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Background Congenital heart defect is the leading malformation in China. There may have been changes in congenital heart defect incidence because of birth policy shift in China over past years. This study aimed to investigate the epidemiology, prenatal diagnosis, and outcomes of congenital heart disease to improve medical and policy decisions. Methods Data on cases of congenital heart disease identified during 2014–2018 were taken from the Zhejiang provincial birth defects surveillance system. Chi-square test, odds ratio (OR) and 95% confidence interval (CI) were used to explore epidemiology, prenatal diagnosis, and birth outcomes of congenital heart disease. Results The average incidence of congenital heart disease was 16.0 per 1000 births, which increased by 62.2% during 2014–2018(χ2trend = 181.41, P 2 = 1687.67, P Conclusions The high incidence of congenital heart disease in Zhejiang might be attributable to the large proportion of mild congenital heart disease. The incidence of critical congenital heart disease, the prenatal detection rate, and perinatal deaths from congenital heart disease are comparable to those in other studies.

PurposeThis study aims to validate the value of microRNA (miRNA) detection for triaging human papillomavirus (HPV)-positive women in the general population.Patients and MethodsmiR-375 detection in cervical exfoliated cells has been demonstrated to have the superior value to cytology in triaging primary HPV-positive women in the hospital population. In this study, residual samples of cervical exfoliated cells from 10,951 women in a general population were used to detect miRNA. The performance efficiency of miRNA detection in identifying high-grade cervical intraepithelial neoplasia (CIN) was evaluated. Pearson chi-square test and McNemar pairing test were used to compare miRNA detection and cytology.ResultsIn valid 9,972 women aged 25–65, miR-375 expression showed a downward trend along with an increase in cervical lesion severity. The expression level of miR-375 ≤1.0 × 10-3 was identified as positive. In the HPV-positive and 12 HPV genotypes other than 16/18 (HR12)-positive women, miR-375 detection showed equivalent sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to that of cytology (≥ASC-US) and higher or similar sensitivity and NPV but lower specificity and PPV than that of cytology (≥ASC-H) in identifying CIN3+ and CIN2+. In HPV 16-positive women, miR-375 positivity had higher sensitivity and NPV but lower specificity and PPV than that of cytology (≥ASC-H and HSIL) in identifying CIN3+ and CIN2+. The immediate CIN3+ risk of miR-375 positivity was 19.8% (61/308) in HPV-positive, 10.8% (22/204) in HR12-positive, and 43.5% (37/85) in HPV16-positive women, respectively.ConclusionThe detection of miR-375 in cervical exfoliated cells may be an optional method for triaging primary HPV-positive women in population-based cervical cancer screening.

Background Congenital anomalies of the kidney and urinary tract (CAKUTs) are some of the most common birth defects affecting newborns. CAKUTs often have poor birth outcomes owing to the limited experience of physicians in developing countries regarding antenatal and postnatal diagnosis. We aimed to estimate the epidemiology of CAKUTs using data from a hospital-based registry in Zhejiang Province, China. Methods We included a total of 2790 newborns with CAKUTs, identified among 1,748,038 births during 2010–2016. The prevalence and type of CAKUTs, maternal and neonatal characteristics, and associated malformations were analyzed. Results The average prevalence of CAKUTs born to mothers overall and mothers aged ≥35 years were both around 1.60 per 1000 births (95% confidence interval (CI), 1.54–1.66; 95% CI, 1.44–1.83, respectively) during the study period. The prevalence of CAKUTs changed over time among all women and women of advanced maternal age, although no significant trends were observed. CAKUTs were more likely to occur in male than female newborns (odds ratio (OR) 1.28, 95% CI 1.18–1.38), in multiple births than singletons (OR 1.53, 95% CI 1.21–1.92) and in urban areas than rural areas (OR 1.27, 95% CI 1.18–1.37). The overall prenatal detection rate of CAKUTs was 73.87%. The average gestational age at antenatal diagnosis was 26.57 ± 8.70 weeks. A total 22.69% CAKUTs had associated malformations. Congenital heart defects were the most common anomalies, accounting for 8.89% of the whole population. The main proportion in subgroups was hydronephrosis, representing 31.79% of registered CAKUTs. Conclusions There was a nearly twofold increase in the prevalence of CAKUTs from 2010 to 2016 in Zhejiang Province. CAKUTs are strongly associated with male sex, multiple births, urban areas, and other nonurinary congenital malformations.

Background. The World Health Organization estimated that about 1.36 million pregnant women suffered from syphilis in 2008, and nearly 66% of adverse effects occurred in those who were not tested or treated. Syphilis infection is one of the most common maternal factors associated with stillbirth. Objective. This study aimed to determine the risk factors for stillbirth among pregnant women infected with syphilis. Methods. In this retrospective study, data on stillbirth and gestational syphilis from 2010 to 2016 were extracted from the prevention of mother-to-child transmission (PMTCT) program database in the Zhejiang province. A total of 8,724 pregnant women infected with syphilis were included. Multiple logistic regression analysis was performed to determine the degree of association between gestational syphilis and stillbirth. Results. We found that the stillbirth percentage among pregnant women infected with syphilis was 1.7% (152/8,724). Compared with live births, stillbirth was significantly associated with lower maternal age, not being married, lower gravidity, the history of syphilis, nonlatent syphilis stage, higher maternal serum titer for syphilis, inadequate treatment for syphilis, and later first antenatal care visit. In multiple logistic analysis, nonlatent syphilis (adjusted odds ratio (AOR) = 2.03; 95% CI = 1.17, 3.53) and maternal titers over 1 : 4 (AOR = 1.78; 95% CI = 1.25, 2.53) were risk factors for stillbirth, and adequate treatment was the only protective factor for stillbirth (AOR = 0.16; 95% CI = 0.10, 0.25). Conclusions. Nonlatent syphilis and maternal titers over 1 : 4 were risk factors for stillbirth, and adequate treatment was the only protective factor for stillbirth.

Background: Syphilis infection is one of the most common maternal factors related to stillbirth. The study aims to determine the risk factors for stillbirth among pregnant women infected with syphilis. Methods : This was a retrospective study. Data on stillbirth and gestational syphilis were extracted from the PMTCT program database 2010–2016 in Zhejiang Province. A total of 8724 pregnancy women infected with syphilis were included. Multivariable logistic regression analysis was performed to assess the associations between gestational syphilis and stillbirth. Results : The stillbirth rate among pregnant women infected with syphilis was 1.74% (152/8724) in Zhejiang Province, China, from 2010–2016. Compared with live birth, stillbirth was significantly associated with lower maternal age, not being married, lower gravidity, previous history of syphilis, non-latent syphilis stage, and higher maternal serum titer for syphilis, inadequate treatment for syphilis, and later first antenatal care visit. With multivariable logistic regression analysis, non-latent syphilis (adjusted OR=2.03; 95% CI 1.17–3.53) and maternal titers over 1:4 (adjusted OR=1.78; 95% CI 1.25–2.53) were risk factors for stillbirth. Adequate treatment was the only protective factor for stillbirth (adjusted OR=0.16; 95% CI 0.10–0.25). Conclusions : Adequate treatment is effective in reducing the incidence of stillbirths among pregnant women infected with syphilis, and this is particularly important in women diagnosed with high RPR titer (under 1:4). Keywords: risk factors, syphilis, stillbirth, pregnant, syphilis stage, RPR

Background Partner infection is a significant factor in preventing mother-to-child syphilis transmission. We compared pregnancy outcomes between syphilis discordant and syphilis concordant couples. Methods We conducted a retrospective study among 3076 syphilis-positive women who received syphilis screening together with their partners during pregnancy. Multivariate analysis was used to explore risks for abnormal outcomes in objects correcting for the major covariate factors. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated to compare pregnancy outcomes between syphilis concordant and syphilis discordant couples. Results Overall, 657 of the 3076 women were diagnosed with gestational syphilis and had a syphilis-positive partner, giving a partner concordance prevalence of 21.36%. Women in concordant couples were more likely to have higher parity, more children, late antenatal care and syphilis screening, a lower proportion of latent syphilis, and elevated serologic titers than women in discordant couples (P adj = 1.44, 95% CI: 1.10–1.89), untreated pregnancy syphilis (ORadj = 1.67, 95% CI: 1.15–2.43), and higher maternal serum titers (> 1:8) (ORadj = 1.53, 95% CI: 1.17–2.00) increased the risks of adverse pregnancy outcomes. Concordance was associated with increased risk for stillbirth (ORadj = 2.86, 95%CI:1.36–6.00), preterm birth (PTB) (ORadj = 1.38,95%CI:1.02–1.87) and low birth weight (LBW) (ORadj = 1.55, 95%CI:1.13–2.11) compared with discordance. Even among treated women, concordance was associated with increased risk for stillbirth (ORadj = 3.26, 95%CI:1.45–7.31) and LBW (ORadj = 1.52, 95%CI:1.08–2.14). Among women with one treatment course, the risks for PTB(ORadj = 1.81, 95%CI:1.14–2.88) and LBW(ORadj = 2.08, 95%CI:1.28–3.38)were also higher among concordant couples than discordant couples. Nevertheless, there were no significant differences between concordant and discordant couples in risks of stillbirth (ORadj = 2.64, 95% CI: 0.98–7.05),PTB (ORadj = 1.15, 95% CI: 0.76–1.74), and LBW(ORadj = 1.21, 95% CI: 0.78–2.02) among women with two treatment courses. Conclusion Male partner coinfection increased the risks for stillbirth, PTB and LBW, particularly when gestational syphilis treatment was suboptimal. However, this risk could be reduced by adequate treatment.

Background: Despite almost all babies being breastfed initially, the exclusive breastfeeding rate at six months is less than 30% in China. Improving professionals’ knowledge and practical skill is a key government strategy to increase breastfeeding rates. This study aimed to test the effectiveness of a breastfeeding DVD training method for clinicians on improving their knowledge and confidence in the breastfeeding support skills of teaching mothers Positioning and Attachment (P & A) and Hand Expression (HE).\ud Methods: A randomised controlled trial was conducted in three hospitals in Zhejiang province, China in 2014. Participants were recruited before their routine breastfeeding training course and randomly allocated to intervention group (IG) and control group (CG). The 15 min “Breastfeeding: Essential Support Skills DVD” was the intervention for IG and a vaginal delivery DVD was used for CG. All participants completed questionnaires of job information, knowledge and confidence in the two skills before (baseline) and immediately after viewing the DVD (post DVD).\ud Results: Out of 210 participants, 191 completed knowledge assessments before and after watching the DVD (IG n = 96,\ud CG n = 95), with the response rate of 91.0%. At baseline, there are no significant differences in job variables, total knowledge scores and confident scores. The total knowledge score significantly increased post-DVD for IG (pre-DVD: M = 5.39, SD = 2.03; post-DVD: M = 7.74, SD = 1.71; t (95) = − 10.95, p < 0.01), but no significant change in total knowledge score for CG between pre- and post-DVD (pre-DVD: M = 5.67, SD = 1.70; post-DVD: M = 5.56, SD = 1.63; t (94) = 0.85). The total confidence scores were significantly higher post-DVD than pre-DVD in IG (pre-DVD: M = 66.49, SD = 11.27; post- DVD: M = 71.81, SD = 9.33; t (68) = − 4.92, p < 0.01), but no significant difference was seen in CG between pre- and post-DVD total confidence scores (pre-DVD: M = 68.33, SD = 11.08; post-DVD: M = 68.35, SD = 11.40; t (65) = − 0.25). Personal and job variables did not mediate these effects.\ud Conclusions: The breastfeeding training DVD improved professionals’ knowledge and confidence of the two breastfeeding support skills. However, the effect on professionals’ practice and on breastfeeding outcomes needs to be examined in the future.

UNICEF Baby Friendly Initiative (BFHI) is the global standard for maternity and community services requiring all practitioners to be trained to support mothers in the essential skills of supporting positioning and attachment, and hand expression. These studies aim to rigorously assess knowledge in nurses, midwives, and doctors in these skills, tested before and after watching short videos demonstrating these skills. Practitioners were attending BFHI education, and the video study was additional. In Phase 1 clinicians in England were randomised to one of two videos (practitioner role play or clinical demonstration). The results showed improvements in knowledge and confidence, and a preference for clinical demonstration by mothers and infants. The clinical demonstration video was evaluated in China in Phase 2 where expert trainers viewed the video after completing the BHFI workshop, and in Phase 3 practitioners viewed the video before the BHFI workshop. Phase 2 with expert trainers only showed improvement in knowledge of hand expression but not positioning and attachment. In Phase 3 clinicians showed improved knowledge for both skills. In all Phases there were statistically significant improvements in confidence in practice in both skills. \ud Viewing short videos increased knowledge, particularly about teaching hand expression, and confidence in both skills.

Recently, the prevalence of chromosomal abnormalities (CA) increased as the increasing proportion of mothers with advanced age. We aimed to explore the prevalence of CA in relation to maternal age and perinatal features. A retrospective study was performed based on provincial birth defects surveillance data. The relative risk (RR) and 95% confidence interval (CI) were used to calculate maternal age-specific rates of CA. Socio-demographic characteristics of mothers and perinatal features were listed. The total prevalence of CA was 6.38 per 10,000 births, which increased per 10,000 births linearly from 4.02 in 2011 to 9.13 in 2015 (x 2 line-trend =52.69, p

Objectives To determine the effectiveness of treatment in improving pregnancy outcomes among women with syphilis. Methods This is a retrospective study based on the provincial prevention of mother-to-child transmission of syphilis database. All women with syphilis with singleton pregnancies were recruited. We evaluated their pregnancy outcomes by group-specific analyses according to their treatment time and adequacy. Results The syphilis prevalence among pregnant women was 0.3% (4214/1 338 739) in Zhejiang Province, China, during 2013–2014, considering all live births and abortions. Women with singleton pregnancies (3767) were included in the study, including live births and stillbirths (≥28 weeks). The treatment coverage for all women with syphilis was 80.2% (3022/3767), and 68.2% (2062/3022) of the women were treated adequately. Of 745 infants born to untreated pregnant women with syphilis, 1.2% manifested pneumonia, 2.7% asphyxia, 1.6% birth defects, 3.8% congenital syphilis (CS), 14.2% were preterm, 10.1% had low birth weight (LBW) and 3.1% experienced perinatal death. The risks of asphyxia (OR=2.7), CS (OR=3.1), preterm birth (OR=1.5), LBW (OR=1.9) and perinatal death (OR=3.1) were much higher in infants born to mothers treated inadequately than from those treated adequately. Moreover, mothers with syphilis who initiated treatment in the third trimester suffered an increased risk for asphyxia (OR=3.0), CS (OR=6.0) and LBW (OR=1.7) compared with those who initiated treatment in the first trimester. Conclusions Early and adequate treatment could improve the adverse pregnancy outcomes among women with syphilis.

To explore the mortality factors of migrant pregnant women and learn the healthcare utilization status to provide efficient interventions.A case-control study was conducted in Zhejiang province with a case-control ratio of 1: 4. Cases included migrant pregnant women who died. And controls were migrant pregnant women who survived and matched with single birth, age, hospital and gestational weeks. A questionnaire was used to survey social and demographic factors, healthcare status during antenatal or postpartum period and delivery conditions, etc.Seventy-two cases and 288 controls were recruited. There were significant differences in socio-demographic, antenatal care and obstetric complications between two groups (P0.05). No prenatal examination was an important factor affecting maternal mortality by multivariate conditional Logistic regression.Prenatal examination is an important influencing factor of maternal mortality. And improving the ability of utilizing health care system is an efficient method of lowering the migrant maternal mortality.

This is a retrospective study based on surveillance of Human Immunodeficiency Virus type-1 (HIV-1) positive pregnant women and their children in China's Zhejiang Province. HIV counseling and testing, mother and infant characteristics, and outcomes are reported here. This study compares two principal periods, the period from 2007-2009 and the period from 2010 to 2013. The average rate of HIV counseling among pregnant women rose from 84.87% during the earlier period to 99.08% during the latter period. And the rate of HIV testing also rose significantly, from 80.60% to 98.58%. The HIV-1 prevalence among pregnant women increased slightly, from 0.01% to 0.02%. Over 70% of infected women were migrants. Half of these HIV-1 positive pregnant women were 20-30 years old. Significant differences in the characteristics of HIV-1 positive pregnant women were observed with time. The proportion of women who were employed increased dramatically from an average of 15.03% during 2007-2009 to an average of 31.34% during 2010-2013 and the proportion of women who had completed high school education increased from 0.52% to 6.51%. During 2007-2009, an average of 3.11% of these women was diagnosed before their pregnancies. During 2010-2013, this average reached to 32.53%. Sexual contact remained the primary route of transmission route during both periods, accounting for half of the infections. The proportion of women who had acquired HIV by blood transfusion declined noticeably. The proportion of mothers and children with antiretroviral therapy increased considerably over time. The overall mother-to-child transmission rate was found to be 7.14%. Although some progress has been made, further work should be performed, fostering early identification and timely therapy. Particular attention should be paid to health care of migrants.

The management of atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesions (ASCUS/LSIL) is still controversial and it is advisable to make a triage for these two cytological abnormalities. P16(INK4) (P16) has been shown to be a potential biomarker for predicting high-grade cervical intraepithelial neoplasia (CIN) and cervical cancer. The aim of the study was to determine the value of P16 expression by immunostaining method compared with high-risk human papillomavirus (HR-HPV) DNA test in the triage of ASCUS/LSIL women.Totally 86 eligible residual liquid-based cytological specimens with ASCUS and 45 with LSIL were obtained. All specimens were submitted to HR-HPV DNA test (HC2) and P16 immunocytochemical staining simultaneously. And all women underwent colposcopy and biopsy after cytology.The positive rate of P16 staining was 32.6% in ASCUS and 42.2% in LSIL, which was significantly lower than that of HR-HPV test in both ASCUS (P0.05) and LSIL (P0.05). Moreover, the positive rate of P16 staining was 12.7% in normal histology, 61.5% in CIN 1, 87.0% in CIN 2-3, and 100.0% in cancer, in which P16 positive rate was significantly lower than HR-HPV positive rate in normal group. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of P16 staining for predicting CIN 2 or more were 87.5%, 68.6%, 38.9%, 96.0%, and 72.1%, respectively in the ASCUS; while 90.0%, 71.4%, 47.4%, 96.2% and 54.7%, respectively in the LSIL, in which the specificity and accuracy of P16 staining were significantly higher than those of HR-HPV test in both ASCUS and LSIL (P0.05).P16 immunostaining had significantly higher specificity and accuracy than HR-HPV DNA test for predicting for high-grade CIN and cervical cancer in ASCUS and LSIL and can be used for the triage of women with ASCUS/LSIL cytological abnormality.

to explore the value of P16 in the predication of high-grade cervical intraepithelial (HGCIN) by P16 expression in cervical specimens.one hundred ninety-two residual ThinPrep samples were collected and detected by HPV DNA test and P16 detected by immunocytochemistry. All women underwent colposcopy and histological examination of biopsy specimen if needed. P16 test, cytology and HR-HPV DNA (HC2) test were compared based on histological examination of colposcopic biopsies.(1) the expression of P16 showed 16.3% in normal or inflammatory cases, 46.7% in CIN 1, 93.8% in CIN 2, 91.1% in CIN 3 and 100.0% in carcinoma. A positive relation between P16 and the grade of cervical lesions was observed by Spearman analysis (P0.05, r = 0.900). (2) By P16 test, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for ≥ CIN 2 were 94.1%, 78.5%, 77.7%, 94.4% and 85.4% respectively. By HR-HPV DNA test, the sensitivity, specificity, PPV, NPV and accuracy for ≥ CIN 2 were 95.3%, 56.1%, 63.3%, 93.8% and 73.4% respectively. By cytological test, the sensitivity, specificity, PPV, NPV and accuracy for ≥ CIN 2 were 82.4%, 92.5%, 89.7%, 86.8% and 88.0% respectively. There were significant difference of specificity, PPV and accuracy between P16 and HR-HPV DNA (P0.05). And no significant difference of accuracy was found between P16 and cytology (P0.05).the specificity, PPV and accuracy of P16 are significantly higher than those of HR-HPV DNA. Thus P16 test is valuable to diagnose HGCIN in ThinPrep specimens.