Qiu X, He J, Qiu L, Larson CP, Xia H, Lam KB. Int J Gynaecol Obstet. 2013 Sep;122(3):216-8.

OBJECTIVE:
To determine the willingness of pregnant women in Guangzhou, China, to participate in a large-scale birth cohort study.
METHODS:
A cross-sectional survey was conducted of 526 pregnant women who attended their first prenatal class at Guangzhou Women and Children's Medical Center, Guangzhou, China, between September 21 and November 15, 2011. Information on demographic characteristics, willingness to participate, and preferences regarding collection procedures and incentives were analyzed.
RESULTS:
In all, 47.9% of the women were willing to participate in a birth cohort study, whereas 23.0% refused and 29.1% were unsure. The majority of the women willing to participate (95.2%-98.4%) accepted the use of non-invasive data collection methods except for stool collection, and 85.9% would allow their offspring to participate in long-term follow-up. Willingness to participate rose to 85.2% when non-monetary incentives were offered. The most popular incentive was assessment of child development.
CONCLUSION:
The willingness of pregnant Chinese women to participate in long-term observational research was similar to that reported in high-income countries. Non-monetary incentives improved their level of willingness, a finding that might inform future maternal and child health research in low- and middle-income countries.

Qiu X, He JR, Zhao MG, Kuang YS, Xu SQ, Zhang HZ, Hu SP, Chen J, Xia HM. Peptides. 2014 Feb;52:19-22

Adropin is a recently identified peptide and participates in the regulation of energy homeostasis and vascular function. The aim of this study was to examine the relationships between human cord blood adropin levels and fetal growth. A total of 159 newborns [preterm delivery (PTD), n=72; term delivery, n=87] were recruited. Adropin levels in cord blood were determined using enzyme-linked immunosorbent assay kits. Clinical information on fetal growth was collected. Adropin levels in PTD babies (median, 2028; 25th-75th, 1413-2484pg/ml) were lower than those in term delivery babies (median, 2305; 25th-75th, 1960-2684pg/ml, P=0.01). Birth weight and length z score, Ponderal index, placental length, breadth, thickness, surface area, volume and density were not significantly correlated to adropin concentrations in term delivery group. However, we found adropin concentrations were significantly correlated to gestational age at birth (Spearman's correlation coefficient=0.35, P<0.01) and placental weight (Spearman's correlation coefficient=0.24, P=0.04) in PTD group. We also found that boys had lower adropin levels than girls in PTD group (P=0.01). When the analysis was extended to the whole group (PTD and term deliveries combined), the results were similar to those for PTD group alone. After adjusting for maternal age and newborn's sex, every 100pg/ml increase of adropin concentration was significantly associated with a decreased risk of PTD (odds ratio, 0.95; 95% confidence interval, 0.91-0.99). Our study showed that cord blood adropin levels were positively correlated with gestational age and placental weight but not with other fetal growth parameters.

He JR, Xia HM, Liu Y, Xia XY, Mo WJ, Wang P, Cheng KK, Leung GM, Feng Q, Schooling CM, Qiu X. Arch Dis Child. 2014 Dec;99(12):1091-7.

OBJECTIVE:
To formulate a new birthweight reference for different gestational ages in Guangzhou, southern China, and compare it with the currently used reference in China and the global reference.
METHODS:
All singleton live births of more than 26 weeks' gestational age recorded in the Guangzhou Perinatal Health Care and Delivery Surveillance System for the years 2009, 2010 and 2011 (n=510 837) were retrospectively included in the study. In addition, the study sample was supplemented by all singleton live births (n=3538) at gestational ages 26-33 weeks from 2007 and 2008. We used Gaussian mixture models and robust regression to exclude outliers of birth weight and then applied Generalized Additive Models for Location, Scale, and Shape (GAMLSS) to generate smoothed percentile curves separately for gender and parity.
RESULTS:
Of infants defined as small for gestational age (SGA) in the new reference, 15.3-47.7% (depending on gestational age) were considered appropriate for gestational age (AGA) by the currently used reference of China. Of the infants defined as SGA by the new reference, 9.2% with gestational ages 34-36 weeks and 14.3% with 37-41 weeks were considered AGA by the global reference. At the 50th centile line, the new reference curve was similar to that of the global reference for gestational ages 26-33 weeks and above the global reference for 34-40 weeks.
CONCLUSION:
The new birthweight reference based on birthweight data for neonates in Guangzhou, China, differs from the reference currently used in China and the global reference, and appears to be more relevant to the local population.

Yong Guo^1,2, Yu Liu^{1, 2}, Jian-Rong He^{1, 2}, Xiao-Yan Xia^{1, 2, 3}, Wei-Jian Mo², Ping Wang², Qiong Feng², Charles P. Larson⁴, Hui-Min Xia¹, Xiu Qiu^{1, 2}

Background:
Recent surveillance data suggest that mean birth weight has begun to decline in several developed countries. The aim of this study is to examine the changes in birth weight among singleton live births from 2002 to 2012 in Guangzhou, one of the most rapidly developed cities in China.
METHODS:
We used data from the Guangzhou Perinatal Health Care and Delivery Surveillance System for 34108 and 54575 singleton live births with 28–41 weeks of gestation, who were born to local mothers, in 2002 and 2012, respectively. The trends in birth weight, small (SGA) and large (LGA) for gestational age and gestational length were explored in the overall population and gestational age subgroups.
RESULTS:
The mean birth weight decreased from 3162g in 2002 to 3137g in 2012 (crude mean difference, -25g; 95% CI, -30 to -19). The adjusted change in mean birth weight appeared to be slight (-6g from 2002 to 2012) after controlling for maternal age, gestational age, educational level, parity, newborn’s gender and delivery mode. The percentages of SGA and LGA in 2012 were 0.6% and 1.5% lower than those in 2002, respectively. The mean gestational age dropped from 39.2 weeks in 2002 to 38.9 weeks in 2012. In the stratified analysis, we observed the changes in birth weight differed among gestational age groups. The mean birth weight decreased among very preterm births (28-31 weeks), while remained relatively stable among other gestational age subcategories.
CONCLUSION:
Among local population in Guangzhou from 2002 to 2012, birth weight appeared to slightly decrease. The percentage of SGA and LGA also simultaneously dropped, indicating that newborns might gain a healthier weight for gestational age.

Yu Liu, Yong Guo, Changbing Wang, Weidong Li, Jinhua Lu, Songying Shen, Huimin Xia, Jianrong He, and Xiu Qiu

The current study examined the association between temperature change and clinical visits for childhood respiratory tract infections (RTIs) in Guangzhou, China. Outpatient records of clinical visits for pediatric RTIs which occurred from 1 January 2012 to 31 December 2013 were collected from Guangzhou Women and Children's Hospital. Records for meteorological variables during the same period were obtained from the Guangzhou Meteorological Bureau. Temperature change was defined as the difference between the mean temperatures on two consecutive days. A distributed lag non-linear model (DLNM) was used to examine the impact of temperature change on pediatric outpatient visits for RTIs. A large temperature decrease was associated with a significant risk for an RTI, with the effect lasting for ~ 10 days. The maximum effect of a temperature drop (-8.8°C) was reached at lag 2~3 days. Children aged 0-2 years, and especially those aged < 1 year were particularly vulnerable to the effects of temperature drop. An extreme temperature decrease affected the number of patient visits for both upper respiratory tract infections (URTIs) and lower respiratory tract infections (LRTIs). A temperature change between consecutive days, and particularly an extreme temperature decrease, was significantly associated with increased pediatric outpatient visits for RTIs in Guangzhou.

He JR, Yuan MY, Chen NN, Lu JH, Hu CY, Mai WB, Zhang RF, Pan YH, Qiu L, Wu YF, Xiao WQ, Liu Y, Xia HM, Qiu X. Br J Nutr. 2015 Apr 28;113(8):1292-300.

Few studies have explored the relationship between dietary patterns and the risk of gestational diabetes mellitus (GDM). Evidence from non-Western areas is particularly lacking. In the present study, we aimed to examine the associations between dietary patterns and the risk of GDM in a Chinese population. A total of 3063 pregnant Chinese women from an ongoing prospective cohort study were included. Data on dietary intake were collected using a FFQ at 24-27 weeks of gestation. GDM was diagnosed using a 75 g, 2 h oral glucose tolerance test. Dietary patterns were determined by principal components factor analysis. A log-binomial regression model was used to examine the associations between dietary pattern and the risk of GDM. The analysis identified four dietary patterns: vegetable pattern; protein-rich pattern; prudent pattern; sweets and seafood pattern. Multivariate analysis showed that the highest tertile of the vegetable pattern was associated with a decreased risk of GDM (relative risk (RR) 0•79, 95% CI 0.64, 0•97), compared with the lowest tertile, whereas the highest tertile of the sweets and seafood pattern was associated with an increased risk of GDM (RR 1•23, 95% CI 1•02, 1•49). No significant association was found for either the protein-rich or the prudent pattern. The protective effect of a high vegetable pattern score was more evident among women who had a family history of diabetes (P for interaction=0•022). These findings suggest that the vegetable pattern was associated with a decreased risk of GDM, while the sweets and seafood pattern was associated with an increased risk of GDM. These findings may be useful in dietary counselling during pregnancy.

Xiaodan Liu,Wang Liao,Hongxia Peng,Xuequn Luo,Ziyan Luo,Hua Jiang,Ling Xu

Purpose:
Abnormal expression of miRNAs is intimately related to a variety of human cancers. The purpose of this study is to confirm the expression of miR-181a and elucidate its physiological function and mechanism in pediatric acute myeloid leukemia (AML).
METHODS:
Pediatric AML patients and healthy controls were enrolled, and the expression of miR-181a and ataxia telangiectasia mutated (ATM) in tissues were examined using quantitative PCR. Moreover, cell proliferation and cell cycle were evaluated in several cell lines (HL60, NB4 and K562) by using flow cytometry after transfected with miR-181a mimics and inhibitors, or ATM siRNA and control siRNA. Finally, ATM as the potential target protein of miR-181a was examined.
RESULTS:
We found that miR-181a was significantly increased in pediatric AML, which showed an inverse association with ATM expression. Overexpressed miR- 181a in cell lines significantly enhanced cell proliferation, as well as increased the ratio of S-phase cells by miR-181a mimics transfection in vitro. Luciferase activity of the reporter construct identified ATM as the direct molecular target of miR-181a. ATM siRNA transfection significantly enhanced cell proliferation and increased the ratio of S-phase cells in vitro.
CONCLUSION:
The results revealed novel mechanism through which miR-181a regulates G1/S transition and cell proliferation in pediatric AML by regulating the tumor suppressor ATM, providing insights into the molecular mechanism in pediatric AML.

He JR, Liu Y, Xia XY, Ma WJ, Lin HL, Kan HD, Lu JH, Feng Q, Mo WJ, Wang P, Xia HM, Qiu X, Muglia LJ. Environ Health Perspect. 2015 Dec 15.

Background:
Although effects of weather changes on human health have been widely reported, there is limited information regarding effects on pregnant women in developing countries.
OBJECTIVE:
To investigate the association between maternal exposure to ambient temperature and the risk of preterm birth ( < 37 weeks of gestation) in Guangzhou, China.
METHODS:
We used a Cox proportional hazards model to estimate associations between preterm birth and average temperature during each week of gestation, with weekly temperature modeled as a time-varying exposure during four time windows: 1-week, 4-week, late pregnancy (gestational week 20 onwards), and the entire pregnancy. Information on singleton vaginal birth between 2001 and 2011 was collected. Daily meteorological data during the same period were obtained from the Guangzhou Meteorological Bureau.
RESULTS:
A total of 838,146 singleton vaginal births were included, amongst which 47,209 (5.6%) were preterm births. High mean temperatures during the previous 4 weeks, late pregnancy, and the entire pregnancy were associated with an increased risk of preterm birth. Compared with the median temperature (24.4°C), weekly exposures during the past 4 weeks to extreme cold (7.6°C, the 1st percentile) and extreme heat (31.9°C, the 99th percentile) were associated with 17.9% (95% CI: 10.2, 26.2%) and 10.0% (95% CI: 2.9, 17.6%) increased risks of preterm birth, respectively. The association between extreme heat and preterm birth was stronger for preterm births during weeks 20-31 and 32-34 than those during weeks 35-36.
CONCLUSION:
These findings might have important implications in preventing preterm birth in Guangzhou as well as other areas with similar weather conditions.

Nian-Nian Chen, Jian-Rong He, Wei-Dong Li, Ya-Shu Kuang, Ming-Yang Yuan, Xiao-Dan Liu, Hui-Zhu Zhang, Shun-Ping Hu, Hui-Min Xia, Xiu Qiu

OBJECTIVE:
To determine the presence of C1q and tumor necrosis factor-related protein 3 (CTRP3) in cord blood and its relationship with fetal growth among Chinese newborns.
METHODS:
This pilot study recruited 126 infants (small for gestational age [SGA], n=34; appropriate for gestational age [AGA], n=60; large for gestational age [LGA], n=32); cord blood CTRP3 levels were measured, and fetal growth parameters were collected.
RESULTS:
Median (25–75th percentile) CTRP3 levels in the SGA, AGA, and LGA groups were 297.2 (236.4–360.2), 297.5 (261.0–369.9), and 368.6 (298.5–507.1) ng/mL, respectively (P = 0.01). LGA infants had higher CTRP3 levels than AGA infants (multiple linear regression analysis; P = 0.01). The CTRP3 levels were positively correlated with birth weight (r = 0.25, P < 0.01), Ponderal index (r=0.28, P < 0.01), and placental weight (r=0.20, P=0.03) in the total study population. In the subgroup analysis, CTRP3 levels were negatively correlated with birth length z scores (r=-0.39, P=0.03) and were positively correlated with the Ponderal index (r=0.43, P=0.02) only in the SGA group; no other significant correlations were observed. The CTRP3 levels were similar between the sexes (P=0.11).
CONCLUSION:
CTRP3 is present in cord blood and might be involved in fetal growth.

Songying Shen*, Jinhua Lu*, Jianrong He, Yu Liu, Niannian Chen, Mingyang Yuan, Wanqing Xiao, Lan Qiu, Cuiyue Hu, Huimin Xia, Xiu Qiu

Background:
The US Food and Drug Administration recommended that the use of progesterone to reduce the risk of preterm births in women with a previous preterm birth should begin after the 16th week of gestation. In the USA, even a 4•5% reported rate of progesterone use in the first trimester is regarded as a high prescription for unknown fetal risk. Unfortunately, we identified a 10 times higher prevalence of progesterone prescription in early pregnancy in an ongoing study, the Born in Guangzhou Cohort Study (BIGCS) in China. We aimed to investigate the potential effects of progesterone use in early pregnancy on maternal and birth outcomes.
METHODS:
6617 pregnant women were included from the BIGCS between January, 2013, and January, 2015. Progesterone use during early pregnancy ( <14 weeks) was assessed by questionnaires at around 16 weeks of gestation. We used a logistic regression model, adjusted for potential confounders, to study the associations between progesterone use and the risk of preterm births, small for gestational age, large for gestational age, gestational diabetes, caesarean section, and post-partum depression. This study was approved by the Institutional Review Board of Guangzhou Women and Children’s Medical Center, Guangzhou, China. Written informed consent was obtained from all participants.
Findings：
2787 (42%) women reported progesterone use in early pregnancy. After adjusting for potential confounders, women who used progesterone had significantly higher risks of caesarean section (odds ratio 1•31 [95% CI 1•05–1•63]; p=0•0146) and post-partum depression (1•22 [1•00–1•49]; p=0•0497). No effect of progesterone use was reported for preterm-birth prevention, fetal growth, and gestational diabetes.

Journal：Nutrients
There was limited evidence revealing the association of Chinese maternal dietary patterns with fetal growth. We aimed to examine the relationship of maternal dietary patterns during pregnancy to neonatal birth weight and birth weight for gestational age in a Chinese population. A total of 6954 mother-child pairs were included from the Born in Guangzhou Cohort Study. Maternal diet during pregnancy was assessed using a self-administered food frequency questionnaire. Cluster analysis was used to identify dietary patterns.
The following six dietary patterns were identified: "Cereals, eggs, and Cantonese soups" (n 1026, 14.8%), "Dairy" (n 1020, 14.7%), "Fruits, nuts, and Cantonese desserts" (n 799, 11.5%), "Meats" (n 1066, 15.3%), "Vegetables" (n 1383, 19.9%), and "Varied" (n 1224, 17.6%). The mean neonatal birth weight Z scores of women in the above patterns were 0.02, 0.07, 0.20, 0.01, 0.06, and 0.14, respectively. Women in the "Fruits, nuts, and Cantonese desserts" and "Varied" groups had significantly heavier infants compared with those in the "Cereals, eggs, and Cantonese soups" group. Compared with women in the "Cereals, eggs, and Cantonese soups" group, those in the "Varied" group had marginally significantly lower odds of having a small-for-gestational age (SGA) infant after adjustment for other confounders (OR 0.77, 95% CI 0.57, 1.04, p = 0.08).
These findings suggest that compared to a traditional Cantonese diet high in cereals, eggs, and Cantonese soups, a diet high in fruits, nuts, and Cantonese desserts might be associated with a higher birth weight, while a varied diet might be associated with a greater birth weight and also a decreased risk of having a SGA baby.