Background: Although inadequate or excessive gestational weight gain (GWG) has been associated with adverse pregnancy outcomes, most studies in China have applied the Institute of Medicine (IOM) guideline, which may not be optimal for Chinese women. Evidence on early-mid pregnancy weight gain and perinatal outcomes remains limited. Methods: This single-center retrospective cohort study included singleton live births delivered at Shanghai General Hospital between January and December 2021. GWG24 was calculated as measured weight at approximately 24 gestational weeks minus self-reported pre-pregnancy weight and categorized according to the 2022 Chinese GWG guideline. Logistic regression analyses were performed to evaluate associations between GWG24 and pregnancy outcomes. Results: Among 976 women, 122 (12.5%) were below-range, 490 (50.2%) were within-range, and 364 (37.3%) were above-range GWG24. Compared with within-range GWG24, below-range GWG24 was associated with higher odds of small for gestational age (SGA; adjusted OR 3.00, 95% CI 1.46-6.14) and lower odds of large for gestational age (LGA; adjusted OR 0.44, 95% CI 0.23-0.84). Above-range GWG24 was not significantly associated with SGA or LGA. Maternal outcomes included GDM, gestational hypertension, preeclampsia, caesarean delivery, and PPH; neonatal outcomes included SGA, LGA, macrosomia, and low birthweight. Conclusion: Below-range GWG24, classified according to the 2022 Chinese guideline, was associated with higher odds of SGA and lower odds of LGA. GWG24 may help identify women at increased risk of adverse fetal growth outcomes.

Sepsis involves endothelial cell dysfunction leading to the development of lung injury. Fatty acid synthesis contributes to the development of inflammatory injury in sepsis. However, the regulatory mechanisms of fatty acid synthesis-related endothelial activation remain unclear. In this study, we found that fatty acid synthesis in patients with sepsis was greatly disordered. Inhibition of fatty acid synthesis significantly alleviated sepsis-induced endothelial damage and lung injury both in vitro and in vivo. We further found that the release of mtDNA participated in fatty acid synthesis-related regulation of endothelial inflammatory and coagulation activation. Mechanistically, fatty acid synthesis promoted the oligomerization of voltage-dependent anion channel 1 (VDAC1) via ETS proto-oncogene 1 (ETS1)-mediated inhibition of VDAC1 ubiquitination, thereby leading to the increased release of mtDNA and subsequent activation of cGAS-STING signaling and pyroptosis in endothelial cells. Our findings revealed that fatty acid synthesis promoted endothelial dysfunction through mtDNA release, providing new insight into the therapeutic strategies for treating sepsis-associated lung injury.

Effective aerosol drug delivery remains a challenge for treating pulmonary diseases due to physiological barriers such as mucus accumulation, biofilm formation, and rapid macrophage clearance. Here, we developed an inhalable honeycomb-like microsphere (HCLplga-Ab) aerosol platform using FDA-approved poly(lactic-co-glycolic acid) (PLGA) and a pore-forming agent. The platform encapsulates Andrographolide, a bioactive compound derived from traditional Chinese medicine, together with a chitosan-ambroxol coating to achieve mucus penetration, sequential drug release, and prolonged retention in the lungs. The large geometric diameter (∼10-15 μm) combined with an optimal aerodynamic size (∼2.57 μm) ensures deep lung deposition while evading alveolar macrophage clearance. In murine models of acute lung injury (ALI), bacterial pneumonia (Klebsiella pneumoniae), and fungal pneumonia (Candida albicans), HCLplga-Ab demonstrated enhanced mucus penetration and biofilm destruction, uniform and prolonged drug retention in the lungs, and significant reduction in inflammation and pathogen burden. This versatile platform bridges traditional medicine with modern aerosol technology, offering a promising solution for respiratory disorders and clinical translation.

Microbial fouling poses significant challenges in healthcare and maritime industries and impacts more significantly on human health with the spread of drug-resistant bacteria. Mechanical biocidal strategies using nano-scale structures have emerged as a promising antimicrobial approach over the past decade. However, the durability and structural requirements for optimal biocidal performance remain unexplored. Herein, a rationally designed mechano-photocatalytic antimicrobial strategy is reported by systematically optimizing inorganic nanowire (NW) architectures. It is demonstrated that close-packed NWs with diameters less than 100 nm achieve high mechanical biocidal efficiency. The synergistic mechano-photocatalytic approach eliminates >99% of bacteria within 30 mins and inhibits >94% of marine algal fouling. The fabricated NWs exhibit robust durability, retaining 80% bactericidal efficacy through repeated fouling cycles. Even without photocatalytic activation, mechanical disruption alone inactivates >90% of bacteria and prevents >70% of algal attachment. Intriguingly, ultraviolet photostimulation unexpectedly stimulates marine algal growth without the photoactive NWs, contrasting sharply with its inhibitory effect on pathogenic bacteria. These findings advance the rational design of durable mechano-photocatalytic nano-architectures, emphasizing their dual-action antimicrobial potential. The work underscores the viability of inorganic nanostructures in combating microbial fouling across diverse environments, from medical settings to marine infrastructure, while addressing critical gaps in durability for real-world applications.

Acute lung injury (ALI) is a life-threatening condition posing significant challenges to healthcare systems. Effective and precise treatment is vital to preventing the progression of ALI. Cordycepin (Cor), an adenosine analogue with potential anti-inflammatory properties, but is limited by enzymatic degradation in vivo. To address these limitations, we investigated the neutrophils involvement in ALI and developed an effective drug delivery platform to enhance the therapeutic potential of Cor. This multifunctional nano-delivery platform, CPPC, incorporates Cor-loaded polydopamine (PDA) nanoparticles modified with anti-CD11b antibodies, utilizing neutrophils for targeted transport to inflamed areas. Our results demonstrate that CPPC is rapidly recruited to inflamed sites during the early stages of ALI. CPPC protect Cor from oxidative degradation during circulation, thereby increasing its concentration in the affected lung tissue. In a murine model of LPS-induced sepsis-related ALI, CPPC significantly reduced systemic levels of pro-inflammatory cytokines and mitigated lung injury. Furthermore, the capacity of CPPC to carry multiple drugs allows for enhanced therapeutic precision. In murine models of Klebsiella pneumoniae and Streptococcus pneumoniae-induced bacterial pneumonia, CPPC was loaded with antibiotics, demonstrating improved delivery efficiency by leveraging neutrophils. This approach significantly reduced bacterial loading, suppressed cytokine storms, and mitigated lung injury, leading to highly effective therapeutic outcomes.

The study primarily aims to compare alterations in the daily patterns of glucose fluctuations across individuals with different kinds of diabetes in pregnancy and secondly investigate influencing factors that may react with glucose variations. We conducted a retrospective cohort study of 776 pregnant women in Shanghai General Hospital. We grouped participants who were exposed to gestational hyperglycemia into 5 sub-groups [Type 1 diabetes (T1DM), Type 2 diabetes (T2DM), Overt diabetes, Gestational diabetes (GDMA1 and GDMA2). Demographic variables and GV parameters were compared among 5 groups through ANOVA-test and Chi-square test. We estimated odd ratios (ORs) for the association between glucose coefficient of variation (CV) and possible influencing variables. A final total of 776 pregnant women were analyzed. The proportion of pregnant women with pre-gestational diabetes was 31.83

Polymyxins are the last line of defense against multidrug-resistant (MDR) Gram-negative bacterial infections. However, this last resort has been threatened by the emergence of superbugs carrying the mobile colistin resistance gene-1 (mcr-1). Given the high concentration of matrix metalloproteinase 3 (MMP-3) in bacterial pneumonia, limited plasma accumulation of colistin (CST) in the lung, and potential toxicity of ionic silver (Ag+), we designed a feasible clinical transformation platform, an MMP-3 high-performance lung-targeted bio-responsive delivery system, which we named “CST&Ag@CNMS”. This system exhibited excellent lung-targeting ability (>80% in lungs), MMP-3 bio-responsive release property (95% release on demand), and synergistic bactericidal activity in vitro (2–4-fold minimum inhibitory concentration reduction). In the mcr-1+ CST-resistant murine pneumonia model, treatment with CST&Ag@CNMS improved survival rates (70% vs. 20%), reduced bacteria burden (2–3 log colony-forming unit [CFU]/g tissue), and considerably mitigated inflammatory response. In this study, CST&Ag@CNMS performed better than the combination of free CST and AgNO3. We also demonstrated the superior biosafety and biodegradability of CST&Ag@CNMS both in vitro and in vivo. These findings indicate the clinical translational potential of CST&Ag@CNMS for the treatment of lung infections caused by CST-resistant bacteria carrying mcr-1.

PURPOSE:We aimed to explore the prevalence and within-host evolution of resistance in polymyxin-heteroresistant carbapenem-resistant Klebsiella pneumoniae (PHR-CRKP) in critically ill patients. METHODS:We performed an epidemiological analysis of consecutive patients with PHR-CRKP from clinical cases. Our study investigated the within-host resistance evolution and its clinical significance during polymyxin exposure. Furthermore, we explored the mechanisms underlying the dynamic evolution of polymyxin resistance at both subpopulation and genetic levels, involved population analysis profile test, time-killing assays, competition experiments, and sanger sequencing. Additionally, comparative genomic analysis was performed on 713 carbapenemase-producing K. pneumoniae strains. RESULTS:We enrolled 109 consecutive patients, and PHR-CRKP was found in 69.7% of patients without previous polymyxin exposure. 38.1% of PHR-CRKP isolates exhibited polymyxin resistance and led to therapeutic failure in critically ill scenarios. An increased frequency of resistant subpopulations was detected during PHR-CRKP evolution, with rapid regrowth of resistant subpopulations under high polymyxin concentrations, and a fitness cost in an antibiotic-free environment. Mechanistic analysis revealed that diverse mgrB insertions and pmrB hypermutations contributed to the dynamic changes in polymyxin susceptibility in dominant resistant subpopulations during PHR evolution, which were validated by comparative genomic analysis. Several deleterious mutations (e.g. pmrBLeu82Arg, pmrBSer85Arg) were firstly detected during PHR-CRKP evolution. Indeed, specific sequence types of K. pneumoniae demonstrated unique deletions and deleterious mutations. CONCLUSIONS:Our study emphasizes the high prevalence of pre-existing heteroresistance in CRKP, which can lead to polymyxin resistance and fatal outcomes. Hence, it is essential to continuously monitor and observe the treatment response to polymyxins in appropriate critically ill scenarios.

AbstractBackground Although the association between inadequate or excessive gestational weight gain (GWG) and adverse pregnancy outcomes has been investigated in China, most studies use the Institute of Medicine (IOM) guidelines, which might not be suitable for Chinese women characteristics. Besides, studies exploring association between GWG in the second trimester and pregnancy outcomes are relatively few. Methods A total of 976 cases of live-birth singleton pregnancies at the Shanghai General Hospital were included in this retrospective observational study. Patients were classified into three groups including GWG during 24 gestational weeks (G24WG) within, below and above the Standard of Recommendation for Weight Gain during Pregnancy Period published by Maternal and Child Health Standards Professional Committee of National Health Commission (NHC), China PR in 2022 (2022 Chinese GWG guidelines), which specifies the recommended value of weight gain of natural singleton pregnancy in China. Binary logistic regression was used to estimate the adjusted odds ratio (OR) and 95% confidence intervals (CIs) of adverse pregnancy outcomes among three G24WG groups. Results Of the 976 women analyzed, 12.6% had G24WG below the 2022 Chinese GWG guidelines, while 37.2% had G24WG above the 2022 Chinese GWG guidelines. Women with G24WG below the 2022 Chinese GWG guidelines had a higher risk of Small for Gestational Age (SGA, Adjusted OR = 2.690, 95% CI: 1.334–5.427, P = 0.006) and a lower risk of Large for Gestational Age (LGA, Adjusted OR = 0.435, 95% CI: 0.228–0.829, P = 0.011) than women who had G24WG within the 2022 Chinese GWG guidelines. Conclusions G24WG is a strong predictor of newborn anthropometric outcomes and help doctors provide appropriate nutritional counseling for pregnant women in China.

Pregnant women with a high triglyceride-glucose (TyG) index during early pregnancy may increase the risk of gestational diabetes mellitus (GDM), and dietary fiber could play an important role in glucose and lipid metabolism. However, no trials have tested the effects of dietary fiber on preventing GDM in women with a high TyG index. This study aims to investigate whether GDM can be prevented by dietary fiber supplementation in women with a TyG index ≥8.5 during early pregnancy (<20 weeks). A randomized clinical trial was performed among 295 women with a TyG index ≥8.5 before 20 weeks of gestation, divided into a fiber group (24 g dietary fiber powder/day) or a control group (usual care). The intervention was conducted from 20 to 24+6 gestational weeks, and both groups received guidance on exercise and diet. The primary outcomes were the incidence of GDM diagnosed by a 75 g oral glucose tolerance test at 25–28 gestational weeks, and levels of maternal blood glucose, lipids. Secondary outcomes include gestational hypertension, postpartum hemorrhage, preterm birth, and other maternal and neonatal complications. GDM occurred at 11.2

To editor: Hypertriglyceridemia is a major risk factor for cardiovascular disease and acute pancreatitis.1 Accordingly, during pregnancy, the growing serum lipid levels have potentially critical implications.2,3 However, the management of gestational hypertriglyceridemia is further complicated because of the lack of safety data for most of the lipid-lowering agents.1 Here, we present a case who is a young pregnant patient who developed very severe hypertriglyceridemia (>1000 mg/dL) and was successfully treated with insulin therapy plus fenofibrate in a timely and effective manner without noticeable adverse effects, with a purpose of providing a real-world approach or some references for obstetricians. The patient has given her consent to publish the clinical information and figures in the journal. A 32-year-old in vitro fertilization (IVF) multigravid woman, G3P0, in her regular antenatal care, at 30 weeks of gestation presented into the ward with complaints of onset of severe hypertriglyceridemia (HTG) on August 1, 2021. Her obstetric history was significant for 2 spontaneous abortions. The patient and her husband were distantly related, and there was no family history of lipid disorders. Her history was impressive for HTG pancreatitis, which occurred twice in the year 2011 and 2017, respectively. She was treated with an absolute diet as well as plasmapheresis for almost 1 month when the first onset of pancreatitis was triggered by HTG, which was fueled by overindulgence in greasy food when she was 22 years old. A recurrence of pancreatitis caused by overeating 6 years later compelled her to be admitted to another hospital again to receive some treatments, but we are not able to secure enough details. All we can approach as she had been on exercise and taking fenofibrate 160 mg orally per day since the second outbreak, making her level of triglyceride (TG) range from 3 to 5 mmol/L until she got pregnant. Since the beginning of 2020, she has tried IVF after failures of preconception for many years, and luckily for her, she got pregnant and did not experience abortion on her third IVF. For the reason of being pregnant and the potential danger to the fetus, she was advised to cease oral fenofibrate because of it being classified as category C drugs; however, when she experienced her initial antenatal examination at the gestation of 9 weeks, her TG and total cholesterol (TC) were notably as high as 32.72 mmol/L and 16.04 mmol/L separately (Fig. 1). After that day, attempts at adherence to the recommended 20%-of-calories-as-fat diet as well as fenofibrate orally 160 mg every day for 1 week as an outpatient were unsuccessful because of the TC and TG mounting to 40.3 mmol/L and 14.66 mmol/L, respectively, which led to the need for hospitalization for implementation and management of an even more stringent diet also for other more effective treatments. After hospitalization, supervised low-fat content food and intravenous fluid therapy were instituted in conjunction with intravenous insulin and 5% dextrose infusion as well as fenofibrate orally 160 mg/d. Within 15 days of admission, her plasma TG level had fallen by more than two-thirds, to 12.39 mmol/L and TC level of 7.36 mmol/L; hence, she was discharged on low-fat content food along with her home medications fenofibrate after counseling about possible adverse effects. Seven weeks after her discharge, her plasma TGs boost again to 26.27 mmol/L and TC 11.9 mmol/L. She was admitted electively to institute more stringent dietary management and intravenous insulin drip and 20 days later at discharge TG was 10.19 mmol/L while TC was evidently reduced to 6.56 mmol/L.Figure 1: Trends of TG and TC levels. TC: Total cholesterol; TG: Triglyceride.In a regular prenatal checkup at 30 weeks of gestation, a fasting blood specimen indicated elevated TC and TG. A severe hypertriglyceridemia to 64.62 mmol/L (normal value <2.28 mmol/L) and a severe hypercholesterolemia 20.16 mmol/L (normal value <5.16 mmol/L) were found (Fig. 2). She was asymptomatic clinically, and the physical examination did not reveal any stigmata associated with elevated TGs or TCs. All she complained about was slightly dizzy in her head this time. Her abdomen was supple, with no tenderness and rebound tenderness; the liver and spleen were impalpable; no contractions were noticed; her weight has increased to 83 kg with a height of 163 cm. Serum analysis revealed normal glucose, blood routine examination, amylase, lipase, and thyroid-stimulating hormone. Electrocardiograph and head magnetic resonance imaging are also negative. Urea, electrolytes, renal, liver, and coagulation function tests were all normal. An abdominal ultrasound scan revealed slight fatty liver, while echocardiography was negative as well as obstetric ultrasound. Once more like old times, she was started on a low-fat (<20% of calories), low-carbohydrate diet and given education by a nutritionist. Besides what we mentioned previously, she was also treated with an insulin drip daily. A lipid panel 2 weeks later revealed a fasting TG level of 38.82 mmol/L and TC level of 14.12 mmol/L. The patient was discharged home on TG being 15.97 mmol/L and TC level of 7.45 mmol/L after 18 days. At 36 weeks of gestation, this patient was found to have a blood pressure of 150/100 mm Hg on labetalol 50 mg every 8 hours and her fasting laboratory results revealed TC level of 14.63 mmol/L and TG level of 48.40 mmol/L, which introduced her to present in the hospital again. She was again started with insulin drip and her lipid profile had considerably improved: TG level of 27.71 mmol/L and TC level of 12.74 mmol/L while her blood pressure was fluctuating on 140/90 mm Hg. This patient delivered through the cesarean section with fasting blood glucose being 5.1 mmol/L. A female infant weighing 3530 g with Apgar point of 10-10-10 at 1, 5, and 10 minutes, respectively. On the first day after delivery, her laboratory results showed that her level of TG was reduced to 22.22 mmol/L and TC was 12.23 mmol/L. She was discharged home with fenofibrates for lipids and labetalol for blood pressure.Figure 2: The blood sample shows that the patient had a severe hypertriglyceridemia.Discussion Pathophysiology of hypertriglyceridemia in pregnancy Hyperphagia and elevated lipid accumulation introduce physiologic tripling of the TG level in pregnancy. The mechanism by which pregnancy causes physiologic hypertriglyceridemia is not that clear, although there are several biologically plausible mechanisms. First, the insulin-resistant condition, especially in mid and late pregnancy, decreases LPL activity of adipose tissue and facilitates adipose lipolytic activity; besides, the growing plasma estrogen concentrations during pregnancy also generate gestational hypertriglyceridemia (GHTG). Furthermore, other physiological mechanisms are listed as follows: (1) increased adipose tissue lipolytic products was transferred to the liver, which promotes synthesis of triacylglycerols and the subsequent release of very low density lipoprotein cholesterol (VLDL) into blood; (2) weaken LPL activity spell reduced removal of VLDL from circulation; (3) at second and third trimester, enhanced cholesterylester transfer protein activity motivates the exchange of TGs from low density lipoprotein and high density lipoprotein (HDL) with VLDL; and (4) dramatic downgrade of hepatic lipase downgrades the translation of buoyant HDL2b triacylglycerol-rich particles, into small TC-rich particles.2,4 Regarding the definition, diagnosis, and treatments of GHTG, a consensus has not been established, with most experience and recommendations coming from case reports. Changes in lipid levels during pregnancy start as early as 12 weeks and grow as pregnancy progresses.5 Much of the research in GHTG in the last 2 decades stated that the concentration of TG and TC increases significantly in the gestation period; however, it is still formidable to define what the range of normality is when someone is getting pregnant. Severe HTG is defined as 1000 ≤ TG < 1999 mg/dL (11.3 ≤ TG < 22.5 mmol/L) while extremely severe HTG is TG ≥ 2000 mg/dL (TG ≥ 22.6 mmol/L). Severe HTG is associated with poor pregnancy outcomes, including acute pancreatitis, acute pancreatitis progression to severe pancreatitis, preeclampsia, gestational diabetes, larger than gestational age, smaller than gestational age, macrosomia, intrahepatic cholestasis syndrome during pregnancy, and a growing trajectory of HTG in the future, while it is common to notice a physical increase of lipids level during this stage. The exact pathogenesis behind GHTG remains further investigated; however, risk factors correlated with GHTG are rather evident mainly including poorly controlled diabetes, alcohol abuse, obesity, pregnancy, prior pancreatitis, and personal or family history of HTG and the like,4,6,7 among which this patient was subjected to 2 counts: pregnancy and obesity. Treatments Currently, there still has been a lack of recommendations for prescriptions on HTG in pregnancy, with almost therapies originating from case reports with varying efficacy. However, it should be noted that multidisciplinary units consistent with the department of obstetrics, endocrinology, nutrition, and gastroenterology are mandatory to mitigate or prevent this severe condition. What this team can perform includes weight loss in obese patients, aerobic exercise, avoidance of concentrated sugars, alcohol, medications that can reduce serum TG levels, and strict restrictions on blood sugar in diabetics. Because diet control and physical actions are limited in this particular period, which necessitates sufficient nutrition for the fetus, lipid-lowering drugs, which might throw the fetus into uncertainty, are branded as the first-line therapy for pregnant individuals. Regarding medications on HTG for general populations, drugs aiming at it abound varying from statin to omega-3 polyunsaturated fatty acids to fibrates to heparin eventually to plasma exchange; unluckily, on the contrary, choices are rather restricted for a pregnant woman carrying a fetus in her uterus. Omega-3 polyunsaturated fatty acids, being Food and Drug Administration class C, were found to reduce TG safely and were recommended clinically but with slight effects.8 Statins use among pregnant women is limited because there may be some potential teratogenic effects although studies about statins are controversial.9 Niacin is also noticed to increase level of HDL and lower low density lipoprotein levels. However, the use of niacin is restricted because of its relevant adverse effects from flushing, to gastrointestinal disturbance, and even to liver toxicity.10 Fibrates, promoting the release of LPL, are one of the most common treatment agents for the patients with HTG contributing to the decrease in TG levels; however, it is taken as category C drugs by Food and Drug Administration; hence, its employment remains to be controversial and further research is required. Another treatment modality is heparin, which can activate low density lipoprotein and stimulates the release of endothelial LPL into blood. Heparin has been documented as an effective lowering-lipid levels regime until a woman who use heparin chronically was found to progress AP because heparin depleted the LPL on the surface of the endothelial cells and spelled a hypertriglyceridemic effect.11 After that, more cases of HTG secondary to employment of heparins have been reported; therefore, its use is not recommended.4,12 Despite plasmapheresis therapy was observed to reduce serum TG levels effectively when severe GHTG was refractory to all other regimens, its widespread employment has been restricted by its high-cost, catheter associated inflammation, biological availability, and risks of thromboses. Conclusions In tune with previous studies, this lady who was complicated with GHTG developed gestational diabetes and gestational hypertension as the progress of gestation, which justified the fact that severe GHTG can fuel more adverse events in pregnancy. Thanks to a strict low-fat diet in conjunction with fibrates (gemfibrozil) orally, the TGs level of hers fluctuated at 3 mmol/L and exacerbated after getting pregnant. On the premise of informed consent of this lady, fenofibrate was started again but bred invisible benefits, until insulin was used, there dawned a pronounced degrades of TG as well as TC and few adverse effects or complications related to insulin were observed. Insulin is reputed to curb the degree of diabetes. Unexpectedly, by stimulating LPL synthesis and activity, which gives a subsidy to the degradation of VLDL chylomicron to glycerol and free fatty acids, and inhibiting hormone-sensitive lipase in adipocytes, the key enzyme for decomposing adipocytes TGs into free fatty acids, insulin introduces reduced serum TG level rapidly.12 It is remarkable that there seemed rebounds after insulin therapy and only with once more insulin drip can her TG and TC reduced again; therefore, it came to a conclusion that intravenous insulin drip is laced with benefits temporarily. The treatment of GHTG still faces harsh challenges while multidisciplinary cooperation and low-fat diet are still the footstones. This case cast some lights on that insulin promises to be rapid, effective, and safe in the treatment of GHTG but temporary to some extent. Future research is required to focus on how to secure the longevity of insulin-lowering serum lipids whether multiple subcutaneous injections of insulin can guarantee the long-term effect of lowering blood lipids or not. In addition, the delivery mode and delivery time of persistent severe HTG in late pregnancy are also needed to be further discussed and investigated.

Background: Despite being the most generalized formula in China, the Hadlock IV formula has never been examined to determine if it is suitable for Chinese newborns, nor have the factors that might affect its performance been investigated. However, previous studies have reported varying results about other formulas in other nationalities. This study sought to evaluate the performance of the Hadlock IV formula in estimating fetal weight (FW) in pregnant Chinese women and use ultrasound to identify the factors affecting the accuracy of estimations of newborn weight; through these means, we aimed to create a reference for predicting neonatal weight for obstetricians. Methods: A retrospective observational study comprising data from 976 cases of live-birth singleton pregnancies at the Shanghai General Hospital was conducted. The participants' clinical data were examined and subjected to a logistic regression analysis to identify the multitude of possible factors affecting the estimation of FW. The proportions and correlations between the accurate and inaccurate estimation groups were compared to determine the different prognosis of these 2 groups. The correlations between the accuracy of the sonographic-based fetal weight estimation (SFWE) and newborns with different weight ranges were also analyzed. Results: The overall accuracy rate of the SFWE predicted by the Hadlock IV formula was 79.61%, while that of the inaccurate estimation group was only 20.39%. The incidence of spontaneous vaginal delivery (VD) was lower in the inaccurate estimation group than in the accurate estimation group (40.7% vs. 48.13%; P=0.041). In the inaccurate estimation group, 11.56% (23/199) of the participants underwent a secondary cesarean section (sCS), compared to only 6.44% (50/777) in the accurate estimation group. The low birth weight (LBW) rates and macrosomia rates were lower in the accurate estimation group than in the inaccurate estimation group, with odds ratios (ORs) of 0.483 and 0.459, respectively (P<0.05). The results indicated that the SFWE was more accurate for newborns weighing 2,500-4,000 g than those weight out of this range. In relation to macrosomia, the SFWE was likely to be underestimated, but it was usually overestimated in the LBW group. Conclusions: The overall performance of the Hadlock IV formula in predicting the birth weight of Chinese newborns remains suboptimal. Extra caution should be exercised in cases of suspected large-for-gestational age (LGA) infants, small-for-gestational age (SGA) infants, infants with macrosomia, or LBW fetuses in the Chinese population.

SCOPE:To investigate whether dietary fiber supplementation may reduce the risk of gestational diabetes mellitus (GDM) in advanced maternal age Chinese women (≥35 years). Secondary outcomes include glucose metabolism, diet change, weight gain, and maternal and neonatal outcomes.METHODS AND RESULTS:In a randomized controlled trial, a dietary fiber group (19.56 g day-1 ) or control group (standard prenatal care) was conducted from 20 to 24+6 gestational weeks in advanced maternal age women. Dietary intakes were assessed using a validated 39-item Food Frequency Questionnaire (FFQ). GDM was diagnosed by a 75 g oral glucose tolerance test (OGTT) at 25-28 weeks. After intervention, the incidence of GDM was not significantly different between groups (21.6% vs 12.9%, p = 0.165). The mean increased in carbohydrate intake in the dietary fiber group is significantly lower than in the control group (-0.94 ± 92.12 g vs 32.27 ± 91.81 g, p = 0.032). In addition, the glucose tolerance, weight gain between 20 and 25 weeks, and preterm birth in the intervention group have improved compared to the control group.CONCLUSION:Supplementation with dietary fiber during pregnancy among advanced maternal age Chinese women do not lower the incidence of GDM, but improve glucose metabolism, gestational weight gain, and preterm birth.

[This corrects the article DOI: 10.3389/fphar.2021.785756.].

Objective:The present study aims to evaluate the relationship of thyroid function during the first trimester of pregnancy with lipid levels and pregnancy outcomes.Methods:Women who delivered babies at the Shanghai General Hospital between March 2019 and December 2019 with a known pregnancy outcome and complete data were included in the present study (n = 1779). A retrospective cohort study of all subjects with available first-trimester thyroid function testing and lipid levels data was conducted, and the relationship of thyroid function with lipid levels and pregnancy outcomes was evaluated. The data were analyzed using the SPSS software for statistical correlation.Results:The proportion of caesarean sections was higher in women with hypothyroxinemia (HIA) and hypothyroidism than in women with euthyroidism. Hypothyroidism was shown to be related with polyhydramnios, preterm labor and hypertriglyceridemia. HIA was correlated with increased rates of gestational diabetes mellitus (GDM), preeclampsia, gestational hypertension and hypertriglyceridemia. Compared with the euthyroidism group, the hypothyroidism group had a higher apolipoprotein A1 (Apo A1) level and apolipoprotein B level; the subclinical hypothyroidism group had a higher total cholesterol (TC) level and low-density lipoprotein cholesterol level; the HIA group had higher triglyceride, high-density lipoprotein cholesterol levels and lower TC, Apo A1 levels. TC levels were positively correlated with the thyroid-stimulating hormone level and negatively correlated with free thyroxine (FT4) level, and free triiodothyronine and FT4 levels were positively correlated with GDM occurrence.Conclusion:Thyroid function in early pregnancy is associated with dyslipidemia and pregnancy outcomes; conventional screening of thyroid diseases in early pregnancy may help improve lipid levels and decrease adverse pregnancy outcomes.

1Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People’s Republic of China; 2Department of Gynecology Maternal and Child Health Hospital of Jiading District, Shanghai, 201800, People’s Republic of China; 3Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, 200030, People’s Republic of China; 4Department of Obstetrics and Gynecology, Songjiang Maternal and Child Health-Care Hospital, Shanghai, 201600, People’s Republic of China

Objective: To investigate the effect of dietary fiber intake during pregnancy on the prevention of gestational diabetes mellitus (GDM) in women who are overweight/obese prior to pregnancy.Methods: This randomized controlled trial was conducted in Shanghai General Hospital from June 2021 to March 2022. A total of 98 women who reported BMI≥24 kg/m2 prior to pregnancy were recruited before their 20th gestational week, and randomly (simple random allocation) assigned to the fiber supplement group (12 g of dietary fiber power twice daily) and the control group (standard prenatal care) from 20 to 24+6 gestational weeks. Both groups received nutrition education and dietary advice during the study. GDM diagnosis was performed by an oral glucose tolerance test (OGTT) at 25–28 weeks’ gestation. Data are presented as means with SD, as medians with IQR, or as counts with percentages as appropriate. Comparisons were conducted using a t-test, Mann-Whitney U test, and χ2 test, respectively.Results: The incidence of GDM was significantly reduced in the fiber supplement group compared with the control group: 8.3 vs. 24.0% (χ2 = 4.40, p = 0.036). At OGTT, the mean fasting plasma glucose in the fiber supplement group was significantly lower than before the intervention (4.57 ± 0.38 mmol/L vs. 4.41 ± 0.29 mmol/L, p < 0.01) but not in the control group (4.48 ± 0.42 mmol/L vs. 4.37 ± 0.58 mmol/L, p = 0.150). Compared with the control group, the TG and TG/HDL-C ratio levels in the intervention group were significantly higher than those in the control group (2.19 ± 0.54 mmol/L vs. 2.70 ± 0.82 mmol/L and 1.19 ± 0.49 vs.1.63 ± 0.63, respectively, all P＜0.05). The body weight gain was significantly lower in the fiber supplement group than the control group (1.99 ± 1.09 kg vs. 2.53 ± 1.20kg, p = 0.022). None of the women randomized to the fiber supplement group experienced preterm birth (<37 weeks gestation) compared with 12.0% in the control group (p = 0.040). Excessive weight gain (total weight gain >11.5 kg for overweight, and >9.0 kg for obesity) occurred in 46.7% of women in the fiber supplement group compared with 68.0% in the control group (p = 0.035). There were no differences in other maternal and neonatal outcomes.Conclusion: Increased dietary fiber intake in pregnant women who were overweight/obese prior to pregnancy may reduce the risk of GDM, excessive weight gain, and preterm birth, but it did not improve blood lipids.

Objective: This study aims to investigate the efficiency of insulin on the reduction of gestational lipid profiles and try to propose a real-world approach to assist clinicians.Methods: A retrospective, single-centered cohort study of 35 cases was conducted from October 2018 to July 2021 in Shanghai General Hospital. SPSS version 25.0 was performed to analyze the whole data. For continuous variables, a paired-sample t test was carried out on each variable to make a comparison between before and after treatment.Results: The average pre-pregnancy TGs and TCs of these patients were about 3.96 ± 1.42 mmol/L and 4.78 ± 1.18 mmol/L, respectively. The maximum of TG before insulin treatment was up to 64.62 and TC 20.43 mmol/L, which decreased to 17.34 and 4.92 mmol/L after intervention of the insulin drip. TG was noticed to fall by 77% and 12.71% of TG, respectively. The difference of TG and TC between pre-treatment and post-treatment were statistically significant (p < 0.01), while this difference has not been found in the other laboratory tests reports. The outcomes of newborns and mothers with management of insulin were proven to be improved.Conclusion: The use of insulin in the management of gestational hypertriglyceridemia is safe and efficient, and insulin may become a mainstream in the near future to mitigate serum TG and TC levels in the pregnancy period besides regulating the blood glucose level.

[This corrects the article DOI: 10.3389/fphar.2021.684898.].