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.

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.

Objective:To evaluate the effectiveness of online training on " nutrition during pregnancy" in Beijing, and collect the needs and suggestions for improvement in subsequent training.Methods:In August 2022, a series of training was carried out for related personnel in the maternal and child health care industry, and an online questionnaire survey was conducted to investigate the basic information, desired training methods, course satisfaction and retraining needs. A single factor analysis on the retraining needs of students with different characteristics was conducted by χ2 test. Results:A total of 196 participants participated in the survey. In the overall satisfaction survey of training activities, 178(90.8%) people expressed great or relatively satisfied with this training. The survey on the " type of interaction they like" showed that 177(90.3%) people wanted case studies at the most, followed by 153(78.1%) people who wanted to exchange experience. In addition, the proportion of students willing to participate in training again was significantly different among groups across different ages [16 out of 18 people aged 18-30, 71 out of 74 people aged 31-40 (95.9%), 65 out of 65 people aged 41-50 (100.0%), 39 out of 39 people aged 50 and above (100.0%)], professional titles [36 out of 40 with primary titles (90.0%), 106 out of 107 with intermediate titles (99.1%), 49 out of 49 with senior titles (100.0%)], and years of work [46 out of 50 with less than 10 years (92.0%), 41 out of 42 with 10 to 15 years (97.6%), and 104 out of 104 with more than 15 years (100.0%)], all P<0.05. Conclusions:More than 90.0% of people are basically satisfied with the training effect, and people with different characteristics have high needs for retraining. This study provides favorable support for the adjustment and setting of subsequent training courses.

BackgroundPregnancy is a pivotal phase in a woman’s life, demanding special attention to ensure maternal and fetal health. Prenatal education plays a vital role in promoting healthy pregnancies and reducing adverse outcomes for pregnant women. Mobile prenatal education programs have gained traction due to their accessibility and timeliness, especially in light of finite health care resources and the constraints imposed by the COVID-19 pandemic. ObjectiveThis study aims to develop and evaluate the effectiveness of a mobile-based prenatal education program in improving pregnancy outcomes. MethodsWe developed a mobile-based prenatal education curriculum in collaboration with a multidisciplinary maternal care team from Peking Union Medical College Hospital (PUMCH) in Beijing, China. Data were retrospectively collected from 1941 pregnant women who had registered for the PUMCH mobile prenatal education program and subsequently delivered at PUMCH between May 2021 and August 2022. The study compared pregnancy outcomes between the completing group, which were pregnant women who had completed at least 1 course, and the noncompleting group. We also analyzed differences among course topics within the completing group and assessed course topic popularity among pregnant women. ResultsThe PUMCH mobile prenatal education curriculum consists of 436 courses across 9 topics. Out of the participants, a total of 1521 did not complete any courses, while 420 completed at least 1 course. Compared with the noncompleting group, pregnant women who completed courses exhibited a significant reduction in the risk of gestational diabetes mellitus, induced abortion, postpartum infection, fetal intrauterine distress, and neonatal malformation. Among those in the completing group, a total of 86% (361/420) started course completion during the first and second trimesters. Furthermore, completing courses related to topics of pregnancy psychology and pregnancy nutrition was associated with reduced risks of premature rupture of membranes and small for gestational age infants, respectively. Pregnancy psychology and postpartum recovery were the preferred topics among pregnant women. ConclusionsThe study demonstrates the potential of mobile-based prenatal education programs in improving pregnancy outcomes and supporting health care providers in delivering effective prenatal education. The rise of mobile prenatal education presents an opportunity to improve maternal and child health outcomes. Further research and broader implementation of such programs are warranted to continually improve maternal and child health.

What is already known about this topic?:Elevated gestational weight gain (GWG) during pregnancy among women diagnosed with gestational diabetes mellitus (GDM) is correlated with an increased instance of large for gestational age (LGA) and macrosomia. However, it remains uncertain whether managing weekly GWG following a GDM diagnosis positively impacts fetal birth weight.What is added by this report?:Our study found that GWG following GDM diagnosis correlates positively with the risk of LGA and macrosomia among all body mass index (BMI) subgroups, especially for overweight and obese women.What are the implications for public health practice?:The results of this research highlight the importance of enforcing a more stringent regulation on GWG on a weekly basis for overweight and obese women diagnosed with GDM, particularly when considering neonatal growth.

Abstract Objective Determine the composition and characteristics of intestinal microbiota in GDM patients during mid- and late pregnancy, and identify possible differences in bacterial composition based on comparisons with a normal healthy population. Methods The participants were recruited at 24 to 28 weeks of gestation, and stool samples were collected twice in the second and third trimesters, and were examined based on next-generation sequencing. Test results and pregnancy outcomes were recorded, and baseline conditions and intestinal microecological composition were compared between the two groups. Results Compared with the healthy control group, the composition ratio of Bacteroides and Megamonas was significantly increased, whereas that of Bifidobacterium, Dialister, and Escherichia coli was significantly reduced. At the species level, the combination of Eubacterium hallii, Butyrate-producing Bacterium GM2.1, and Clostridium disporicum enabled an effective discrimination between the two groups (AUC = 93.64%, P < 0.05, 95% CI: 89.83–97.45%). Conclusion Compared with the healthy control group, we detected significant differences in the composition ratio of gut microbiota during late pregnancy in the gestational diabetes group, and also observed a reduction in bacterial diversity and an increase in microbial disorder.

Abstract Objective Determine the composition and characteristics of intestinal microbiota in GDM patients during mid- and late pregnancy, and identify possible differences in bacterial composition based on comparisons with a normal healthy population. Methods The participants were recruited at 24 to 28 weeks of gestation, and stool samples were collected twice in the second and third trimesters, and were examined based on next-generation sequencing. Test results and pregnancy outcomes were recorded, and baseline conditions and intestinal microecological composition were compared between the two groups. Results Compared with the healthy control group, the composition ratio of Bacteroides and Megamonas was significantly increased, whereas that of Bifidobacterium , Dialister , and Escherichia coli was significantly reduced. At the species level, the combination of Eubacterium hallii , Butyrate-producing Bacterium GM2.1, and Clostridium disporicum enabled an effective discrimination between the two groups (AUC = 93.64%, P < 0.05, 95% CI: 89.83–97.45%). Conclusion Compared with the healthy control group, we detected significant differences in the composition ratio of gut microbiota during late pregnancy in the gestational diabetes group, and also observed a reduction in bacterial diversity and an increase in microbial disorder.

Abstract Background Abnormal liver function indicators during pregnancy may be independent risk factors for preterm birth (PTB). However, the relationship between liver function indicators in the first trimester and PTB was not clearly understood. This study aimed to assess whether these indicators in the first trimester could predict subsequent risk of PTB. Methods From July 1, 2020, to June 30, 2022, a retrospective cohort study was conducted including 5,567 pregnant women who gave birth at Peking Union Medical College Hospital, China. We collected liver function indicators (ALB, albumin; ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; γ-GT, γ-glutamyl transferase), and clinical history and demographic information from pregnant women and their infants. Multivariate logistic regression models were used to estimate aOR (adjusted odds ratios) and 95% CIs (confidence intervals). Results PTB incidence was 6.4% (275/5,152) in this cohort. The highest quartile of γ-glutamyl transferase (γ-GT) was associated with an increased risk of PTB compared to the lowest quartile [aOR 1.47(95% CI 1.02~2.14]), after adjusting for confounding factors.Other individual liver function indicators (ALB, ALP, ALT and AST) were not significantly associated with PTB. The association with PTB was found among female infant in higher concentrations of γ-GT. Conclusions During the first trimester, higher concentrations of γ-GT, but not other liver function indicators, were significantly associated with an increased risk of PTB among Chinese pregnancy women.

ObjectiveThis study was designed to explore the composition of the intestinal microbiota and its longitudinal variation between the second trimester (T2) and the third trimester (T3) in women with gestational diabetes mellitus (GDM) and pregnant women with normal glucose tolerance.MethodsThis observational study was conducted at Peking Union Medical College Hospital (PUMCH). Women with GDM and pregnant women with normal glucose tolerance were enrolled in the study, and fecal samples were collected during T2 (weeks 24~28) and T3 (weeks 34~38). Fecal samples were analyzed from 49 women with GDM and 42 pregnant women with normal glucose tolerance. The 16S rRNA gene amplicon libraries were sequenced to analyze the microbiota and QIIME2 was used to analyze microbiome bioinformatics.ResultsThe four dominant phyla that Firmicutes, Bacteroidetes, Actinobacteria and Proteobacteria which accomplish about 99% of the total relative abundance did not significantly change between the T2 and T3 in the GDM and healthy groups. At the genus level, the relative abundance of Scardovia (0 vs. 0.25%, P = 0.041) and Propionibacterium (0 vs. 0.29%, P = 0.041) increased significantly in the control group, but not in the GDM group. At the phylum level, the relative abundance of Firmicutes and Actinobacteria was significantly different between women with GDM and pregnant women with normal glucose tolerance in both T2 and T3. In T2 and T3, the relative abundances of unidentified_Lachnospiraceae, Blautia, and Parabacteroides were significantly higher in the GDM group than in the control group (P<0.05). The relative abundance of Bifidobacterium in the GDM group was lower than in the control group in both T2 and T3.ConclusionsThe intestinal microbiota composition was stable from T2 to T3 in the GDM and control groups; however, the intestinal microbiota composition was different between the two groups.

What is already known about this topic? Joint effects of gestational weight gain (GWG) and hyperglycemia on adverse pregnancy outcomes suggest that lower optimal GWG is optimal for women with gestational diabetes mellitus (GDM). However, there is still a lack of guidelines. What is added by this report? Optimal weekly GWG range after diagnosis of GDM for underweight, normal-weight, overweight, and obese women was 0.37–0.56 kg/week, 0.26–0.48 kg/week, 0.19–0.32 kg/week, and 0.12–0.23 kg/week, respectively. What are the implications for public health practice? The findings may be used to inform prenatal counseling regarding optimal gestational weight gain for women with gestational diabetes mellitus, and suggest the need for weight gain management.

Objective To analyze maternal blood exposure to non-therapeutic antibiotics in late pregnancy and explore the effects of low-dose antibiotics on fetal growth and development.Methods A total of 104 pregnant women in late pregnancy (28-32 weeks) without serious pregnancy complications were enrolled,who had regular antenatal examination and delivery in Peking Union Medical College Hospital and did not use therapeutic antibiotics 2 months before pregnancy and in the whole pregnant process.The levels of antibiotics in the maternal blood were detected by liquid chromatography-tandem mass spectrometry,and the pregnant women were assigned into an antibiotic exposure group (antibiotic positive) and a non-exposure group (antibiotic negative).The length,weight,placental weight,and placental volume of the newborns in the two groups were measured,and the data were statistically analyzed by t test or χ2 test.Results The maternal blood antibiotic test showed 7 positive cases (6.73%,antibiotic exposure group) and 97 negative cases (93.27%,non-exposure group). The average length of newborns in the antibiotic exposure group and the non-exposure group was (49.57±1.40) cm and (48.85±1.77) cm,respectively,with no significant difference (t=1.060,P=0.363).The average weight of newborns in the antibiotic exposure group and the non-exposure group was (3558.57±382.95) g and (3275.36±356.41) g,respectively,with significant difference (t=2.021,P=0.046).The mean placental weight in the antibiotic exposure group and the non-exposure group was (676.43±124.59) g and (631.96±129.25) g,respectively,with no significant difference (t=0.881,P=0.380).The mean placental volume in the antibiotic exposure group and the non-exposure group was (724.67±174.91) cm3 and (676.82±220.86) cm3,respectively,with no significant difference (t=0.560,P=0.388).Compared with those in the non-exposure group,the neonatal length,neonatal weight,placental weight,and placental volume in the antibiotic exposure group increased by 1.47%,8.65%,7.04%,and 7.07%,respectively.Conclusion There are antibiotics in the environment,and maternal blood exposure to non-therapeutic antibiotics can promote the growth and development of the fetus and placenta,especially increasing the fetal weight.

Objective To investigate recommendations for appropriate gestational weight gain (GWG) of Chinese females. Methods In total of 3,172 eligible women in the first trimester were recruited into the Chinese Pregnant Women Cohort Study (CPWCS) project. Pregnancy complications and outcomes were collated using the hospital medical records system. The method of occurrence of participants with adverse pregnancy outcomes (Occurrence Method) was conducted to calculate the recommended total GWG for each participant’s pre-pregnancy BMI. Occurrence Method data were judged against the Institute of Medicine (IOM) and Japanese recommended criteria in terms of the total occurrence of adverse pregnancy outcomes of pregnant women with appropriate weight gain. Results The most frequent GWG was ≥ 14 kg and < 16 kg (19.4%), followed by ≥ 10 kg and < 12 kg (15.5%) and ≥ 12 kg and < 14 kg (15.2%). The most frequently occurring adverse pregnancy outcomes were cesarean sections for underweight (30.0%), normal weight (40.4%), overweight (53.6%) and obese (53.7%) women. A large for gestational age (LGA) accounted for 18.0% of the overweight and 20.9% of the obesity group. Gestational diabetes mellitus (GDM) occurred in 16.9% of overweight and 23.1% of obese women. The recommended total GWG in a Chinese women population is ≥ 8 and < 12 kg if underweight, ≥ 12 and < 14 kg for normal weight, ≥ 8.0 and < 10.0 kg if overweight, and < 8 kg for women with obesity. Conclusions Current Chinese recommendations provide the optimal ranges of GWG to minimize the occurrence of undesirable pregnancy outcomes for each group of pre-pregnancy BMIs in a Chinese population. Trial registration Registered with ClinicalTrials ( NCT03403543 ).

BACKGROUND:Gestational anemia is a serious public health problem that affects pregnant women worldwide. Pregnancy conditions and outcomes might be associated with the presence of gestational anemia. This study investigated the association of pregnancy characteristics with anemia, exploring the potential etiology of the disease.AIM:To assess the association of pregnancy parameters with gestational anemia.METHODS:A nested case-control study was conducted based on the Chinese Pregnant Women Cohort Study-Peking Union Medical College Project (CPWCS-PUMC). A total of 3172 women were included. Patient characteristics and gestational anemia occurrence were extracted, and univariable and multivariable logistic regression models were used to analyze the association of pregnancy parameters with gestational anemia.RESULTS:Among the 3172 women, 14.0% were anemic, 46.4% were 25-30 years of age, 21.9% resided in eastern, 15.7% in middle, 12.4% in western 18.0% in southern and 32.0% in northern regions of China. Most women (65.0%) had a normal prepregnancy body mass index. Multivariable analysis found that the occurrence of gestational anemia was lower in the middle and western regions than that in the eastern region [odds ratio (OR) = 0.406, 95% confidence interval (CI): 0.309-0.533, P < 0.001)], higher in the northern than in the southern region (OR = 7.169, 95%CI: 5.139-10.003, P < 0.001), lower in full-term than in premature births (OR = 0.491, 95%CI: 0.316-0.763, P = 0.002), and higher in cases with premature membrane rupture (OR=1.404, 95%CI: 1.051-1.876, P = 0.02).CONCLUSION:Gestational anemia continues to be a health problem in China, and geographical factors may contribute to the situation. Premature birth and premature membrane rupture may be associated with gestational anemia. Therefore, we should vigorously promote local policy reformation to adapt to the demographic characteristics of at-risk pregnant women, which would potentially reduce the occurrence of gestational anemia.

In the integrated management of gestational diabetes mellitus (GDM), health education plays an important role and directly affects patients' blood glucose level control, pregnancy, and neonatal outcome.The rapid growth of the Internet has ushered in an era of big data and the rational use of the Internet.We developed an innovative mobile application (app) combining a teaching model of the flipped classroom and GDM management, which allows pregnant women to learn about and help prevent GDM.This app can overcome the treatment barriers for those patients that cannot go to the hospital, enhance health promotion efforts, and improve GDM management.

Objective To explore the performance of mobile health platform for standardized management of pregnant women with gestational diabetes mellitus(GDM). Methods A randomized controlled trial was conducted,in which 295 women with GDM were randomized into two groups(traditional management group and mobile health management group)by a computer-generated sequence.The traditional management group accepted standardized GDM management,and the mobile health management group was supplemented by mobile health management based on the standardized management.The glycemic control rate and the incidences of low birth weight,macrosomia,preterm birth,premature rupture of membranes,postpartum hemorrhage after cesarean section,neonatal asphyxia,malformation,and admission to the neonatal intensive care unit were compared between the two groups. Results The glycemic control rate in mobile health management group was significantly higher than that in the traditional management group [(67.22±22.76)% vs.(60.69±21.28)%,P=0.004].The incidences of low birth weight,macrosomia,preterm birth,premature rupture of membranes,postpartum hemorrhage after cesarean section,neonatal asphyxia,malformation,and admission to the neonatal intensive care unit demonstrated no significant differences between groups(all P > 0.05). Conclusions Mobile health applied in standardized management is conducive to the glycemic control of GDM women,whereas it does not significantly improve the pregnancy outcomes.Due to the short time of intervention,the effects of mobile health on pregnancy outcomes need further study.

Aims: To investigate the effects of mobile health based peripartum management of gesta-tional diabetes mellitus (GDM) on postpartum diabetes and factors associated with postpar-tum diabetes. Methods: Women with GDM (n = 309) were randomly assigned to receive standard manage-ment (SM) or mobile management (MM). 75-g OGTT was performed at 6 weeks postpartum. Results: The incidence of postpartum T2DM in the MM group was much higher than that in SM group (12.36% vs. 3.88%, P = 0.0291). The fasting, 1-h and 2 h OGTT at 24-28 weeks of gestation of T2DM women were higher than those women without T2DM (fasting, 6.08 vs. 4.90, P = 0.0052; 1-h, 13.20 vs. 10.00, P < 0.0001; 11.96 vs. 8.83, P = 0.0026) in MM group. The 1-h and 2 h OGTT at 24-28 weeks of gestation of T2DM women were higher than those women without T2DM (11.54 vs. 9.78, P = 0.0484; 10.68 vs. 8.68, P = 0.0108) in SM group. Higher OGTT values at 24-28 weeks of gestation were risk factors of postpartum T2DM. Conclusions: Higher OGTT values at 24-28 weeks of gestation were risk factors to develop postpartum T2DM. Mobile health based peripartum management of GDM increased the risk of postpartum diabetes among women with GDM for lacking of postpartum manage-ment. Further studies of mobile health based postpartum management of GDM are needed. ClinicalTrials.gov registration number NCT03748576. (c) 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).