Search

Background: The rate of autism spectrum disorder (ASD) has been rising worldwide, and therefore it is important to identify potential causes of ASD to facilitate early prevention. This study examined the role of breastfeeding and the association between caesarean delivery (CD) and children's autism spectrum disorder. Methods: The data were from the Ma'anshan birth cohort (MABC) in China, that was set up between May 2013 and September 2014. Women within 14 gestational weeks were recruited. The delivery mode was extracted from medical notes and infant feeding was obtained from questionnaire surveys. Autism-like behaviour was assessed using the Checklist for Autism in Toddlers (CHAT-23) when children were 18 months old, and 3 years of age. At 5 years of age, autism-like behaviour was assessed using the Clancy Autism Behavior Scale behavior. Structural equation models tested the mediation effects of breastfeeding between CD and children's autism spectrum disorder. Results: In all, 1520 (48.89%) women gave birth via CD, and 406 (13.86%) children were identified with autism-like behaviours at 18 months. Compared with women giving birth via vaginal delivery, those giving birth via CD were more likely to experience a higher proportion of delayed initiation of breastfeeding (p < 0.01), and delayed onset of lactogenesis (p < 0.01). CD was associated with a lower proportion of exclusive breastfeeding at 4 months after delivery (p = 0.02). Autism-like behaviour was less likely amongst infants with exclusively breastfeeding at 4 months than amongst those not exclusively breastfeeding at 4 months (p < 0.01). SEM indicated that women who gave birth by CD were more likely to stop exclusive breastfeeding in the first 4 months (standard estimations = − 0.04, p = 0.02), and those children who were not exclusively breastfed at 4 months were more likely to have autism-like behaviours (standard estimations = − 0.05, p < 0.01). The associations persisted at 3 years, but not at 5 years. Conclusions: Exclusive breastfeeding at 4 months of age mediated the association between caesarean delivery and children's autism-like behaviours. [ABSTRACT FROM AUTHOR]

Background: Maternal selenium (Se) deficiency is associated with some adverse pregnant outcomes. However, it remains controversial whether maternal Se deficiency during gestation enhances the risks for low-birth-weight (LBW) and small-for-gestational-age (SGA) newborns.Methods: For our cohort study, total 3133 mother-and-infant pairs were selected. Maternal serum Se concentration was detected by graphite furnace atomic absorption spectrometry. According to international references for maternal serum Se concentration, subjects were divided into Se deficiency (<45.0 μg/L), Se insufficiency (45.0-94.9 μg/L) and Se sufficiency (≥95.0 μg/L).Results: There was a positive relation of maternal serum Se concentration in gestation and neonatal birth weight. Further analysis showed that the risks for LBW and SGA in SD group were significantly higher than that in SI and SS group, the adjusted ORs for LBW and SGA newborns were 1.87 (95%CI: 1.02, 3.45; P = 0.04) and 1.47 (95%CI: 1.07, 2.02; P = 0.02) in SI group, and 3.92 (95%CI: 2.03, 7.57; P < 0.001) and 2.77 (95%CI: 1.92, 4.02; P < 0.001) in SD group compared to SS group. In different gender subgroup, positive relations were observed between maternal Se deficiency and the risk for LBW girls, as well as the risks for both SGA girls and boys.Conclusion: Maternal Se deficiency in gestation was positively associated with the risk for LBW girls, as well as the risks for both SGA girls and boys. [ABSTRACT FROM AUTHOR]

Background: The biological pathways through which vitamin D is involved in the regulation of systemic inflammation remain largely unknown. Objective: The objective of this study was to evaluate the role of vitamin D status on the relationship between lipid profile and high-sensitivity C-reactive protein (hs-CRP) in pregnant women. Design: Serum 25-hydroxyvitamin D (25(OH)D), hs-CRP, and indicators of lipid profiles (total cholesterol, TC; triglyceride, TG; high-density lipoprotein cholesterol, HDL-C; low-density lipoprotein cholesterol, LDL-C), were measured in 2479 pregnant women during the second trimester. Potential confounding including maternal sociodemographic characteristics, perinatal health status, diet, and lifestyle was prospectively collected. Multiple regression models and cubic models were used to evaluate the associations. Results: There was a significant non-linear relationship between lipid profile (TC, TG, HDL-C, LDL-C) and hs-CRP (P < 0.05). Increased serum 25(OH)D was significantly associated with decreasing TC, TG, HDL-C, LDL-C, and hs-CRP levels. Compared with medium levels of lipids group, pregnant women with higher levels of TC or TG have higher levels of hs-CRP, and pregnant women with lower levels of TC, HDL-C or LDL-C also have higher levels of hs-CRP in the vitamin D deficient group, and there was a significant correlation between low levels of TG and decreased hs-CRP (adjusted β for TG: -0.063, 95%CI: − 0.120,-0.007) in the non-vitamin D deficient group. Mediators that had appreciable shares of the associations between 25(OH)D and hs-CRP was TG (10.2% of the association; β = − 0.011; total indirect effect: 95% CI: − 0.019, − 0.002). The cubic model suggested that a steep increase in the adjusted regression coefficient of lipid with hs-CRP up to 50 nmol/L of 25(OH)D, and the highest adjusted regression coefficients were observed in pregnant women with 25(OH)D above 50 nmol/L. Conclusion: Our findings suggest that high levels of vitamin D during pregnancy may improve lipid profile levels and inhibit elevated hs-CRP induced by high lipid metabolism. [ABSTRACT FROM AUTHOR]

Background: To evaluate the safety and efficacy of IOUS in robotic liver surgery and propose a standard protocol of IOUS for safe robot-assisted hepatectomy.Methods: Between February 2015 and December 2016, liver resection was performed in 110 patients with robotic approach in Tongji Hospital. In these patients, IOUS was routinely performed. All data about demographic, surgical procedure, postoperative course were collected prospectively and analyzed.Results: A four steps IOUS protocol in robotic liver surgery was proposed, including exploration, verification, guidance, and confirmation. A total of 11 additional lesions in 11 patients were detected and 7 patients accepted strategic surgical modification. No patient suffered from any single or multiple organ dysfunctions, and there were no mortalities observed.Conclusion: IOUS is indispensable to understand lesions and vessels in robotic liver surgery. A four-step standard protocol of IOUS is essential for safe robot-assisted hepatectomy. [ABSTRACT FROM AUTHOR]

Background: It is reported that lipid emulsion enriched in n-3 fatty acids (FAs) helps us to improve postoperative recovery for surgical patients with biliary tract disease. Its role for postoperative patients with obstructive jaundice is as yet unclear. The object of this study was to evaluate the safety and efficacy of n-3 fatty acid-based parenteral nutrition (PN) for patients with obstructive jaundice following surgical procedures.Methods: Data were collected from patients with obstructive jaundice who received PN, including n-3 PUFA-enriched lipid emulsions and standard non-enriched lipid emulsions (e.g., soybean oil). We then calculated a propensity score, the probability of receiving different PN, by the propensity score matched (PSM) method. After matching, we compared isonitrogenous total PN with 20% Structolipid and 10% n-3 fatty acid (Omegaven, Fresenius-Kabi, Germany) (treatment group) to Structolipid alone (control group) for 5 days postoperatively, in the absence of enteral nutrition.Results: Before the propensity score matching, there were 226 patients enrolled. After propensity score stratification, 108 cases remained, and all covariates were balanced. Among matched patients with PN, patients in the control group were at a higher risk for long-term jaundice recovery (12.9 ± 8.5 VS 16.4 ± 7.9 P = 0.029), lower velocity of reduction in jaundice (P = 0.045), and lower pre-albumin (P = 0.002). No significant difference as found in terms of comorbidities, white blood cell (WBC), albumin and other aspects.Conclusion: PN with n-3 PUFA-enriched lipid emulsions was safe and effective in accelerating jaundice recovery for patients after surgical procedures. This trial was registered at clinicaltrials.gov as NCT03376945. [ABSTRACT FROM AUTHOR]

Background: Vitamin D has been demonstrated a "neuroprotective" effect, but it is unclear whether early-life adequate vitamin D protect adverse neurodevelopment. We aimed to examine the role of neonatal vitamin D in the association of maternal depression (MD) symptoms with toddlers ADHD.Methods: Participants included 1 125 mother-infant pairs from the China-Anhui Birth Cohort study. MD was assessed by the Center for Epidemiological Studies Depression Scale (CES-D) at 30-34 gestational weeks. Toddlers ADHD was reported by the Conners' Hyperactivity Index (CHI) at 48-54 months postpartum. Multiple logistic regression models were performed to evaluate the association of maternal depressive score and toddlers ADHD while cord blood 25(OH)D levels were stratified.Results: Toddlers of mothers with higher depression score were at higher risk of ADHD (20.1% vs 11.1%, P = 0.003; adjusted RR=1.75, 95% CI: 1.10-2.81). Among toddlers with neonatal vitamin D deficiency (VDD), ADHD risk was significantly increased with maternal MD (adjusted RR=3.74, 95% CI: 1.49-9.41), but the association was not found in toddlers with neonatal vitamin D adequacy (VDA). Compared to toddlers without MD, toddlers with both MD and neonatal VDD had higher risk of ADHD (adjusted RR=3.10, 95% CI: 1.44-6.63). But the risk did not significantly increase in toddlers with MD and neonatal VDA (adjusted RR=1.53, 95% CI: 0.86-2.72).Limitations: Maternal depressive symptoms in early pregnancy and anxious symptoms were needed to include.Conclusion: This prospective study indicated that the detrimental effect of maternal prenatal depressive symptoms on offspring's ADHD symptoms strengthened in toddlers with neonatal VDD. [ABSTRACT FROM AUTHOR]

Background: Pregnancy-related anxiety plays a major role in shaping offspring's neural development. However, its gender-specific effect on children's emotional and behavioral development is controversial and the knowledge of critical period is limited. This study aims to examine gender-specific effect of pregnancy-related anxiety on preschooler's emotional and behavioral development.Methods: This study was based on the China-Anhui Birth Cohort Study (C-ABCS). A total of 3443 mother-child pairs were included in final data analysis. Pregnancy-related anxiety was assessed by Pregnancy-Related Anxiety Questionnaire respectively in the 1st and 3rd trimester of pregnancy. Strengths and Difficulties Questionnaires (SDQ) were completed by parents to assess preschool emotional and behavioral development in boys and girls. Logistic regression models were used to examine the association between pregnancy-related anxiety and preschoolers' emotional and behavioral problems.Results: The overall prevalence of pregnancy-related anxiety was 31.6%. Compared with those whose mothers without pregnancy-related anxiety in either 1st or 3rd trimester, preschool boys born of mothers with pregnancy-related anxiety in the 1st trimester and in the 3rd trimester had an increased risk of conduct problems. Pregnancy-related anxiety in the 1st, 3rd trimester and in both trimesters all related with preschool boys' hyperactivity and total difficult problems. Pregnancy-related anxiety in the 1st trimester and in both 1st and 3rd trimester increased the risk of preschool girls' emotional problems and total difficult problems.Conclusion: Pregnancy-related anxiety may relate with preschool boys' externalizing problems in early and late of pregnancy and increase the risk of internalizing problems in girls in early pregnancy.Limitations: There was no data on pregnancy-related anxiety in the second trimester. [ABSTRACT FROM AUTHOR]