Objective This study investigated the clinical outcome of monochorionic diamniotic (MCDA) twins with selective intrauterine growth restriction (sIUGR). Study Design International Peace Maternal and Child Health Hospital of Shanghai ultrasound database was investigated to identify all MCDA delivered from January 2013 to December 2017. After identifying 43 pairs of MCDA twins with sIUGR and 282 pairs of normal MCDA twins, we compared clinical outcomes between the two groups. Results Compared with normal twins, sIUGR fetuses had significantly shorter gestational age at delivery, smaller average birth weight of both twins, more significant intertwin difference in birth weight, lower Apgar scores, and higher intrauterine fetal demise (IUFD) rate, and smaller placental weight. The rate of abnormal umbilical cord insertions and abnormal blood flow in the ductus venosus (DV) and middle cerebral artery (MCA) is significantly higher in the sIUGR group. In addition, the subtype analysis of sIUGR groups indicated the poorest outcomes in type II with no significant difference between type I and III. Conclusion MCDA twins with sIUGR generally exhibited limited clinical outcomes than normal MCDA twins. These limitations are mainly associated with abnormal umbilical cord insertions and blood flow in the DV and MCA. Clinical outcomes differed among the three types of sIUGR, with type II having the worst prognosis and the highest IUFD rate. Key points

Abstract Background Sedentary behavior may influence the respiratory health, but the joint effects of sedentary behavior and physical activity on pulmonary function remains poorly elucidated. We aimed to estimate the association between sedentary behavior and physical activity with pulmonary function. Methods A total of 12,343 participants aged 12–79 years were analyzed from the U.S. NHANES 2007–2012. Participants were categorized into 16 groups according to the cross-tabulation of sedentary behavior time (0–4.0, 4.1–8.0, 8.1–12.0, and > 12.0 h/day) and moderate or vigorous physical activity (MVPA) (0, 1–149, 150–299, and ≥ 300 min/week). Generalized linear models were used to test the association of sedentary behavior and MVPA with pulmonary function. Results Participants with sedentary behavior > 4.0 h/day were negatively related to FEV1 (forced expiratory volume in 1 s) (β ranging from -0.015 to -0.009, p < 0.05). Compared with the reference group (0 min of MVPA and > 12.0 h/day of sedentary behavior), the negative association of sedentary behavior ≤ 8.0 h/day with FEV1 may be reduced through appropriate MVPA (β ranging from 0.019 to 0.030, p < 0.05). For sedentary behavior > 8.0 h/day, even MVPA ≥ 300 min/week may not decrease the negative relationships. Similar results were also observed in FVC (forced vital capacity) (β ranging from 0.018 to 0.030, p < 0.05). In participants aged ≥ 45 years, the associations were more notable. Conclusion This study indicated the sedentary behavior ≤ 4.0 h/day was a relatively healthy lifestyle for pulmonary function. Only below 8.0 h/day of sedentary behavior, the negative association with pulmonary function may be reduced through appropriate MVPA.

Background: Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) may adversely affect fetal brain development, yet no study has investigated the potential association between prenatal PFAS exposure and infant sleep. Objectives: To explore the associations of prenatal PFAS exposure with infant sleep disturbances during the first year of life in a prospective cohort study. Methods: We recruited 4127 pregnant women from the Shanghai Birth Cohort (SBC) and followed their children from birth to 12 months old. A total of 2366 infants were included in the 6-month analyses, and 2466 infants in the 12-month analyses. Ten PFAS were quantified in blood serum collected in the first trimester. Sleep quality was measured using the Brief Infant Sleep Questionnaire. We used multiple linear regression and multinomial logistic regression to estimate the individual effects of PFAS on sleep outcomes. We utilized a quantile-based gcomputation model to determine the joint effects of the PFAS mixture on infant sleep outcomes. Additionally, generalized estimating equation (GEE) models were performed to examine the longitudinal effects of PFAS exposure during pregnancy. Results: In infants aged 6 months, perfluorooctane sulfonate and perfluoroheptanoic acid were associated with a more than 2-fold risk of parent-reported sleep problems as severe. Perfluorodecanoic acid was associated with an increased risk of often or almost always snoring in one-year-old infants (relative risk ratios, 1.79; 95% CI, 1.12-2.86). PFAS mixtures were positively associated with nighttime awakenings both among infants aged 6 months (13, 0.11; 95% CI, 0.04-0.19) and 12 months (13, 0.11; 95% CI, 0.05-0.18). Prenatal exposure to PFAS were associated with longer sleep latency, increased nighttime awakenings, longer nocturnal wakefulness hours, snoring, and earlier sleep-onset time in infants aged 6-12 months, according to GEE models. Conclusions: Our study suggests that prenatal exposure to PFAS may increase the risk of sleep disturbance in infants.

BACKGROUND:In utero perfluoroalkyl substances (PFAS) exposure has been associated with childhood adiposity, but the mechanisms are poorly known.OBJECTIVE:To investigate the potential mediating role of neonatal metabolites in the relationship between prenatal PFAS exposure and childhood adiposity trajectories in the first four years of life.METHODS:We analyzed the data for 1671 mother-child pairs from the Shanghai Birth Cohort study. We included those with PFAS exposure information in early pregnancy, neonatal metabolites data and at least three child anthropometric measurements at 6, 12, 24 and/or 48 months. Body mass index (BMI) z-score trajectories were identified using latent class growth mixture modeling. The associations between PFAS concentrations and trajectory classes were assessed using multinomial logistic regression. Screening and penalization-based selection was used to identify neonatal amino acids and acylcarnitines with significant mediation effects.RESULTS:Three BMI z-score trajectories in early childhood were identified: a persistent increase trajectory (Class 1, 2.2 %), a stable trajectory (Class 2, 66 %), and a transient increase trajectory (Class 3, 32 %). Increased odds of being in Class 1 were observed in association with one log-unit increase in concentrations of perfluorooctane sulfonate (odds ratio [OR], 1.76 [95 % CI, 0.96-3.23], Class 2 as reference; OR, 2.36 [95 % CI, 1.27-4.40], Class 3 as reference), perfluorononanoic acid (OR, 1.90 [95 % CI, 0.97-3.72], Class 2 as reference; OR, 2.23 [95 % CI, 1.12-4.42], Class 3 as reference) and perfluorodecanoic acid (OR, 1.95 [95 % CI, 1.12-3.38], Class 2 as reference; OR, 2.14 [95 % CI, 1.22-3.76], Class 3 as reference). The effect of prenatal PFAS exposure on being in Class 1 was significantly but partly mediated by octanoylcarnitine (2.64 % for perfluorononanoic acid and 3.70 % for sum of 10 PFAS).CONCLUSIONS:In utero PFAS exposure is a risk factor for persistent growth in BMI z-score in early childhood. The alteration of neonatal acylcarnitines suggests a potential molecular pathway.

Introduction This retrospective study aimed to evaluate clinical outcomes of monochorionic diamniotic (MCDA) twins with selective intrauterine growth restriction (sIUGR). Materials and methods MCDA twins, either sIUGR and non-sIUGR, underwent expectant management from 2016 to 2019 in our hospital were included. sIUGR fetuses were classified into three types according to umbilical artery Doppler assessment. Non-sIUGR were considered as the control group. Outcomes were pregnancy outcomes and maternal complications. Results Forty-three sIUGR (type I: 23; type II: 14, and type III: 6) and 282 non-sIUGR fetuses were included. The sIUGR group had a significantly earlier birth, lower birth weight of the twins, larger inter-twin weight difference, lower Apgar score of the twins, and higher intrauterine fetal death (IUFD) than the non-sIUGR group (all p < 0.001). The same trend was found in the sIUGR type II group compared to type I and III groups. A significantly lower gestational diabetes rate (p = 0.01) and placenta weight (p < 0.001), and higher proportions of abnormal placental umbilical cord insertion (p < 0.001), and ultrasound Doppler monitoring indicators (p = 0.006) were found in the sIUGR group than the non-sIUGR group. Conclusions The MCDA twins with sIUGR showed poorer outcomes than the non-sIUGR group. Doppler interrogation was a useful clinical marker for fetal outcome.

A large proportion of women experience depression during the postpartum period. Few studies have investigated the use of mobile technology to prevent postpartum depression in women. This study investigated the preliminary effectiveness of the CareMom program, a new app-based cognitive behavioral therapy program, on reducing the depressive symptoms of mothers during the very early postpartum period via a pilot randomized controlled study. The participants were recruited during birth hospitalization (within 3 days after giving birth) and randomized to the waiting-list control and CareMom groups. Over the four-week intervention period, the CareMom group was required to complete 28 daily challenges via CareMom. The depressive (via EPDS) and anxiety (via GAD-7) levels of participants were measured at baseline and every 7 days postbaseline for 4 weeks. A total of 112 eligible participants were randomly allocated to the two groups (CareMom: n = 57; control: n = 55). At week 4, the CareMom group achieved a significantly lower EPDS score than the control group at week 4 (p = 0.037). In addition, the EPDS (p < 0.001) scores of the CareMom group were significantly lower than the baseline values. However, the control group did not show any significant reduction in this measure. No significant reduction of GAD-7 scores was observed for CareMom and control groups at week 4. This study provides preliminary evidence of the effectiveness of CareMom in reducing depressive symptoms in the general postpartum population during the very early postpartum period.

BackgroundPreeclampsia is a heterogeneous and complex disease with its pathogenesis mechanism not fully elucidated. A certain subset of patients with preeclampsia exhibit disturbances in lipid metabolism before clinical symptoms. Moreover, there is a tendency for preeclampsia to run in families. Whether genetic factors play a role in abnormal lipid metabolism during the incidence of preeclampsia has not been well investigated. MethodsPreeclampsia patients (n = 110) and healthy age- and gravidity-matched pregnant women (n = 110) were enrolled in this study. Peripheral blood specimens were used for genomic analysis (n = 10/group) or laboratory validation (n = 100/group). We retrospectively obtained the baseline clinical characteristics of 68 preeclampsia patients and 107 controls in early pregnancy (12-14 gestational weeks). Correlation analyses between differential genes and baseline lipid profiles were performed to identify candidate genes. In vitro and in vivo gain-of-function models were constructed with lentivirus and adeno-associated virus systems, respectively, to investigate the role of candidate genes in regulating lipid metabolism and the development of preeclampsia. ResultsWe observed that preeclampsia patients exhibited significantly elevated plasma TC (P = 0.037) and TG (P < 0.001) levels and increased body mass index (P = 0.006) before the disease onset. Within the region of 27 differential copy number variations, six genes potentially connected with lipid metabolism were identified. The aberrant copies of APOBEC3A, APOBEC3A_B, BTNL3, and LMF1 between preeclampsia patients and controls were verified by quantitative polymerase chain reaction. Especially, APOBEC3A showed a significant positive correlation with TC (P < 0.001) and LDL (P = 0.048) in early pregnancy. Then, our in vitro data revealed that overexpression of APOBEC3A disrupted lipid metabolism in HepG2 cells and affected both cholesterol and fatty acid metabolisms. Finally, in vivo study in a hepatic-specific overexpressed APOBEC3A mouse model revealed abnormal parameters related to lipid metabolism. Pregnant mice of the same model at the end of pregnancy showed changes related to preeclampsia-like symptoms, such as increases in sFlt-1 levels and sFlt-1/PLGF ratios in the placenta and decreases in fetal weight. ConclusionOur findings established a new link between genetics and lipid metabolism in the pathogenesis of preeclampsia and could contribute to a better understanding of the molecular mechanisms of preeclampsia.

Background: A restrictive use of episiotomy was recommended by the obstetric society in China, but limited information has been published on the episiotomy practice at a country level. While midline episiotomy has been demonstrated as a risk factor for 3 rd or 4 th degree lacerations, the effects of mediolateral episiotomy (the more common type) in China, remain unclear. Methods: The China Labor and Delivery Survey is a cross-sectional investigation with a cluster random sampling scheme in 2015-2016. We calculated the episiotomy rate by parity at national and regional levels. Associated factors of episiotomy were selected using mixed models with a random effect for the hospital-level clustering. Logistic regression models were fitted to examine the effects of mediolateral episiotomy on maternal and neonatal outcomes among the propensity score-matched “normal” women. Findings: The episiotomy rate was 41·7% [95% confidence interval (CI): 40·1% - 43·2%] in nulliparae and 21·5% (95% CI: 19·4% - 23·5%) in multiparae in China. Associated factors of episiotomy included prepregnancy BMI, maternal diseases, and obstetric factors. More than half of episiotomies in nulliparae and one-fourth in multiparae had no indications. Mediolateral episiotomy without indicators increased the risk of 3 rd or 4 th degree perineal laceration [odds ratio (OR) =2·64, 95% CI: 1·08-6·48)] in nulliparae without neonatal benefits. Interpretation: Episiotomy was performed more than medical necessary in China. Mediolateral episiotomy without indications more than doubled the risk of 3 rd and 4 th degree perineal laceration in nulliparae without neonatal benefits. Funding: The project was supported by National Natural Science Foundation of China (81273091) and Shanghai Health Commission Programme (GWIV-26.2). Declaration of Interest: The authors declare that they have no competing interests. Ethical Approval: The study protocol was approved by the Research Project Review Panel of the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction at the Department of Reproductive Health and Research of WHO, and the WHO Research Ethics Review Committee, Geneva, Switzerland, and the ethics committees at the Xinhua Hospital and all participating centers.

Background A high birth weight discordance (BWD) places twins at high risks of adverse perinatal outcomes; however, there is no commonly accepted definition of intertwin BWD. Given that gestational age (GA) is closely associated with both BWD and adverse neonatal outcomes, the aim of our study is to develop a measure that takes both BWD and GA into account to define BWD and explore the potentially optimal delivery time in dichorionic twins, with the balance against the risk of intrauterine demise and adverse neonatal outcomes. Methods About 99,000 mixed gender twin pairs from the US matched multiple birth file from 1995 to 2000 were enrolled in our study. We set up a two-dimensional matrix model to select the BWD cutoff point related to outcomes. The optimal delivery time was identified based on the risks of adverse neonatal outcomes and fetal death by GA. Results The combination of BWD and GA had a higher predictive performance for adverse neonatal outcomes than BWD alone (area under ROC curve (AUC): 0.816 vs. 0.523, p < .001). When GA was controlled for, the growth discordant cutoff point was BWD at the 40% level. The optimal delivery time suggested in dichorionic twins with BWD higher than 40% was identified at 33-34 gestational weeks. Conclusions The combination of BWD and GA was a better predictor for adverse neonatal outcomes than BWD alone. In dichorionic twins with BWD >40%, pregnancy may be continued till 33-34 gestation weeks if there is no indication for immediate delivery.

Abstract Objective: We aimed to evaluate the relationship between mode of first delivery with subsequent placenta previa, placenta accreta/increta, and significant postpartum hemorrhage (PPH). Method: This retrospective cohort study included women with two consecutive singleton deliveries between 2007 and 2017 at our institution if the women were nulliparous and delivered at term at the time of first delivery. The first pregnancy delivery mode was classified as (1) vaginal delivery, (2) antepartum cesarean delivery (CD) without labor, or (3) intrapartum CD after the onset of labor. Within these three groups, rates of placenta previa, placenta accreta/increta, and significant PPH at the time of the second delivery were compared. Significant PPH was defined as hemorrhage requiring a blood transfusion. Results: A total of 8208 women were analyzed. Most first deliveries were vaginal (n = 5210, 63.5%), followed by antepartum CD (n = 2432, 29.6%) and intrapartum CD (n = 566, 6.9%). The incidence of placenta previa in subsequent deliveries differed by previous delivery mode: vaginal, 0.9%; antepartum CD, 2.0%; intrapartum CD, 1.6% (p < .001). Similar differences were also observed with respect to placenta accreta/increta (0.5 versus 1.5 versus 0.9%, p < .001) and PPH (0.6 versus 1.2 versus 0.4%, p = .017). Compared to the previous vaginal delivery group, the antepartum CD group had increased risks of placenta previa (aORs 2.02, 95% CI 1.35–3.05), placenta accreta/increta (aOR 2.52; 95% CI 1.53–4.14) and PPH (aOR 1.78, 95% CI 1.14–2.98) in subsequent pregnancies. However, the previous intrapartum CD was not significantly associated with increased risks of these complications. Conclusion: Previous antepartum CD was associated with two-fold increased risks of placenta previa, placenta accreta/increta, and significant PPH in the second delivery compared to women with a prior vaginal delivery. The increased risks of subsequent abnormal placentation following primary antepartum CD may be important for counseling concerning nonmedically indicated elective cesarean. Condensation: Previous antepartum cesarean delivery (CD) was associated with two-fold increased risks of placenta previa, placenta accreta/increta, and significant PPH in the second delivery.

Objective We aimed to describe changes in cesarean delivery (CD) rates after the change of the one-child policy in China by using the Robson classification in a large Chinese population. Study Design This retrospective cohort study included 91,015 women who delivered at >= 24 weeks of gestation at a large tertiary obstetric center in Shanghai, China from 2011 to 2016. We analyzed CD rate trend and CD contribution trend in each Robson group. Logistic regression was used to calculate the odds of CD while adjusting for confounding variables. Results The overall CD rate decreased from 49.0% in 2011 to 40.6% in 2016. In nulliparous women with singleton cephalic term pregnancy and planned CD, the CD contribution rate was reduced significantly from 29.3% in 2011 to 16.4% in 2016 ( p <0.001). In multiparous with a scarred uterus, the CD contribution rate began to increase from 3.8% in 2011 to 9.1% in 2016 ( p <0.001). Compared with delivery in 2011, delivery in 2016 was associated with a 37% (adjusted odds ratio [aOR]: 0.63; 95% confidence interval [CI]: 0.60-0.66) reduction in CD. This reduction was observed in both nulliparous women with singleton cephalic term pregnancy (aOR: 0.57; 95% CI: 0.54-0.60), and multiparous women with singleton cephalic term pregnancy without scar (aOR: 0.41; 95% CI: 0.30-0.55). Conclusion The rate of cesarean delivery in our Chinese population has declined significantly in the past few years.

There is an increasing prevalence of women who tend to delay childbirth until a very advanced age. However, there is sparse data regarding very advanced maternal age (vAMA) and the interplay between vAMA and assisted reproductive technology (ART) on adverse perinatal outcomes. The study aimed to assess the risk of adverse maternal and neonatal outcomes of vAMA women (≥43 years), and to investigate the effect of maternal age on adverse maternal and neonatal outcomes in ART pregnancies.

Background: Premature delivery is the leading risk factor for congenital cerebral palsy (CCP). Intrauterine infection, leading to an inflammatory state, may link preterm birth and CCP. We evaluated the strength of the association between intrauterine infection and CCP, and determined if the effects of funisitis are directly or indirectly mediated.

Objective: To compare maternal and neonatal outcomes by forceps vaginal delivery versus cesarean delivery during the second stage of labor. Methods: We conducted a retrospective cohort study in a large tertiary maternity center in Shanghai, China through 2007-2016. A total of 7046 women carrying a singleton term nonanomalous fetus with vertex presentation who underwent forceps vaginal delivery, or cesarean delivery from a low station in the second stage of labor were included. Results: Of the 7046 women, 6265 underwent forceps and 781 underwent second stage cesarean delivery. Forceps were associated with lower frequency of maternal infection (2.2 versus 4.7%), but higher incidence of mild postpartum hemorrhage (PPH) (4.3 versus 0.6%). When the procedures were performed for fetal indication, forceps were associated with lower frequency of the composite of perinatal mortality and/or hypoxic ischemic encephalopathy (HIE) (0.5 versus 1.9%; adjusted odds ratio (aOR), 0.24; 95% CI: 0.08-0.75), and also shorter decision to delivery interval (12.3 +/- 3.5 versus 19.1 +/- 5.0 min). The neonatal infection rate was higher in the forceps group (3.9 versus 2.0%). There were no differences in other neonatal outcomes including birth trauma. Conclusions: In women who had a need for intervention during the second stage with a station of +2 or below, forceps were associated with a lower frequency of maternal infection but a higher rate of PPH. Deliveries performed for nonreassuring status were accomplished faster by forceps and were associated with a lower frequency of the composite of perinatal mortality and HIE.

BackgroundPrevious studies suggest that caesarean section (CS) may increase the risk of asthma in children, but none of them could preclude potential confounding effects of underlying medical indications for CS. We aim to assess the association between CS itself (without medical indications) and risk of childhood asthma.MethodsWe conducted a hospital-based case-control study on childhood asthma with 573 cases and 812 controls in Shanghai. Unconditional logistic regression models in SAS were employed to control for potential confounders.ResultsOur study found that CS without medical indication was significantly associated with elevated asthma risk (adjusted OR = 1.58 [95% CI 1.17-2.13]). However, this risk was attenuated in children fed by exclusive breastfeeding in the first six months after birth (adjusted OR = 1.39 [95% CI 0.92-2.10]). In contrast, the risk was more prominent in children with non-exclusive breastfeeding or bottle feeding (adjusted OR = 1.91 [95% CI 1.22-2.99]).ConclusionsCS without medical indication was associated with an increased risk of childhood asthma. Exclusive breastfeeding in infancy may attenuate this risk.

In the present study, the mechanisms underlying the pathogenesis of unexplained recurrent spontaneous abortion (URSA) were explored. The protein and mRNA expression of two C-type lectin-like receptors (CLRs), namely dendritic cell-specific intercellular adhesion molecule-3-grabbing non-integrin (DC-SIGN) and mannose receptor (MR), and two Toll-like receptors (TLRs), namely TLR2 and TLR4, in the decidua and dendritic cells (DCs) was compared between URSA patients and normal controls. URSA patients had significantly lower protein and mRNA expression of DC-SIGN and significantly higher expression of TLR2 and TLR4 in decidual tissues compared with normal controls. In addition, URSA patients had significantly higher levels of the T helper (Th) 1 cytokines interleukin (IL)-2 and interferon-γ, and significantly lower levels of the Th2 cytokines IL-10 and transforming growth factor β1 in decidual tissues compared with the control group. The TLR2 agonist synthetic triacylated lipoprotein (Pam3CSK4) and the TLR4 agonist lipopolysaccharide were used to demonstrate that TLR2 and TLR4 modulate Th1/Th2 cytokine imbalance in DC-T cell cocultures. The results suggest that the balance between CLRs and TLRs was tilted towards a TLR-dominant response in URSA patients, which may disrupt maternal-fetal immune tolerance, resulting in spontaneous abortion.

OBJECTIVE:To explore the serum levels of suppressor of cytokine signaling 3 (SOCS3), tumor necrosis factor-alpha (TNF-α) and interleukin-10 (IL-10) in preeclampsia mothers and determine their clinical values.METHODS:A total of 40 preeclampsia mothers at International Peace Maternity and Child Health Hospital of China Welfare Institute Affiliated to Shanghai Jiaotong University from March 2011 to August 2013 were enrolled into observation group. Another 40 cases of mothers without pregnancy complications were selected as control group. Then the serum contents of SOCS3, TNF-α and IL-10 were detected and their correlations analyzed.RESULTS:(1) The mRNA levels of SOCS3 of observation and control groups were 38 ± 6and 100 ± 16while the mRNA levels of TNF-α 226 ± 40 and 100 ± 19 respectively; (2)the proteins levels of SOCS3 of observation group were lower than those of control group (P < 0.05) while the proteins levels of TNF-α of observation group were higher than those of control group (P < 0.05); (3)the mRNA and protein contents of SOCS3 were negatively correlated with mRNA and protein contents of TNF-α and positively correlated with IL-10.CONCLUSION:The serum content of SOCS3 decreases significantly in preeclampsia so that there is a down-regulation of Th1 type cytokine TNF-α and an up-regulation of Th2 type cytokine IL-10. And it may play an important role in the occurrence of disease.

OBJECTIVE There is substantial disparity in perinatal outcomes between white and African-American women, but the underlying biological mechanisms are poorly understood. The placenta is the principal metabolic, respiratory, excretory, and endocrine organ of the fetus. We studied the association between maternal race and types and severity of placental pathology. METHODS Using data from the U.S. Collaborative Perinatal Project (1959-1966), we studied 32,295 African-American and white women with singleton births. CPP pathologists conducted detailed placental examinations following a standard protocol with quality control procedures. Logistic regression modeling was used to test the association between race and placental pathology adjusting for potential confounders. RESULTS Compared to white women, African-American women had a higher risk of fetal neutrophilic infiltration (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 1.0-1.4), and 1.5-fold higher risk of low placental weight (95% CI, 1.3-1.7). However, various placental vascular lesions were significantly less common in African-American women, including infarcts and thrombosis in the cut surface, villous infarcts in the intervillous space, emergence of stromal fibrosis and Langerhans layer in the terminal villi, old hemorrhage in the maternal surface, thrombosis in the intervillous space, and calcification throughout the cut surface (aOR ranging from 0.5 to 0.8). Similar patterns were observed in pregnancies with pregnancy associated hypertension, small-for-gestational-age, and preterm birth. CONCLUSION As compared with white women, African-American had higher prevalence of inflammatory lesions but lower prevalence of vascular lesions in placental pathology.

OBJECTIVE: The purpose of this study was to describe the risks and benefits of cesarean delivery on maternal request (CDMR) in a Chinese population.STUDY DESIGN: A retrospective cohort study of mode of delivery was conducted at the largest obstetric center in Shanghai, China, from 2007-2013. Eligibility criteria included singleton term nulliparous women with vertex presentation; women with major fetal anomalies or stillbirth before labor were excluded.RESULTS: A total of 66,226 women were included in the analysis: 40,560 women (61.2%) had planned vaginal birth, with 32,833 spontaneous vaginal deliveries (80.9%), 4990 intrapartum CDs (12.3%), and 2737assisted vaginal deliveries (6.7%). A total of 16,333 women (24.7%) underwent CDMR. We observed no significant difference between the CDMR and planned vaginal delivery groups in the frequencies of maternal intensive care unit admission (0.2% vs 0.2% ), severe postpartum hemorrhage (0.5% vs 0.5%), maternal infection (1.3% vs 1.3%), organ injuries (0.4% vs 0.5%), and thromboembolic disorders (0.1% vs 0.1%). The perinatal mortality rate was similar in the 2 groups (0.4% vs 0.6%; adjusted odds ratio, 0.51; 95% confidence interval, 0.20-1.30; P = .159). The frequencies of birth trauma (0.2% vs 1.1%), neonatal infection (0.4% vs 0.7%), hypoxic ischemic encephalopathy (0.4% vs 1.8%), and meconium aspiration syndrome (0.2% vs 0.6%) were lower; the frequency of respiratory-distress syndrome (0.6% vs 0.4%) was higher in the CDMR group.CONCLUSION: Compared with nulliparous women who tried vaginal delivery, women who underwent CDMR had similar short-term maternal outcomes with some neonatal benefit.

Background Previous studies suggest that maternal antibiotics exposure during pregnancy may increase the risk of childhood asthma, but the results were inconsistent. Furthermore, most studies did not examine periconception period as an exposure window. We aim to assess the associations between maternal exposure to specific antibiotics before and during pregnancy and the risk of asthma in early childhood. Methods Data from the Collaborative Perinatal Project were used. Maternal exposure to antibiotics before and during pregnancy was recorded at each prenatal visit. A total of 39,907 singleton children were followed up to 7 years of age. Multilevel multiple logistic regression models were used to control for potential confounders and account for multiple pregnancies per woman. Results Maternal use of penicillin or chloramphenicol was associated with an increased risk of asthma in the offspring (adjusted odds ratio = 1.21, 95% confidence interval 1.08–1.36 for penicillin; 1.72 [1.14–2.59] for chloramphenicol). The risk was significantly increased if penicillin or chloramphenicol was used in the 1st trimester (1.09 [1.04–1.13] for penicillin and 1.23 [1.01–1.51] for chloramphenicol). Conclusion Maternal exposure to certain antibiotics is associated with childhood asthma by 7 years of age. Early pregnancy may be a sensitive window.