Pu-Yu Su

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.

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.

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.

Self-reported weight status rather than BMI may be closely related to psychopathological symptoms among Mainland Chinese adolescents

Evidence in respect of the psychological consequences of child and adolescent obesity is mixed. More studies indicated that mental health appears to be more strongly associated with concern about weight and shape, regardless of body mass index (BMI). Using the data from a national large school-based cohort (N = 10 403), we examined the association between obesity, perceived obesity and mental health. There was no relationship between BMI weight status and psychopathological symptoms after adjusting for weight perception and other factors for both genders. More importantly, it was determined that perception of weight as either underweight or overweight was related to higher behavioral symptoms and social adaptation problems. In conclusion, psychological well-being of adolescents is more related to weight perception than BMI is.

Maternal serum cadmium level during pregnancy and its association with small for gestational age infants: a population-based birth cohort study.

The association between maternal cadmium (Cd) exposure during pregnancy and the increased risk of fetal growth restriction (FGR) remains controversial. The present study evaluated the association between maternal serum Cd level and risk of small for gestational age (SGA) infants in a Chinese population. The present study analyzed a subsample of the C-ABCS cohort that recruited 3254 eligible mother-and-singleton-offspring pairs. Maternal serum Cd level during pregnancy was measured by graphite furnace atomic absorption spectrometry. The rate and odds ratio (OR) for SGA infant were calculated. The rate for SGA infant was 10.6% among subjects with H-Cd (≥1.06 μg/L), significantly higher than 7.5% among subjects with L-Cd (<1.06 μg/L). OR was 1.45 (95% CI: 1.11, 1.90; P = 0.007) among subjects with H-Cd. Adjusted OR for SGA infants was 1.43 (95% CI: 1.09, 1.88; P = 0.007) among subjects with H-Cd. Taken together, we observe the fact that maternal Cd exposure at middle gestational stage, elevates the risk of SGA in contrast to early gestational stage. The present results might be interesting and worth more discussing, and guarantee to further studies.

National estimates of pubertal milestones among urban and rural Chinese boys

Aim: To provide up-to-date pubertal characteristics in a representative population of boys from both urban and rural areas of China. Subjects and methods: The China Puberty Research Collaboration enrolled 15 011 boys of Chinese Han ethnicity aged 6.0–18.9 years in eight regions including both urban and rural areas. Stages of genital and pubic hair development were assessed by trained physicians according to the Tanner method. Testicular volume was evaluated with a Prader orchidometer. Results: Median age for onset of testicular volume of 4 mL or greater was 11.02 years. Median age for onset of genital (G2), pubic hair development (PH2) and spermarche was 11.24 years, 12.67 years and 14.32 years, respectively. Boys with BMI ≥ 85th percentile reached the onset of TV ≥ 4 ml (11.09 years), G2 (11.34 years) and G3 (13.01 years) later than boys with a normal BMI (10.95 years, 11.1 years and 12.88 years, respectively). Urban boys achieved pubertal milestones at an earlier age than rural peers except for G5 (13.4 vs 13.76 years) and PH5 (12.86 years vs 13.14 years). Conclusions: There is an asynchronous pattern in the onset of puberty among Chinese boys. Higher BMI is related to early pubertal onset but fast pubertal progression. Urban boys achieved onset of puberty earlier than rural boys in China.

Self-assessment of pubertal Tanner stage by realistic colour images in representative Chinese obese and non-obese children and adolescents

Aim:  This investigation aims to evaluate the validity of self‐assessment of pubertal Tanner stage in representative Chinese children and adolescents.

Periconceptional folic acid supplementation among women attending antenatal clinic in Anhui, China: Data from a population-based cohort study

OBJECTIVES to examine the rate of periconceptional and optimal folic acid supplementation, and to characterise their patterns and determinants among antenatal women in central China. DESIGN data from 4290 women in the Anhui Birth Defects and Child Development Cohort Study recruited between October 2008 and September 2009 were analysed. SETTING seven Maternal and Child Health Centres of two cities (Hefei and Maanshan) in Anhui province of central China. PARTICIPANTS women initiating prenatal care were included and asked to complete a structured questionnaire regarding folic acid supplementation. FINDINGS sixty-eight per cent (2905/4290) of pregnant women reported taking folic acid supplementation periconceptionally (i.e. at some point before or during early pregnancy), and 32.8% (1405/4290) and 65.2% (2797/4290) had taken it before or during early pregnancy, respectively. However, only 16.1% (690/4290) used it optimally (i.e. regularly from four weeks before pregnancy throughout four weeks after pregnancy). Use of periconceptional folic acid was significantly associated with educational level, household income, registered residence, age, gestational age at recruitment, and planning of pregnancy. CONCLUSION optimal folic acid supplementation was relatively low. IMPLICATIONS FOR PRACTICE further efforts are needed to inform the population and promote the use of folic acid supplementation.

Effects of Prenatal Phthalate Exposure on Thyroid Hormone Concentrations Beginning at The Embryonic Stage

Limited studies have consistently shown an association of phthalates exposure with thyroid hormones (THs) in pregnant women. However, it remains unknown on which specific phthalates can affect THs and whether any effects could differ by gestational age. In the present study, we investigated associations between serum concentrations of phthalate monoesters [monoethyl phthalate (MEP), mono-(n + iso)-butyl phthalate (MBP) and mono(2-ethylhexyl) phthalate (MEHP)] and THs [thyroid-stimulating hormone (TSH), total thyroxine (TT4) and free thyroxine (FT4)] in Chinese pregnant women. 1,397 women were recruited from the China-Anhui Birth Cohort. Maternal serum samples were collected and used to measure phthalate metabolites and THs. Covariate-adjusted linear regression analyses showed that natural log (Ln)-transferred concentrations of MBP and LnMEHP were negatively associated with TT4 (β = −0.277 and –0.461, respectively; p < 0.001). Stratification analyses by gestational weeks showed significant associations of LnMBP and LnMEHP with TT4 in gestational weeks 5 to 8, 9 to 12, and 13 to 20. Our findings suggest an association of serum phthalates with lower TT4. The influence of MBP and MEHP on TT4 concentrations throughout the early pregnancy may begin from the embryonic stage (gestational weeks 5 to 8).