), and "moderate nutrient diet" (MND). Multiple logistic regression indicated that pregnant women preferring Mala flavor were more likely to follow an HCD and had a higher risk of excessive GWG. Moreover, those adhering to an HCD were at an increased risk of excessive GWG. Mediation analysis showed that the preference for Mala flavor influenced excessive GWG through HCDs, with a significant indirect effect and an insignificant direct effect. Our study suggests that a preference for Mala flavor is positively associated with excessive GWG, mediated by HCD patterns. However, these findings should be approached with caution due to the exploratory nature of the study.

The association between air pollution exposure and gestational diabetes mellitus (GDM) have been studied extensively; however, conclusions regarding the sensitive exposure period and effect of exposure remain inconsistent. We conducted a retrospective cohort study involving 2593 pregnant participants from Kunshan, China. Daily concentrations of particulate matter less than 2.5 μm (PM2.5) and less than 10 μm (PM10), carbon monoxide (CO), nitrogen dioxide (NO2), and sulfur dioxide (SO2) data were collected from the nearest air quality monitoring stations based on each participant's address. Average pollutant concentrations were then calculated for various window periods. The prevalence rate of GDM was 11.7 %. The first trimester was identified as a critical exposure window using distributed lag non-linear models. Quantile-based g-computation analysis revealed that exposure to a mixture of the five pollutants during the first trimester was significantly associated with GDM risk. Specifically, each quartile increase in combined exposure was associated with a 45 % increased risk of GDM (RR=1.45, 95 % CI: 1.24, 1.70), primarily driven by SO2 (31.6 %), PM2.5 (31.6 %), CO (22.0 %), and PM10 (14.8 %). This effect was not observed for exposure to any single pollutant alone. Our study expands the methodology for assessing air pollution exposure and deepens scientific understanding of its impact on pregnancy outcomes.

Gestational diabetes mellitus (GDM) poses both short-term and long-term health risks to mothers and infants. This study aims to examine the mechanisms involving insulin resistance mediated by exosomal miRNAs. We enrolled 2284 pregnant women from First People's Hospital of Kunshan, Jiangsu Province in this continuous follow-up study. Plasma exosomes from patients with GDM and healthy pregnancies during the first trimester were co-cultured with human choriocarcinoma (JEG-3) cell lines. Plasma exosome samples collected at 8-12 and 24-28 gestational weeks were analyzed using high-throughput small-RNA sequencing. The expression levels of exosomal miRNAs were validated via real-time polymerase chain reaction. Receiver operating characteristic (ROC) analysis was employed to assess their potential as early predictors. Plasma exosomes from the GDM group exhibited lower expressions of Let-7c-5p and miR-27a-5p compared to those from normal pregnancies by sequencing and validation during early pregnancy (p < 0.05). These changes may influence the development and growth of JEG-3 cells. miR-122-5p expression was elevated in GDM cases. The expression trajectories of these three miRNAs declined from early to late pregnancy. This miRNA panel showed potential as an early predictive biomarker for GDM (area under the ROC curve, 0.844; p < 0.05). Our findings demonstrate the significant role of exosomal miRNAs in GDM's pathogenesis and reveal a novel pattern of miRNA expression decline from early to late pregnancy. These miRNAs, particularly in combination, may be used as potential predictive biomarkers for GDM.

BackgroundGestational diabetes mellitus (GDM) is a multifaceted and complex condition. Genetic factors, maternal exposure to bisphenol A (BPA), and thyroid-stimulating hormone (TSH) levels have been associated with GDM. However, existing findings are inconsistent, and evidence regarding their interactions remains limited. This study aimed to identify single-nucleotide variants (SNVs) associated with GDM and to examine whether the genetic influence on GDM would be modulated by maternal BPA and TSH levels during pregnancy.MethodsThis case–control study was nested within a prospective cohort of 2,884 pregnant women in South China from July 2016 to December 2020. Significant SNVs between cases and controls were identified by whole-exome sequencing and validated by Sequenom MassARRAY. Functional and pathway enrichment analyses were applied to explore potential biological pathways. The relationship between GDM and maternal SNVs’ genotype, BPA, and TSH was evaluated by logistic regression models and marginal effect analyses.ResultsWe identified 308 missense variants among 1,770 SNVs linked to GDM. After validation, the allele frequencies of PPARGC1A rs8192678 C > T (p = 0.005, FDR = 0.077) and GCK rs2971672 A > C (p = 0.007, FDR = 0.077) showed significant differences between cases and controls. In an exploratory analysis using logistical regression, the odds ratio (OR) for GDM was 0.417 (95% CI: 0.225–0.774) among women with the TT genotype of PPARGC1A rs8192678 and 0.470 (95% CI: 0.262–0.846) among those with the CC genotype of GCK rs2971672 compared to the wild type. Sub-population analysis revealed that urinary BPA levels were linked to an increased risk of GDM, with an OR of 2.295 (95% CI: 1.361–3.867). The protective effect ofPPARGC1A rs8192678 in GDM was confirmed and was non-linearly modified by sqrt-BPA levels. Additionally, this effect was modified by sqrt-TSH in a dose-dependent manner. The protective association was strongest at moderate BPA exposure levels (e.g., at sqrt-BPA = 2 and 3, the dy/dx for CT + TT vs. CC was −0.20 and −0.194, respectively; p < 0.01). At the highest level of BPA or TSH, the protective genetic effect was attenuated and became statistically non-significant.ConclusionThe study highlights the associations between GDM and the missense variant of PPARGC1A rs8192678, further revealing that the genetic effect is modified slightly by urinary BPA and serum TSH levels. The modification displayed a quasi-U-shaped distribution in relation to BPA and decreased as TSH levels increased.

IntroductionCapping actin protein, gelsolin-like (CAPG) is a potential therapeutic target in various cancers. However, the potential immunotherapeutic effects and prognostic value of CAPG in uterine corpus endometrial carcinoma (UCEC) remain unclear.MethodsThe characterization, methylation effects, prognostic value, targeted miRNAs of CAPG, and the correlation of CAPG with immune cell infiltration and ferroptosis in UCEC were investigated using multiple public databases and online tools. Furtherly, we explored the potential physiological function of CAPG using EdU and Transwell migration assays, identified the cell localization and expression of CAPG and GPX4 by immunofluorescence, and detected the intracellular Fe2+ levels using a FerroOrange fluorescent probe in Ishikawa cells. Additionally, the OncoPredict package was used to analyze the potential chemotherapeutic drugs for UCEC.ResultsCAPG showed generally high expression in tumor group. The overall survival rate of the high-risk group was significantly lower than that of the low-risk group. Enrichment analysis indicated that CAPG is involved in immune-related pathways and is closely associated with the tumor microenvironment. CAPG expression levels were affected by abnormal DNA methylation and/or targeted miRNAs, infiltration levels and marker genes of various immune cells, thereby impacting immune response, ferroptosis, and patient prognosis. Ferroptosis analysis indicated that ALOX5 and VLDLR were the top CAPG-related ferroptosis markers; glutathione metabolism levels in tumor group were generally high, and decitabine was a ferroptosis inducer. CAPG-siRNA suppressed the cell proliferation and invasion, and markedly elevated the expression levels of immune-related genes IL8, TNF, TLR4 and the intracellular Fe2+ levels. CAPG co-located with GPX4 in nucleus and co-regulated ferroptosis and metabolism in Ishikawa cells. Moreover, four chemotherapy drugs showed better sensitivity to UCEC patients in the low-risk cohort.ConclusionsCAPG may serve as a potential biomarker of UCEC owing to its role in modulating the immune response and ferroptosis, providing novel perspectives for combined immunotherapy of UCEC.

Objective: This study aims to find new plasma biomarkers in early pregnancy.Design: The original study enrolled 1219 pregnant women. We investigated protein expression profiles of placental tissues from women with GDM (n = 89) and normal glucose tolerance (NGT) (n = 83). Maternal plasma samples between two groups in early and middle pregnancy were used for validation of candidate biomarkers. Methods: Differentially expressed proteins (DEPs) were identified by label-free quantitative proteomics from human placenta samples between two groups. Several DEPs were validated in plasma by Luminex assays. An automatic biochemical analyzer was used to detect blood lipid indexes. The associations of GAL-3BP with biochemical indicators were demonstrated by Pearson's correlation analysis. Binary logistic regression was used to model potential predictive indicators in early pregnancy of GDM. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic accuracy of the predictive model and the value of GAL-3BP.Results: 123 DEPs were found in placenta involved in ribosomal function, pancreatic secretion, oxidative phos-phorylation, and inflammatory signaling pathway. Plasma GAL-3BP are significantly higher in women with GDM than NGT in the first (p = 0.008) and second (p = 0.026) trimester, but C9 and VWF have no difference. The predictive value of GAL-3BP in the first trimester of pregnancy (AUC 0.64) is better than that in the second trimester (AUC 0.61), and combined predictive model of TG and GAL-3BP at early pregnancy has greater pre-dictive and diagnostic value for GDM (AUC 0.69) than individual GAL-3BP (AUC 0.64).Conclusions: Plasma TG and GAL-3BP has good predictive and diagnostic value at early pregnancy, suggesting that these two indicators may be used as biomarkers for early prediction and diagnosis of GDM. Significance: The advantage of this study is that circulating TG and GAL-3BP might differentiate the progress of women with GDM and normal glucose tolerance (NGT) at the early stage of pregnancy. It is the first study to consider the role of GAL-3BP as an early predictive biomarker in the development of GDM during the whole pregnancy. Another advantage is that volunteers in this study were recruited from two provinces in China to eliminate the impacts of environmental confounders. The similar changes of blood glucose/lipid indicators for women with GDM and NGT in both regions was found in the first and second trimester of pregnancy, which added to the reliability of analytical results.

Abstract Background An accurate evaluation of cognitive function, physical health, and psychological health is fundamental for assessing health problems in the elderly population, and it is important to identify the necessity of early therapeutic intervention. The objective of this study was to evaluate the states of mental and physical functions and to investigate the relationships between sociodemographic features and these functions in a community-dwelling elderly population. Methods This community-based cross-sectional study was conducted in a suburban district of Shanghai, China. A total of 1025 participants aged 60–89 years underwent investigations of demographic and lifestyle features and a multidimensional geriatric evaluation comprising the Montreal Cognitive Assessment (MoCA), Short Physical Performance Battery (SPPB), and Geriatric Depression Scale (GDS). Results The results of the multivariate linear regression models demonstrated that the MoCA and SPPB scores decreased with advancing age (all P < 0.01). However, the GDS score did not exhibit an age-related decrease (P = 0.09). Both sex and living alone influenced the MoCA score (P < 0.01 and P = 0.04, respectively), SPPB score (P < 0.01 and P = 0.04, respectively), and GDS score (P < 0.01 and P < 0.01, respectively). A higher education level was related to better MoCA and SPPB scores (all P < 0.01). Furthermore, age and sex had interactive effects on the MoCA score (P = 0.03) and SPPB score (P < 0.01). The kernel-weighted local polynomial smoothing curves exhibited similar trends. Conclusions It is imperative to develop a more sensitive evaluation of physical function, and to encourage various intellectually and emotionally stimulating social activity strategies to promote healthy aging, especially in elderly women and those living alone who have a low education level.

Abstract Background Maternal folate may not reach an optimal level to prevent neural tube defects if supplementation commenced post-conception or took place pre-conception only. Our study aimed to investigate the continuation of folic acid (FA) supplementation from pre-conception to post-conception during peri-conceptional period and to examine its differences in FA supplementation between the subgroups taking the initiation timing into consideration. Methods This study was conducted in two community health service centers in Jing-an District of Shanghai. Women accompanying their children to pediatric health clinics of the centers were recruited and asked to recall information concerning their socioeconomic and previous obstetric characteristics, utilization of healthcare and FA supplementation before and/or during pregnancy. The continuation of FA supplementation during peri-conceptional period were categorized into three subgroups: Supplementing with FA pre- and post-conception; supplementing with FA preconception only or post-conception only; no FA supplements pre-conception and post-conception. The relationship between FA continuation and couples’ characteristics were examined as setting the first subgroup as the base reference. Results Three hundred and ninety-six women were recruited. Over 40% of the women started FA supplementation after conception and 30.3% of them supplemented with FA from pre-conception to the first trimester of their pregnancy. Compared to this one-third of participants, women who didn’t supplemented with any FA during peri-conceptional period were more likely to have no utilization of pre-conception healthcare ( $$OR$$ OR = 2.47, 95% $$CI$$ CI : 1.33–4.61) or antenatal care ( $$OR$$ OR = 4.05, 95% $$CI$$ CI : 1.76–9.34), or who had a lower family socioeconomic status ( $$OR$$ OR = 4.36, 95% $$CI$$ CI : 1.79–10.64). Women who supplemented with FA pre-conception only or post-conception only were more likely to have no utilization of pre-conception healthcare ( $$OR$$ OR = 2.94, 95% $$CI$$ CI : 1.79–4.82), or to have no previous pregnancy complication ( $$OR$$ OR =1.80, 95% $$CI$$ CI : 0.99–3.28). Conclusion Over two-fifth of the women started FA supplementation and only one-third of them had an optimal supplementation from pre-conception to the first trimester. Maternal utilization of healthcare before or during pregnancy together with maternal and paternal socioeconomic status may play a role in the continuation to FA supplementation pre- and post-conception.

BACKGROUND:Maternal air pollutants exposure is associated with a number of adverse pregnancy outcomes, including recurrent spontaneous abortion (RSA). However, the underlying mechanisms are still unknown. The present study aimed to understand the mechanism of RSA and its relationship with air pollution exposure. We compared data of decidual tissue from individuals with induced abortions and those with RSA by bulk RNA sequencing (RNA-seq), reduced representation bisulfite sequencing (RRBS), and single-cell RNA sequencing (scRNA-seq). Differentially expressed genes (DEGs) were verified using RT-qPCR and pyrosequencing. A logistic regression model was used to investigate the association between air pollutants exposure and RSA.RESULTS:We identified 98 DEGs with aberrant methylation by overlapping the RRBS and RNA-seq data. Nineteen immune cell subsets were identified. Compared with normal controls, NK cells and macrophages accounted for different proportions in the decidua of patients with RSA. We observed that the methylation and expression of IGF2BP1 were different between patients with RSA and controls. Furthermore, we observed significant positive associations between maternal air pollutants exposure during the year prior to pregnancy and in early pregnancy and the risk of RSA. Mediation analyses suggested that 24.5% of the effects of air pollution on the risk of RSA were mediated through IGF2BP1 methylation.CONCLUSION:These findings reveal a comprehensive cellular and molecular mechanism of RSA and suggest that air pollution might cause pregnancy loss by affecting the methylation level of the IGF2BP1 promoter.

Objective:To examine the association between parental characteristics and risk of autism spectrum disorder (ASD) in children.Methods:In this case-control study, the cases were defined as children who were diagnosed with ASD and were recruited from June 2018 to February 2019 in Shanghai Mental Center ( n=104). The controls were defined as children who did not have ASD and were recruited in the two community health centers in Jing-an District of Shanghai during the same period ( n=149). All children recruited in this study were 2-6 years old. A multivariate logistic regression model was used to examine the association between parental characteristics and the risk of ASD in offspring, and further to estimate the interaction coefficient. Results:According to multivariate regression analysis, the association between maternal age, previous pregnancy complication and the risk of ASD in children appeared to be not statistically significant. After adjusted, advanced paternal age (≥35 years old)( OR=3.65, 95% CI=1.19-11.15, P=0.023), parental disease before or during pregnancy ( OR=3.34, 95% CI=1.41-7.94, P=0.006) and gender of child (male) ( OR=5.84, 95% CI=2.98-11.44, P<0.001) were associated with increased risk of ASD. The results also showed that the boys whose father was 35 years old or more had a higher risk of ASD than the boys whose fahter was less 35 years old and the girls whose father was 35 years old or more ( P=0.005, P=0.006). Conclusion:Advanced paternal age was associated with increased risk of ASD in offspring and this effect may be more pronounced in boys.

OBJECTIVE:Evidence for the association between subclinical thyroid dysfunction before conception and its pregnancy outcomes is inconsistent. Thus, we evaluated the relationship between preconception thyroid-stimulating hormone (TSH) levels and adverse pregnancy outcomes. DESIGN:Retrospective cohort study. METHODS:A total of 50,217 women without prior thyroid disease who became pregnant within 1 year after undertaking a routine TSH test in the Chongqing Municipality of China (2010-2016) were studied. Restricted cubic spline regression and logistic regression were used to estimate the association between preconception TSH levels and pregnancy outcomes. The main outcomes were individual and composite adverse pregnancy outcomes (CAPOs) comprising pregnancy loss, small for gestational age, large for gestational age, and preterm birth. RESULTS:Incidence of CAPO was 24.19%. Increased preconception TSH level was positively associated with CAPO (odds ratio [OR]/SD: 1.04, 95% confidence interval [CI]: 1.01-1.07) when TSH was ≥2.1 mIU/L, positively associated with pregnancy loss (OR/SD: 1.06, 95% CI: 1.01-1.12) when TSH was <2.1 mIU/L, negatively and positively associated with preterm delivery when TSH levels were <1.3 mIU/L (OR/SD: 0.90, 95% CI: 0.83-0.97) and >3.0 mIU/L (OR/SD: 1.08, 95% CI: 1.00-1.17), respectively. Women with subclinical hypothyroidism before conception were at a higher risk for CAPO (adjusted odds ratio [aOR]: 1.12, 95% CI: 1.04-1.22), while those with subclinical hyperthyroidism had a higher risk of preterm delivery (aOR: 1.31, 95% CI: 1.01-1.70). CONCLUSIONS:Nonlinear associations were indicated between preconception TSH levels and pregnancy outcomes. Subclinical thyroid dysfunction before conception was associated with an increased risk of adverse pregnancy outcomes.

Aim: This study aimed to explore the genetic risk factors and validate variants of abnormal uterine bleeding after copper intrauterine device insertion. Methods: Whole-exome sequencing was performed and several variants were validated by Sequenom MassARRAY. Results: Eight variants showed potential clinical damage according to American College of Medical Genetics and Genomics criteria. By combined analysis of screening and validation, NFASC RS2802808 C>G p.Ile971Met (Pallele = 0.009 and Pgenotype = 0.027) and PIGR RS2275531 C>T p.Gly365Ser (Pallele = 0.009 and Pgenotype = 0.013) variants were identified as significantly associated with abnormal uterine bleeding with a false discovery rate <0.05. NFASC and PIGR may play a role in abnormal uterine bleeding by regulating coagulation fibrinolysis and endometrial epithelium inflammation functions. Conclusion: These findings provide a genetic basis for clinical individualization and precision of intrauterine device implantation.

Abstract Aims The aim of this study was to investigate the association between gene methylation alterations and the development of GDM, as well as to investigate the potential epigenetic mechanisms of GDM. Methods Reduced representation bisulfite sequencing (RRBS) and RNA sequencing (RNA-seq) analysis were performed on placental tissues from women with GDM and healthy controls. After pyrosequencing, correlation and linear regression analysis were applied based on the effect of methylated-differentially expressed genes (DEGs). Results HOXD9, ALDH1A2, CSMD1, TRIM67, and PAX8, five candidate DEGs, were identified. TRIM67 exhibited significant hypermethylation levels at different CpG sites. Hypermethylation of TRIM67 promoter was significantly positively correlated with 1h and 2h OGTT glucose levels and negatively correlated with Lipoprotein(a). Conclusions Hypermethylation of the TRIM67 in the placenta of women with GDM may cause insulin resistance, which may correlate with the development of GDM. These findings provide new insights for further studies on the pathophysiology of GDM.

IgG antibodies against the 2,3-di-o-acyltrehalose glycolipid of Mycobacterium tuberculosis were determined in a set of 49 sera from patients with pulmonary tuberculosis and 65 negative control subjects. We compared a conventional ELISA method using a beta-galactosidase anti-human IgG conjugate developed with ONPG, with an amplification ELISA system constituted of an anti-human IgG biotinylated conjugate, a streptavidin-alkaline phosphatase complex, and NADP as a substrate. The resulting NAD was measured by using a redox enzymatic recycling system of alcohol dehydrogenase, diaphorase and iodonitrotetrazolium as chromogen. With specificity set at 92.31% in both methods, we obtained a sensitivity of 42.86% in the conventional method and a sensitivity of 61.22% in the amplified method. We conclude that by using a more sensitive method we can detect cases that otherwise could be identified as false negatives.

In this study, we investigated the association between altered methylation in the maternal placenta and hyperglycaemia and explored the epigenetic mechanisms underlying gestational diabetes mellitus (GDM). Reduced representation bisulphite sequencing (RRBS) and RNA sequencing (RNA-seq) were performed on placental tissues obtained from women with GDM and healthy controls. Further, pyrosequencing, correlation analyses, and linear regression analyses were performed to valuate relationships between aberrantly methylated-differentially expressed genes and clinical parameters. The EMBOSS and JASPAR databases were used for a computational analysis of CpG islands and transcription factor-binding sites in the TRIM67 promoter region. A CpG island with a length of 264 bp in the placental TRIM67 promoter region in the GDM group exhibited significant hypermethylation at four CpG sites. The hypermethylation of the TRIM67 promoter region in the maternal placenta showed a significant, positive correlation with the 1 h and 2 h oral glucose tolerance test (OGTT) values and a negative correlation with lipoprotein(a). Placental DNA methylation levels in the TRIM67 promoter region were markedly elevated in GDM and were associated with blood glucose and lipid levels during healthy pregnancy.

Reproductive tract infection has become a major public health issue all over the world for its high and growing prevalence. It can cause adverse pregnancy outcomes in pregnant women and their foetuses. This study aimed to investigate the trends and risk factors of the prevalence of reproductive tract infections among women who prepared to conceive in the Chongqing Municipality (China) from 2012 to 2016. A multi-center cross-sectional study was conducted between January 2012 and December 2016. Women aged 20–49 years who intended to get pregnant were recruited for this study. All participants underwent preconception examination, which included testing for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, syphilis, bacterial vaginosis and candidiasis according to the national diagnostic standard. A total of 439,372 women with testing results for all six types of reproductive tract infections were included in our final analyses. Logistic regression and factor analysis were used to determine the possible sociodemographic factors associated with prevalence trends. In our study, the overall positive rate of RTIs among the 439,372 women of reproductive age was 5.03%. Candidiasis was the most common infection in our population (2.47%), followed by bacterial vaginosis (1.28%), syphilis (0.73%), T. vaginalis (0.49%), C. trachomatis (0.20%) and N. gonorrhoeae (0.06%). The prevalence of reproductive tract infections was highest among women aged 35 years and above, with a primary or lower education level, history of pregnancy, delivery, induced abortion, or spontaneous abortion. From 2012 to 2016, the trend of the overall prevalence of reproductive tract infections was V-shaped, decreasing steadily from 2012 to 2015, with a slight rise in 2016. Our results suggest that the distribution change of age, education level, gravidity, parity, and history of induced abortion influenced this trend. Since the number of high-risk women who intend to become pregnant is growing in the Chongqing Municipality, pre-conception positive preventions including health education, regular screening, and timely treatment of reproductive tract infections are needed to prevent the impact of reproductive tract infections on maternal health and infant safety. Reproductive tract infections (RTIs) can cause serious health problems, such as spontaneous abortion and congenital diseases in pregnant women and their foetuses. However, there is a lack of studies focusing on the prevalence of RTIs and their trends among women who intend to conceive. This cross-sectional study examined data collected from 439,372 women during their preconception care to investigate the trend and related risk factors of the prevalence of RTIs, thereby providing essential data for their prevention. Participants were women from all 39 counties in the Chongqing Municipality of China, and data were collected between 2012 and 2016. We found that the overall prevalence of the six types of RTIs among these women was 5.03%, which was relatively lower than that in other populations in previous studies. Age, education level, history of pregnancy or delivery, and history of abortion were all associated with the prevalence of RTIs. The prevalence trend from 2012 to 2016 was V-shaped decreased steadily from 2012 until 2015 and rose slightly in 2016. Our data suggested that this trend might be influenced by changes in the proportion of ‘high-risk’ women, that is, women with higher age, lower education level, and a history of pregnancy or induced abortion. This study suggests that health education and regular screening are necessary to face new challenges experienced by older women or women with previous pregnancies who intended to get pregnant in recent years in China.

Aim Intrauterine device (IUD) is a commonly used contraceptive method worldwide. Abnormal uterine bleeding (AUB) is one of the most common side effects of Cu-IUDs. Since AUB varies among Cu-IUD users, changes in the bleeding-related genetic factors may contribute to AUB. This study aimed to determine the genetic risk factors of AUB after Cu-IUD insertion. Methods We conducted a case-control study on women who experienced AUB after Cu-IUD insertion (case:control = 62:59). Six candidate variants were genotyped using the Sequenom MassARRAY. Genotype and allele frequencies were analyzed using SHEsisPlus. We performed Pearson's Chi-squared test to analyze categorical data, and ESEfinder to predict the impact on splicing regulation. Results MCM8 coding sequence variants: rs3761873-A>C was in Exon 7 and rs16991617 A>G was in Exon 12 of all 19 exons, both of which were significantly different between cases and controls (p(allele) = 0.039 and p(genotype) = 0.092). rs6022 and rs6029 in F5 gene and rs3761873 and rs16991617 in the MCM8 gene showed strong linkage disequilibrium (R-2 > 0.8). ESEfinder indicated that the variants of MCM8 may affect the splicing regulation. Conclusions MCM8 rs376187 and rs16991617 were associated with AUB in Cu-IUDs users. MCM8 may play a role in AUB by regulating functions of reproductive organs and primary ovarian insufficiency. Our findings may improve the understanding of the genetic basis of AUB caused by Cu-IUDs.

Background Little is known on the co-occurrence and heterogeneity of child sexual abuse (CSA) or health risk behavior (HRB) prevalence nor the associations among the victims. Objectives To detect the prevalence and subgroups of adolescents reporting CSAs or HRBs, and to examine the association between the subgroups. Methods Participants were secondary school students in a national survey in China ( N = 8746). Self-reported CSA and HRB experiences were collected through a computer assisted questionnaire. Prevalence and confidence intervals were calculated. Multigroup latent class analysis (LCA) was used to examine latent subgroups of CSA and HRB. Dual latent class regression analysis was used to examine the association between CSA and HRB classes. Results A total of 8746 students participated in our study. The prevalence of having ever experienced any of the reported seven CSA items was 12.9%. The preferred LCA model consisted of a three-class CSA latent variable, i.e. “Low CSAs”(95.7% of the total respondents), “Verbal or exhibitionism CSAs”(3.3%), and “high multiple CSAs” (1.1%); and a three-class HRB latent variable, i.e. “Low HRBs”(70.5%), “externalizing HRBs” (20.7%), and “internalizing HRBs” (8.7%). Students in the “Verbal or exhibitionism CSAs” or “high multiple CSAs” classes had higher probabilities of being in “externalizing HRBs” or “internalizing HRBs” classes. The probabilities were higher in “high multiple CSAs” class(male externalizing OR 4.05, 95%CI 1.71–9.57; internalizing OR 11.77, 95%CI 4.76–29.13; female externalizing OR 4.97, 95%CI 1.99–12.44; internalizing OR 9.87, 95%CI 3.71–26.25) than those in “Verbal or exhibitionism CSA”(male externalizing OR 2.51, 95%CI 1.50–4.20; internalizing OR 3.08, 95%CI 1.48–6.40; female externalizing OR 2.53, 95%CI 1.63–3.95; internalizing OR 6.05, 95%CI 3.73–9.80). Conclusions Prevalence of CSA items varies. Non-contact CSAs are the most common forms of child sexual abuse among Chinese school students. There are different latent class co-occurrence patterns of CSA items or HRB items among the respondents. CSA experiences are in association with HRB experiences and the associations between latent classes are dose-responded. Multi-victimization has more significantly negative effects. The results could help identify high-risk subgroups and promote more nuanced interventions addressing adverse experiences and risk behaviors among at-risk adolescents.