Fang-Biao Tao

Maternal Thyroid Function in the First Twenty Weeks of Pregnancy and Subsequent Fetal and Infant Development: A Prospective Population-Based Cohort Study in China

CONTEXT There are a few prospective population-based cohort studies evaluating the effects of maternal thyroid dysfunctions on fetal and infant developments, but they are inconsistent. OBJECTIVE The objective of the study was to investigate the effects of maternal thyroid dysfunction on fetal and infant development. SETTING AND PARTICIPANTS The study was nested within a prospective population-based China-Anhui Birth Defects and Child Development study. A total of 1017 women with singleton pregnancies participated in this study. Maternal serum samples in the first 20 wk of pregnancy were tested for thyroid hormones (TSH and free T(4)). Pregnant women were classified by hormone status into percentile categories based on laboratory assay and were compared accordingly. MAIN OUTCOMES Outcomes included fetal loss, malformation, birth weight, preterm delivery, fetal stress, neonatal death, and infant development. RESULTS Clinical hypothyroidism was associated with increased fetal loss, low birth weight, and congenital circulation system malformations; the adjusted odds ratios [95% confidence interval (CI)] were 13.45 (2.54-71.20), 9.05 (1.01-80.90), and 10.44 (1.15-94.62), respectively. Subclinical hypothyroidism was associated with increased fetal distress, preterm delivery, poor vision development, and neurodevelopmental delay; the adjusted odds ratios (95% CI) were 3.65 (1.44-9.26), 3.32 (1.22-9.05), 5.34 (1.09-26.16), and 10.49 (1.01-119.19), respectively. Isolated hypothyroxinemia was related to fetal distress, small for gestational age, and musculoskeletal malformations; the adjusted odds ratios (95% CI) were 2.95 (1.08-8.05), 3.55 (1.01-12.83), and 9.12 (1.67-49.70), respectively. Isolated hyperthyroxinemia was associated with spontaneous abortion; the adjusted odds ratio (95% CI) was 6.02 (1.25-28.96). Clinical hyperthyroidism was associated with hearing dysplasia; the adjusted odds ratio (95% CI) was 12.14 (1.22-120.70). CONCLUSIONS Thyroid dysfunction in the first 20 wk of pregnancy may result in fetal loss and dysplasia and some congenital malformations.

Maternal anxiety during pregnancy and adverse birth outcomes: A systematic review and meta-analysis of prospective cohort studies

BACKGROUND Previous studies concerning the association between maternal anxiety during pregnancy and adverse birth outcomes have provided controversial findings. METHODS In this systematic review, a meta-analysis was utilized to investigate the association between maternal anxiety and preterm birth (PTB) and/or low birth weight (LBW). Literature was searched until June 2013. Only prospective cohort studies that reported data on maternal anxiety during pregnancy with PTB and/or LBW were included. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using fixed or random effects models depending on the size of heterogeneity. RESULTS Twelve studies totaling 17,304 pregnant women reported PTB data; and six studies totaling 4948 pregnant women reported LBW data. Maternal anxiety during pregnancy was associated with significant increased risk of PTB (pooled RR=1.50, 95% CI=1.33-1.70) and LBW (pooled RR=1.76, 95% CI=1.32-2.33). LIMITATIONS Potential moderators could not be adequately considered due to insufficient information. In addition, the effects of different types of anxiety disorder on the risk of these adverse birth outcomes could not be investigated. CONCLUSIONS The results suggested that maternal anxiety during pregnancy was positively related to an increased risk of PTB and LBW. Healthcare providers should give close attention to anxiety in pregnant women and provide appropriate mental health support in order to improve outcomes for both mothers and infants.

Maternal vitamin D deficiency during pregnancy elevates the risks of small for gestational age and low birth weight infants in Chinese population.

CONTEXT Vitamin D deficiency is common in pregnant women. Nevertheless, the association between maternal vitamin D status during pregnancy and the risk of having small for gestational age (SGA) and low birth weight (LBW) infants is uncertain. OBJECTIVE The objective of this study was to investigate whether there is a correlation between maternal vitamin D deficiency during pregnancy and the risk of having SGA and LBW infants in a Chinese population. DESIGN AND PARTICIPANTS This was a population-based birth cohort study that recruited 3658 eligible mother-and-singleton-offspring pairs. MAIN OUTCOME MEASURES Serum 25-hydroxyvitamin D was measured by RIA. The rate and relative risk (RR) for SGA and LBW infants were calculated among subjects with vitamin D deficiency and insufficiency during pregnancy. RESULTS There was a positive correlation between maternal serum 25-hydroxyvitamin D level and offspring birth weight (r = 0.477; P < .001). Further analysis showed that 4.98% of neonates were LBW infants among the subjects with vitamin D deficiency (RR, 12.00; 95% confidence interval [CI], 4.37, 33.00) and 1.32% among the subjects with vitamin D insufficiency (RR, 3.18; 95% CI, 1.07, 9.48). After adjustment for confounders, the RR for LBW infants was 12.31 (95% CI, 4.47, 33.89) among subjects with vitamin D deficiency and 3.15 (95% CI, 1.06, 9.39) among subjects with vitamin D insufficiency. Moreover, 16.01% of neonates were SGA infants among subjects with vitamin D deficiency (RR, 5.72; 95% CI, 3.80, 8.59) and 5.59% among subjects with vitamin D insufficiency (RR, 1.99; 95% CI, 1.27, 3.13). After adjustment for confounders, the RR for SGA infants was 6.47 (95% CI, 4.30, 9.75) among subjects with vitamin D deficiency and 2.01 (95% CI, 1.28, 3.16) among subjects with vitamin D insufficiency. CONCLUSION Maternal vitamin D deficiency during pregnancy elevates the risk of SGA and LBW infants in a Chinese population.

Low Physical Activity and High Screen Time Can Increase the Risks of Mental Health Problems and Poor Sleep Quality among Chinese College Students

Objective To test the independent and interactive associations of physical activity (PA) and screen time (ST) with self-reported mental health and sleep quality among Chinese college students. Method Data were collected in October, 2013. The gender, age, residential background, body mass index (BMI), perceived family economy and perceived study burden were obtained from a total of 4747 college students (41.6% males and 58.4% females). The outcomes were self-reported PA status, ST, anxiety, depression, psychopathological symptoms and sleep quality. Analyses were conducted with logistic regression models. Results Overall, 16.3%, 15.9% and 17.3% of the students had psychological problems, such as anxiety, depression and psychopathological symptoms, respectively. The prevalence of poor sleep quality was 9.8%. High ST was significantly positively associated with anxiety (OR=1.38, 95%CI: 1.15-1.65), depression (OR=1.76, 95%CI: 1.47-2.09), psychopathological symptoms (OR=1.69, 95%CI: 1.43-2.01) and poor sleep quality (OR=1.32, 95%CI: 1.06-1.65). High PA was insignificantly negatively associated with anxiety, depression, psychopathological symptoms and poor sleep. Low PA and high ST were independently and interactively associated with increased risks of mental health problems and poor sleep quality (p<0.05 for all). Conclusion Interventions are needed to reduce ST and increase PA in the lifestyles of young people. Future research should develop and measure the impacts of interventions and their potential consequences on sleep, health, and well being.

Does prenatal maternal stress impair cognitive development and alter temperament characteristics in toddlers with healthy birth outcomes

The aim of this study was to assess the cognitive and behavioural development of children with healthy birth outcomes whose mothers were exposed to prenatal stress but did not experience pregnancy complications.

Effects of emotional symptoms and life stress on eating behaviors among adolescents

The aim of this study was to explore possible effects of emotional symptoms (depressive symptoms and anxiety symptoms) and life stress on eating behaviors (restrained, emotional and external eating behaviors) among junior and high school students in China. A total of 5473 students in Xuzhou, Jiangsu Province were sampled to participate in this survey based on a clustering sampling approach. The survey collected sociodemographic data, emotional symptoms, life stress and eating behaviors of adolescents. Spearman correlation coefficients were measured and tested to examine the relationship between eating behaviors and emotional symptoms as well as life stress. In addition, we analyzed the data using Chi-square tests and multivariate logistic regression models. The results showed positive correlation between emotional symptoms, life stress, and eating behaviors. Furthermore, depressive symptoms, anxiety symptoms and life stress were significantly associated with unhealthy eating behaviors, after adjusting for gender, age, BMI, parental education level and self-assessed family economic status. This study suggests that a comprehensive intervention focusing on emotion and stress management would be helpful for the prevention of unhealthy eating behaviors among Chinese adolescents.

Pregnancy loss and anxiety and depression during subsequent pregnancies: data from the C-ABC study.

OBJECTIVE Previous studies have shown that pregnancy loss may affect the mental health of women in subsequent pregnancies. The China Anhui Birth Defects and Child Development cohort study therefore aimed to investigate the influence of pregnancy loss on anxiety and depression in subsequent pregnancies. STUDY DESIGN In total, 20,308 pregnant women provided written informed consent and completed the study questionnaire. The Self-rating Anxiety Scale and Center for Epidemiologic Studies-Depression Scale were used to evaluate anxiety and depression in pregnant women. Pearsons χ(2) test and binary logistic regression were used for statistical analyses. RESULTS Of 20,308 pregnant women, 1495 (7.36%) had a history of miscarriage and 7686 (37.85%) had a history of induced abortion. The binary logistic regression model found that pregnant women with a history of miscarriage had a significantly higher risk of anxiety and depression in the first trimester than primigravidae after stratified analysis according to the timing of the first prenatal visit (p<0.05). Compared with pregnant women with no history of miscarriage, women who had a history of miscarriage and an interpregnancy interval of less than 6 months had increased risk of anxiety symptoms (p<0.05) and depression symptoms (p<0.05) during the first trimester. Women with an interpregnancy interval of 7-12 months had a 2.511-fold higher risk of depression (p<0.05) than women with no history of miscarriage. These findings were not changed after adjustment for maternal age, maternal education, family income, place of residence and pre-pregnancy body mass index. CONCLUSIONS Women with a history of miscarriage experienced significant anxiety and depression during their next pregnancy. A short interpregnancy interval and the first trimester are risk factors for adverse mental health.

Cortisol reactivity, delay discounting and percent body fat in Chinese urban young adolescents.

The purpose of this study is to test the relation of cortisol reactivity, delay discounting and percent body fat (PBF) in adolescents aged 12-13 years (N=87), and evaluate the delay discounting as potential components in models of adolescent obesity. Anthropometry and body composition measurements were assessed in adolescents. The cortisol reactivity to Trier Social Stress Test for Children (TSST-C) and delay discounting were measured. The result showed increased cortisol reactivity and greater delay discounting were associated with higher PBF in girls. Structural equation modeling supported greater delay discounting as a mediator of relations between increased cortisol reactivity and PBF in adolescent girls. The proposed mediation model indicated that cortisol reactivity is linked to PBF through delay discounting, thereby supporting a significant indirect relationship. The direct relationship between increased cortisol reactivity and higher PBF was significant in a model that did not include delay discounting, and was still significant in the mediation model that included delay discounting. This study provides the first evidence that greater delay discounting may partially account for the relationship of hyperactivity of the HPA-axis and higher PBF in girls.

Early Menarche and Psychopathological Symptoms in Young Chinese Women

OBJECTIVE To evaluate the psychopathological symptoms, suicide, and self-harming behaviors among students with early, on-time, and late menarche in high school and college and the association of early menarche with these disorders. METHODS The design consisted of a cross-sectional study of 5597 high school students and 2768 college students. Menarche age, suboptimal mental health status, anxiety, depression, suicide, and self-harming behaviors were obtained by self-report questionnaire. RESULTS In high school students, all the disorders occurred at significantly higher frequency in those with early menarche than in those with on-time and late menarche. In college students, only suboptimal mental health status, depression, and suicidal ideation happened at significantly higher frequency in the early menarche group than in the other two groups. The college group had a lower frequency of all the disorders than the high school group for all three groups of girls, that is, with early, on-time, or late menarche. In a multivariate logistic regression model, early menarche persisted as a risk factor for all the disorders after other factors were controlled. CONCLUSIONS Psychopathological symptoms, suicide, and self-harming behaviors are more common in early menarche students than in on-time and late menarche students. The effects of early menarche on the disorders might dissipate over time. Early menarche might serve as a predictor for the disorders in Chinese girls.

Maternal zinc deficiency during pregnancy elevates the risks of fetal growth restriction: a population-based birth cohort study

We investigated the association between maternal zinc level during pregnancy and the risks of low birth weight (LBW) and small for gestational age (SGA) infants in a large population-based birth cohort study. In this study, 3187 pregnant women were recruited. For serum zinc level, 2940 pregnant women were sufficient (≥56 μg/dL) and 247 deficient (<56 μg/dL). Of interest, 7.3% newborns were with LBW among subjects with low zinc level (RR: 3.48; 95% CI: 2.03, 5.96; P < 0.001). Adjusted RR for LBW was 3.41 (95% CI: 1.97, 5.91; P < 0.001) among subjects with low zinc level. Moreover, 15.0% newborns were with SGA among subjects with low zinc level (RR: 1.98; 95% CI: 1.36, 2.88; P < 0.001). Adjusted RR for SGA was 1.93 (95% CI: 1.32, 2.82; P < 0.001) among subjects with low zinc level. A nested case-control study within above cohort showed that maternal serum zinc level was lower in SGA cases as compared with controls. By contrast, maternal serum C-reactive protein, TNF-α and IL-8 levels were significantly higher in SGA cases than that of controls. Moreover, nuclear NF-κB p65 was significantly up-regulated in placentas of SGA cases as compared with controls. Taken together, maternal zinc deficiency during pregnancy elevates the risks of LBW and SGA infants.