OBJECTIVES:To investigate the changes in fetal cardiac function in pregnant women with well-controlled gestational diabetes mellitus (GDM) using a novel ultrasound technology named HOLO-PW. Secondly, we aim to evaluate the predictive ability of cardiac function parameters for adverse perinatal outcomes and establish an individualized nomogram. METHODS:This study included 122 pregnant women with well-controlled GDM and 256 pregnant women with normal blood glucose. Fetal cardiac function parameters were extracted based on the HOLO-PW technology. The differences between the 2 groups were analyzed. Subgroup analysis was performed in the GDM group according to the pregnancy outcome and fetal growth status. The effectiveness of cardiac function parameters in predicting adverse pregnancy outcomes in GDM was evaluated by receiver operating characteristic (ROC) curves. Independent predictors were identified through logistic regression with LASSO variable selection, and a nomogram was developed. The model's performance was evaluated with ROC analysis, calibration curves, and decision curve analysis (DCA). RESULTS:Compared with the control cohort, the myocardial performance index (MPI), K index (KI), isovolumic contraction time (ICT), and isovolumic relaxation time (IRT) of left and right ventricles were increased in the fetuses of GDM cohort (p < .05). Compared with the appropriate for gestational age (AGA), the fetuses with abnormal growth in the GDM cohort presented significant differences in the cardiac function parameters (p < .05). The incidence of adverse pregnancy outcomes in the GDM cohort was higher than that in the control cohort. The cardiac function parameters of fetuses with adverse and normal perinatal outcomes significantly differed in the GDM cohort (p < .05). We also evaluated the predictive capacity of each heart function parameter for adverse pregnancy outcomes in GDM. The LMPI showed the strongest ability to predict adverse pregnancy outcomes with an AUC of 0.951 (95% CI: 0.909-0.993). A nomogram constructed with the 3 key predictors selected by LASSO regression (LMPI, LKI, and RIRT) demonstrated excellent discrimination, with an AUC of 0.960 (95% CI: 0.924-0.996). The model was well calibrated, and DCA indicated clinical utility. CONCLUSION:Even under well-controlled glycemic conditions, fetal cardiac function is altered in GDM pregnancies. In this cohort, a model based on fetal cardiac function parameters showed good predictive performance for composite adverse perinatal outcomes. However, external validation is required before clinical implementation.

To establish gestational age-specific reference ranges for two new indices, the forehead-anterior cerebral artery angle (FACAA) and forehead-anterior cerebral artery distance (FACAD), and to objectively evaluate their diagnostic effectiveness, measured using Doppler technology with microvascular flow imaging, for identifying holoprosencephaly, even the semilobar and lobar types, in early pregnancy. We evaluated FACAA and FACAD in 462 normal fetuses between 12 and 34 gestational weeks (GW) to generate normative reference ranges. Additionally, we evaluated these two indices in 41 fetuses with holoprosencephaly and 34 fetuses with similar two-dimensional ultrasound features (the study group), including 20 fetuses with agenesis of the corpus callosum and 14 with isolated absent septum pellucidum/septo-optic dysplasia. In the normal group, FACAA was almost stable throughout pregnancy, whereas FACAD increased with GW. All fetuses with holoprosencephaly had both smaller FACAA (13.99–38.00°, ≤5th percentile) and shorter FACAD (1.6–10.5 mm, ≤5th percentile). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and negative likelihood ratio (LR–) of FACAA for the prediction of holoprosencephaly in fetuses with an intracranial malformation were 100

Ultrasound has become the primary modality for fetal central nervous system examination and diagnosing malformations. However, the effectiveness of fetal brain examinations remains highly operator-dependent. Deep learning, a key branch of artificial intelligence (AI), has demonstrated significant advantages in image recognition, proving particularly valuable in medical imaging. Consequently, several studies have proposed the use of deep learning models as tools for fetal brain ultrasound examinations. AI has achieved clinical applications in fetal brain ultrasonography, encompassing standard plane recognition, biometric measurements, structural identification, and malformation diagnosis. This review systematically analyzes the applications of AI in fetal brain ultrasound examination and discusses unmet clinical needs and future development.

Background: A multitude of studies have presented inconsistent outcomes regarding the association between maternal folic acid (FA) and/or multivitamin (MV) supplementation and congenital heart disease (CHD) in offspring. This study aimed to estimate supplementation time and CHD based on a prospective China birth cohort study (CBCS). Methods: In the CBCS, 114,670 singleton pregnant women who had pregnancy outcomes until August 2021 and responded to the early pregnancy questionnaire were recruited. The participants were divided into three groups: no FA or MV supplementation, supplementation commencing before pregnancy, and supplementation commencing from early pregnancy. Unadjusted and adjusted logistic regression analyses were employed to calculate the odds ratio (OR) to estimate the relative risk (RR) value of CHD exposure to FA and/or MV. Additionally, the results of this study were combined with previous studies to calculate the pooled RR. Finally, stratification and sensitivity analyses, including the propensity score matching method, were conducted to identify the robustness of the association. Results: Compared with the non-supplemented group, the RRs of CHD in groups with FA and/or MV supplementation, with supplementation before pregnancy, and with supplementation from early pregnancy were 1.23 (95% confidence interval [CI]: 0.76-2.00), 1.30 (95% CI: 0.80-2.13) and 1.19 (95% CI: 0.73-1.93), all demonstrating no statistically significant difference. The pooled RR from the forest plot was 0.98 (95% CI: 0.95-1.01), which is consistent with the findings of this study. Furthermore, the results remained approximately the same in the stratification or sensitivity analyses in different datasets, including performing 1:1 or 1:2 propensity score matching. Conclusions: The present study suggests that FA or MV supplementation before or during early pregnancy may not influence the risk of offspring developing CHD.

OBJECTIVE:To explore a simple quantitative method for detecting fetal abnormal Sylvian fissure (SF) on ultrasonographic screening and to investigate its value in fetuses with SF abnormalities. METHODS:As the control group, 128 patients were examined prospectively by 2D ultrasound from 22 to 31 gestational weeks. We measured the depth of the SF (SFD) and width of the SF (SFW) and defined a new parameter, namely, the SF ratio (SFR), as the ratio of the SFW to the SFD. Reference equations were constructed for the SF parameters and gestational age (GA). Thirty-eight fetuses with SF abnormalities were included in the study group. RESULTS:In total, 310 ultrasound examinations were performed on 128 patients in the control group. The plateau-like insula was always present, and the SFD, SFW, and SFR increased with increasing gestational weeks between 22 and 31 gestational weeks. SFD (mm) = -1.48GA2-0.02GA+16.81 (R2 = 0.803). SFW (mm) = 5.62GA2-0.08GA-79.34 (R2 = 0.880). SFR = 0.53GA2-0.01GA-6.55 (R2 = 0.619). The SFR was >0.7 from 22 to 24 gestational weeks and >1 after 25 gestational weeks in the control group. In the study group, the SFD, SFW, and SFR values were below the 5th percentile of the respective normal ranges in 26/38 (68.4%), 38/38 (100%), and 38/38 (100%) patients with abnormal SF. There were significant differences in three parameters between the two groups (P<0.05). With respect to the final diagnosis, 30/38 (78.9%) fetuses had malformations of cortical development (MCD), and 8/38 (21.1%) fetuses had multiple CNS malformations. CONCLUSIONS:The SFR was >0.7 from 22-24 gestational weeks, and a value >1 after 25 weeks may serve as a simple parameter for detecting abnormal SF. An abnormal SF tends to be an indicator of CNS anomalies, especially MCD.

Left–right laterality disorders are a heterogeneous group of disorders caused by an altered position or orientation of the thoracic and intra-abdominal organs and vasculature across the left–right axis. They mainly include situs inversus and heterotaxy. Those disorders are complicated by cardiovascular abnormalities significantly more frequently than situs solitus. In this study, 16 patients with a fetal diagnosis of laterality disorder with congenital heart defects (CHD) were evaluated with a single nucleotide polymorphism array (SNP-arry) combined with whole-exome sequencing (WES). Although the diagnostic rate of copy number variations was 0 and the diagnostic rate of WES was 6.3

BACKGROUND:Frontonasal dysplasia (FND) is a rare congenital anomaly resulting from the underdevelopment of the frontonasal process, and it can be syndromic or nonsyndromic. The typical features of FND include a deformed nose and ocular hypertelorism, which are sometimes associated with cleft lip and/or palate. Only approximately 10 cases of prenatally diagnosed nonsyndromic FND have been reported in the past 30 years.CASE PRESENTATION:A 33-year-old woman (G2P1) was referred to our center at 20 gestational weeks for bilateral hydrocephaly. We detected typical features of FND, including severe hypertelorism, median nasal bifidity, a minor cleft lip, and multiple limb anomalies using three-dimensional (3D) ultrasound. A hypoplastic corpus callosum, unilateral microtia, and a ventricular septal defect were also detected. Genetic testing, including karyotype analysis, copy number variation (CNV) analysis, trio-whole exome sequencing (trio-WES), and trio-whole-gene sequencing (trio-WGS), was performed; however, we did not find any de novo gene variants in the fetus as compared to the parents. Postmortem examination confirmed the prenatal diagnosis of FND.CONCLUSION:The present case expands the wide phenotypic spectrum of prenatal FND patients. 3D ultrasound is a useful tool for detecting facial and limb deformities.

BACKGROUND:Posterior fossa malformation (PFM) is a relatively uncommon prenatal brain malformation. Genetic diagnostic approaches, including chromosome karyotyping, copy number variant (CNV) testing, and whole-exome sequencing (WES), have been applied in several cases of fetal structural malformations. However, the clinical value of appropriate genetic diagnostic approaches for different types of PFMs has not been confirmed. Therefore, in this study, we aimed to analyze the value of different combined genetic diagnostic approaches for various types of fetal PFMs. METHODS:This retrospective study was conducted at Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital. Fifty-one pregnant women diagnosed with fetal PFMs who underwent genetic testing in our hospital from January 1, 2017 to December 31, 2022 were enrolled; women with an isolated enlarged cisterna magna were excluded. All participants were categorized into two groups according to the presence of other abnormalities: isolated and non-isolated PFMs groups. Different combined approaches, including karyotype analysis, CNV testing, and trio-based WES, were used for genetic analysis. The detection rates of karyotype analysis, CNV testing, and WES were measured in the isolated and non-isolated groups. RESULTS:In isolated PFMs, pathogenic/likely pathogenic (P/LP) CNVs were detected in four cases (36.36%, 4/11), whereas G-banding karyotyping and WES showed negative results. In non-isolated PFMs, a sequential genetic approach showed a detection rate of 47.5% (19/40); karyotyping revealed aneuploidies in five cases (16.67%, 5/30), CNV testing showed P/LP CNVs in five cases (16.13%, 5/31), and WES identified P/LP variants (in genes CEP20, TMEM67, OFD1, PTPN11, ARID1A, and SMARCA4) in nine cases (40.91%, 9/22). WES showed a detection rate of 83.33% (5/6) in fetuses with Joubert syndrome. Only six patients (five with Blake's pouch cyst and one with unilateral cerebellar hemisphere dysplasia) survived. CONCLUSIONS:We recommend CNV testing for fetuses with isolated PFMs. A sequential genetic approach (karyotyping, CNV testing, and WES) may be beneficial in fetuses with non-isolated PFMs. Particularly, we recommend WES as the first-line genetic diagnostic tool for Joubert syndrome.

Objectives Little study has reported the association of maternal weight gain in early pregnancy with fetal congenital heart disease (CHD). We aimed to explore the potential relationship based on a China birth cohort while adjusting by multiple factors.Design Cohort study.Setting China birth cohort study conducted from 2017 to 2021.Participants The study finally included 114 672 singleton pregnancies in the 6–14 weeks of gestation, without missing data or outliers, loss to follow-up or abnormal conditions other than CHD. The proportion of CHD was 0.65% (749 cases).Primary and secondary outcome measures Association between maternal pre-pregnancy weight gain and CHD in the offspring were analysed by multivariate logistic regression, with the unadjusted, minimally adjusted and maximally adjusted methods, respectively.Results The first-trimester weight gain showed similar discrimination of fetal CHD to that period of maternal body mass index (BMI) change (DeLong tests: p=0.091). Compared with weight gain in the lowest quartile (the weight gain less than 0.0 kg), the highest quartile (over 2.0 kg) was associated with a higher risk of fetal CHD in unadjusted (OR 1.36, 95% CI: 1.08 to 1.72), minimally adjusted (adjusted OR (aOR) 1.29, 95% CI: 1.02 to 1.62) and maximally adjusted (aOR 1.29, 95% CI: 1.02 to 1.63) models. The association remains robust in pregnant women with morning sickness, normal pre-pregnancy BMI, moderate physical activity, college/university level, natural conception or with folic acid (FA) and/or multivitamin supplementation.Conclusions and relevance Although the association of maternal pre-pregnancy weight gain on fetal CHD is weak, the excessive weight gain may be a potential predictor of CHD in the offspring, especially in those with morning sickness and other conditions that are routine in the cohort, such as normal pre-pregnancy BMI, moderate physical activity, college/university level, natural conception or with FA and/or multivitamin supplementation.

BACKGROUND:Blake's pouch cyst (BPC) is a midline cystic anomaly of the posterior fossa. BPC has been shown to have a risk of aneuploidy prenatally. Copy number variation (CNV) and/or genetic syndromes have been reported in a few prenatal/postnatal cases with BPC. The purpose of this study is to determine the additional value of CNV analysis for prenatal diagnosis and prognosis evaluation of BPC. METHODS:We reviewed the sonographic findings and genetic results of BPC diagnosed within 6 years at our center. Patients were classified into the isolated and non-isolated groups based on the prenatal and postnatal imaging. We analyzed the chromosomal abnormalities by conventional karyotype analysis combined with chromosomal microarray analysis (CMA) or CNV sequencing (CNV-seq). RESULTS:We recruited 467 low-risk fetuses as the control group to establish normal references of vermian area and brainstem-vermis (BV) angle. Prenatal/postnatal MRI or neonatal neurosonography was used as diagnostic criteria. 34 patients were diagnosed as BPC, including 21 (61.8%) patients with non-isolated and 13 (38.2%) with isolated. Twenty-two patients underwent CMA/CNV-seq, among them 14 patients were performed both CMA/CNV-seq and karyotype analysis. Seven (7/22, 31.8%) patients with BPC had chromosomal abnormalities, including 3 (3/22, 13.6%) patients with chromosomal aneuploidy - trisomy 21, 18 and 13, and 4 (4/22, 18.2%) patients had pathogenic CNVs located at 3p, 9p, Xp/Xq and 7p. Anomalies in fetal heart (35.3%), central nervous system (CNS) (26.5%) and limb (14.7%) were the three top anomalies accompanying BPC. CONCLUSIONS:CNV analysis could provide some additional information for prenatal diagnosis and prognosis counseling for patients with non-isolated BPC. And, it adds less value for patients with isolated BPC, however, isolated BPC can be a soft marker for aneuploidy.

Limited evidence exists regarding the association between ambient temperature and blood pressure (BP) level of pregnant women. To investigate the associations of ambient temperature with maternal BP and hypertensive disorders of pregnancy (HDP), we studied 105,063 participants in 38 centers of 17 provinces from November 2017 to December 2021. BP was measured with standardized automated digital sphygmomanometers. Ambient temperature was classified into five classes as very hot, moderate hot, mild, moderate cold, and very cold. Generalized linear mixed models were used to investigate the ambient temperature-BP/HDP associations, controlling for multiple covariates. No significant associations of first-trimester ambient temperature with maternal BP and HDP prevalence were observed. Compared with mild temperature, second-trimester very cold and second-trimester moderate cold were statistically associated with the increase of 1.239 mmHg (95% CI: 0.908, 1.569) and 0.428 mmHg (95% CI: 0.099, 0.757) for second-trimester systolic blood pressure (SBP), respectively. Similar trends were also observed in the association between second-trimester cold exposure and second-trimester diastolic blood pressure (DBP), in the association between second-trimester cold exposure and third-trimester SBP/DBP as well as in the association between third-trimester cold exposure and third-trimester SBP/DBP although some estimates were not statistically significant. Furthermore, in the second and third trimester, very cold [second trimester: adjusted odds ratio (aOR) = 1.298; third trimester: aOR = 1.236) and moderate cold (second trimester: aOR = 1.208; third trimester: aOR = 1.146) exposures also increased the odds of HDP, and these associations were stronger among participants aged ≥35 years or from North China. The second and third trimesters are the critical exposure windows for ambient temperature exposure-BP/HDP associations. During this period, exposure to cold ambient temperature was associated with elevated BP as well as increased HDP prevalence among most Chinese pregnant women, those aged ≥35 years or from North China being more vulnerable.

(1) Background: There is no reliable way to assess antenatal fetal pulmonary hypoplasia; however, the biological parameters of the fetal lung can help in evaluating fetal lung development. This study aimed to establish the reference intervals for normal fetal lung biological parameters at 21–40 weeks among the Chinese population. (2) Methods: This was a cross-sectional study of Chinese groups, and included a total of 1388 normal single pregnant women at 21–40 weeks’ gestation. We selected 2134 images of a standard four-chamber view (4CV). ImageJ software (Release 2.14.0) was used to measure the left and right lung areas using a manual tracing method; the elliptic function key was used to measure the fetal thoracic circumference (TC), thoracic area (TA), head circumference (HC), heart area (HA), and abdominal circumference (AC). Based on the above measurements, the following parameters were calculated: lung area to head circumference ratio (LHR), total lung area (TLA), TLA/Weight (mm2/g), cardiothoracic ratio (CTR), lung–thoracic area ratio (TLA/TA), lung–heart area ratio (TLA/HA), TC/AC, and TC/HC. (3) Results: The left and right lung areas and LHRs positively correlated with gestational age (R2 = 0.85, 0.88, 0.66, 0.71, p < 0.001). From 21–40 weeks, the left and right lung areas and TLA increased by about 3.33 times, 3.16 times, and 3.22 times, respectively. The means of left and right LHRs increased by about 1.94 times and 1.84 times, respectively. TLA/Weight (mm2/g) was weakly correlated with gestational age, while CTR, TLA/TA, TLA/HA, TC/AC, and TC/HC had no significant correlation with gestational age. There was no statistically significant difference in fetal lung parameters between different genders of newborns, p > 0.05. (4) Conclusions: Our study establishes the reference intervals for normal Chinese fetal lung biological parameters at 21–40 weeks. Moreover, the reference intervals apply to fetuses of different genders. This paper can provide a reference for the prenatal non-invasive assessment of fetal pulmonary hypoplasia.

BackgroundTo evaluate the role of a standardized first-trimester scan in screening different kinds of central nervous system malformations and to report a 3-year experience from a tertiary center using an unselected cohort.MethodsThis was a retrospective analysis of prospectively collected data from a single center evaluating first-trimester scans with predesigned standardized protocols performed between 1 May 2017 and 1 May 2020, involving 39,526 pregnancies. All pregnant women underwent a series of prenatal ultrasound scans at 11-14, 20-24, 28-34 and 34-38 weeks of gestation. Abnormalities were confirmed by magnetic resonance imaging, postmortem examination or trained ultrasound professionals. Pregnancy outcomes and some postnatal follow-up were obtained from maternity medical records and telephone calls.ResultsA total of 38,586 pregnancies included in the study. The detection rates of CNS anomalies by ultrasound in the first, second, third and late third trimester were 32%, 22%, 25%, and 16%, respectively. And there were 5% of CNS anomalies missed by prenatal ultrasound. In the first-trimester scan, we diagnosed all cases of exencephaly, anencephaly, alobar holoprosencephaly and meningoencephalocele, and some cases of posterior cranial fossa anomalies (20%), open spina bifida (67%), semilobar holoprosencephaly (75%) and severe ventriculomegaly (8%). Vein of Galen aneurysmal malformation, closed spina bifida, lobar holoprosencephaly, intracranial infection, arachnoid cyst, agenesis of the corpus callosum, cysts of the septum pellucidum and isolated absence of the septum pellucidum were never detected during the first trimester. The abortion rates of fetal CNS anomalies detected by first-trimester scan, second-trimester scan, and third- trimester scan were 96%, 84% and 14%, respectively.ConclusionsThe study showed that almost 1/3 of central nervous system anomalies were detected by the standard first-trimester scan and these cases were associated with a high rate of abortion. Early screening for fetal abnormalities gives parents more time for medical advice and safer abortion if needed. It is therefore recommended that some major CNS anomalies should be screened in the first trimester. The standardized anatomical protocol, consisting of four fetal brain planes, were recommended for routine first trimester ultrasound screening.

目的 探讨频谱多普勒超声评价胎盘血管瘤孕妇胎儿血流参数变化的应用价值.资料与方法 回顾性选择2015年9月—2018 年 12 月首都医科大学附属北京妇产医院病理确诊胎盘血管瘤孕妇胎儿 15 例(胎盘血管瘤组)及正常胎儿 91 例(对照组),孕龄 28～40 周,比较两组左心室心肌做功指数(MPI)、二、三尖瓣口E/A值、脐动脉、大脑中动脉和静脉导管多普勒参数及围生结局,并分析MPI与妊娠结局的相关性.结果 与对照组比较,胎盘血管瘤组胎儿左心室MPI[(0.44±0.05)ms比(0.47±0.06)ms;t=2.156,P＜0.05]、二、三尖瓣口E/A值显著增高(0.69±0.11比0.75±0.16,0.71±0.10比0.76±0.14;t=1.988、1.764,P均＜0.05),脐动脉搏动指数显著降低(0.88±0.12比0.78±0.15;t=-3.143,P＜0.05),大脑中动脉搏动指数及静脉导管搏动指数差异无统计学意义(P均＞0.05).与对照组比较,胎盘血管瘤组新生儿出生孕龄、身高及体重降低(P均＜0.05),胎盘血管瘤组左心室MPI每升高0.1,新生儿转ICU风险增加的比值比为10.754(95%CI 2.354～49.140).结论 胎盘血管瘤组胎儿心功能受损,左心室MPI与不良结局具有相关性.多普勒超声能够为早期监测宫内状况提供依据.

肝脏肿瘤约占围产期胎儿肿瘤的 5％;肝血管瘤约占 60％,是最常见先天性良性肿瘤,而肝母细胞瘤则为最常见先天性恶性肿瘤[1].本研究主要观察胎儿肝脏肿瘤超声表现.

目的 探讨频谱多普勒超声评估前置胎盘胎儿心功能的价值.方法 选择临床确诊前置胎盘孕妇 89 例(前置胎盘组)和健康孕妇 89 例(对照组),孕周 28～40 周,比较两组胎儿左心室的等容舒张时间(IRT)、等容收缩时间(ICT)、射血时间(ET)及心肌做功指数 MPI;二三尖瓣口 E/A值及围生结局.结果 与对照组相比,前置胎盘组LV-MPI、IRT显著增高(P＜0.01);前置胎盘组ICT、ET及二三尖瓣E/A值无显著性差异(P＞0.05).前置胎盘组胎儿 LV-MPI预测不良结局 ROC曲线下面积为 0.66(95%置信区间为 0.58～0.74,P＜0.001).结论 前置胎盘孕妇胎儿心功能降低,左心室 MPI 在一定程度上与不良结局显著相关,从而为早期监测宫内状况提供依据.

Blake′s陷窝囊肿属于颅后窝的中线囊性病变，可孤立存在，也可合并其他严重畸形，其预后与合并的畸形及是否存在染色体异常有关。Blake′s陷窝囊肿的产前与产后诊断存在不一致性，笔者从Blake′s陷窝囊肿的胚胎发育、产前超声诊断及鉴别诊断、遗传与预后等方面进行综述，以期提高对该病的产前诊断水平。

Background: Little evidence exists regarding the combined effect between ambient temperature and air pollution expo-sure on maternal blood pressure (BP) and hypertensive disorders of pregnancy (HDP).Objectives: To assess effect modification by temperature exposure on the PM1-BP/HDP associations among Chinese pregnant women based on a nationwide study. Methods: We conducted a cross-sectional country-based population study in China, enrolling 86,005 participants from November 2017 to December 2021. BP was measured with standardized sphygmomanometers. HDP was defined ac-cording to the American College of Obstetricians and Gynecologists' recommendations. Daily temperature data were obtained from the European Centre for Medium-Range Weather Forecasts. PM1 concentrations were evaluated using generalized additive model. Generalized linear mixed models were used to examine the health effects, control-ling for multiple covariates. We also performed a series of stratified and sensitivity analyses.Results: The pro-hypertensive effect of PM1 was observed in the first trimester. Cold exposure amplifies the first trimester PM1-BP/HDP associations, with adjusted estimate (a & beta;) for systolic blood pressure (SBP) of 3.038 (95 % CI: 2.320-3.755), a & beta; for diastolic blood pressure (DBP) of 2.189 (95 % CI: 1.503-2.875), and aOR for HDP of 1.392 (95 % CI: 1.160-1.670). Pregnant women who were educated longer than 17 years or living in urban areas appeared to be more vulnerable to the modification in the first trimester. These findings remained robust after sensitivity analyses.Conclusions: First trimester maybe the critical exposure window for the PM1-BP/HDP associations among Chinese preg-nant women. Cold exposure amplifies the associations, and those with higher education level or living in urban areas appeared to be more vulnerable.