11 November 2024, Volume 35 Issue 6

    

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  Caregiver burden and risk factors among children with autism spectrum disorder

  RAO Yingting, ZHONG Meiling, XIA Yuwen, MA Yidi, ZHANG Yaoyun, DONG Yanjun, ZHANG Yihang, LIU Shunkai, WU Meiqi, JIA Meixiang, WANG Xiaoli, FANG Hai, ZHANG Yali, LI Zhiwen, ZHANG Le

  Chinese Journal of Reproductive Health. 2024, 35(6): 501-508.

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  Objective To investigate the current situation and possible risk factors of caregiver burden of children with autism spectrum disorder (ASD) in China, and provide reference for relevant departments to formulate intervention measures. Methods A cross-sectional study was carried out in the parent communities and rehabilitation centers for ASD children from December 16th, 2022 to February 20th, 2023. A total of 141 caregivers were surveyed, and 114 valid questionnaires were collected. The Chinese version of the Zarit Burden Interview (ZBI) was used to evaluate the caregiver burden among children with ASD. They were divided into no or very light burden (0~20 points), mild burden (21~39 points), moderate burden (40~59 points) and severe burden (60 points and above) according to the total scale score. Multiple linear regression was used to analyze the risk factors with stepwise method. Results The ZBI total score of caregiver burden among children with ASD was (52.8±12.0). 15 cases (13.2%) were of mild burden, 64 cases (56.1%) were of moderate burden, and 35 cases (30.7%) were of severe burden. Family structure, parents′ social support level, delaying work and whether receiving disability subsidies are the influencing factors of the caregiver burden (R²=0.373,F=4.957). Conclusion Caregiver burden generally exists in the families of children with ASD, and most families face moderate to severe care burden. Our findings highlight the importance of improving the accessibility and availability of treatment and rehabilitation services, and providing psychological, social and economic support for caregivers of children with ASD.
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  Study on the effect and mechanism of dandelion extract in the treatment of ovarian hypofunction

  WANG Lin, LIU Miao, LIU Suying, DONG Xi, CHE Qi

  Chinese Journal of Reproductive Health. 2024, 35(6): 509-513.

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  Objective To study the therapeutic effect of dandelion extract (Shawkea T-1) on ovarian hypofunction and its mechanism. Methods Menopausal transition mice were the intervention group for ovarian hypofunction, and healthy young female mice were the control group. The number of ovarian antral follicles in menopausal transition mice fed with dandelion extract for 30 days was observed. At the same time, human granulosa cell line (KGN) was cultured. The apoptosis of KGN cells was compared after incubation with dandelion extract using flow cytometry,TUNEL and apoptosis PCR array. Results The number of ovarian antral follicles in postmenopausal mice fed with dandelion extract was significantly higher than that in the control group (P<0.01). The apoptosis rate of KGN cells of dandelion extract culture group was significantly lower than that in control group (P<0.05). 20 up-regulated genes and 4 down regulated genes were screened by apoptosis PCR chip (P<0.05). Conclusion In the animal model, dandelion extract can effectively treat the ovarian hypofunction of female mice. The underlying mechanism may be due to the decreasing apoptosis rate of granulosa cells.
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  Effect of lactation diet in rats with pre-pregnancy obesity and excessive gestational weight gain on inflammatory and iron-related indicators in the offspring

  MA Yirui, GU Yu, LI Hongtian, ZHOU Yubo, LIU Jianmeng

  Chinese Journal of Reproductive Health. 2024, 35(6): 514-520.

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  Objective To investigate the effects of lactation diet in rats with pre-pregnancy obesity and excessive gestational weight gain on inflammatory and iron-related indicators in the offspring. Methods A total of 24 SPF-rated Wistar female rats were randomly divided into pre-pregnancy obesity group (Pre-obe) and excessive gestational weight gain group (GWG) in a 1:1 ratio, and further divided equally into Pre-obe high-fat diet group (n=6), Pre-obe standard diet group (n=6), GWG high-fat diet group (n=6), and GWG standard diet group (n=6) according to lactation diet. A total of 48 offspring rats were included in the study with 12 rats in each group; they were weaned on the 21st day after birth, and all were fed a standard diet after weaning. Body weights were measured on the days 0, 7, 14, 21, 28, 35 and 42 after birth. Interleukin-6 (IL-6), hepcidin, ferritin, hemoglobin (Hgb), mean corpuscular hemoglobin (Mch), and mean corpuscular volume (Mcv) in the serum/whole blood were measured on the days 28, 35 and 42 after birth. Results Compared with a high-fat diet during lactation, the standard diet significantly reduced the body weight. Compared with a high-fat diet during lactation, the standard diet significantly reduced the level of IL-6 (152.97 pg/mL vs. 105.24 pg/mL on day 28;155.15 pg/mL vs. 110.53 pg/mL on day 35; 155.4 pg/mL vs. 139.02 pg/mL on day 42, P<0.017) and Hepcidin (119.99 ng/mL vs. 99.67 ng/mL, P<0.05), and increased the level of Mch (22.43 pg vs. 23.32 pg, P<0.05) and Mcv (72.71 fL vs. 75.71 fL, P<0.05) of the offspring in Pre-obe. Compared with a high-fat diet during lactation, the standard diet significantly reduced the level of IL-6 (140.21 pg/mL vs. 127.57 pg/mL on day 35, P<0.017), and increased the level of Hgb (107.25 g/L vs. 112.92 g/L on day 35, P<0.017) and Mcv (72.90 fL vs. 74.34 fL, P<0.05) of the offspring in GWG. In addition, the standard diet during lactation significantly reduced the level of Ferritin (50.60 ng/mL vs. 42.06 ng/mL, P<0.05) and Hgb (110.53 g/L vs. 106.28 g/L, P<0.05) of the offspring in Pre-obe. After adjusting for inflammatory indicators (IL-6 and Hepcidin), the effect of lactation diet on multiple iron-related indicators of the offspring in Pre-obe and GWG was no longer statistically significant. Conclusion Our results suggest that the standard diet during lactation in rats with pre-pregnancy obesity and excessive weight gain during pregnancy reduces the inflammatory response and increases the levels of iron-related indicators in the offspring, and the inflammatory response may play a mechanistic role in the association between maternal diet during lactation and iron-related indicators in the offspring.
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  The role and analysis of STAT3 mediatedregulation of trophoblast apoptosis, proliferation, invasion, and migration by methylation inhibitor 5-AZA-DC in preeclampsia

  HUANG Shao′e, XIE Liqing, DING Zhizhu, ZHAO Xiaoyong, ZHANG Xiaoli

  Chinese Journal of Reproductive Health. 2024, 35(6): 521-530.

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  Objective To investigate the regulation of the methyltransferase inhibitor 5-aza-2-deoxycytidine (5-AZA-DC) on trophoblast apoptosis, proliferation, invasion, and migration in preeclampsia. Methods Placental tissue samples were collected from 40 normal pregnancies (normal pregnancy group) and 40 preeclampsia (PE group) patients. Hematoxylin-eosin (HE) staining was performed on the placental tissues after delivery, and whole-genome bisulfite sequencing (WGBS) was conducted on the placental tissues. Trophoblast cell lines HTR8/Svneo, JEG-3, JAR, and BeWo were cultured in vitro and divided into blank control group (Control group), STAT3 silencing group (shSTAT3 group), and STAT3 overexpression group (STAT3OE group). Cells were treated with 5-AZA-DC, and cell apoptosis, proliferation, invasion, and migration were assessed using CCK8, flow cytometry, Transwell invasion assays, and scratch assays. Statistical analysis was performed using t-tests and one-way ANOVA. Results (1) In placental tissue, compared to the normal pregnancy group, the PE group showed reduced vascular lumens, vascular occlusion, blood flow, fibrin deposition in the intervillous stroma, and visible infarction and hyaline degeneration in the villi. WGBS revealed a significant increase in methylation levels in the PE group, with statistically significant differences in the methylation of genes such as STAT3 [(17.25±1.05 vs 30.36±1.33),P＜0.01],PTEN[(13.33±0.71 vs 23.05±1.17),P＜0.02],TSC2[(15.28±1.43 vs 26.53±1.15),P＜0.02]. (2) In the cell lines, compared to the Control group, 5-AZA-DC intervention significantly reduced trophoblast apoptosis while increasing cell proliferation, invasion, and migration. These differences were statistically significant (P＜0.05). Conclusion STAT3 is a key gene in the pathogenesis of preeclampsia.The intervention with 5-AZA-DC intervention has significant effects on trophoblast apoptosis, proliferation, invasion, and migration in preeclampsia. 5-AZA-DC may be a potential epigenetic therapeutic agent for preeclampsia.
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  The influence of postpartum weight on the occurrence of stress urinary incontinence

  SONG Yuman, YANG Shanshan, JIANG Hua

  Chinese Journal of Reproductive Health. 2024, 35(6): 531-535.

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  Objective To analyze the influence of postpartum weight on postpartum stress urinary incontinence (SUI) after childbirth. Methods Data were collected from January to December 2018 from 6,500 postpartum women undergoing postpartum examinations at Nanjing Maternity and Child Health Care Hospital. Among them, 6,338 women (97.5%) returned valid response questionnaires after being randomly selected for questionnaire surveys and pelvic surface electromyography testing. The 6,338 postpartum women were divided into the postpartum SUI group (540 cases) and the control group (5,798 cases). According to the classification criteria of adult weight determination in the People′s Republic of China Health Industry Standard—Classification of Adult Weight (WS/T 428-2013), participants were classified into underweight (BMI <18.5 kg/m²), normal weight (18.5 kg/m² ≤ BMI <24 kg/m²), overweight (24 kg/m² ≤ BMI <28 kg/m²), and obese (BMI ≥28 kg/m²) groups. The relationship between postpartum weight and postpartum SUI was analyzed, and the severity and impact of SUI on life in different postpartum weight groups were assessed. The pelvic floor electromyography values of the SUI and normal groups with different postpartum weights were compared. Results The incidence of postpartum SUI was 8.5%. The incidence rates of postpartum SUI in the underweight, normal weight, overweight, and obese groups were 6.1%, 8.0%, 9.7%, and 11.0%, respectively. The incidence rate increased gradually with increasing postpartum BMI (P=0.037). Multivariate logistic regression analysis showed that the occurrence of SUI in the postpartum overweight group and postpartum obese group was 1.36 times (95%CI:1.09-1.68) and 1.67 times (95%CI:1.11-2.53) higher, respectively, than that in the postpartum normal weight group. Conclusion Postpartum overweight and obesity are high-risk factors for postpartum SUI. Early management of postpartum weight is beneficial for reducing the risk of postpartum SUI occurrence.
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  A single-center study on the use of antenatal corticosteroids in late preterm births

  WANG Hui, LIU Chen, CAO Lifang, ZHANG Xuefeng

  Chinese Journal of Reproductive Health. 2024, 35(6): 536-541.

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  Objective To investigate the use patterns of antenatal corticosteroids among pregnant women at risk of late preterm birth, and to evaluate the likelihood and influencing factors of administering the treatment at the optimal time (delivery within 2-7 days after the first dose of dexamethasone). Methods A retrospective study was conducted among 155 pregnant women (aged 23-54 years) who gave birth at our hospital between January 2017 and December 2022, who received antenatal corticosteroids during gestational weeks 34-36. 119 pregnant women received antenatal corticosteroids therapy during weeks 34-36 and delivered before 37 weeks, while another 36 pregnant women received antenatal corticosteroids during weeks 34-36 but delivered at term. Based on the indications for antenatal corticosteroid administration, the participants were divided into spontaneous preterm birth risk group (98 pregnant women) and iatrogenic preterm birth risk group (57 pregnant women). The average age of pregnant women in the spontaneous preterm birth risk group were (31.8±4.3) years, and that of the iatrogenic preterm birth risk group was (32.2±3.9) years. The timing of antenatal corticosteroid administration and maternal characteristics were compared between the two groups. Multivariable logistic regression was conducted to adjust for confounding factors and assess the factors associated with optimal timing of antenatal corticosteroid administration. Results The prevalence of optimal timing of antenatal corticosteroid administration was 29.7%. The proportion of women receiving corticosteroids at the optimal time in the iatrogenic preterm birth group was significantly higher than in the spontaneous preterm birth (P＜0.05). Compared to the iatrogenic preterm birth, women in the spontaneous preterm birth were more likely to have a delivery interval > 7 days after the administration of antenatal corticosteroids (P＜0.05) and had a higher probability of delivering at full term (P＜0.05). Logistic regression analysis revealed that women in the iatrogenic preterm birth group were 8.68 times more likely to receive antenatal corticosteroids at the optimal time than those in spontaneous preterm birth (95% CI:2.69-28.02). Additionally, women with premature rupture of membranes were 4.09 times more likely to receive antenatal corticosteroids at the optimal time than those without premature rupture of membranes (95% CI:1.24-13.45). Conclusion Regardless of the indication for late preterm antenatal corticosteroid administration, the likelihood of pregnant women at risk of late preterm birth receiving optimal timing of antenatal corticosteroid administration was low. However, women with risk of iatrogenic preterm birth were more likely to receive antenatal corticosteroid at the optimal time of administration. In addition, premature rupture of membranes is also a factor influencing the timing of optimal antenatal corticosteroid administration.
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  Analysis of deaths from congenital malformations among children under 5 years old in Beijing,2016-2022

  CHEN Xiaozheng, LI Yichen

  Chinese Journal of Reproductive Health. 2024, 35(6): 542-546.

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  Objective To analyze the data of congenital abnormal deaths among children under 5 years old, explore the trend of congenital abnormal deaths from 2016 to 2022. Methods We collect data of child mortality from 2016 to 2022, and analyze the congenital abnormal deaths rate、proportion 、age and regional distribution. Results (1)From 2016(62.3/10⁵)to 2022(34.8/10⁵),the mortality rate of congenital malformations among children under 5 years old in Beijing was significantly decreased —a decrease of 44.1 percent(P＜0.01). The mortality rates of congenital heart disease, neural tube defects, and other congenital malformation were significantly decreased(P＜0.05), while the mortality rate of Down′s synfrome was not decreased(P＞0.05). The proportion of congenital malformations death among children under 5 years old in Beijing was significantly decreased from 23.4%(2016)to 18.1%(2022)(P＜0.05). (2)There are differences in mortality rates among different diseases between urban and suburban areas.The mortality rate of congenital heart disease was significantly decreased in both urban and rural areas(P＜0.01), while the mortality rate of neural tube defects was only decreased in rural area(P＜0.05), the mortality rate of other congenital malformations was only decreased in urban area(P＜0.05). (3)The proportion of deaths caused by congenital abnormalities in the neonatal period continues to decrease, and there are differences in the age distribution characteristics of deaths among different congenital abnormalities. Conclusion The three-level prevention of birth defects in Beijing has achieved significant results, but there are still differences between urban and suburban areas. More targeted measures can be taken in different periods (such as before pregnancy, during pregnancy, and after birth) and regions based on the causes of different congenital abnormalities, differences in suburban areas, and characteristics of age of death, in order to further reduce the mortality rate of congenital abnormalities in children.