Objective To investigate the impact of sleep duration on glucose homeostasis in individuals with gestational diabetes mellitus (GDM).Design Cross-sectional observational study.Setting Secondary-level maternity care at two centres in Ningbo, China.Participants A total of 381 women with GDM were included (median age 30.6 years (IQR 28.2–33.1); median gestational age 26.0 weeks (IQR 25.0–27.0)). All participants underwent 2 weeks of continuous glucose monitoring (CGM), and nocturnal sleep duration was assessed using a structured questionnaire.Outcomes CGM-derived summary metrics were analysed using multivariable linear regression, and 24-hour glucose trajectories were evaluated using functional data analysis (FDA).Results Long sleep duration (>9 hours/day) was associated with higher mean glucose, time above range, coefficient of variation, the pregnancy-specific glucose risk index and lower time in range (β values were 2.41 mg/dL, 1.84%, 1.04%, 1.88% and −1.85%, respectively; all p<0.05). Each additional hour of sleep increased glucose levels, variability and risk (β: mean glucose 1.29 mg/dL, time above range 0.89%, coefficient of variation 0.45%, pregnancy-specific glucose risk index 0.91%; all p<0.05), while reducing time in range (β=−0.87%; p<0.05). The FDA showed that participants with long sleep (>9 hours/day) had elevated glucose by 2.1–5.8 mg/dL from 10:55 to 00:45, lasting for 13.8 hours.Conclusions In GDM, long sleep duration was associated with less favourable glucose patterns, suggesting possible windows of greater vulnerability in glucose regulation. These findings indicate that sleep behaviours may represent an important behavioural characteristic relevant to clinical glucose management in pregnancy and warrant further investigation.

Pregnant women undergoing assisted reproductive technology (ART) have an increased risk of gestational diabetes mellitus (GDM), potentially linked to altered immune regulation, but the underlying circulating immune features remain unclear. Here we show an integrated single-cell transcriptomic, immune receptor repertoire, and plasma proteomic analysis of peripheral blood from 32 women with GDM and 31 normal pregnancies after ART. GDM is associated with increased proportions of CD8+ T cells and elevated plasma levels of CD6, CXCL5, MMP10, and 4E-BP1. Cytotoxic CD8+ T cell subsets display enhanced effector and cytotoxic activity, while B cells, monocytes, and natural killer cells exhibit activated phenotypes. Transcription factors from the FOS and JUN families and KLF6 are implicated in immune activation, accompanied by distinct T cell and B cell receptor repertoire features. The hypothesis-generating multi-omic results highlight potential therapeutic targets and offered insights for future research and management ART-associated pregnancy complications. Multimodal immune profiling of ART pregnancies reveals systemic immune hyperactivation in gestational diabetes, characterized by activated CD8⁺ T cells, altered immune repertoires, and inflammatory signaling driven by FOS/JUN and KLF6.

OBJECTIVE:To investigate non-linear associations between pre-pregnancy BMI and new-onset hypertensive disorders of pregnancy (HDP), and the relationship between gestational weight gain (GWG) trajectories and HDP. METHODS:Using data from the Ningbo Birth Cohort of Population Undergoing ART (NBart) cohort (June 2018-June 2024), we included women with singleton ART pregnancies. Restricted cubic splines, latent class mixed models, and logistic regression were applied. RESULTS:Of 4219 eligible pregnancies, 255 (6.0%) developed HDP. Risk increased when pre-pregnancy BMI exceeded 21.5 kg/m2 (∼6% higher per 0.5 kg/m2 gain). In stratified analyses, risk also increased below 16.6 kg/m2; the J-shaped relationship was evident in normal-weight women; a significant non-linear association was not detected within the overweight and obese subgroups alone. Advanced maternal age, nulliparity, primary infertility, and frozen embryo cycle amplified BMI-related risk. Exceeding recommended GWG guidelines at various pregnancy stages increased HDP risk; refined GWG thresholds were proposed for ART pregnancies. Two GWG patterns-concave negative (0-20 ± 1 weeks; aOR = 0.540, 95% CI: 0.290-0.944) and delayed acceleration (entire gestation period; aOR = 0.627, 95% CI: 0.380-0.996)-were inversely associated with HDP. Both featured minimal or negative early-pregnancy weight change followed by steady gain, occurred predominantly in overweight and obese women, and total GWG was lower compared with other patterns. CONCLUSIONS:Maintaining optimal pre-pregnancy BMI and adhering to the proposed, more conservative GWG thresholds for ART pregnancies may reduce HDP risk. Distinct GWG trajectories may further modulate this risk.

Gestational diabetes mellitus (GDM), a prevalent pregnancy complication, can adversely impact both maternal and neonatal health post-delivery due to poor glycemic control. Although numerous studies highlight the close association between blood lipids and GDM, the specific correlation between lipid profiles and the prognosis of GDM remains ambiguous. This study was conducted at the Women and Children’s Hospital of Ningbo University, with data collected between December 2017 and December 2018. A total of 841 GDM participants were categorized into good glycemic control (GGC, N = 524) and poor glycemic control (PGC, N = 317) groups based on ACOG and ADA criteria. Blood lipid indices were analyzed using univariate and multivariate logistic regression analyses, with further stratification by maternal age, parity, and pre-pregnancy BMI. In the third trimester, the PGC group exhibited significantly lower levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c) (P < 0.05). Multivariate analysis revealed that a 1 mmol/L increase in HDL-c during late pregnancy reduced the risk of PGC by 54

Objective This study aimed to assess the associations between multidimensional sleep features and type 2 diabetes mellitus (T2DM).Methods We conducted a systematic search across the PubMed, Embase, Web of Science, and Scopus databases for observational studies examining the association between nighttime sleep duration, nighttime sleep quality, sleep chronotype, and daytime napping with type 2 diabetes mellitus (T2DM), up to October 1, 2024. If I2 < 50%, a combined analysis was performed based on a fixed-effects model, and vice versa, using a random-effects model.Results Our analysis revealed that a nighttime sleep duration of less than 7 h (odds ratio [OR] = 1.18; 95% CI = 1.13, 1.23) or more than 8 h (OR = 1.13; 95% CI = 1.09, 1.18) significantly increased the risk of T2DM. Additionally, poor sleep quality (OR = 1.50; 95% CI = 1.30, 1.72) and evening chronotype (OR = 1.59; 95% CI = 1.18, 2.13) were associated with a notably greater risk of developing T2DM. Daytime napping lasting more than 30 min augments the risk of T2DM by 7-20%. Interactively, the incidence of T2DM was most significantly elevated among individuals with poor sleep quality and nighttime sleep duration of more than 8 h (OR = 2.15; 95% CI = 1.19, 3.91).Conclusions A U-shaped relationship was observed between sleep duration and type 2 diabetes mellitus (T2DM), with the lowest risk occurring at a sleep duration of 7 to 8 h. Additionally, poor sleep quality, evening chronotypes, and daytime napping exceeding 30 min emerged as potential risk factors for T2DM. These high-risk sleep characteristics interacted with one another, amplifying the overall risk of developing the disease.

AIMS:Aimed to investigate the associations of serum urate with all-cause and cause-specific mortality in diabetes and to assess whether estimated glomerular filtration rate (eGFR) mediates these associations. METHODS:We analyzed 18,809 UK Biobank participants with diabetes, free of CVD or cancer at baseline, followed for a median of 13.5 (12.8-14.4) years. Cox and Fine-Gray models estimated mortality risks, restricted cubic splines assessed nonlinear associations, and Aalen additive hazards models evaluated mediation. RESULTS:During follow-up, 2984 deaths occurred (739 CVD, 1065 cancer). Compared with the lowest urate quartile (< 4.6 mg/dL), participants in the highest quartile (> 6.3 mg/dL) had significantly higher risks of all-cause mortality (HR = 1.329, 95% CI 1.190-1.485), CVD mortality (HR = 1.391, 95% CI 1.115-1.736), cancer mortality (HR = 1.258, 95% CI 1.042-1.518), and other-cause mortality (HR = 1.245, 95% CI 1.042-1.487). A J-shaped association was observed, with all-cause mortality rising above 5.4 mg/dL of urate. Sex-stratified analyses revealed higher inflection points in males than females (7.2 mg/dL vs. 5.7 mg/dL). Mediation analysis indicated that eGFR explained 36.4% of the association between urate and all-cause mortality, with an indirect effect of 10 (95% CI 4.5-15.2) events per 1,000 person-years. CONCLUSIONS:Elevated serum urate, even within the normal range, was independently associated with all-cause and cause-specific mortality in diabetes, partly mediated by reduced eGFR. These findings support considering subclinical hyperuricemia in risk stratification, especially among individuals with early-stage diabetes and preserved metabolic and renal function.

To assess the association between hypoglycemia exposure and the risk of developing microvascular diseases (MVDs) in type 2 diabetes patients via continuous glucose monitoring (CGM), aiming to identify optimal hypoglycemia thresholds for improved glucose management. A total of 174 type 2 diabetes patients underwent 2 weeks of CGM. Binary multivariate logistic regression assessed the association between hypoglycemia exposure and MVDs prevalence at thresholds of 3.0-3.9 mmol/L. After 14 days of monitoring, 79.9

Background:Previous studies have demonstrated the effects of ambient temperature on the risk of pregnancy complications. However, the associations between multiple meteorological factors and pregnancy complications have rarely been studied. Methods:We carried out a retrospective study on the impacts of meteorological factors on pregnancy complications in different trimesters in Ningbo, China, from 2013-2023. Daily meteorological factors data were obtained from the National Aeronautics and Space Administration (NASA). Moreover, a meteorological factor score (MFS) was calculated. Logistic regression models were applied to assess the effects of individual meteorological factors and MFS on pregnancy complications during different trimesters. Distributed lag nonlinear models were used to explore the sensitive time windows of extreme meteorological factors in different weeks of gestation. The interaction effects of extreme meteorological factors were assessed. Results:A total of 92,332 participants were included in the study, with diagnoses as follows: gestational diabetes mellitus (GDM) in 17,814 participants (19.29%), gestational hypertension (GH) in 3,860 participants (4.18%), preeclampsia (PE) in 3,101 participants (3.36%), and hypothyroidism in 17,418 participants (18.86%). Participants in the highest MFS quintile during the first trimester had greater risks of GDM (aOR = 1.186, 95% CI [1.079-1.304]), GH (aOR = 1.596, 95% CI [1.323-1.925]), PE (aOR = 1.347, 95% CI [1.094-1.658]) and hypothyroidism (aOR = 1.257, 95% CI [1.141-1.385]) compared to the lowest quintile. Extreme meteorological exposures influenced complications within distinct windows: risks of GDM, GH, and PE concentrated in mid-pregnancy (3rd-5th months), while hypothyroidism showed first-trimester vulnerability. Interactions between meteorological factors collectively influenced the risk of hypothyroidism. Conclusions:Our findings demonstrated that elevated temperature, increased precipitation, prolonged sunshine duration, and reduced surface pressure were critical risk factors for pregnancy complications. Targeted protective measures should be taken to reduce the risk of pregnancy complications.

Since the birth of the first infant conceived through assisted reproductive technology (ART) in 1978, over 10 million individuals worldwide have been born using these methods. ART has offered hope to many facing infertility. However, concerns remain regarding potential health risks in ART-conceived offspring. Current evidence suggests that these individuals are at increased risk of adverse perinatal outcomes, such as low birth weight and small size for gestational age, compared to naturally conceived peers. These disparities may result from intrauterine growth restriction, often leading to rapid postnatal catch-up growth. This pattern may increase the risk of developing metabolic syndrome later in life. Birth weight is a key indicator of fetal growth and an important predictor of postnatal development. It carries significant prognostic value for long-term health. The causes of birth weight differences in ART offspring are complex. They may involve ART procedures, parental infertility, and intrauterine environmental factors. Understanding how these elements interact with early growth trajectories is crucial. This review explores the multidimensional factors influencing birth weight in ART-conceived offspring, knowledge that can guide personalized monitoring strategies and early intervention measures to prevent metabolic disorders. It also lays a critical foundation for establishing a theoretical framework for long-term health risk management in ART-conceived individuals.

We aimed to comprehensively analyze the impact of both maternal age and birth spacing on adverse maternal and neonatal outcomes. A total of 151,301 pregnancies in China from January 1, 2010, to December 31, 2021 were included, and 8,222 subjects matched their primary and second pregnancy information. Join point regression was used to analyze the temporal trends of adverse outcomes with maternal age and birth spacing. The mean maternal age at delivery rose from 27.1 years to 28.5 between 2010 and 2021, and the average annual percentage change in advanced maternal age (≥ 35 years) was 1.2

Diabetic retinopathy (DR) is a serious complication of diabetes caused by long-term hyperglycemia that leads to microvascular and neuronal damage in the retina. The molecular mechanisms of DR involve oxidative stress, inflammatory responses, neurodegenerative changes, and vascular dysfunction triggered by hyperglycemia. Oxidative stress activates multiple metabolic pathways, such as the polyol, hexosamine, and protein kinase C (PKC) pathways, resulting in the production of, which in turn promote the formation of advanced glycation end products (AGEs). These pathways exacerbate vascular endothelial damage and the release of inflammatory factors, activating inflammatory signaling pathways such as the NF-κB pathway, leading to retinal cell damage and apoptosis. Additionally, DR involves neurodegenerative changes, including the activation of glial cells, neuronal dysfunction, and cell death. Research on the multiomics molecular markers of DR has revealed complex mechanisms at the genetic, epigenetic, and transcriptional levels. Genome-wide association studies (GWASs) have identified multiple genetic loci associated with DR that are involved in metabolic and inflammatory pathways. Noncoding RNAs, such as miRNAs, circRNAs, and lncRNAs, participate in the development of DR by regulating gene expression. Proteomic, metabolomic and lipidomic analyses have revealed specific proteins, metabolites and lipid changes associated with DR, providing potential biomarkers for the early diagnosis and treatment of this disease. This review provides a comprehensive perspective for understanding the molecular network of DR and facilitates the exploration of innovative therapeutic approaches.

Background China's fertility policy has dramatically changed in the past decade with the successive promulgation of the partial two -child policy, universal two -child policy and three -child policy. The trajectories of maternal and neonatal health accompanied the changes in fertility policy are unknown. Methods We obtained data of 280 203 deliveries with six common pregnancy complications and thirteen perinatal outcomes between 2010 and 2021 in eastern China. The average annual percent change (AAPC) was calculated to evaluated the temporal trajectories of obstetric characteristics and adverse outcomes during this period. Then, the autoregressive integrated moving average (ARIMA) models were constructed to project future trend of obstetric characteristics and outcomes until 2027. Results The proportion of advanced maternal age (AMA), assisted reproduction technology (ART) treatment, gestational diabetes mellitus (GDM), anaemia, thrombocytopenia, thyroid dysfunction, oligohydramnios, placental abruption, small for gestational age (SGA) infants, and congenital malformation significantly increased from 2010 to 2021. However, the placenta previa, large for gestational age (LGA) infants and stillbirth significantly decreased during the same period. The AMA and ART treatment were identified as independent risk factors for the uptrends of pregnancy complications and adverse perinatal outcomes. The overall caesarean section rate remained above 40%. Importantly, among multiparas, a previous caesarean section was found to be associated with a significantly reduced risk of hypertensive disorders of pregnancy (HDP), premature rupture of membranes (PROM), placenta previa, placental abruption, perinatal asphyxia, LGA infants, stillbirths, and preterm births. In addition, the ARIMA time series models predicted increasing trends in the ART treatment, GDM, anaemia, thrombocytopenia, postpartum haemorrhage, congenital malformation, and caesarean section until 2027. Conversely, a decreasing trend was predicted for HDP, PROM, and placental abruption premature, LGA infants, SGA infants, perinatal asphyxia, and stillbirth. Conclusions Maternal and neonatal adverse outcomes became more prevalent from 2010 to 2021 in China. Maternal age and ART treatment were independent risk factors for adverse obstetric outcomes. The findings offered comprehensive trajectories for monitoring pregnancy complications and perinatal outcomes in China, and provided robust intervention targets in obstetric safety. The development of early prediction models and the implementation of prevention efforts for adverse obstetric events are necessary to enhance obstetric safety.

ObjectiveTo explore the effects of green spaces exposure on common psychiatric disorders.MethodsPubMed, Embase, Web of Science and MEDLINE were screened and articles published prior to November 15, 2023 were included. Analyses were performed on common psychiatric disorders, categorized into depression, anxiety, dementia, schizophrenia, and attention deficit hyperactivity disorder (ADHD). And the subgroup analyses were conducted for depression, anxiety, dementia, and schizophrenia.ResultsIn total, 2,0064 studies were retrieved, 59 of which were included in our study; 37 for depression, 14 for anxiety, 8 for dementia, 7 for schizophrenia and 5 for ADHD. Green spaces were found to benefit the moderation of psychiatric disorders (OR = 0.91, 95% CI: 0.89 to 0.92). Green spaces positively influence depression (OR = 0.89, 95% CI: 0.86 to 0.93), regardless of the cross-sectional or cohort studies. Green spaces can also help mitigate the risk of anxiety (OR = 0.94, 95%CI:0.92 to 0.96). As an important index for measuring green spaces, a higher normalized difference vegetation index (NDVI) level related to a lower level of depression (OR = 0.95, 95%CI:0.91 to 0.98) and anxiety (OR = 0.95, 95%:0.92 to 0.98). The protection was also found in dementia (OR = 0.95, 95% CI: 0.93 to 0.96), schizophrenia (OR = 0.74, 95% CI: 0.67 to 0.82), and ADHD (OR = 0.89, 95% CI: 0.86 to 0.92) results.ConclusionGreen spaces decrease the risk of psychiatric disorders, including depression, anxiety, dementia, schizophrenia, and ADHD. Further studies on green spaces and psychiatric disorders are needed, and more green spaces should be considered in city planning.

ObjectiveOur study was conducted to explore the link between oxidative balance score (OBS) and rheumatoid arthritis (RA).MethodsA total of 21,415 participants were included in our research from five cycles (2011–2012, 2013–2014, 2015–2016, 2017–2018, and 2017–2020) of the National Health and Nutrition Examination Survey (NHANES). Moreover, 20 elements related to diet as well as lifestyle were combined to calculate OBS. The relationship between OBS and RA was assessed by employing multivariable regression analysis, and further exploration was carried out through subgroup analysis, restricted cubic spline analysis, and sensitivity analysis. Multiple covariates were selected to adjust the model for more robust results.ResultsIn our cross-sectional study, a higher OBS has a protective effect on the development of RA (OR = 0.98, 95% CI: 0.97 to 0.99). In contrast to individuals aged ≥60, the result is more prominent in the population aged 20–60 (OR = 0.97, 95% CI: 0.96 to 0.98). Marital status appears to introduce interference in the relationship between OBS and RA, and unmarried individuals exhibited different outcomes (OR = 1.02, 95% CI: 0.99 to 1.04) compared to others. The positive influence of OBS was more evident in patients with chronic kidney disease and cardiovascular disease, while it was stronger in individuals without diabetes and liver disease.ConclusionA higher OBS correlates with a reduced odd of RA. Further studies are needed to shoot more sights on improving dietary habits and lifestyles to gain proper OBS and explore whether OBS can be one of the measurements utilized to measure the risk of RA.

As the incidence of type 2 diabetes mellitus (T2DM) is increasing rapidly and its consequences are severe, effective intervention and prevention, including sleep-related interventions, are urgently needed. As a component of sleep architecture, naps, alone or in combination with nocturnal sleep, may influence the onset and progression of T2DM. Overall, napping is associated with an increased risk of T2DM in women, especially in postmenopausal White women. Our study showed that napping >30 minutes (min) increased the risk of T2DM by 8-21%. In addition, non-optimal nighttime sleep increases T2DM risk, and this effect combines with the effect of napping. For nondiabetic patients, napping >30 min could increase the risks of high HbA1c levels and impaired fasting glucose (IFG), which would increase the risk of developing T2DM later on. For diabetic patients, prolonged napping may further impair glycemic control and increase the risk of developing diabetic complications (e.g., diabetic nephropathy) in the distant future. The following three mechanisms are suggested as interpretations for the association between napping and T2DM. First, napping >30 min increases the levels of important inflammatory factors, including interleukin 6 and C-reactive protein, elevating the risks of inflammation, associated adiposity and T2DM. Second, the interaction between postmenopausal hormonal changes and napping further increases insulin resistance. Third, prolonged napping may also affect melatonin secretion by interfering with nighttime sleep, leading to circadian rhythm disruption and further increasing the risk of T2DM. This review summarizes the existing evidence on the effect of napping on T2DM and provides detailed information for future T2DM intervention and prevention strategies that address napping.

This study conducted a high-throughput sequencing analysis of the T- and B- repertoires in the newly diagnosed GDM patients and evaluated the association between abnormal adaptive immunity and GDM. The unique TCR CDR3 clonotypes were mildly decreased in GDM patients, and the similarity of TCR V-J distributions was higher in the GDM group. Moreover, the usages of the V gene and V-J pair and the frequency distributions of some CDR3 amino acids (AAs) both in BCR and TCR were significantly different between groups. Moreover, the cytokines including IL-4, IL-6, IFN-γ and IL-17A were synchronously elevated in the GDM cases. Our findings provide a comprehensive view of BCR and TCR repertoires at newly diagnosed GDM patients, revealing the mild reduction in unique TCRB CDR3 sequences and slight alteration of the V gene, V-J combination and CDR3 (AA) usages of BCR and TCR. This work provides deep insight into the mechanism of maternal adaptive immunity in GDM and provides novel diagnostic biomarkers and potential immunotherapy targets for GDM.