Objective: We adopted the area under the curve (AUC) of oral glucose tolerance test (OGTT) as a measure method of the severity of maternal hyperglycemia and investigated its relationship with adverse perinatal outcome...Objective: We adopted the area under the curve (AUC) of oral glucose tolerance test (OGTT) as a measure method of the severity of maternal hyperglycemia and investigated its relationship with adverse perinatal outcomes among women with and without gestational diabetes mellitus (GDM). Research design and methods: This is a retrospective cohort study. Our study group collected the medical records of 15,296 women who received perinatal care in 15 hospitals in Beijing and who delivered from July 1, 2013, to December 31, 2013. And several original articles on this cohort have been published. In this study, we analyze the relationship between AUC and adverse perinatal outcomes, so that in multiple pregnant cases, patients with pre-pregnancy diabetes, hypertension, and abnormal kidney function and those who did not receive a 75-g OGTT were excluded. A Chi-squared test and logistic regression analysis were used to determine the associations. Results: In total, 13,561 women were included. As the AUC of OGTT increased, the prevalence of macrosomia (odds ratio [OR] 1.059, 95% confidence interval [95% CI] 1.029 - 1.090, p < 0.001) and hypertensive diseases (OR 1.106, 95% CI 1.064 - 1.149, p < 0.001) also increased. For patients with same levels of AUC values, no significant differences in the risk of macrosomia, preterm birth and neonatal complications were observed between the GDM and non-GDM groups. Women with an AUC higher than 14.20 (mmol * h/L) had a higher risk of adverse outcomes regardless of the presence of GDM. Conclusions: The AUC could be a measure method of the severity of maternal hyperglycemia, and women with a high AUC should undergo aggressive management to avoid adverse outcomes regardless of the presence of GDM.展开更多
Background:Alterations in the placental expression of glucose transporters(GLUTs),the crucial maternal-fetal nutrient transporters,have been found in women with hyperglycemia in pregnancy(HIP).However,there is still u...Background:Alterations in the placental expression of glucose transporters(GLUTs),the crucial maternal-fetal nutrient transporters,have been found in women with hyperglycemia in pregnancy(HIP).However,there is still uncertainty about the underlying effect of the high-glucose environment on placental GLUTs expression in HIP.Methods:We quantitatively evaluated the activity of mammalian target of rapamycin(mTOR)and expression of GLUTs(GLUT1,GLUT3,and GLUT4)in the placenta of women with normal pregnancies(CTRL,n=12)and pregnant women complicated with poorly controlled type 2 diabetes mellitus(T2DM,n=12)by immunohistochemistry.In addition,BeWo cells were treated with different glucose concentrations to verify the regulation of hyperglycemia.Then,changes in the expression of GLUTs following the activation or suppression of the mTOR pathway were also assessed using MHY1485/rapamycin(RAPA)treatment or small interfering RNA(siRNA)-mediated silencing approaches.Moreover,we further explored the alteration and potential upstream regulatory role of methyltransferase-like 3(METTL3)when exposed to hyperglycemia.Results:mTOR,phosphorylated mTOR(p-mTOR),and GLUT1 protein levels were upregulated in the placenta of women with T2DM compared with those CTRL.In BeWo cells,mTOR activity increased with increasing glucose concentration,and the expression of GLUT1,GLUT3,and GLUT4 as well as GLUT1 cell membrane translocation were upregulated by hyperglycemia to varying degrees.Both the drug-mediated and genetic depletion of mTOR signaling in BeWo cells suppressed GLUTs expression,whereas MHY1485-induced mTOR activation upregulated GLUTs expression.Additionally,high glucose levels upregulated METTL3 expression and nuclear translocation,and decreasing METTL3 levels suppressed GLUTs expression and mTOR activity and vice versa.Furthermore,in METTL3 knockdown BeWo cells,the inhibitory effect on GLUTs expression was eliminated by activating the mTOR signaling pathway using MHY1485.Conclusion:High-glucose environment-induced upregulation of METTL3 in trophoblasts regulates the expression of GLUTs through mTOR signaling,contributing to disordered nutrient transport in women with HIP.展开更多
Intrahepatic cholestasis of pregnancy(ICP)is a significant gestational complication in late pregnancy,potentially leading to severe perinatal complications such as intrauterine fetal demise and preterm birth.The Obste...Intrahepatic cholestasis of pregnancy(ICP)is a significant gestational complication in late pregnancy,potentially leading to severe perinatal complications such as intrauterine fetal demise and preterm birth.The Obstetrics Group of the Gynecology and Obstetrics Branch and the Perinatal Medicine Branch of the Chinese Medical Association organized a panel of domestic experts to deliberate and propose recommendations based on domestic and international guidelines,recent evidence-based medical evidence about key clinical issues including risk factors,clinical manifestations,perinatal outcomes,diagnosis,severity grading,maternal and fetal monitoring,treatment methods,timing,and methods of pregnancy termination,and postpartum follow-up for ICP,with the aim to guide its clinical diagnosis,treatment,and management.展开更多
Advanced atomic tracking techniques play a critical role in characterizing structural evolution,elucidating fundamental mechanisms of exotic phenomena and tailoring delicate properties.Thermally driven structural modu...Advanced atomic tracking techniques play a critical role in characterizing structural evolution,elucidating fundamental mechanisms of exotic phenomena and tailoring delicate properties.Thermally driven structural modulation in 2D crystals,such as the charge density wave(CDW),often leads to intriguing quantum properties,making them a valuable platform for exploring fundamental physics and potential device applications.However,despite their significance,experimental studies addressing atomic tracking of thermally-driven structural evolution in 2D crystals have been limited.Herein,we utilize high-accuracy variable-temperature atomic tracking measurements with scanning tunneling microscopy(STM)to directly observe a series of structural transitions in a model 2D crystal,namely NbSe_(2).With the atomic tracking technique,we confirm the existence of the universal thermally-driven CDW transition hysteresis between the heating and cooling cycles.This transition hysteresis,characterized by a constant temperature offset,represents a new phenomenon of structural evolution.Our findings provide a feasible method to track CDW transitions at the atomic scale in 2D crystals,significantly contributing to a better understanding and the potential modulation of these materials'functions in nanodevices.展开更多
To editor:The disorders associated with placenta accreta spectrum(PAS)are potentially severe obstetric complications that should be managed by expert centers with substantial re-sources to provide both preoperative an...To editor:The disorders associated with placenta accreta spectrum(PAS)are potentially severe obstetric complications that should be managed by expert centers with substantial re-sources to provide both preoperative and intraoperative as-sessments and then prearrange a multidisciplinary team with an appropriate delivery plan.Placenta accreta spectrum was first described in 1937 as“attempts to remove the pla-centa led to major postpartum hemorrhage that required emergency or secondary hysterectomy to control bleeding.”1 In 1966,Luke et al-classified this condition into placenta creta(or vera,adherenta),increta,and perceta based on the depth of placenta villi adhesion or invasion,as determined by pathological features.Although infrequent,there have been significant advances in the global evolution of the strat-egies used to manage PAS,especially over the last decade.展开更多
To the Editor:Placenta accreta spectrum(PAS)disorders refer to a spectrum of abnormal placentation.PAS subtypes include placenta accreta(creta or adherenta,PA),placenta increta(PI),and placenta percreta(PP).The incide...To the Editor:Placenta accreta spectrum(PAS)disorders refer to a spectrum of abnormal placentation.PAS subtypes include placenta accreta(creta or adherenta,PA),placenta increta(PI),and placenta percreta(PP).The incidence of PAS has dramatically increased over the past four decades.A study using a nationally representative sample in the United States showed that the prevalence of PAS was 0.29%among women who underwent cesarean delivery with live birth.[1]Women with PAS are at a considerably higher risk of concurrent hemorrhage,bladder and urinary tract injury,and hysterectomy during delivery.[1]展开更多
Objective:This study aimed to determine the likelihood of gestational diabetes mellitus(GDM)in subsequent pregnancy among women without GDM history and to identify risk factors for GDM in subsequent pregnancy.Methods:...Objective:This study aimed to determine the likelihood of gestational diabetes mellitus(GDM)in subsequent pregnancy among women without GDM history and to identify risk factors for GDM in subsequent pregnancy.Methods:This retrospective cohort study involved participants who delivered twice in same hospital of 18 research centers when delivered the second baby from January 2018 to December 2018.Finally 6204 women were enrolled and 5180 women without GDM history were analyzed further.Women were categorized as non-GDM or GDM based on the blood glucose values of the subsequent pregnancy,and the characteristics and GDM risk of these groups were compared.A univariate analysis of potential risk factors was performed using the Chi-squared test and/ort-test for qualitative or quantitative variables,respectively.Associations withP values<0.1 were chosen to be included in the multivariate binary logistic regression model.Results:In primary analysis of 6204 women,the incidence of GDM in subsequent pregnancy is 48.9%(490/1002)in women with GDM history and 16.1%(835/5202)in women without GDM history.In a further analysis for 5180 women without GDM at index pregnancy,compared with the non-GDM group,the GDM group had a significantly higher age,prepregnancy body mass index,and blood glucose value at each oral glucose tolerance test(OGTT)timepoint(fasting,1 h and 2 h)during the index and subsequent pregnancies,as well as higher weight retention during the interval between the two pregnancies(P<0.001).Age above 35 years in subsequent pregnancy(odds ratio(OR)=1.540,95%confidence interval(CI)=1.257-1.886,P<0.001),macrosomia in index pregnancy(OR=1.749,95%CI=1.277-2.395,P=0.001),OGTT blood glucose values in index pregnancy(fasting,OR=2.487,95%CI=1.883-3.285,P<0.001;1 h,OR=1.142,95%CI=1.051-1.241,P=0.002;2 h,OR=1.290,95%CI=1.162-1.432,P<0.001)and weight retention(OR=1.052,95%CI=1.035-1.068,P<0.001)were independent risk factors for GDM in subsequent pregnancy.Conclusion:For women without GDM history,GDM risk factors including age,macrosomia history,OGTT value,and weight retention,these can be evaluated before a subsequent pregnancy.Early warning and interventions are needed for women at high risk.展开更多
Background:The APPEC study is a large-population randomized controlled trial in China evaluating the role of low-dose aspirin prophylactic treatment for pre-eclampsia.There was no statistically significant difference ...Background:The APPEC study is a large-population randomized controlled trial in China evaluating the role of low-dose aspirin prophylactic treatment for pre-eclampsia.There was no statistically significant difference in postpartum hemorrhage(PPH)incidence between the aspirin and control groups.This study aimed to evaluate the potential bleeding risk of 100 mg aspirin in high-risk pregnant women and the difference in the incidence of PPH according to maternal characteristics.Methods:This is a secondary data analysis of the APPEC study.Platelet counts and coagulation test results were collected at five follow-up visits.Subgroups defined by maternal age(<35 years and≥35 years),pre-pregnancy body mass index(pre-BMI,<28 kg/m 2 and≥28 kg/m 2),parity,gestational age at enrollment,and medical history,including pre-eclampsia,chronic hypertension,and diabetes mellitus,were analyzed.Logistic regression analysis was used to determine the statistical significance of the difference in the incidence of PPH after aspirin administration in pregnant women in each subgroup.Adjustment using multiple logistic regression models followed these analyses.Binary logistic regression was used to determine the relationship between pre-BMI and PPH.Results:There was no significant difference between the aspirin and control groups in bleeding risk(3.4%[16/464]vs.3.0%[13/434],T=0.147,P=0.701).No significant difference was found in the incidence of PPH in total(relative risk=1.220,95%confidence interval[CI]=0.720–2.067,P=0.459;aspirin group vs.control group,6.5%[30/464]vs.5.3%[23/434],P=0.459)or in subgroup analysis.A significant correlation between pre-BMI and PPH was found in the aspirin group,while in the control group there was no significant correlation(aspirin group,odds ratio[OR]=1.086,95%CI=1.004–1.175,P=0.040;control group,OR=1.060,95%CI=0.968–1.161,P=0.209).Conclusions:A dosage of 100 mg of aspirin per day,initiated from 12 to 20 gestational weeks until 34 weeks of gestation,did not increase the risk of potential bleeding and PPH regardless of the maternal characteristic.In the aspirin group,the positive correlation between BMI and PPH was significant.Trial Registration:ClinicalTrials.gov,NCT01979627.展开更多
Two-dimensional(2D)twisted moirématerials,a new class of van der Waals(vdW)layered heterostructures with different twist angles between neighboring layers,have attracted tremendous attention due to their rich eme...Two-dimensional(2D)twisted moirématerials,a new class of van der Waals(vdW)layered heterostructures with different twist angles between neighboring layers,have attracted tremendous attention due to their rich emerging properties.In this review,we systematically summarize the recent progress of 2D twisted moirématerials.Firstly,we introduce several representative fabrication methods and the fascinating topographies of the twisted moirématerials.Specifically,we discuss various remarkable physical properties related to twisted angles,including flat bands,unconventional superconductivity,ferromagnetism,and ferroelectricity.We also analyze the potential applications in various twisted moirésystems.Finally,the challenges and future perspectives of the twisted moirématerials are discussed.This work would spur edge-cutting ideas and related achievements in the scientific and technological frontiers of 2D twisted moirématerials.展开更多
Hyperglycemia is one of the most common complications women encounter during pregnancy,and is associated with a higher incidence of short-and long-term health risks for both the mother and offspring.In 2022,the Matern...Hyperglycemia is one of the most common complications women encounter during pregnancy,and is associated with a higher incidence of short-and long-term health risks for both the mother and offspring.In 2022,the Maternal-Fetal Medicine Committee of the Chinese Society of Obstetrics and Gynecology,Chinese Medicine Association,worked with the Chinese Society of Perinatal Medicine and the Professional Committee of Gestational Diabetes Mellitus of the Chinese Maternal and Child Health Association to update the Guidelines for the diagnosis and management of hyperglycemia in pregnancy in China.The aim was to further standardize the management of hyperglycemia in pregnancy from the aspects of screening,diagnosis,monitoring,treatment,and prevention of gestational diabetes mellitus,and consequently to further improve the health of mother and child.展开更多
Objective::This study aimed to reach a consensus among obstetric experts on the prevention and treatment of preterm single births in China.Methods::Based on the scoping literature review and the 2014 edition of preter...Objective::This study aimed to reach a consensus among obstetric experts on the prevention and treatment of preterm single births in China.Methods::Based on the scoping literature review and the 2014 edition of preterm birth of Clinical Diagnosis and Treatment guidelines,we generated the Delphi survey statements with five evaluation dimensions,including the definition of preterm birth,exclusion of risk factors for preterm birth,prevention,and prediction of preterm birth,treatment of preterm birth,and evaluation of intervention outcomes of preterm birth.Obstetric experts from the Obstetrics and Gynecology Branch of the Chinese Medical Association formed the expert group for this survey.All the obstetric experts participated two-round modified Delphi survey via an anonymous online survey and an online panel.Mean scores,rank sum,full score ratio,and the lowest score ratio were calculated to reflect the concentration of expert opinions.The coefficient of variation and Kendall W coefficient were used to reflect the expert opinion coordination degree of the survey statement.Results::The expert response rate for both rounds of surveys was 100%(41/41).Experts reached an agreement on 36 statements in five dimensions of preterm birth prevention and treatment in the first round of the survey and reached a consensus on the remaining 13 statements in the second round.A total of 49 statements(mean scores≥3,full score ratio≥20%,coefficient of variation≤0.3)were explicitly included in this guideline to form recommendations,while the remaining three clinical issues that did not reach a consensus require further determination based on evidence quality.The Kendall W coefficient in the two rounds of the Delphi survey were 0.20(P<0.001)and 0.29(P<0.001).Conclusion::The five dimensions and 49 statements,agreed upon through a two-round Delphi study,determined the recommended statements to be included in the updated guidelines for the prevention and treatment of preterm birth in China.The defined lower limit is set at≥28 gestational weeks;however,an update has been made to the definition of premature birth,specifying that"with the consent of the mother and her family,treatment is not abandoned for viable infants≥26 gestational weeks."展开更多
With the widespread transmission of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the medical community has organized efforts to determine a series of clinical questions about the virus.Critical question...With the widespread transmission of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the medical community has organized efforts to determine a series of clinical questions about the virus.Critical questions have also arisen in the field of maternal-fetal medicine and have received increasing attention,as physiological and immunologic changes in pregnancy might potentially increase the susceptibility to SARS-CoV-2 infection and complications of the virus.1 Many early reports indicated that pregnant women with SARS-CoV-2 infection were not prone to experiencing severe disease.展开更多
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread worldwide and threatened human’s health.With the passing of time,the epidemiology of coronavirus disease 2019 evolves and the know...The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread worldwide and threatened human’s health.With the passing of time,the epidemiology of coronavirus disease 2019 evolves and the knowledge of SARS-CoV-2 infection accumulates.To further improve the scientific and standardized diagnosis and treatment of maternal SARS-CoV-2 infection in China,the Chinese Society of Perinatal Medicine of Chinese Medical Association commissioned leading experts to develop the Recommendations for the Diagnosis and Treatment of Maternal SARS-CoV-2 Infection under the guidance of the Maternal and Child Health Department of the National Health Commission.This recommendations includes the epidemiology,diagnosis,management,maternal care,medication treatment,care of birth and newborns,and psychological support associated with maternal SARS-CoV-2 infection.It is hoped that the recommendations will effectively help the clinical management of maternal SARS-CoV-2 infection.展开更多
Objective This study aimed to determine the most pertinent factors responsible for placenta accreta spectrum disorders in patients without any history of pregnancy and evaluate their prognostic implications.Methods Th...Objective This study aimed to determine the most pertinent factors responsible for placenta accreta spectrum disorders in patients without any history of pregnancy and evaluate their prognostic implications.Methods This retrospective cohort study included 1009 patients diagnosed with placenta accreta spectrum disorders based on standardized diagnostic criteria across 10 tertiary hospitals in China between January 1,2018,and December 31,2018;45 patients without a history of pregnancy were selected.The collected data mainly included demographic characteristics(including age,operative history,and ultrasound findings)and maternal-fetal outcomes(including any history of intraoperative bleeding,blood transfusion details,maternal-fetal complications,and fetal Apgar scores).SPSS 24.0 was used for statistical analyses.The Mann-Whitney U test and logistic regression were performed;a two-tailed P<0.050 was considered statistically significant.Results Ultrasound-based detection of placenta previa(χ^(2)=9.911,P=0.003)showed a strong association with placenta accreta spectrum types.The severity of placenta accreta spectrum was directly proportional to the likelihood of having coexistent complete placenta previa(χ^(2)=11.626,P=0.009)and being diagnosed by ultrasound(χ^(2)=5.449,P=0.047).Blood transfusion also impacted placenta accreta spectrum types in relation to maternal prognosis(χ^(2)=8.785,P=0.004).On univariate analysis,older age led to more complications(U=82.000,P=0.011),and in vitro fertilization-embryo transfer caused more intraoperative bleeding(U=91.500,P=0.007).Although the 1-and 5-minute Apgar scores were statistically significant,the rates of neonatal asphyxia did not differ(P>0.050).Endometrial damage led to lower Apgar scores on both univariate(1 minute:U=29.500,P=0.027;and 5 minutes:U=33.500,P=0.031)and multivariate(1 minute:β=−1.510,95%confidence interval,−2.639 to 0.381,P=0.010;and 5 minutes:β=−0.968,95%confidence interval,−1.779 to 0.157,P=0.021)analyses.Conclusion In patients who had no history of pregnancy,placenta previa was a strong risk factor for severe placenta accreta spectrum disorders.Endometrial damage led to lower Apgar scores;this warrants greater consideration in the clinic.展开更多
To the Editor:Obesity characterized with excess accumulation of white adipose tissue increases the prevalence of gestational diabetes mellitus(GDM).Exposure to intrauterine hyperglycemia increases the long-term sequel...To the Editor:Obesity characterized with excess accumulation of white adipose tissue increases the prevalence of gestational diabetes mellitus(GDM).Exposure to intrauterine hyperglycemia increases the long-term sequelae including cardiovascular abnormalities and metabolic syndrome in adult offspring.[1]As early as two decades ago,Dr.David Barker provided evidence that nutritional exposures in utero has a lasting impact on offspring’s health status in adulthood.[2]This emphasizes the critical role of early intrauterine environmental exposures and highlights the potential origins of adult metabolic diseases.展开更多
Since the emergence of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)in December 2019,the virus has overwhelmed the world’s health.Pregnant women as a vulnerable group,the broad implications of SARS-CoV-...Since the emergence of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)in December 2019,the virus has overwhelmed the world’s health.Pregnant women as a vulnerable group,the broad implications of SARS-CoV-2 for obstetrical care and perinatal outcomes have raised concern and promoted the rapid development of research.Chinese clinicians and scientists working in obstetrics rapidly reported globally the clinical characteristics,pregnancy outcomes,and vertical transmission potential of SARS-CoV-2 infection in pregnancy on February 12,2020[1]and published clinical management consensus specific for SARS-CoV-2 infection in pregnancy at the earliest time,[2]which were valuable for preventive and clinical practice in China and elsewhere in the early stages of the pandemic.With the passing of time and updating of information,developments have been achieved in our understanding of obstetric outcomes,vertical transmission,and therapeutics for the treatment and prevention of SARS-CoV-2 infection;furthermore,the progress shed light on the gaps in current knowledge for future work.展开更多
With the advances in fetal medicine,there will be more cases of congenital hypothyroidism(CH)diagnosed in the fetal period.However,there is no consensus on the management protocol.We present a successful case of conse...With the advances in fetal medicine,there will be more cases of congenital hypothyroidism(CH)diagnosed in the fetal period.However,there is no consensus on the management protocol.We present a successful case of conservatively managed fetal goitrous hypothyroidism due to compound heterozygous TG mutations.Goiter was observed in a fetus at 23 weeks of gestation.Because there was no evidence of transplacental passage of antithyroid antibody and drugs,iodine overload,and iodine deficiency,the fetus was highly suspected to have CH.Considering the potential risks of amniocentesis/cordocentesis,and lack of available parenteral levothyroxine in China,the fetus was closely monitored thereafter.A male neonate was delivered vaginally without complications at 39 weeks of gestation.We verified severe hypothyroidism in the infant and immediately initiated levothyroxine therapy.His growth and mental development were normal at the age of 8 month.Whole-exome sequencing showed that the neonate had two compound heterozygous mutations in the TG gene.We also performed a literature review of the prognosis of postnatal treatment of CH due to TG mutations and the result showed that postnatal treatment of CH due to TG mutations has a favorable prognosis.However,further prospective studies are warranted to verify this conclusion.展开更多
Gestational diabetes mellitus(GDM)is a specific disease during pregnancy that is characterized by the onset of abnormal maternal glucose tolerance,1 which was first discovered by O’Sullivan and Mahan2 in 1964.Since t...Gestational diabetes mellitus(GDM)is a specific disease during pregnancy that is characterized by the onset of abnormal maternal glucose tolerance,1 which was first discovered by O’Sullivan and Mahan2 in 1964.Since then,the gradual understanding of the impact of GDM on the long-term risk of maternal diabetes and other metabolic diseases has led to modifications in the diagnostic criteria of GDM by different associations and organizations.展开更多
Imaging biomolecules in real space is crucial for gaining a comprehensive understanding of the properties and functions of biological systems at the most fundamental level.Among the various imaging techniques availabl...Imaging biomolecules in real space is crucial for gaining a comprehensive understanding of the properties and functions of biological systems at the most fundamental level.Among the various imaging techniques available for biomolecules and their assembled nanostructures,scanning probe microscopy(SPM)provides a powerful and nondestructive imaging option.SPM is unique in visualizing intrinsically disordered biomolecules at the nanometer scale(e.g.,glycans).This review highlights recent achievements in studying biomolecules using SPM technique,focusing on DNA bases,amino acids,proteins,and glycans.The atomic-level analysis of biomolecules made possible by SPM allows for a more accurate definition of the local structure–property relationship.High-resolution SPM imaging of single biomolecules offers a new way to study basic processes of life at the molecular level.展开更多
文摘Objective: We adopted the area under the curve (AUC) of oral glucose tolerance test (OGTT) as a measure method of the severity of maternal hyperglycemia and investigated its relationship with adverse perinatal outcomes among women with and without gestational diabetes mellitus (GDM). Research design and methods: This is a retrospective cohort study. Our study group collected the medical records of 15,296 women who received perinatal care in 15 hospitals in Beijing and who delivered from July 1, 2013, to December 31, 2013. And several original articles on this cohort have been published. In this study, we analyze the relationship between AUC and adverse perinatal outcomes, so that in multiple pregnant cases, patients with pre-pregnancy diabetes, hypertension, and abnormal kidney function and those who did not receive a 75-g OGTT were excluded. A Chi-squared test and logistic regression analysis were used to determine the associations. Results: In total, 13,561 women were included. As the AUC of OGTT increased, the prevalence of macrosomia (odds ratio [OR] 1.059, 95% confidence interval [95% CI] 1.029 - 1.090, p < 0.001) and hypertensive diseases (OR 1.106, 95% CI 1.064 - 1.149, p < 0.001) also increased. For patients with same levels of AUC values, no significant differences in the risk of macrosomia, preterm birth and neonatal complications were observed between the GDM and non-GDM groups. Women with an AUC higher than 14.20 (mmol * h/L) had a higher risk of adverse outcomes regardless of the presence of GDM. Conclusions: The AUC could be a measure method of the severity of maternal hyperglycemia, and women with a high AUC should undergo aggressive management to avoid adverse outcomes regardless of the presence of GDM.
基金National Natural Science Foundation of China(No.81830044)National Key Research and Development Program of China(No.2021YFC2700700)+1 种基金National High Level Hospital Clinical Research Funding(No.22cz020401-4811009)Peking University Medicine Sailing Program For Young Scholars’Scientific&Technological Innovation(No.BMU2022PY017)
文摘Background:Alterations in the placental expression of glucose transporters(GLUTs),the crucial maternal-fetal nutrient transporters,have been found in women with hyperglycemia in pregnancy(HIP).However,there is still uncertainty about the underlying effect of the high-glucose environment on placental GLUTs expression in HIP.Methods:We quantitatively evaluated the activity of mammalian target of rapamycin(mTOR)and expression of GLUTs(GLUT1,GLUT3,and GLUT4)in the placenta of women with normal pregnancies(CTRL,n=12)and pregnant women complicated with poorly controlled type 2 diabetes mellitus(T2DM,n=12)by immunohistochemistry.In addition,BeWo cells were treated with different glucose concentrations to verify the regulation of hyperglycemia.Then,changes in the expression of GLUTs following the activation or suppression of the mTOR pathway were also assessed using MHY1485/rapamycin(RAPA)treatment or small interfering RNA(siRNA)-mediated silencing approaches.Moreover,we further explored the alteration and potential upstream regulatory role of methyltransferase-like 3(METTL3)when exposed to hyperglycemia.Results:mTOR,phosphorylated mTOR(p-mTOR),and GLUT1 protein levels were upregulated in the placenta of women with T2DM compared with those CTRL.In BeWo cells,mTOR activity increased with increasing glucose concentration,and the expression of GLUT1,GLUT3,and GLUT4 as well as GLUT1 cell membrane translocation were upregulated by hyperglycemia to varying degrees.Both the drug-mediated and genetic depletion of mTOR signaling in BeWo cells suppressed GLUTs expression,whereas MHY1485-induced mTOR activation upregulated GLUTs expression.Additionally,high glucose levels upregulated METTL3 expression and nuclear translocation,and decreasing METTL3 levels suppressed GLUTs expression and mTOR activity and vice versa.Furthermore,in METTL3 knockdown BeWo cells,the inhibitory effect on GLUTs expression was eliminated by activating the mTOR signaling pathway using MHY1485.Conclusion:High-glucose environment-induced upregulation of METTL3 in trophoblasts regulates the expression of GLUTs through mTOR signaling,contributing to disordered nutrient transport in women with HIP.
基金supported by National Key Research and Development Program of China (2022YFC2704702).
文摘Intrahepatic cholestasis of pregnancy(ICP)is a significant gestational complication in late pregnancy,potentially leading to severe perinatal complications such as intrauterine fetal demise and preterm birth.The Obstetrics Group of the Gynecology and Obstetrics Branch and the Perinatal Medicine Branch of the Chinese Medical Association organized a panel of domestic experts to deliberate and propose recommendations based on domestic and international guidelines,recent evidence-based medical evidence about key clinical issues including risk factors,clinical manifestations,perinatal outcomes,diagnosis,severity grading,maternal and fetal monitoring,treatment methods,timing,and methods of pregnancy termination,and postpartum follow-up for ICP,with the aim to guide its clinical diagnosis,treatment,and management.
基金National Key Research and Development Program of China Stem Cell and Translational Research,Grant/Award Numbers:2021YFA1400100,2019YFA0308000,2020YFA0308800National Natural Science Foundation of China,Grant/Award Numbers:92163206,62271048,61888102,61971035,12304205,62101037+1 种基金Beijing Municipal Natural Science Foundation,Grant/Award Numbers:Z190006,4192054China Postdoctoral Science Foundation,Grant/Award Numbers:2020M680382,2021M700407。
文摘Advanced atomic tracking techniques play a critical role in characterizing structural evolution,elucidating fundamental mechanisms of exotic phenomena and tailoring delicate properties.Thermally driven structural modulation in 2D crystals,such as the charge density wave(CDW),often leads to intriguing quantum properties,making them a valuable platform for exploring fundamental physics and potential device applications.However,despite their significance,experimental studies addressing atomic tracking of thermally-driven structural evolution in 2D crystals have been limited.Herein,we utilize high-accuracy variable-temperature atomic tracking measurements with scanning tunneling microscopy(STM)to directly observe a series of structural transitions in a model 2D crystal,namely NbSe_(2).With the atomic tracking technique,we confirm the existence of the universal thermally-driven CDW transition hysteresis between the heating and cooling cycles.This transition hysteresis,characterized by a constant temperature offset,represents a new phenomenon of structural evolution.Our findings provide a feasible method to track CDW transitions at the atomic scale in 2D crystals,significantly contributing to a better understanding and the potential modulation of these materials'functions in nanodevices.
基金the National Key Research and Development Program of China under grant number 2022YFC2704501.
文摘To editor:The disorders associated with placenta accreta spectrum(PAS)are potentially severe obstetric complications that should be managed by expert centers with substantial re-sources to provide both preoperative and intraoperative as-sessments and then prearrange a multidisciplinary team with an appropriate delivery plan.Placenta accreta spectrum was first described in 1937 as“attempts to remove the pla-centa led to major postpartum hemorrhage that required emergency or secondary hysterectomy to control bleeding.”1 In 1966,Luke et al-classified this condition into placenta creta(or vera,adherenta),increta,and perceta based on the depth of placenta villi adhesion or invasion,as determined by pathological features.Although infrequent,there have been significant advances in the global evolution of the strat-egies used to manage PAS,especially over the last decade.
基金Strategic Collaborative Research Program of the Ferring Institute of Reproductive Medicine(No.FIRMA 181104)National Key Research and Development Program of China(No.2021YFC2700700)
文摘To the Editor:Placenta accreta spectrum(PAS)disorders refer to a spectrum of abnormal placentation.PAS subtypes include placenta accreta(creta or adherenta,PA),placenta increta(PI),and placenta percreta(PP).The incidence of PAS has dramatically increased over the past four decades.A study using a nationally representative sample in the United States showed that the prevalence of PAS was 0.29%among women who underwent cesarean delivery with live birth.[1]Women with PAS are at a considerably higher risk of concurrent hemorrhage,bladder and urinary tract injury,and hysterectomy during delivery.[1]
基金supported by grants from the National Program on Basic Research Project of China(2019FY101005 to Geng Song)the World Diabetes Foundation(No.WDF 10-517 and No.WDF 14-908 to Huixia Yang)Scientific Research Seed Fund of Peking University First Hospital(2018SF046 to Geng Song)。
文摘Objective:This study aimed to determine the likelihood of gestational diabetes mellitus(GDM)in subsequent pregnancy among women without GDM history and to identify risk factors for GDM in subsequent pregnancy.Methods:This retrospective cohort study involved participants who delivered twice in same hospital of 18 research centers when delivered the second baby from January 2018 to December 2018.Finally 6204 women were enrolled and 5180 women without GDM history were analyzed further.Women were categorized as non-GDM or GDM based on the blood glucose values of the subsequent pregnancy,and the characteristics and GDM risk of these groups were compared.A univariate analysis of potential risk factors was performed using the Chi-squared test and/ort-test for qualitative or quantitative variables,respectively.Associations withP values<0.1 were chosen to be included in the multivariate binary logistic regression model.Results:In primary analysis of 6204 women,the incidence of GDM in subsequent pregnancy is 48.9%(490/1002)in women with GDM history and 16.1%(835/5202)in women without GDM history.In a further analysis for 5180 women without GDM at index pregnancy,compared with the non-GDM group,the GDM group had a significantly higher age,prepregnancy body mass index,and blood glucose value at each oral glucose tolerance test(OGTT)timepoint(fasting,1 h and 2 h)during the index and subsequent pregnancies,as well as higher weight retention during the interval between the two pregnancies(P<0.001).Age above 35 years in subsequent pregnancy(odds ratio(OR)=1.540,95%confidence interval(CI)=1.257-1.886,P<0.001),macrosomia in index pregnancy(OR=1.749,95%CI=1.277-2.395,P=0.001),OGTT blood glucose values in index pregnancy(fasting,OR=2.487,95%CI=1.883-3.285,P<0.001;1 h,OR=1.142,95%CI=1.051-1.241,P=0.002;2 h,OR=1.290,95%CI=1.162-1.432,P<0.001)and weight retention(OR=1.052,95%CI=1.035-1.068,P<0.001)were independent risk factors for GDM in subsequent pregnancy.Conclusion:For women without GDM history,GDM risk factors including age,macrosomia history,OGTT value,and weight retention,these can be evaluated before a subsequent pregnancy.Early warning and interventions are needed for women at high risk.
基金Major Program of the National Natural Science Foundation of China(No.81490745)State Key Development Program for Basic Research of China(No.2015CB943304)
文摘Background:The APPEC study is a large-population randomized controlled trial in China evaluating the role of low-dose aspirin prophylactic treatment for pre-eclampsia.There was no statistically significant difference in postpartum hemorrhage(PPH)incidence between the aspirin and control groups.This study aimed to evaluate the potential bleeding risk of 100 mg aspirin in high-risk pregnant women and the difference in the incidence of PPH according to maternal characteristics.Methods:This is a secondary data analysis of the APPEC study.Platelet counts and coagulation test results were collected at five follow-up visits.Subgroups defined by maternal age(<35 years and≥35 years),pre-pregnancy body mass index(pre-BMI,<28 kg/m 2 and≥28 kg/m 2),parity,gestational age at enrollment,and medical history,including pre-eclampsia,chronic hypertension,and diabetes mellitus,were analyzed.Logistic regression analysis was used to determine the statistical significance of the difference in the incidence of PPH after aspirin administration in pregnant women in each subgroup.Adjustment using multiple logistic regression models followed these analyses.Binary logistic regression was used to determine the relationship between pre-BMI and PPH.Results:There was no significant difference between the aspirin and control groups in bleeding risk(3.4%[16/464]vs.3.0%[13/434],T=0.147,P=0.701).No significant difference was found in the incidence of PPH in total(relative risk=1.220,95%confidence interval[CI]=0.720–2.067,P=0.459;aspirin group vs.control group,6.5%[30/464]vs.5.3%[23/434],P=0.459)or in subgroup analysis.A significant correlation between pre-BMI and PPH was found in the aspirin group,while in the control group there was no significant correlation(aspirin group,odds ratio[OR]=1.086,95%CI=1.004–1.175,P=0.040;control group,OR=1.060,95%CI=0.968–1.161,P=0.209).Conclusions:A dosage of 100 mg of aspirin per day,initiated from 12 to 20 gestational weeks until 34 weeks of gestation,did not increase the risk of potential bleeding and PPH regardless of the maternal characteristic.In the aspirin group,the positive correlation between BMI and PPH was significant.Trial Registration:ClinicalTrials.gov,NCT01979627.
文摘Two-dimensional(2D)twisted moirématerials,a new class of van der Waals(vdW)layered heterostructures with different twist angles between neighboring layers,have attracted tremendous attention due to their rich emerging properties.In this review,we systematically summarize the recent progress of 2D twisted moirématerials.Firstly,we introduce several representative fabrication methods and the fascinating topographies of the twisted moirématerials.Specifically,we discuss various remarkable physical properties related to twisted angles,including flat bands,unconventional superconductivity,ferromagnetism,and ferroelectricity.We also analyze the potential applications in various twisted moirésystems.Finally,the challenges and future perspectives of the twisted moirématerials are discussed.This work would spur edge-cutting ideas and related achievements in the scientific and technological frontiers of 2D twisted moirématerials.
基金supported by the National Key Research and Development Program of China(grant number:2021YFC2700700)Beijing Natural Science Foundation(grant 7202205)National Natural Science Foundation of China(grant 81830044)。
文摘Hyperglycemia is one of the most common complications women encounter during pregnancy,and is associated with a higher incidence of short-and long-term health risks for both the mother and offspring.In 2022,the Maternal-Fetal Medicine Committee of the Chinese Society of Obstetrics and Gynecology,Chinese Medicine Association,worked with the Chinese Society of Perinatal Medicine and the Professional Committee of Gestational Diabetes Mellitus of the Chinese Maternal and Child Health Association to update the Guidelines for the diagnosis and management of hyperglycemia in pregnancy in China.The aim was to further standardize the management of hyperglycemia in pregnancy from the aspects of screening,diagnosis,monitoring,treatment,and prevention of gestational diabetes mellitus,and consequently to further improve the health of mother and child.
文摘Objective::This study aimed to reach a consensus among obstetric experts on the prevention and treatment of preterm single births in China.Methods::Based on the scoping literature review and the 2014 edition of preterm birth of Clinical Diagnosis and Treatment guidelines,we generated the Delphi survey statements with five evaluation dimensions,including the definition of preterm birth,exclusion of risk factors for preterm birth,prevention,and prediction of preterm birth,treatment of preterm birth,and evaluation of intervention outcomes of preterm birth.Obstetric experts from the Obstetrics and Gynecology Branch of the Chinese Medical Association formed the expert group for this survey.All the obstetric experts participated two-round modified Delphi survey via an anonymous online survey and an online panel.Mean scores,rank sum,full score ratio,and the lowest score ratio were calculated to reflect the concentration of expert opinions.The coefficient of variation and Kendall W coefficient were used to reflect the expert opinion coordination degree of the survey statement.Results::The expert response rate for both rounds of surveys was 100%(41/41).Experts reached an agreement on 36 statements in five dimensions of preterm birth prevention and treatment in the first round of the survey and reached a consensus on the remaining 13 statements in the second round.A total of 49 statements(mean scores≥3,full score ratio≥20%,coefficient of variation≤0.3)were explicitly included in this guideline to form recommendations,while the remaining three clinical issues that did not reach a consensus require further determination based on evidence quality.The Kendall W coefficient in the two rounds of the Delphi survey were 0.20(P<0.001)and 0.29(P<0.001).Conclusion::The five dimensions and 49 statements,agreed upon through a two-round Delphi study,determined the recommended statements to be included in the updated guidelines for the prevention and treatment of preterm birth in China.The defined lower limit is set at≥28 gestational weeks;however,an update has been made to the definition of premature birth,specifying that"with the consent of the mother and her family,treatment is not abandoned for viable infants≥26 gestational weeks."
基金National Key Research and Development Plan(2021YFC2700702)Beijing Natural Science Foundation(7202205)。
文摘With the widespread transmission of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the medical community has organized efforts to determine a series of clinical questions about the virus.Critical questions have also arisen in the field of maternal-fetal medicine and have received increasing attention,as physiological and immunologic changes in pregnancy might potentially increase the susceptibility to SARS-CoV-2 infection and complications of the virus.1 Many early reports indicated that pregnant women with SARS-CoV-2 infection were not prone to experiencing severe disease.
文摘The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread worldwide and threatened human’s health.With the passing of time,the epidemiology of coronavirus disease 2019 evolves and the knowledge of SARS-CoV-2 infection accumulates.To further improve the scientific and standardized diagnosis and treatment of maternal SARS-CoV-2 infection in China,the Chinese Society of Perinatal Medicine of Chinese Medical Association commissioned leading experts to develop the Recommendations for the Diagnosis and Treatment of Maternal SARS-CoV-2 Infection under the guidance of the Maternal and Child Health Department of the National Health Commission.This recommendations includes the epidemiology,diagnosis,management,maternal care,medication treatment,care of birth and newborns,and psychological support associated with maternal SARS-CoV-2 infection.It is hoped that the recommendations will effectively help the clinical management of maternal SARS-CoV-2 infection.
文摘Objective This study aimed to determine the most pertinent factors responsible for placenta accreta spectrum disorders in patients without any history of pregnancy and evaluate their prognostic implications.Methods This retrospective cohort study included 1009 patients diagnosed with placenta accreta spectrum disorders based on standardized diagnostic criteria across 10 tertiary hospitals in China between January 1,2018,and December 31,2018;45 patients without a history of pregnancy were selected.The collected data mainly included demographic characteristics(including age,operative history,and ultrasound findings)and maternal-fetal outcomes(including any history of intraoperative bleeding,blood transfusion details,maternal-fetal complications,and fetal Apgar scores).SPSS 24.0 was used for statistical analyses.The Mann-Whitney U test and logistic regression were performed;a two-tailed P<0.050 was considered statistically significant.Results Ultrasound-based detection of placenta previa(χ^(2)=9.911,P=0.003)showed a strong association with placenta accreta spectrum types.The severity of placenta accreta spectrum was directly proportional to the likelihood of having coexistent complete placenta previa(χ^(2)=11.626,P=0.009)and being diagnosed by ultrasound(χ^(2)=5.449,P=0.047).Blood transfusion also impacted placenta accreta spectrum types in relation to maternal prognosis(χ^(2)=8.785,P=0.004).On univariate analysis,older age led to more complications(U=82.000,P=0.011),and in vitro fertilization-embryo transfer caused more intraoperative bleeding(U=91.500,P=0.007).Although the 1-and 5-minute Apgar scores were statistically significant,the rates of neonatal asphyxia did not differ(P>0.050).Endometrial damage led to lower Apgar scores on both univariate(1 minute:U=29.500,P=0.027;and 5 minutes:U=33.500,P=0.031)and multivariate(1 minute:β=−1.510,95%confidence interval,−2.639 to 0.381,P=0.010;and 5 minutes:β=−0.968,95%confidence interval,−1.779 to 0.157,P=0.021)analyses.Conclusion In patients who had no history of pregnancy,placenta previa was a strong risk factor for severe placenta accreta spectrum disorders.Endometrial damage led to lower Apgar scores;this warrants greater consideration in the clinic.
基金National Key Research and Development Program of China(No.2021YFC 2700700)National Natural Science Foundation of China under grant(Nos.81830044,81801471)+1 种基金Beijing Natural Science Foundation under grant(Nos.7192206)Peking University First Hospital Medicine Fund of Fostering Young Scholars under grant(No.2021CR01)
文摘To the Editor:Obesity characterized with excess accumulation of white adipose tissue increases the prevalence of gestational diabetes mellitus(GDM).Exposure to intrauterine hyperglycemia increases the long-term sequelae including cardiovascular abnormalities and metabolic syndrome in adult offspring.[1]As early as two decades ago,Dr.David Barker provided evidence that nutritional exposures in utero has a lasting impact on offspring’s health status in adulthood.[2]This emphasizes the critical role of early intrauterine environmental exposures and highlights the potential origins of adult metabolic diseases.
基金supported by a grant from the National Key Research and Development Program of China(No.2021YFC2700700)
文摘Since the emergence of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)in December 2019,the virus has overwhelmed the world’s health.Pregnant women as a vulnerable group,the broad implications of SARS-CoV-2 for obstetrical care and perinatal outcomes have raised concern and promoted the rapid development of research.Chinese clinicians and scientists working in obstetrics rapidly reported globally the clinical characteristics,pregnancy outcomes,and vertical transmission potential of SARS-CoV-2 infection in pregnancy on February 12,2020[1]and published clinical management consensus specific for SARS-CoV-2 infection in pregnancy at the earliest time,[2]which were valuable for preventive and clinical practice in China and elsewhere in the early stages of the pandemic.With the passing of time and updating of information,developments have been achieved in our understanding of obstetric outcomes,vertical transmission,and therapeutics for the treatment and prevention of SARS-CoV-2 infection;furthermore,the progress shed light on the gaps in current knowledge for future work.
文摘With the advances in fetal medicine,there will be more cases of congenital hypothyroidism(CH)diagnosed in the fetal period.However,there is no consensus on the management protocol.We present a successful case of conservatively managed fetal goitrous hypothyroidism due to compound heterozygous TG mutations.Goiter was observed in a fetus at 23 weeks of gestation.Because there was no evidence of transplacental passage of antithyroid antibody and drugs,iodine overload,and iodine deficiency,the fetus was highly suspected to have CH.Considering the potential risks of amniocentesis/cordocentesis,and lack of available parenteral levothyroxine in China,the fetus was closely monitored thereafter.A male neonate was delivered vaginally without complications at 39 weeks of gestation.We verified severe hypothyroidism in the infant and immediately initiated levothyroxine therapy.His growth and mental development were normal at the age of 8 month.Whole-exome sequencing showed that the neonate had two compound heterozygous mutations in the TG gene.We also performed a literature review of the prognosis of postnatal treatment of CH due to TG mutations and the result showed that postnatal treatment of CH due to TG mutations has a favorable prognosis.However,further prospective studies are warranted to verify this conclusion.
文摘Gestational diabetes mellitus(GDM)is a specific disease during pregnancy that is characterized by the onset of abnormal maternal glucose tolerance,1 which was first discovered by O’Sullivan and Mahan2 in 1964.Since then,the gradual understanding of the impact of GDM on the long-term risk of maternal diabetes and other metabolic diseases has led to modifications in the diagnostic criteria of GDM by different associations and organizations.
基金support of the Beijing Natural Science Foundation(Nos.Z190006 and 4192054)National Key Research and Development Program of China(Nos.2019YFA0308000,2020YFA0308800,and 2021YFA1400100)+1 种基金National Natural Science Foundation of China(Nos.92163206,61971035,61725107,and 62271048)the Strategic Priority Research Program of Chinese Academy of Sciences(No.XDB30000000).
文摘Imaging biomolecules in real space is crucial for gaining a comprehensive understanding of the properties and functions of biological systems at the most fundamental level.Among the various imaging techniques available for biomolecules and their assembled nanostructures,scanning probe microscopy(SPM)provides a powerful and nondestructive imaging option.SPM is unique in visualizing intrinsically disordered biomolecules at the nanometer scale(e.g.,glycans).This review highlights recent achievements in studying biomolecules using SPM technique,focusing on DNA bases,amino acids,proteins,and glycans.The atomic-level analysis of biomolecules made possible by SPM allows for a more accurate definition of the local structure–property relationship.High-resolution SPM imaging of single biomolecules offers a new way to study basic processes of life at the molecular level.
