OBJECTIVE:To investigate whether prophylactic tranexamic acid reduces the incidence of postpartum haemorrhage in women with placenta praevia compared with placebo. DESIGN:Randomised, double blind, placebo controlled, phase 3 study. SETTING:24 maternity units across China between July 2023 and March 2025. PARTICIPANTS:1732 women with placenta praevia undergoing caesarean delivery. INTERVENTIONS:Participants were randomly (1:1) assigned to receive prophylactic oxytocin and either tranexamic acid (1 g in 10 mL) or placebo (10 mL normal saline) diluted in 40 mL normal saline intravenously over 10 minutes, initiated within five minutes of umbilical cord clamping. MAIN OUTCOME MEASURES:The primary outcome was postpartum haemorrhage, defined as calculated estimated blood loss ≥1000 mL or as red cell transfusion within two days after delivery. Serious adverse events included thromboembolic events, seizures, acute kidney or liver injury, and maternal death. RESULTS:Of 1732 women with placenta praevia who were randomised, 38 were excluded because they withdrew consent or were determined to be ineligible after randomisation. Primary outcome data were available for 99.8% (1691/1694) of the remaining women. Placenta accreta spectrum was diagnosed in 303 participants (17.9%). The primary outcome occurred in 29.7% (251/845) of the tranexamic acid group and 35.1% (297/846) of the placebo group (relative risk 0.85, 95.2% confidence interval (CI) 0.75 to 0.96; P=0.01). The rates of serious adverse events were similar between the tranexamic acid group and placebo group (0.5% (4 of 837) v 0.5% (4 of 845); relative risk 1.01, 95% CI 0.25 to 4.00). CONCLUSIONS:In women with placenta praevia who underwent caesarean delivery and received prophylactic oxytocin, treatment with tranexamic acid resulted in a statistically significant yet modest reduction in the incidence of postpartum haemorrhage, with no signal of increased serious adverse events. TRIAL REGISTRATION:ClinicalTrials.gov NCT05811676.

Importance:More than one-half of infants younger than 6 months worldwide are partially or exclusively bottle fed. Compared with teat-vented bottles, bottom-vented bottles may reduce air ingestion during feeding, thereby mitigating gastrointestinal discomfort. Objective:To evaluate the effectiveness of bottom-vented bottles vs teat-vented bottles in improving infant gastrointestinal function. Design, Setting, and Participants:This multicenter randomized clinical trial was conducted from September 2024 to January 2025 at 5 maternal and child health care hospitals in China. Infants aged 0 to 90 days were enrolled. Interventions:Infants were fed breast milk or formula for 14 days using bottom-vented or teat-vented bottles. Main Outcomes and Measures:The primary outcome was mild gastrointestinal discomfort (MGD) at week 2, defined as an Infant Gastrointestinal Symptom Questionnaire (IGSQ) score greater than 23 (range, 13-65). Secondary outcomes included MGD at week 1, weight change from baseline to day 14, IGSQ score, colic, and maternal postpartum anxiety or depression at week 2. Post hoc outcomes included flatulence and crying during and/or after feeding. For the primary outcome, mixed-effects log-binomial regression models were used to estimate relative risks (RRs) with 95% CIs. Results:A total of 1055 infants aged 0 to 90 days were enrolled and randomized to bottom-vented (527 infants) or teat-vented (528 infants) groups. Of 1041 infants in the modified intention-to-treat analysis (mean [SD] age, 25.4 [24.9] days; 575 males [55.2%]), 521 infants in the bottom-vented group did not have a significantly lower MGD prevalence at week 2 than the 520 infants in the teat-vented group (185 infants [35.5%] vs 197 infants [37.9%]; RR, 0.94; 95% CI, 0.80-1.10; P = .44). Similar results were observed for MGD prevalence at week 1. A post hoc subgroup analysis showed a significantly lower MGD prevalence with bottom-vented bottles among infants aged 61 to 90 days (15 infants [21.1%] vs 24 infants [47.1%]; RR, 0.45; 95% CI, 0.26-0.77), but not among younger infants (P = .009 for interaction). Furthermore, bottom-vented group had a lower risk of crying during and/or after feeding (168 infants [32.2%] vs 212 infants [40.8%]; RR, 0.79; 95% CI, 0.67-0.92; P = .003). No significant between-group differences were observed for other secondary outcomes. Conclusions and Relevance:In this randomized clinical trial of feeding bottles with different venting methods, bottom-vented compared with teat-vented bottles did not result in a significant reduction in MGD prevalence among infants aged 0 to 90 days. However, a significant reduction was observed among infants aged 61 to 90 days in an exploratory post hoc analysis, which warrants future confirmation. Trial Registration:Chinese Clinical Trial Registry Identifier: ChiCTR2400090082.

What is already known about this topic?:Intraocular pressure (IOP) is essential for ocular homeostasis and glaucoma prevention. However, its developmental patterns and associations with refractive errors in children remain incompletely understood. What is added by this report?:This study identifies a biphasic IOP trajectory peaking in grade 6 (approximately age 12 years) (18.2±2.9 mmHg) and a pubertal reversal in sexual dimorphism, with higher IOP in prepubertal girls vs. in boys from grade 10 onward, significant by grade 12 [mean difference -0.5 mmHg; 95% confidence interval (CI): -0.9, -0.1], while challenging uniform IOP-myopia causality through grade-stratified analyses. What are the implications for public health practice?:Findings support the implementation of grade- and sex-specific pediatric IOP monitoring to improve targeted prevention of pediatric glaucoma and promote overall ocular health. They also underscore the need for further research on IOP dynamics to better inform myopia management strategies.

QuestionDo bottom-vented bottles reduce the risk of mild gastrointestinal discomfort (MGD) in infants compared with teat-vented bottles?FindingsIn this randomized clinical trial of 1055 infants aged 0 to 90 days, MGD prevalence at week 2 was not significantly different between the bottom-vented group (35.5%) and the teat-vented group (37.9%). However, an exploratory post hoc subgroup analysis suggested a potential benefit in infants aged 61 to 90 days, with a significantly lower prevalence in the bottom-vented group (21.1% vs 47.1%).MeaningThese findings suggest potential benefits of bottom-vented bottles for decreasing the risk of MGD in infants older than 60 days. This randomized clinical trial evaluates the effectiveness of bottom-vented bottles vs teat-vented bottles in improving infant gastrointestinal function. ImportanceMore than one-half of infants younger than 6 months worldwide are partially or exclusively bottle fed. Compared with teat-vented bottles, bottom-vented bottles may reduce air ingestion during feeding, thereby mitigating gastrointestinal discomfort.ObjectiveTo evaluate the effectiveness of bottom-vented bottles vs teat-vented bottles in improving infant gastrointestinal function.Design, Setting, and ParticipantsThis multicenter randomized clinical trial was conducted from September 2024 to January 2025 at 5 maternal and child health care hospitals in China. Infants aged 0 to 90 days were enrolled.InterventionsInfants were fed breast milk or formula for 14 days using bottom-vented or teat-vented bottles.Main Outcomes and MeasuresThe primary outcome was mild gastrointestinal discomfort (MGD) at week 2, defined as an Infant Gastrointestinal Symptom Questionnaire (IGSQ) score greater than 23 (range, 13-65). Secondary outcomes included MGD at week 1, weight change from baseline to day 14, IGSQ score, colic, and maternal postpartum anxiety or depression at week 2. Post hoc outcomes included flatulence and crying during and/or after feeding. For the primary outcome, mixed-effects log-binomial regression models were used to estimate relative risks (RRs) with 95% CIs.ResultsA total of 1055 infants aged 0 to 90 days were enrolled and randomized to bottom-vented (527 infants) or teat-vented (528 infants) groups. Of 1041 infants in the modified intention-to-treat analysis (mean [SD] age, 25.4 [24.9] days; 575 males [55.2%]), 521 infants in the bottom-vented group did not have a significantly lower MGD prevalence at week 2 than the 520 infants in the teat-vented group (185 infants [35.5%] vs 197 infants [37.9%]; RR, 0.94; 95% CI, 0.80-1.10; P = .44). Similar results were observed for MGD prevalence at week 1. A post hoc subgroup analysis showed a significantly lower MGD prevalence with bottom-vented bottles among infants aged 61 to 90 days (15 infants [21.1%] vs 24 infants [47.1%]; RR, 0.45; 95% CI, 0.26-0.77), but not among younger infants (P = .009 for interaction). Furthermore, bottom-vented group had a lower risk of crying during and/or after feeding (168 infants [32.2%] vs 212 infants [40.8%]; RR, 0.79; 95% CI, 0.67-0.92; P = .003). No significant between-group differences were observed for other secondary outcomes.Conclusions and RelevanceIn this randomized clinical trial of feeding bottles with different venting methods, bottom-vented compared with teat-vented bottles did not result in a significant reduction in MGD prevalence among infants aged 0 to 90 days. However, a significant reduction was observed among infants aged 61 to 90 days in an exploratory post hoc analysis, which warrants future confirmation.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2400090082

OBJECTIVE:To describe the myopia prevalence and spherical equivalent among primary school students in a district of Anhui Province in 2019, to analyze their changes in 2020 and 2024, to obtain baseline data, and to explore the potential impact of changes in screen time on vision, providing scientific evidence for myopia prevention and control strategies. METHODS:This cross-sectional study included all the primary school students who underwent vision screening in 2019 (baseline period), 2020 (period of increased screen time), and 2024 (period of slightly resumed screen time). Data on grade, gender, uncorrected distance visual acuity, and refraction were extracted from the screening database. Noncycloplegic refraction was assessed using an FKR-710 autorefractor to measure sphere and cylinder, and uncorrected distance visual acuity was assessed using an K238-AZ LCD visual acuity chart. The spherical equivalent was calculated as sphere + 0.5 × cylinder. Myopia was defined as uncorrected distance visual acuity < 5.0 in either eye with a corresponding spherical equivalent ≤ -0.50 D. Myopia prevalence and spherical equivalent were described using percentage and mean with 95%confidence interval (CI). The Chi-square test and One-way analysis of variance were used to compare myopia prevalence and spherical equivalent across different years, followed by stratified analysis by grade. RESULTS:A total of 183 204 students were screened: 45 294 in 2019, 52 922 in 2020, and 84 988 in 2024. In 2019, the myopia prevalence was 30.8%(95%CI: 30.4%, 31.2%), higher in girls (33.7%) than in boys (28.4%) and increased with grade (P < 0.001), rising from 11.0%in Grade 1 to 35.7%in Grades 2-6. Compared with 2019, the myopia prevalence in 2020 increased by 4.3 (3.7, 4.9) percentage points to 35.1%(P < 0.001). By 2024, it further increased by 6.7 (6.2, 7.2) percentage points from the 2020 level to 41.8%(P < 0.001). In grade-stratified analyses, compared with 2019, Grade 1 students showed the largest increase in 2020; compared with 2020, Grade 1 students showed the smallest subsequent increase in 2024. Quantitative analysis of spherical equivalent showed that the mean spherical equivalent in 2020 was -0.72 D, representing a myopia shift of -0.21 D (-0.23 D, -0.19 D) compared with the 2019 level (P < 0.001); by 2024, the mean spherical equivalent was -0.68 D, indicating a hyperopic shift of 0.04 D (0.02 D, 0.06 D) compared with the 2020 level (P < 0.001). Further grade-stratified analyses indicated that the mean spherical equivalent for Grade 1 students in 2024 (0.08 D) had nearly returned to the 2019 level (0.09 D). CONCLUSION:The myopia prevalence among primary school students in the study area was 30.8%in 2019, higher than the global level and approximately twice that of the United States and four times that of Germany, indicating that myopia prevention and control among primary school students remains challenging. The myopia prevalence in 2020 and 2024 was higher than in 2019, suggesting that lifestyle changes, such as increased screen time, affect the short-term visual status. Younger students experienced the greatest increase in myopia prevalence in 2020 and the mildest subsequent increased in 2024, and their spherical equivalent in 2024 had almost recovered to the 2019 level, but not for older students. These findings indicate greater ocular plasticity in younger students, i.e. more sensitive to negative exposures and easier to recover after removing such exposures, warranting further investigation on the underlying mechanisms. Additionally, patterns of higher myopia prevalence in girls than in boys and a gradual increase with grade support previous studies, also enhancing the reliability of the relevant results in our study.

Background: Experimental studies indicated that maternal choline and betaine status have the potential to alter fetal growth, but epidemiological data remain sparse. Objective: We aimed to investigate the association of maternal and cord blood choline and betaine concentrations with birthweight outcomes. Methods: This prospective cohort study involved 988 mother-infant dyads from Hebei and Shandong provinces. Plasma concentrations of choline and betaine in maternal late pregnancy and cord blood were quantified using ultra-performance liquid chromatography-mass spectrometry. Multivariable linear or logistic regression was performed to examine their association with continuous or binary birthweight outcomes. Results: Maternal plasma choline and betaine concentrations in late pregnancy (median [interquartile range]; 12.34 [10.13, 14.78] and 14.99 [12.01, 18.36] μmol/L) were significantly lower than those in cord blood (29.98 [24.74, 35.93] and 31.14 [25.56, 37.28] μmol/L). Each 1 μmol/L increase of late-pregnancy and cord blood betaine concentrations were associated with 9.87 g (95% confidence interval [CI]: -16.08, -3.66 g) and 5.29 g (95% CI: -8.52, -2.06 g) lower birthweight, respectively. Compared with the lowest quintile, the highest quintiles of late-pregnancy and cord blood betaine concentrations were associated with lower risks of large-for-gestational-age (adjusted odds ratios [ORs] = 0.47 [95% CI: 0.24, 0.90] and 0.31 [95% CI: 0.17, 0.56]) and macrosomia (adjusted ORs = 0.12 [95% CI: 0.03, 0.43] and 0.15 [95% CI: 0.05, 0.40]). These associations, particularly for cord blood, persisted and appeared more pronounced in pregnancies with maternal overweight/obesity or gestational diabetes mellitus (GDM), but the interaction effect did not reach statistical significance. No significant associations were observed for choline in any periods. Conclusions: Higher plasma concentrations of betaine in maternal late-pregnancy and cord blood were associated with lower birthweight. These findings emphasize the importance of sufficient betaine status during pregnancy, especially among mothers with obesity or GDM.

BACKGROUND:Both low and high haemoglobin (Hb) concentrations associate with increased risks of adverse pregnancy outcomes, with the optimal Hb concentrations remaining elusive. OBJECTIVES:This study investigated the associations between Hb concentrations and maternal/neonatal outcomes and determined optimal Hb ranges during the second and third trimesters. METHODS:Retrospectively, data from 41,956 singleton live births delivered at Fuyang Women and Children's Hospital, a tertiary hospital in China, from 2018 to 2023, were analysed. Poisson regression with restricted cubic splines was employed to associate Hb concentrations with maternal (gestational diabetes mellitus [GDM], preeclampsia, and postpartum haemorrhage [PPH]) and neonatal outcomes (preterm birth [PTB], small for gestational age [SGA] birth, and neonatal asphyxia), applying generalised estimating equations to account for repeated measures. Optimal Hb ranges were determined using interquartile ranges from a low-risk subgroup and thresholds identified via the combined risk curve method, incorporating PPH and neonatal outcomes. RESULTS:A total of 120,263 Hb measurements were analysed. U-shaped relationships emerged between Hb concentration and preeclampsia, PPH, PTB, SGA and neonatal asphyxia, whereas that with GDM was nearly linear. These patterns were consistent in both the second and third trimesters. The optimal ranges of 10.6-11.8 and 10.7-12.1 g/dL were identified by the low-risk subgroup approach for the second and third trimesters, respectively, whereas those by the combined risk curve method yielded slightly broader ranges of 9.6-11.7 g/dL and 9.9-12.0 g/dL, respectively. CONCLUSIONS:The findings of this study reveal U-shaped relationships between maternal Hb concentrations and maternal/neonatal outcomes, with 10.5-12.5 g/dL as the optimal Hb concentration during the second and third trimesters, considering combined risks and clinical feasibility. Future multicentre studies are warranted to validate these ranges in broader populations.

OBJECTIVE:To examine during cesarean delivery the effects of delayed umbilical cord clamping at different timings vs early clamping in regard to neonatal hemoglobin levels and maternal blood loss. STUDY DESIGN:In total, 359 pregnant women scheduled for term cesarean delivery at 2 hospitals were randomly assigned to 4 groups: early clamping (<15 seconds; control) or delayed by 30 seconds, 60 seconds, or 90 seconds. Primary outcomes were neonatal hemoglobin levels within 72 hours after delivery; and the change in maternal hemoglobin levels before and after delivery, an indicator of blood loss, with a prespecified noninferiority margin of -0.87 g/dL. The secondary and exploratory outcomes included neonatal hyperbilirubinemia and polycythemia. RESULTS:Overall adherence to the assigned interventions was 96.1%. Compared with controls, all delayed groups showed significantly higher neonatal hemoglobin levels, with mean differences (95% CI) of 1.17 (0.53-1.80), 0.89 (0.25-1.54), and 1.11 (0.47-1.76) g/dL in groups delayed for 30 seconds, 60 seconds, and 90 seconds, respectively. In regard to the change in maternal hemoglobin levels, lower limits of the 95% CIs for the differences between delayed groups and controls were all higher than the margin (-0.48, -0.11, and -0.37 g/dL, respectively). Secondary and exploratory outcomes did not show any substantial difference across groups. CONCLUSIONS:For term elective cesarean delivery, cord clamping delayed by 30 seconds, 60 seconds, or 90 seconds vs early clamping led to similar increases in neonatal hemoglobin, and was not worse in terms of maternal blood loss. REGISTRATION SITE:ClinicalTrials.gov (NCT05492214; https://clinicaltrials.gov/).

Objective:Data on homocysteine (Hcy) status and its determinants are limited among women during pregnancy and postpartum. This cross-sectional study aimed to investigate Hcy levels during pregnancy and postpartum, and to explore the determinants like geographic factor. Methods:This study was conducted in women at mid-pregnancy, late-pregnancy and postpartum from southern, central and northern China. Approximately 132 women were included in each stratum by the three phases and regions. Plasma Hcy concentrations were assessed using high-performance liquid chromatography (HPLC), with hyperhomocysteinemia defined as > 10.0 µmol/L. Quantile regression was to estimate medians and interquartile ranges ( IQRs), and logistic regression to examine the determinants of hyperhomocysteinemia. Results:For 1,190 women included, the median (IQR) Hcy concentration was 5.66 (4.62, 7.37) μmol/L. The adjusted median in mid-pregnancy, late-pregnancy and postpartum women was 4.75 (4.13, 5.54), 5.72 (4.81, 6.85) and 7.09 (5.65, 8.75) μmol/L, respectively, showing an increasing trend ( P < 0.001). This increasing trend persisted across the three regions. Higher Hcy concentrations were observed in women residing in northern region and those with younger age or lower economic status. A total of 106 (8.9%) women had hyperhomocysteinemia, with a higher prevalence in those residing in northern region (16.0%), or in postpartum women (16.5%). Conclusion:Hcy levels, varying with geographic region, maternal age and economic status, are increased from mid-pregnancy to late-pregnancy and postpartum, indicating a need to monitor Hcy levels in pregnant and postpartum women to control potential risks related to elevated Hcy levels.

Introduction:Non-cycloplegic refraction is widely utilized in vision screening. However, interpreting non-cycloplegic refraction results remains a significant challenge in both clinical practice and public health settings. This study aimed to establish grade- and sex-specific reference values for non-cycloplegic spherical equivalent (SE) to enhance myopia screening and risk prediction among Chinese students. Methods:A comprehensive study was conducted between 2020 and 2024, involving 67,260 students from kindergarten through high school across 10 provincial-level administrative divisions (PLADs) in China. The Lambda-Mu-Sigma method was employed to model non-cycloplegic SE. Reference values were established by calculating SE centiles corresponding to myopia and high myopia prevalence across grades 0 through 12. Results:Among boys, the estimated prevalence of myopia and high myopia increased from 1.2% and <0.1% in grade 0 (senior kindergarten) to 82.4% and 11.6% in grade 12 (third year of high school), respectively. For twelfth-grade boys, the 82.4th and 11.6th percentiles of SE (-0.99 D and -6.16 D) were established as reference values for screening myopia and high myopia, respectively. The corresponding percentiles in lower grades served as predictive reference values for grade 12 outcomes. For instance, a grade-0 boy with non-cycloplegic SE>0.70 D (82.4th percentile) was predicted to remain free of myopia before grade 12. Similarly, SE>-0.73 D (11.6th percentile) indicated a low likelihood of developing high myopia before grade 12. Conclusions:This study established comprehensive non-cycloplegic SE reference values for screening and predicting myopia among Chinese students. The methodology developed here may be applicable to other regions where student myopia prevalence patterns demonstrate relative stability.

Objective: To evaluate the effectiveness of prophylactic tranexamic acid in reducing postpartum hemorrhage (PPH) in high-risk populations, specifically pregnant women with placenta previa, by conducting multicenter randomized controlled trials with sufficient statistical power, in order to establish high-quality evidence for its widespread use in PPH prevention. Methods: This multicenter randomized, double-blind, placeto-controlled trial with two parallel groups will enroll 1680 patients undergoing cesarean delivery with placenta previa. Participants will be randomly assigned to receive either tranexamic acid (1 g) or placebo intravenously immediately after birth. The primary outcome will be the incidence of PPH, defined as a calculated estimated blood loss exceeding 1000 mL or the need for red blood cell transfusion before postpartum day 2. With 80% statistical power, this study aims to detect a 20% reduction in the incidence of PPH, from 33.0% to 26.4%. Discussion: Tranexamic acid is a cost-effective and easily accessible medication that shows promise in reducing the risk of PPH during cesarean delivery in high-risk patients, such as those with placenta previa. This large-scale, adequately powered, multicenter randomized placebo-controlled trial is designed to determine whether the routine prophylactic use of tranexamic acid during cesarean delivery in patients with placenta previa will offer clinical benefits that outweigh the associated risks. Trial registration: ClinicalTrials.gov NCT05811676 (March 15, 2023).

Background: Folic acid supplementation (FAS) before and in early pregnancy prevents neural tube defects, but the benefits of extending FAS to late pregnancy on pregnancy outcomes remain unclear. We aimed to investigate the associations between duration of FAS and a spectrum of pregnancy outcomes, and to determine whether the associations were modified by maternal age or pre-pregnancy body mass index (BMI). Methods: This prospective multicenter study included 15,694 singleton pregnancies. We used mixed-effects log-binomial regression models to estimate the adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for gestational diabetes mellitus (GDM), gestational hypertensive disorders (GHDs), pre-eclampsia, preterm birth, macrosomia, small (SGA) and large for gestational age (LGA), and the interaction effects of advanced maternal age and pre-pregnancy BMI. Results: Of 15,694 women, 4523 (28.8%) did not take FAS before or during pregnancy, 2854 (18.2%) took FAS only during peri-pregnancy, 921 (5.9%) took FAS from peri- to mid-pregnancy, and 7396 (47.1%) took it through late pregnancy. Compared with women without FAS, those supplemented until mid-pregnancy were associated with lower risks of GHDs (aRR 0.84, 95% CI 0.74, 0.96) and pre-eclampsia (aRR 0.81, 95% CI 0.67, 0.97). Supplementation until late pregnancy was associated with lower risks of preterm birth (aRR 0.67, 95% CI 0.59, 0.76), SGA (aRR 0.74, 95% CI 0.63, 0.87), and LGA (aRR 0.88, 95% CI 0.79, 0.97). Among women of advanced maternal age or with overweight/obesity, supplementation until mid-pregnancy was associated with higher risk of GDM. Conclusions: Extending FAS until mid-pregnancy is associated with lower risks of GHDs and preeclampsia, and extending it until late pregnancy is associated with lower risks of preterm birth, SGA, and LGA. However, women of advanced maternal age or with overweight/obesity should be cautious about prolonging FAS.

CONTEXT:Gestational weight gain (GWG) is known to be a risk factor for offspring obesity, a precursor of cardiometabolic diseases. Accumulating studies have investigated the association of GWG with offspring cardiometabolic risk factors (CRFs), leading to inconsistent results. OBJECTIVE:This study synthesized available data from cohort studies to examine the effects of GWG on offspring CRFs. DATA SOURCE:Four electronic databases, including PubMed, Web of Science, Scopus, and Embase, were searched through May 2023. DATA EXTRACTION:Cohort studies evaluating the association between GWG and CRFs (fat mass [FM], body fat percentage [BF%], waist circumference [WC], systolic blood pressure [SBP] and diastolic blood pressure, high-density-lipoprotein cholesterol [HDL-C] and low-density-lipoprotein cholesterol, triglyceride [TG], total cholesterol, fasting blood glucose, and fasting insulin levels) were included. Regression coefficients, means or mean differences with 95% confidence intervals [CIs], or standard deviations were extracted. DATA ANALYSIS:Thirty-three cohort studies were included in the meta-analysis. Higher GWG (per increase of 1 kg) was associated with greater offspring FM (0.041 kg; 95% CI, 0.016 to 0.067), BF% (0.145%; 95% CI, 0.116 to 0.174), WC (0.154 cm; 95% CI, 0.036 to 0.272), SBP (0.040 mmHg; 95% CI, 0.010 to 0.070), and TG (0.004 mmol/L; 95% CI, 0.001 to 0.007), and with lower HDL-C (-0.002 mmol/L; 95% CI, -0.004 to 0.000). Consistently, excessive GWG was associated with higher offspring FM, BF%, WC, and insulin, and inadequate GWG was associated with lower BF%, low-density lipoprotein cholesterol, total cholesterol, and TG, compared with adequate GWG. Most associations went non-significant or attenuated with adjustment for offspring body mass index or FM. CONCLUSIONS:Higher maternal GWG is associated with increased offspring adiposity, SBP, TG, and insulin and decreased HDL-C in offspring, warranting a need to control GWG and to screen for cardiometabolic abnormalities of offspring born to mothers with excessive GWG. SYSTEMATIC REVIEW REGISTRATION:PROSPERO registration no. CRD42023412098.

An adequate choline intake is essential for infant health. Choline profiles in human milk, critical for setting adequate intake levels and developing infant formulas, varied markedly across studies. This study aimed to systematically review and analyze choline concentrations and compositions in human milk and explore influencing factors. PubMed, Embase, Web of Science, Scopus, and CNKI were searched through August 16, 2025, for studies reporting total choline (TC) or water-soluble choline (WSC) concentrations in milk from healthy mothers within six months postpartum. Three-level meta-analytic models were used. Seventeen studies involving 1747 women were included. The primary analysis of seven studies reporting both TC and WSC showed a pooled TC concentration of 126.2 mg/L (95% CI: 103.7, 148.7), with WSC accounting for 83.3% (76.1%, 90.6%). The secondary analysis included ten additional studies reporting only WSC, estimating TC at 134.2 mg/L (122.6, 145.8), consistent with the primary analysis (p = 0.507). Across all studies, TC significantly increased from 71.5 mg/L in colostrum to 152.2 mg/L in transitional milk, then stabilized at 145.0 mg/L in mature milk. Although TC concentrations varied by assay methods and geographic regions, economic levels of countries demonstrated a significant influence. These findings could provide guidance for infant feeding.

Objectives: We aim to establish a predictive model for recurrent preeclampsia. Methods: A retrospective review of medical records from three hospitals between 2010 and 2021 was conducted. The study included women who had two consecutive singleton deliveries at the same hospital, with the first delivery complicated by preeclampsia. A multivariable logistic regression model was constructed using a training cohort, and subsequently cross-validated and tested using an independent cohort. The model's performance was assessed in terms of discrimination and calibration, and its clinical utility was evaluated using decision curve analysis (DCA). Results: Among 296 405 deliveries, 694 women met the inclusion criteria, with 151 (21.8%) experiencing recurrent preeclampsia. The predictive model incorporated 10 risk factors from previous preeclampsia, including gestational weeks with elevated blood pressure, gestational diabetes mellitus (GDM), pericardial effusion, heart failure, limb edema, serum creatinine, white blood cell count, low platelet counts within one week before delivery, SBP on the first postpartum day, and postpartum antihypertensive use. Additionally, one risk factor from the index pregnancy was included, which was antihypertensive use before 20 weeks. The model demonstrated better discrimination, calibration, and a net benefit across a wide range of recurrent preeclampsia risk thresholds. Furthermore, the model has been translated into a clinical risk calculator, enabling clinicians to calculate individualized risks of recurrent preeclampsia. Conclusion: Our study demonstrates that a predictive tool utilizing routine clinical and laboratory factors can accurately estimate the risk of recurrent preeclampsia. This predictive model has the potential to facilitate shared decision-making by providing personalized and risk-stratified care.

Objective: Compare the clinical severity of second preeclampsia with the first preeclampsia. Methods: This retrospective longitudinal cohort study was conducted in three teaching hospitals in Guangzhou, where there were a total of 296 405 deliveries between 2010 and 2021. Two consecutive singleton deliveries complicated with preeclampsia were included. Clinical features, laboratory results within 1 week before delivery, and maternal and neonatal outcomes of both deliveries were collected. Univariate analyses were made using paired Wilcoxon tests and McNemar tests. Multivariable logistic regression and generalized linear models were performed to assess the association of adverse maternal and neonatal outcomes with second preeclampsia. Results: A total of 151 women were included in the study. The mean maternal age was 28 and 33 years for the first and second deliveries, respectively. The proportion of preventive acetylsalicylic acid use was 4.6% for the first delivery and 15.2% for the second delivery. No significant differences were observed in terms of blood pressure on admission, gestational weeks of admission and delivery, application of perinatal antihypertensive agents, rates of preterm delivery, and severe features between the two occurrences. However, the rates of heart disease, edema, and admission to the ICU were lower, and hospital stays were shorter in the second preeclampsia compared with the first preeclampsia. Sensitivity analysis conducted among women who did not use preventive acetylsalicylic acid yielded similar results. After adjusting for potential confounding variables, the occurrence of second preeclampsia was associated with significantly decreased risks of heart disease, edema, complications, and admission to the NICU, with odds ratios ranging between 0.157 and 0.336. Conclusion: Contrary to expectations, the second preeclampsia did not exhibit worse manifestations or outcomes to the first occurrence. In fact, some clinical features and outcomes appeared to be better in the second preeclampsia.

Fetal growth monitoring is important for twin pregnancies. However, there has been no clinically validated tool for monitoring fetal growth of twin pregnancies in China. This study aims to develop and validate a chorionicity-specific growth chart of ultrasound estimated fetal weight (EFW) for Chinese twin pregnancies. This retrospective cohort study included all twin pregnancies who delivered two live fetuses with gestational age ≥ 34 weeks without severe obstetric complications at a tertiary hospital from January 2007 to March 2021. The participants were divided into a development set (delivered in or before December 2017) and a validation set (delivered in or after January 2018). Chorionicity-specific growth charts were created using the generalized additive models for location, scale, and shape (GAMLSS) based on the development set. The fetuses from the validation set were classified into three groups based on the last EFW: small-for-gestational-age (SGA) indicated by both the newly established twin charts and the Hadlock singleton chart currently used for twin pregnancies in China, suspected SGA indicated by only the singleton chart, and no SGA indicated by either chart. The incidence of neonatal outcomes among the three groups was then compared accordingly, including intensive care unit (NICU) stay length, respiratory diseases, and neurological disorders. The development set included 883 twin pregnancies and a total of 6374 EFW measurements between 16 and 38 weeks of gestation, and the validation set included 801 twin pregnancies and 7630 EFW measurements. In the development set, monochorionic diamniotic (MCDA) twins had a significantly lower EFW compared to dichorionic diamniotic (DCDA) twins beginning at 26 weeks, with the difference gradually increasing thereafter, supporting the establishment of chorionicity-specific growth charts. Of the 1,602 twin neonates in the validation set, 103 (6.4

BACKGROUND AND AIMS:Evidence on the association of maternal obesity with offspring cardiometabolic health is limited, particularly for the Asian population. We aimed to examine the associations of maternal body mass index (BMI) in early pregnancy and gestational weight gain (GWG) rate in mid- and late-pregnancy with childhood cardiometabolic traits. METHODS AND RESULTS:We used data of 1452 mother-child pairs from a population-based prospective cohort study in China. Maternal BMI in early pregnancy and GWG rate in mid- and late-pregnancy were calculated. Childhood cardiometabolic traits were assessed at aged 4-7 years, including BMI, BMI-z, systolic blood pressure (SBP), diastolic blood pressure, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, total cholesterol, triglycerides, fasting glucose, and C-reactive protein. Each 1 kg/m2 increase in maternal BMI in early pregnancy was associated with 0.46% (95% confidence interval, 0.19%-0.72%) higher children BMI, 0.05 (0.02-0.08) higher BMI-z, 0.41% (0.22%-0.59%) higher waist circumference, and 0.24% (0.03%-0.46%) higher SBP. Each 1 kg/week higher GWG rate in mid- and late-pregnancy was associated with higher children SBP (4.58% [1.46%-7.71%]), triglycerides (18.28% [3.13%-33.44%]), and fasting glucose (5.83% [2.64%-9.02%]) and lower BMI-z (-0.45 [-0.82 to -0.08]). Additional adjustment for offspring BMI attenuated the associations for maternal BMI but not for GWG rate. CONCLUSIONS:The increase in maternal BMI and GWG are associated with adverse cardiometabolic profiles in childhood. The association between maternal BMI and childhood cardiometabolic traits is likely mediated using the offspring BMI.