To characterize longitudinal metabolic alterations associated with gestational diabetes mellitus (GDM) and to identify candidate metabolite signals for earlier risk assessment using a widely targeted metabolomics platform. In this prospective cohort, 35 women who developed GDM and 35 matched healthy controls underwent fasting blood sampling in early pregnancy (6–13 weeks) and mid-pregnancy (24–28 weeks). Widely targeted metabolomics and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed. Multivariate analyses, logistic regression, receiver operating characteristic (ROC) analysis, internal cross-validation, and restricted cubic spline modeling were applied within an exploratory framework. In early pregnancy, 11 differential metabolites were identified, including 6 amino acid-related metabolites, but no robust signal remained after false discovery rate (FDR) correction. By mid-pregnancy, 35 differential metabolites were identified, including 13 amino acid-related metabolites. Among 19 amino acid-related metabolites examined in focused analyses, L-arginine was the only amino acid-related metabolite that remained significant after FDR correction (FDR = 0.043). Higher mid-pregnancy L-arginine was associated with increased odds of GDM (aOR = 2.840, 95

Drug exposure during pregnancy and early life is typically considered a short-term clinical intervention rather than a determinant of long-term pharmacological outcomes. Consequently, the developmental context is largely absent from drug discovery and drug development paradigms, where efficacy, safety and target engagement are evaluated predominantly in adult, steady-state systems. This disconnect may contribute to unexplained variability in drug response and toxicity later in life. Pregnancy is accompanied by dynamic remodeling of the maternal gut microbiota and its metabolic output, generating bioactive microbial metabolites that regulate immune tone, metabolic homeostasis and the expression of drug-metabolizing enzymes and transporters. These microbial signals intersect with pharmacological interventions across gestation, shaping maternal pharmacokinetics, placental regulation and fetal drug exposure during developmentally sensitive windows. Importantly, microbiota-drug interactions initiated during pregnancy do not terminate at birth. Instead, they extend into infancy through vertical microbial transmission, breast milk-mediated metabolic signaling, and the immaturity of neonatal drug-handling systems, collectively contributing to developmental programming of drug responsiveness beyond early life. In this review, we propose a microbiota-informed framework that reframes perinatal drug exposure as a developmentally embedded signal operating across a maternal-placental-infant continuum. This perspective introduces a missing developmental dimension into drug discovery and highlights new opportunities to improve translational predictability and precision pharmacotherapy across the life course.

OBJECTIVE:To evaluate the availability, quality, and delivery of maternal nutrition services in antenatal clinics across Beijing, focusing on service types, provider qualifications, resource adequacy, and barriers to effective service delivery. The study also aims to identify factors influencing service availability and institutional variation and propose a framework for improving maternal nutrition care in urban China. METHODS:A cross-sectional study was conducted across 110 antenatal clinics in Beijing, using structured surveys targeting institutional characteristics, service coverage, personnel qualifications, and service delivery methods, supplemented by qualitative insights from open-ended responses. RESULTS:Among 104 valid responses, 56% of institutions offered prenatal nutrition education classes. Provision varied descriptively by facility type (e.g. 12.5% in private hospitals vs ∼55-57% in other facility types), but the facility-type comparison was not statistically significant (chi-square = 5.72, df = 3, p = 0.13). While 76% of institutions reported having personnel with formal nutrition qualifications, gaps in training and reliance on non-specialized staff were common. Resource constraints (e.g. space, equipment, and limited digital support) were frequently reported as barriers. Institutional respondents reported high perceived patient satisfaction and the presence of feedback systems, but no patient-level outcomes were measured. CONCLUSION:This city-wide institutional survey suggests that maternal nutrition services in Beijing antenatal clinics are broadly available but heterogeneous in delivery, staffing, and resources. Observed contrasts across facility types should be interpreted as descriptive patters rather than confirmed group differences. Future work should evaluate whether standardization, workforce development, infrastructure strengthening, and digital support improve service quality and equity, using patient-level and implementation indicators.

BackgroundMaternal health during the perinatal period is a global public health priority. While antenatal education is widely implemented, conventional lecture-based models often fail to achieve sustained behavior change. Innovative approaches that integrate experiential learning with digital support may enhance maternal knowledge, self-management, and pregnancy outcomes. ObjectiveThe aim of this study is to evaluate the feasibility and preliminary effectiveness of a combined experiential class and online logging intervention for pregnant women in China and to explore the mechanisms underpinning its impact on health practices and service experiences. MethodsA mixed methods design was used in a district-level maternal and child health hospital in Beijing. In the quantitative arm, 40 women (intervention group, n=20; control group, n=20) were enrolled in a quasi-experimental comparison. Outcomes included knowledge-attitude-practice indicators, service satisfaction, and clinical birth outcomes. Given the limited sample size, a qualitative arm was conducted to complement statistical findings: semistructured interviews with 20 women (10 per group) were analyzed thematically. Quantitative and qualitative results were integrated during interpretation to provide a comprehensive evaluation. ResultsCompared with the experiential class alone, the combined intervention was associated with higher knowledge scores (mean difference 1.6 points, 95% CI 0.8-2.4), stronger adherence to recommended health practices (composite adherence score difference 1.0, 95% CI 0.4-1.6), and higher overall service satisfaction (mean difference 0.6, 95% CI 0.2-1.0). Across multiple domains, a higher proportion of participants in the intervention group met dietary, exercise, and supplementation recommendations. Clinical outcome differences were exploratory, as the study was not powered for these end points. Qualitative analysis revealed 3 mechanisms, such as empowerment and self-efficacy, practice and persistence, and systemic/environmental support, through which the intervention influenced experiences and practices. ConclusionsThe experiential class plus online logging model is feasible and acceptable in a real-world antenatal setting. Although limited by a small sample size, findings suggest that the intervention improves maternal knowledge, health practices, and service experiences and may inform future adequately powered trials to evaluate pregnancy outcomes. Qualitative insights highlight mechanisms of health practice change and provide contextual depth, underscoring the value of mixed methods designs in maternal health research.

BackgroundMaternal health literacy (MHL) represents a potentially modifiable public health determinant concentrated among socioeconomically disadvantaged populations. While 15–45% of pregnant women demonstrate inadequate health literacy, its impact across the full spectrum of infant and early childhood outcomes remains inadequately characterized, limiting understanding of its broader public health significance.ObjectiveTo systematically synthesize evidence on associations between MHL and infant/child health outcomes from birth through age three, and to examine whether MHL functions as a systemic determinant across outcome domains.MethodsFollowing PRISMA guidelines, we searched MEDLINE, Embase, and Web of Science from inception through March 2025. Studies examining associations between validated MHL measures and any child health outcomes up to age three were included. Methodological quality was assessed using JBI checklists, and the certainty of evidence using the GRADE framework. Narrative synthesis was conducted.ResultsEight studies (n = 13,407 participants) from seven countries met inclusion criteria. Higher MHL was consistently associated with favorable birth weight. A pattern consistent with a behavioral pathway hypothesis emerged: outcomes requiring maternal behavioral competencies (e.g., symptom recognition, care-seeking) showed stronger and more consistent associations (e.g., reduced neonatal jaundice readmission, diaper dermatitis) than medically-determined conditions. Limited evidence also suggested MHL effects beyond the perinatal period, with inadequate MHL associated with increased risks of nutritional deficiencies and developmental delays (over four-fold increased risk in vulnerable populations). JBI assessment indicated generally adequate quality, while GRADE rated the certainty of evidence as Low to Very Low due to cross-sectional designs and imprecision.ConclusionMHL shows promising systematic associations with infant outcomes across multiple domains spanning the early life course, operating primarily through behavioral pathways requiring maternal agency. This pattern supports conceptualizing MHL as a potential foundational public health determinant and equity-relevant intervention target. However, low certainty of evidence underscores the need for standardized measurement, longitudinal studies, and intervention trials to establish causality.

Maternal health during the perinatal period is a global public health priority. While antenatal education is widely implemented, conventional lecture-based models often fail to achieve sustained behaviour change. Innovative approaches that integrate experiential learning with digital support may enhance maternal knowledge, self-management, and pregnancy outcomes. To evaluate the feasibility and preliminary effectiveness of a combined experiential class and online logging intervention for pregnant women in China, and to explore the mechanisms underpinning its impact on health behaviours and service experiences. A mixed-methods design was employed in a district-level maternal and child health hospital in Beijing. In the quantitative arm, 40 women (intervention group, n=20; control group, n=20) were enrolled in a quasi-experimental comparison. Outcomes included knowledge-attitude-practice (KAP) indicators, service satisfaction, and clinical birth outcomes. Given the limited sample size, a qualitative arm was conducted to complement statistical findings: semi-structured interviews with 20 women (10 per group) were analyzed thematically. Quantitative and qualitative results were integrated during interpretation to provide a comprehensive evaluation. Compared with experiential class alone, the combined intervention significantly improved maternal knowledge, healthy behaviour adherence, and satisfaction, with favourable but non-significant trends in clinical outcomes. Qualitative analysis revealed three mechanisms-empowerment and self-efficacy, practice and persistence, and systemic/environmental support-through which the intervention influenced experiences and behaviours. The experiential class plus online logging model is feasible and acceptable in a real-world antenatal setting. While limited by small sample size, findings suggest the intervention improves maternal knowledge, behaviours, and service experiences, with potential to optimize pregnancy outcomes. Qualitative insights highlight mechanisms of behavioural change and provide contextual depth, underscoring the value of mixed-methods designs in maternal health research.

Background:Although blood pressure in singleton pregnancies is related to multiple adverse pregnancy outcomes, the blood pressure threshold has been controversial. Objective:To explore the blood pressure reference threshold of singleton pregnant women in the second and third trimesters. Study design:A bidirectional single-centre cohort study was undertaken. Clinical data were collected for women with singleton pregnancies who underwent regular antenatal examinations and delivered at Peking Union Medical College Hospital between July 2020 and June 2023. Blood pressure was recorded at 20-24 and 28-32 weeks of gestation, and hypertension and pre-eclampsia were used as the primary outcomes. The percentiles of blood pressure were calculated, and the 95th percentile was used as the upper limit for the second and third trimesters of pregnancy. Poisson regression was used to calculated adjusted relative risk (aRR) and 95 % confidence intervals (CI) were used to analyse the relationship between elevated blood pressure and adverse pregnancy outcomes, and to further explore the impact of changes in blood pressure in the second and third trimesters on pregnancy outcomes. p-values < 0.05 were considered to indicate significance. Results:In total, 7854 pregnant women with singleton pregnancies were included in this study. For pregnant women who did not experience adverse outcomes related to blood pressure, the 95th percentiles of systolic and diastolic blood pressure in the second trimester were 131 mmHg and 80 mmHg, respectively. Corresponding data for the third trimester were 130 mmHg and 80 mmHg, respectively. Therefore, 130/80 mmHg was taken as the upper limit of blood pressure. After excluding confounding factors, regardless of trimester, the risks of gestational hypertension, pre-eclampsia, preterm birth, low birth weight and neonatal intensive care unit (NICU) admission were found to be significantly higher in pregnant women with elevated blood pressure (p < 0.05). Pregnant women with sustained elevated blood pressure (i.e. in both the second and third trimesters) had aRR values for gestational hypertension, pre-eclampsia, premature birth, low birth weight and NICU admission that were 19.08 (95 % CI 13.04-28.03; p < 0.001), 11.43 (95 % CI 6.94-18.64; p < 0.001), 2.53 (95 % CI 1.83-3.42; p < 0.001), 2.98 (95 % CI 2.05-4.21; p < 0.001) and 1.79 (95 % CI 1.29-1.79; p < 0.001) times higher than those of normotensive pregnant women, respectively. Conclusion:The blood pressure threshold of singleton pregnant women in the second and third trimesters is 130/80 mmHg. Sustained elevated blood pressure is harmful to the health of mothers and infants. Management and monitoring should be strengthened for pregnant women with elevated blood pressure.

Perinatal depression (PD) is a highly prevalent psychological disorder that has a detrimental effect on infant and maternal physical and mental health, but effective and objective assessment of PD is still insufficient. In recent years, the functional near-infrared spectroscopy (fNIRS) has been acknowledged as an effective non-invasive tool for clinical assessment of depression. This study proposed a free association semantic task (FAST) paradigm for fNIRS-based assessment of PD. To better address the emotion characteristics of PD, the participants are required to generate a dynamic concept chain based on positive, negative or neutral seed words, while 48-channel fNIRS recordings over frontal and bilateral temporal regions. Results from twenty-two late-pregnant women revealed that, the oxyhemoglobin (oxy-Hb) changes during the FAST with the positive and negative seed words over the frontal region were correlated with PD severity, which was different from the correlation patterns in the FAST with neutral seed word and the classical verbal fluency test (VFT). Furthermore, distinct correlation patterns were also observed in the FAST with the positive and negative seed words, manifested in fNIRS channels corresponding to the right dorsolateral prefrontal cortex (DLPFC) and right inferior frontal gyrus (IFG), respectively. Moreover, regression analyses showed that the FAST with positive and negative seed words can well explain the severity of PD. Our findings suggest the proposed FAST paradigm as a promising approach for PD assessment.

Traditional Chinese medicine (TCM) is widely used by pregnant and breastfeeding women in China, yet predictors of its use intention remain understudied in mainland China. This study applied an extended Theory of Planned Behavior (TPB) framework to identify factors influencing TCM use intention in this population. A cross-sectional survey was conducted among 264 pregnant and breastfeeding women from diverse regions in mainland China between July and October 2023. Data were collected through an online questionnaire that included demographic information, TPB-based measures (attitudes, subjective norms, perceived behavioral control, intention), and past TCM use experiences. Structural Equation Modeling (SEM) was used to test hypothesized relationships. The results showed that 37.5

Objective Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. Electronic health records (EHRs) promise GDM risk prediction, but missing data poses a challenge to developing reliable and generalizable risk prediction models. This study aims to address the problem of missing EHR data in GDM prediction before 12 weeks gestation. Methods A total of 5066 women with singleton pregnancies, aged 18 to 50, were included in this retrospective study. This study evaluated 6 imputation methods, combined with 4 classification machine learning models. The evaluation encompassed downstream predictive performance, robustness to variable missingness, ability to restore original data distribution, and influence on feature selection based on 10-fold cross-validation. Results Our findings revealed a significant improvement in model performance with imputation. When using the top 30 features, logistic regression (LR) with multivariate imputation by chained equations using classification and regression trees (mice) achieved the highest area under the receiver operating characteristic curve of 0.6899, compared to 0.6336 for the LR model without imputation. Mice also led to the best average performance across prediction models and yielded the most accurate restoration of the original data distribution. LR models trained on data imputed by mice remained the most robust across varying levels of missingness. The classification algorithm primarily accounted for differences in predictive performance. In addition, we identified 18 key features for early GDM prediction in the Chinese population. Conclusion This study demonstrates the critical role of imputation in improving the performance and fairness of GDM prediction models. The findings provide practical guidance for integrating imputation into clinical machine learning pipelines.

Gestational Diabetes Mellitus (GDM) is a common metabolic disorder during pregnancy, raising significant health risks to both mother and child. With the advent of mobile health (mHealth) technologies, there is a growing potential to enhance GDM prevention strategies. This study investigates the impact of mobile-based prenatal education and diet recording on GDM prevention, utilizing the self-management application of the Peking Union Medical College Hospital mHealth-Enhanced Prenatal Care Program in Beijing, China. We retrospectively analyzed records from 1,666 pregnant women enrolled in the program from May 2021 to July 2022, with an average age of 32 years. Of these, 378 participants (22.7%) engaged actively in the program. Our analysis reveals that active participation in both prenatal education and diet recording from early pregnancy significantly reduces the incidence of GDM, with an odds ratio (OR) of 0.37, and a p-value of 0.034. This real-world study highlights the potential of mHealth applications to enhance prenatal care and establish more effective GDM prevention strategies.

Objective:The study aimed to obtain more evidence on the association of gestational weight gain and pre-pregnancy body mass index (BMI) with macrosomia. Methods:The data on 5409 live births delivered at Peking Union Medical College Hospital from July 2020 to June 2022 were collected. Group analyses were performed according to the presence or absence of macrosomia. Multivariable binary logistic regression and incidence heatmaps was used to analyze the related factors of macrosomia. Results:The following variables were significantly associated with macrosomia: overweight (odds ratio [OR]: 2.24, 95% confidence interval [CI]: 1.62-3.10), obesity (OR: 4.56, 95% CI: 2.93-6.98), excessive gestational weight gain (OR: 2.39, 95% CI: 1.67-3.43), gestational age at delivery at 39-41 weeks (OR: 3.83, 95% CI: 2.56-5.95), gestational age at delivery over 41 weeks (OR: 7.88, 95% CI: 4.37-14.19), education level of junior college or below (OR: 1.95, 95% CI: 1.19-3.09), and multipara (OR: 1.62, 95% CI: 1.09-2.42). "v" represents the mean weekly weight gain during the second and third trimesters. A higher v value increased the risk of macrosomia by 2.6-fold (95% CI: 1.37-4.89, P = 0.003). Compared to normal weight women, after adjustment for different pre-pregnancy BMI subgroups, overweight pregnant women had higher weekly weight gain in the second and third trimesters (OR: 4.57, 95% CI: 2.27-9.10, P < 0.001). Obese pregnant women had higher average weekly weight gain during the second and third trimesters, and the OR value for macrosomia was 11.33 (95% CI: 4.95-25.18, P < 0.001). To reduce the incidence of macrosomia in overweight pregnant women, v = 0.32 could be considered the critical threshold of average weekly weight gain in these women in the second and third trimesters of pregnancy. Conclusion:Pre-pregnancy BMI and weight gain during pregnancy are closely related to macrosomia. The introduction of average weekly weight gain values in the second and third trimesters of pregnancy probably help pregnant women minimizing adverse pregnancy-related outcomes.

Purpose: To assess the impact of maternal pre-pregnancy body mass index (BMI) on longitudinal fetal growth, and the potential mediation effect of the maternal fasting plasma glucose in first trimester. Methods: In this retrospective cohort study, we collected pre-pregnancy BMI data and ultrasound measurements during pregnancy of 3879 singleton pregnant women who underwent antenatal examinations and delivered at Peking Union Medical College Hospital. Generalized estimation equations, linear regression, and logistic regression were used to examine the association between prepregnancy BMI with fetal growth and adverse neonatal outcomes. Mediation analyses were also used to examine the mediating role of maternal fasting plasma glucose (FPG) in first trimester. Results: A per 1 Kg/m2 increase in pre-pregnancy BMI was associated with increase fetal body length Z-score (I3 0.010, 95% CI 0.001, 0.019) and fetal body weight (I3 0.017, 95% CI 0.008, 0.027). In mid pregnancy, pre-pregnancy BMI also correlated with an increase Z-score of fetal abdominal circumference, femur length (FL). Pre-pregnancy BMI was associated with an increased risk of large for gestational age and macrosomia. Mediation analysis indicated that the associations between pre-pregnancy BMI and fetal weight in mid and late pregnancy, and at birth were partially mediated by maternal FPG in first trimester (mediation proportion: 5.0%, 8.3%, 1.6%, respectively). Conclusion: Maternal pre-pregnancy BMI was associated with the longitudinal fetal growth, and the association was partly driven by maternal FPG in first trimester. The study emphasized the importance of identifying and managing mothers with higher pre-pregnancy BMI to prevent fetal overgrowth.

Background The increasing prevalence of gestational diabetes mellitus (GDM) is a major challenge, particularly in rural areas of China where control rates are suboptimal. This study aimed to evaluate the effectiveness of a GDM subsidy program in promoting GDM screening and management in these underserved regions. Methods This multicenter, randomized controlled trial (RCT) was conducted in obstetric clinics of six rural hospitals located in three provinces in China. Eligible participants were pregnant women in 24–28 weeks’ gestation, without overt diabetes, with a singleton pregnancy, access to a telephone, and provided informed consent. Participants were randomly assigned in a 1:1 ratio to either the intervention or control groups using an internet-based, computer-generated randomization system. The intervention group received subsidized care for GDM, which included screening, blood glucose retesting, and lifestyle management, with financial assistance provided to health care providers. In contrast, the control group received usual care. The primary outcomes of this study were the combined maternal and neonatal complications associated with GDM, as defined by the occurrence of at least one pre-defined complication in either the mother or newborn. The secondary outcomes included the GDM screening rate, rates of glucose retesting for pregnant women diagnosed with GDM, dietary patterns, physical activity levels, gestational weight gain, and antenatal visit frequency for exploratory purposes. Primary and secondary outcomes were obtained for all participants with and without GDM. Binary outcomes were analyzed by the generalized linear model with a link of logistic, and odds ratios (OR) with 95% confidence intervals (CIs) were reported. Count outcomes were analyzed by Poisson regression, and incidence rate ratios with 95% CIs were reported. Results A total of 3294 pregnant women were randomly assigned to either the intervention group ( n = 1649) or the control group ( n = 1645) between 15 September 2018 and 30 September 2019. The proportion of pregnant women in the intervention group who suffered from combined maternal and/or neonatal complications was lower than in the control group with adjusted OR = 0.86 (0.80 to 0.94, P = 0.001), and a more significant difference was observed in the GDM subgroup (adjusted OR = 0.66, 95% CI 0.47 to 0.95, P = 0.025). No predefined safety or adverse events of ketosis or ketoacidosis associated with GDM management were detected in this study. Both the intervention and control groups had high GDM screening rates (intervention: 97.2% [1602/1649]; control: 94.5% [1555/1645], P < 0.001). Moreover, The intervention group showed a healthier lifestyle, with lower energy intake and more walking minutes ( P values < 0.05), and more frequent blood glucose testing (1.5 vs. 0.4 visits; P = 0.001) compared to the control group. Conclusion In rural China, a GDM care program that provided incentives for both pregnant women and healthcare providers resulted in improved maternal and neonatal health outcomes. Public health subsidy programs in China should consider incorporating GDM screening and management to further enhance reproductive health. Trial registration China Clinical Trials Registry ChiCTR1800017488. https://www.chictr.org.cn/

Prenatal exposure to Benzo[a]pyrene (BaP) has been suggested to increase the risk of adverse pregnancy outcomes. However, the role of placental apoptosis on BaP reproductive toxicity is poorly understood. We conducted a maternal animal model of C57BL/6 wild-type (WT) and transformation-related protein 53 (Trp53) heterozygous knockout (p53KO) mice, as well as a nested case-control study involving 83 women with PB and 82 term birth from a birth cohort on prenatal exposure to BaP and preterm birth (PB). Pregnant WT and p53KO mice were randomly allocated to BaP treatment and control groups, intraperitoneally injected of low (7.8 mg/kg), medium (35 mg/kg), and high (78 mg/kg) doses of 3,4-BaP per day and equal volume of vegetable oil, from gestational day 10.5 until delivery. Results show that high-dose BaP treatment increased the incidence of preterm birth in WT mice. The number of fetal deaths and resorptions increased with increasing doses of BaP exposure in mice. Notably, significant reductions in maternal and birth weights, increases in placental weights, and decrease in the number of livebirths were observed in higher-dose BaP groups in dose-dependent manner. We additionally observed elevated p53-mediated placental apoptosis in higher BaP exposure groups, with altered expression levels of p53 and Bax/Bcl-2. In case-control study, the expression level of MMP2 was increased among women with high BaP exposure and associated with the increased risk of all PB and moderate PB. Our study provides the first evidence of BaP-induced reproductive toxicity and its adverse effects on maternal-fetal outcomes in both animal and population studies.

Abstract Objective We sought to investigate the impact of individualized exercise guidance during pregnancy on the incidence of macrosomia and the mediating effect of gestational weight gain (GWG). Design A prospective randomized clinical trial. Setting A Hospital in Xingtai District, Hebei Province. Population Older than 20 years of age, mid-pregnancy, and singleton pregnant women without contraindications to exercise during pregnancy. Methods A randomized clinical trial was conducted from December 2021 to September 2022 to compare the effects of standard prenatal care with individualized exercise guidance on the incidence of macrosomia. Main outcome measure Incidence of macrosomia. Results In all, 312 singleton women were randomized into an intervention group (N = 162) or a control group (N = 150). Participants who received individualized exercise guidance had a significantly lower incidence of macrosomia (3.73% vs. 13.61%, P = 0.002) and infants large for gestational age (9.94% vs. 19.73%, P = 0.015). However, no differences were observed in the rate of preterm birth (1.86% vs. 3.40%, P = 0.397) or the average gestational age at birth (39.14 ± 1.51 vs. 38.69 ± 1.85, P = 0.258). Mediation analysis revealed that GWG mediated the effect of exercise on reducing the incidence of macrosomia. Conclusion Individualized exercise guidance may be a preventive tool for macrosomia, and GWG mediates the effect of exercise on reducing the incidence of macrosomia. However, evidence does not show that exercise increases the rate of preterm birth or affects the average gestational age at birth. Trial registration The trial is registered at www.clinicaltrails.gov [registration number: NCT05760768; registration date: 08/03/2023 (retrospectively registered)].

Abstract Background Vitamin D deficiency is common in pregnancy, however, its effects has not been fully elucidated. Here, we conducted targeted metabolomics profiling to study the relationship. Methods This study enrolled 111 pregnant women, including sufficient group (n = 9), inadequate group (n = 49) and deficient group (n = 53). Ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS)-based targeted metabonomics were used to characterize metabolite profiles associated with vitamin D deficiency in pregnancy. Results Many metabolites decreased in the inadequate and deficient group, including lipids, amino acids and others. The lipid species included fatty acyls (FA 14:3, FA 26:0; O), glycerolipids (MG 18:2), glycerophospholipids (LPG 20:5, PE-Cer 40:1; O2, PG 29:0), sterol lipids (CE 20:5, ST 28:0; O4, ST 28:1; O4). Decreased amino acids included aromatic amino acids (tryptophan, phenylalanine, tyrosine) and branched-chain amino acids (valine, isoleucine, leucine), proline, methionine, arginine, lysine, alanine, L-kynurenine,5-hydroxy-L-tryptophan, allysine. Conclusions This targeted metabolomics profiling indicated that vitamin D supplementation can significantly affect lipids and amino acids metabolism in pregnancy.

ObjectiveTo investigate the association of triglyceride to high density lipoprotein-cholesterol ratio (TG/HDL-C) in early pregnancy with the risk of gestational diabetes mellitus (GDM).MethodsRetrospectively collected clinical data of singleton pregnant women who received regular antenatal care and delivered at Peking Union Medical College Hospital from July 2020 to June 2022. Based on the results of the 75 g oral glucose tolerance test (OGTT) from 24 to 28 weeks, pregnant women were classified into GDM group and normal glucose tolerance (NGT) group. Multiple Logistic regression was used to evaluate the correlation between TG /HDL-C in early pregnancy (8-12+6weeks) and GDM, and triglyceride-glucose (TyG) index was used as a reference to assess the value of TG/HDL-C in early pregnancy in predicting GDM.ResultsA total of 1617 singleton pregnant women who met the inclusion and exclusion criteria were enrolled, with 372 (23.01%) in the GDM group and 1245 (76.99%) in the NGT group. After adjusting for confounding factors, such as maternal age, ethnicity, pre-pregnancy BMI, GDM history and family history of diabetes, pregnant women in the highest TG/HDL-C quartile had a 2.46-fold higher risk of developing GDM than those in the lowest TG/HDL-C quartile (OR=2.46, 95% CI: 1.73-3.51). Pregnant women in the highest TyG index quartile had a 2.36-fold higher risk of developing GDM than those in the lowest TyG index quartile (OR=2.36, 95% CI: 1.67-3.37). The efficacy of TG/HDL-C in early pregnancy in predicting GDM (area under the curve: 0.607 vs. 0.608) and the degree of improvement in the basic risk model of GDM (net reclassification improvement: 0.240 vs. 0.270; integrated discrimination improvement: 0.022 vs. 0.024) were both close to the TyG index.ConclusionsHigher TG/HDL-C in early pregnancy was independently associated with higher risk of GDM. Its predictable value was comparable to that of TyG index.

Gestational diabetes mellitus (GDM) is prevalent among pregnant individuals and is linked to increased risks for both mothers and fetuses. Although GDM is known to cause disruptions in gut microbiota and metabolites, their potential transmission to the fetus has not been fully explored. This study aimed to characterize the similarities in microbial and metabolic signatures between mothers with GDM and their neonates as well as the interactions between these signatures. This study included 89 maternal-neonate pairs (44 in the GDM group and 45 in the normoglycemic group). We utilized 16S rRNA gene sequencing and untargeted metabolomics to analyze the gut microbiota and plasma metabolomics of mothers and neonates. Integrative analyses were performed to elucidate the interactions between these omics. Distinct microbial and metabolic signatures were observed in GDM mothers and their neonates compared to those in the normoglycemic group. Fourteen genera showed similar alterations across both groups. Metabolites linked to glucose, lipid, and energy metabolism were differentially influenced in GDM, with similar trends observed in both mothers and neonates in the GDM group. Network analysis indicated significant associations between Qipengyuania and metabolites related to bile acid metabolism in mothers and newborns. Furthermore, we observed a significant correlation between several genera and metabolites and clinical phenotypes in normoglycemic mothers and newborns, but these correlations were disrupted in the GDM group. Our findings suggest that GDM consistently affects both the microbiota and metabolome in mothers and neonates, thus elucidating the mechanism underlying metabolic transmission across generations. These insights contribute to knowledge regarding the multiomics interactions in GDM and underscore the need to further investigate the prenatal environmental impacts on offspring metabolism.