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Clozapine is the gold standard for treatment-resistant schizophrenia, but its use is constrained by the risk of severe neutropenia, thus requiring mandatory lifelong hematological monitoring in many jurisdictions. However, a significant evidence gap persists regarding the long-term comparative risk profiles of clozapine versus other second-generation antipsychotics (SGAs), complicating shared decision-making.
Aims
To compare the risk of neutropenia associated with clozapine versus non-clozapine SGAs, assess temporal risk evolution and identify high-risk subgroups to optimise monitoring.
Method
This retrospective cohort study used Hong Kong’s electronic health records to identify patients initiating clozapine or non-clozapine SGAs (2003–2019), with follow-up until 2023. Outcomes included minor (absolute neutrophil count (ANC) 1.0–1.5 × 109/litre) and serious neutropenia (ANC <1.0 × 109/litre). Serious neutropenia leading to clozapine discontinuation within 6 weeks was considered clozapine-associated.
Results
Among 4868 clozapine and 38 277 non-clozapine SGA users, clozapine users showed higher unadjusted incidences of minor (7.05 v. 3.74%) and serious neutropenia (2.53 v. 1.45%). However, adjusted rates of serious neutropenia were similar between groups (0.37 v. 0.36 per 100 person-years). Clozapine was associated with higher risks of minor (incidence rate ratio (IRR) 5.91; 95% CI 3.96–8.70) and serious neutropenia (IRR 3.48; 1.70–6.84) in the first 18 weeks. Bayesian change-point analysis showed sharply declining clozapine-associated risk after 26–29 weeks, converging with non-clozapine SGAs by 82–135 weeks (around 2 years). No significant early excess risk was found in patients younger than 45, while males experienced a transient risk of minor neutropenia.
Conclusions
The risk of clozapine-associated neutropenia is highest in the initial 18 weeks, declining to levels seen with non-clozapine SGAs by 2 years. Weekly monitoring for 18 weeks and monthly for up to 2 years is advisable, with potential for personalised schedules based on age and sex.
With the expansion of human activities in Antarctica, understanding snow strength characteristics has become crucial for developing transportation infrastructure such as snow roads and runways. Previous studies have established that the uniaxial compressive strength of snow is primarily governed by density and sintering time, and that pressure sintering can significantly reduce the time required for snow layers to achieve target strength. However, the strengthening effects of pressure sintering on reconstituted and compacted Antarctic snow and the underlying mesoscale mechanisms remain poorly understood. This study addresses this knowledge gap through experiments on reconstituted and compacted Antarctic snow, comparing pressure sintering (experimental group with 40 KPa pressure) with conventional sintering (control group). Results demonstrated that the experimental group achieved a final density of 0.521 g cm−3 and 86% higher compressive strength of 0.246 MPa compared to the control group’s 0.500 g cm−3 and 0.132 MPa, respectively. Mesoscale analysis demonstrated that the minimum cut density index increased by 54% in the pressure-applied direction. Similarly, the directional connectivity index showed a 39% improvement along the same axis. Additionally, the process resulted in increased mean structure thickness (representing the average local dimension of the ice matrix) and microstructural orthotropy of the experimental group. The findings herein provide a theoretical basis for optimizing snow compaction techniques in Antarctic snow engineering.
Solidification of droplets is of great importance to various technological applications, drawing considerable attention from scientists aiming to unravel the fundamental physical mechanisms. In the case of multicomponent droplets undergoing solidification, the emergence of concentration gradients may trigger significant interfacial flows that dominate the freezing dynamics. Here, we experimentally investigate the fascinating interfacial freezing dynamics of supercooled ethanol–water droplets, accompanied with the migration and growth of massive ice particles. We reveal that this unique freezing dynamics is driven by solidification-induced solutal Marangoni flow within the droplets. Our model, which incorporates the temperature- and concentration-dependent properties of the ethanol–water mixture, quantitatively predicts both the migration velocity and the growth rate of the ice particles. The former is determined by the solutal Marangoni flow velocity, while the latter is governed by a balance between the latent heat release and the enhanced thermal dissipation by the Marangoni flow. Moreover, we show that the final wrapping state of droplets can be modulated by the concentration of ethanol. Our findings may pave the way for novel insights into the physicochemical hydrodynamics of multicomponent liquids undergoing phase transitions.
The Hyphantria cunea (Drury) is a highly polyphagous invasive pest that has become widespread and destructive in China. Although sex pheromone components of H. cunea have been identified, the weak field attraction of synthetic sex pheromone has hindered the application of sex pheromone-based lures in efficient monitoring and management of this pest. In this study, the electroantennographic (EAG) and field responses of H. cunea male adults to three synthetic sex pheromone components, including Z9, Z12, Z15-18Ald (C18:Ald), Z3, Z6-9S,10 R-epoxy-21Hy (C21-2Epo), and 1, Z3, Z6-9S,10 R-epoxy-21Hy (C21-3Epo), were evaluated. Male antennae exhibited significant dose-dependent response to three individual components and a ternary mixtures. The younger and virgin male moths showed stronger electrophysiological activity to synthetic compounds, whereas sensitivity decreased significantly after mating. Among the three components, C21-3Epo elicited the strongest antennal responses. Field trapping revealed that neither single compounds nor binary blends attracted males, whereas only the ternary blend of C18:3Ald, C21-2Epo, and C21-3Epo (ratio 8:1:1; 10 mg total load) effectively captured large numbers of males. In addition, the field trapping indicated that the green rubber septum functioned as a practical dispenser for synthetic pheromones. The Unitraps baited with the green rubber septum showed significantly higher trapping efficiency than cotton wicks, highlighting the septum as a promising dispenser for field deployment of synthetic sex pheromones. Finally, the green rubber septum baited with a ternary blend monitored the dynamics of H. cunea occurrence and detected that the emergence period overlapped with the commercially available synthetic lure. In general, the bioactivity of the synthetic sex pheromone of H. cunea was validated. It could effectively capture H. cunea male adults, be used to monitor and control H. cunea, and further be incorporated into the integrated pest management programme.
Major depressive disorder (MDD) patients exhibit a mood-congruent emotional processing bias within the amygdala toward negative facial stimuli at both unconscious and conscious levels. Therefore, our study aimed to investigate the temporal and spatial dynamics of amygdala along with its interactions with the whole brain during implicit and explicit conditions in MDD.
Methods
Thirty MDD patients and 26 healthy controls (HCs) underwent magnetoencephalography (MEG) recordings and performed implicit and explicit emotional face recognition tasks with happy, sad, and neutral facial expressions. Using the amygdala as a seed region, time frequency representations (TFR) and functional connectivity (FC) were calculated. Pearson correlation analyses measured the relationship between TFR and FC values with clinical symptoms.
Results
During implicit processing, MDD patients exhibited left amygdala activation in the gamma power (60–70 Hz) before 250 ms in response to sad facial stimuli compared to HCs. In the implicit mode, there were increased FC between the right amygdala and several brain regions in the occipitoparietal lobes, as well as higher FC between the left amygdala and putamen in MDD patients. Additionally, the right amygdala was positively correlated with the severity of depression and anxiety during implicit processing.
Conclusions
MDD patients had lateralized amygdala activation in response to sad facial expressions during unconscious emotional recognition of facial stimuli. Our study provided valuable insights into the spatiotemporal dynamics of facial emotional recognition associated with depressive and anxiety-related cognitive bias during implicit and explicit processing.
which arises from the iterated Laguerre operator on functions. We will prove the sequence $\{a_n\}$ of a unified form given by Griffin, Ono, Rolen and Zagier asymptotically satisfies this inequality while the Maclaurin coefficients of the functions in Laguerre-Pólya class have not to possess this inequality. We also prove the companion version of this inequality. As a consequence, we show the Maclaurin coefficients of the Riemann Ξ-function asymptotically satisfy this property. Moreover, we make this approach effective and give the exact thresholds for the positivity of this inequalityfor the partition function, the overpartition function and the smallest part function.
Diagnostic classification models assume the existence of latent attribute profiles, the possession of which increases the probability of responding correctly to questions requiring the corresponding attributes. Through the use of longitudinally administered exams, the degree to which students are acquiring core attributes over time can be assessed. While past approaches to longitudinal diagnostic classification modeling perform inference on the overall probability of acquiring particular attributes, there is particular interest in the relationship between student progression and student covariates such as intervention effects. To address this need, we propose an integrated Bayesian model for student progression in a longitudinal diagnostic classification modeling framework. Using Pòlya-gamma augmentation with two logistic link functions, we achieve computationally efficient posterior estimation with a conditionally Gibbs sampling procedure. We show that this approach achieves accurate parameter recovery when evaluated using simulated data. We also demonstrate the method on a real-world educational testing data set.
Patients with schizophrenia have a significantly elevated risk of mortality. Clozapine is effective for treatment-resistant schizophrenia, but its use is limited by side-effects. Understanding its association with mortality risk is crucial.
Aims
To investigate the associations of clozapine with all-cause and cause-specific mortality risk in schizophrenia patients.
Method
In this 18-year population-based cohort study, we retrieved electronic health records of schizophrenia patients from all public hospitals in Hong Kong. Clozapine users (ClozUs) comprised schizophrenia patients who initiated clozapine treatment between 2003 and 2012, with the index date set at clozapine initiation. Comparators were non-clozapine antipsychotic users (Non-ClozUs) with the same diagnosis who had never received a clozapine prescription. They were 1:2 propensity score matched with demographic characteristics and physical and psychiatric comorbidities. ClozUs were further defined according to continuation of clozapine use and co-prescription of other antipsychotics (polypharmacy). Accelerated failure time (AFT) models were used to estimate the risk of all-cause and cause-specific mortality (i.e. suicide, cardiovascular disease, infection and cancer).
Results
This study included 9,456 individuals (mean (s.d.) age at the index date: 39.13 (12.92) years; 50.73% females; median (interquartile range) follow-up time: 12.37 (9.78–15.22) years), with 2020 continuous ClozUs, 1132 discontinuous ClozUs, 4326 continuous non-ClozUs and 1978 discontinuous Non-ClozUs. Results from adjusted AFT models showed that continuous ClozUs had a lower risk of suicide mortality (acceleration factor 3.01; 99% CI: 1.41–6.44) compared with continuous Non-ClozUs. Continuous ClozUs with co-prescription of other antipsychotics exhibited lower risks of suicide mortality (acceleration factor 3.67; 1.41–9.60) and all-cause mortality (acceleration factor 1.42; 1.07–1.88) compared with continuous Non-ClozUs. No associations were found between clozapine and other cause-specific mortalities.
Conclusions
These results add to the existing evidence on the effectiveness of clozapine, particularly its anti-suicide effects, and emphasise the need for continuous clozapine use for suitable patients and the possible benefit of clozapine polypharmacy.
Cavitation bubble pulsation and liquid jet loads are the main causes of hydraulic machinery erosion. Methods to weaken the load influences have always been hot topics of related research. In this work, a method of attaching a viscous layer to a rigid wall is investigated in order to reduce cavitation pulsations and liquid jet loads, using both numerical simulations and experiments. A multiphase flow model incorporating viscous effects has been developed using the Eulerian finite element method (EFEM), and experimental methods of a laser-induced bubble near the viscous layer attached on a rigid wall have been carefully designed. The effects of the initial bubble–wall distance, the thickness of the viscous layer, and the viscosity on bubble pulsation, migration and wall pressure load are investigated. The results show that the bubble migration distance, the normalised thickness of the oil layer and the wall load generally decrease with the initial bubble–wall distance or the oil-layer parameters. Quantitative analysis reveals that when the initial bubble–wall distance remains unchanged, there exists a demarcation line for the comparison of the bubble period and the reference period (the bubble period without viscous layer under the same initial bubble–wall distance), and a logarithmic relationship is observed that $\delta \propto \log_{10} \mu ^*$, where $\delta =h/R_{max}$ is the thickness of the viscous layer h normalised by the maximum bubble radius $R_{max}$, $\mu ^* = \mu /({R_{max }}\sqrt {{\rho }{{\mathop {P}\nolimits } _{{atm}}}})$ is the dynamic viscosity $\mu$ normalised by water density $ \rho $ and atmospheric pressure $P_{atm}$. The results of this paper can provide technical support for related studies of hydraulic cavitation erosion.
With the escalating laser peak power, modulating and detecting the intensity, duration, phase and polarization of ultra-intense laser pulses progressively becomes increasingly arduous due to the limited damage thresholds of conventional optical components. In particular, the generation and detection of ultra-intense vortex lasers pose great challenges for current laser technologies, which has limited the widely potential applications of relativistic vortex lasers in various domains. In this study, we propose to reconstruct the vortex phase and generate and amplify the relativistic vortex lasers via surface plasma holograms (SPHs). By interfering with the object laser and reference laser, SPHs are formed on the target and the phase of the interfering laser is imprinted through the modulation of surface plasma density. In particular, using the quadrature phase-shift interference, the vortex phase of the object laser can be well reconstructed. The generated vortex lasers can be focused and enhanced further by one order of magnitude, up to $1.7\times {10}^{21}$ W/cm${}^2$, which has been demonstrated by full three-dimensional particle-in-cell simulations. For the first time, we provide a practical way to detect the phase of relativistic vortex lasers, which can be applied in large 1–10 PW laser facilities. This will promote future experimental research of vortex-laser–plasma interaction and open a new avenue of plasma optics in the ultra-relativistic regime.
The longitudinal fields of a tightly focused Laguerre–Gaussian (LG) laser can be used to accelerate electron pulse trains when it is reflected from a solid plasma. However, the normal transverse mode of laser beams in high-power laser systems is approximately Gaussian. A routine and reliable way to obtain high-intensity LG lasers in experiments remains a major challenge. One approach involves utilizing a solid plasma with a ‘light fan’ structure to reflect the Gaussian laser and obtain a relativistic intense LG laser. In this work, we propose a way to combine the mode transformation of a relativistic laser and the process of electron injection and acceleration. It demonstrates that by integrating a nanowire structure at the center of the ‘light fan’, electrons can be efficiently injected and accelerated during the twisted laser generation process. Using three-dimensional particle-in-cell simulations, it is shown that a circularly polarized Gaussian beam with ${a}_0=20$ can efficiently inject electrons into the laser beam in interaction with the solid plasma. The electrons injected close to the laser axis are driven by a longitudinal electric field to gain longitudinal momentum, forming bunches with a low energy spread and a small divergence angle. The most energetic bunch exhibits an energy of 310 MeV, with a spread of 6%. The bunch charge is 57 pC, the duration is 400 as and the divergence angle is less than 50 mrad. By employing Gaussian beams, our proposed approach has the potential to reduce experimental complexity in the demonstrations of twisted laser-driven electron acceleration.
In contemporary neuroimaging studies, it has been observed that patients with major depressive disorder (MDD) exhibit aberrant spontaneous neural activity, commonly quantified through the amplitude of low-frequency fluctuations (ALFF). However, the substantial individual heterogeneity among patients poses a challenge to reaching a unified conclusion.
Methods
To address this variability, our study adopts a novel framework to parse individualized ALFF abnormalities. We hypothesize that individualized ALFF abnormalities can be portrayed as a unique linear combination of shared differential factors. Our study involved two large multi-center datasets, comprising 2424 patients with MDD and 2183 healthy controls. In patients, individualized ALFF abnormalities were derived through normative modeling and further deconstructed into differential factors using non-negative matrix factorization.
Results
Two positive and two negative factors were identified. These factors were closely linked to clinical characteristics and explained group-level ALFF abnormalities in the two datasets. Moreover, these factors exhibited distinct associations with the distribution of neurotransmitter receptors/transporters, transcriptional profiles of inflammation-related genes, and connectome-informed epicenters, underscoring their neurobiological relevance. Additionally, factor compositions facilitated the identification of four distinct depressive subtypes, each characterized by unique abnormal ALFF patterns and clinical features. Importantly, these findings were successfully replicated in another dataset with different acquisition equipment, protocols, preprocessing strategies, and medication statuses, validating their robustness and generalizability.
Conclusions
This research identifies shared differential factors underlying individual spontaneous neural activity abnormalities in MDD and contributes novel insights into the heterogeneity of spontaneous neural activity abnormalities in MDD.
Previous research has suggested a potential link between folic acid (FA) supplementary therapy and gastric ulcers (GU). To investigate this relationship further, we conducted a Mendelian randomisation (MR) analysis using data from the UK Biobank. Our analysis primarily employed inverse-variance weighted (IVW) methods, including both fixed-effect and random-effect models. To ensure the robustness of our findings, additional methods such as the simple median, the weighted median and the penalised weighted median were also applied. The MR analysis aimed to explore the causal effect of FA supplementary therapy on GU. Seven SNP at genetic loci associated with FA supplementary therapy were identified. Both the random-effect and fixed-effect IVW models indicated that genetically predicted FA supplementary therapy significantly reduced the risk of GU (OR, 0·870; 95 % CI 0·826, 0·917, P < 0·001). This result was consistent across other methods, with similar outcomes observed using the simple median (OR, 0·835; 95 % CI 0·773, 0·901, P < 0·001), the weighted median (OR, 0·854; 95 % CI 0·794, 0·919, P < 0·001) and the penalised weighted median (OR, 0·849; 95 % CI 0·789, 0·914, P < 0·001). Leave-one-out sensitivity analysis confirmed that no individual SNP significantly drove the association between FA supplementary therapy and GU. This MR study provides genetic evidence that FA supplementary therapy may decrease the risk of GU.
Species of epiphytic microbiota are closely associated with the fermentation performance of natural forage silage. This study aimed to evaluate the dynamic microbial communities, fermentation parameters, and aerobic stability of Napier grass silage from the same variety and growth period but harvested from three different regions (NGP1, NGP2, and NGP3). After 60 days of ensiling, triplicate silos were opened for sampling and testing aerobic stability. The epiphytic microbiota with higher relative abundances in fresh Napier grass (NGP1, NGP2, and NGP3) were Weissella, Enterobacter, and Lactococcus, respectively. After 60 days of ensiling, NGP3 exhibited higher fermentation quality, indicated by higher lactic acid (LA) concentration and lower pH than that of NGP1 and NGP2. The NH3–N content of all treatments was lower than 100 g/kg total nitrogen. Compared with NGP1 and NGP2 silage, NGP3 silage exhibited a sharp rise in pH and LA consumption during air exposure. After 7 days of air exposure, NGP3 had higher ethanol concentrations and pH. Ruminiclostridium_5, Pediococcus, and Lactobacillus predominated in NGP1, NGP2, and NGP3 silages, respectively, whereas Candida and Monascus predominated in air-exposed NGP3 silage. The bacterial co-occurrence networks from fresh samples to ensiling and air exposure became more complex; however, NGP3 had a higher negative correlation with co-occurrence after air exposure. Different regions had significant effects on the fermentation patterns, bacterial communities, and aerobic stability of Napier grass silage. This was mainly due to variable epiphytic microbiota. Higher fermentation quality of Napier grass silage may also result in accelerated spoilage due to air exposure. Candida and Monascus were primarily responsible for the lower dry matter recovery and higher ethanol contents and air exposure spoilage of Napier grass silage.
Chinese nurses working with immense stress may have issues with burnout during COVID-19 regular prevention and control. There were a few studies investigating status of burnout and associated factors among Chinese nurses. However, the relationships remained unclear.
Objectives
To investigate status and associated factors of nurses’ burnout during COVID-19 regular prevention and control.
Methods
784 nurses completed questionnaires including demographics, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Insomnia Severity Index, Impact of Event Scale-revised, Perceived Social Support Scale, Connor–Davidson Resilience Scale, General Self-efficacy Scale and Maslach Burnout Inventory.
Results
310 (39.5%), 393 (50.1%) and 576 (73.5%) of respondents were at high risk of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). The risk of EE, DP and reduced PA were moderate, high and high. Nurses with intermediate and senior professional rank and title and worked >40 h every week had lower scores in EE. Those worked in low-risk department reported lower scores in PA. Anxiety, post-traumatic stress disorder (PTSD), self-efficacy and social support were influencing factors of EE and DP, while social support and resilience were associated factors of PA.
Conclusion
Chinese nurses’ burnout during COVID-19 regular prevention and control was serious. Professional rank and title, working unit, weekly working hours, anxiety, PTSD, self-efficacy, social support and resilience were associated factors of burnout.
Many studies have investigated the positivity rate of hepatitis B surface antibody (HBsAb) after hepatitis B vaccine (HepB) immunization. However, the antibody level, assessed monthly or at more frequent intervals after each of the three doses, particularly within the first year after birth, has not been previously reported. To elucidate the level of antibody formation at various times after vaccination, the current study used the available detection data of HBsAb in hospitalized children to analyze the HBsAb level after immunization combined with their vaccination history. Both the positivity rate and geometric mean concentration (GMC) increased sequentially with immunization doses, reaching their peaks earlier after the third dose than after the first two doses, and the rate of HBsAb positivity was able to reach 100% between 11 and 90 days after completing the three doses of HepB. Within one year after receiving the three doses, the antibody positivity rate and GMC were maintained above 90% and 100 mIU/mL, respectively, and subsequently steadily declined, reaching the lowest value in the 9th and 10th years. The current findings reveal, in more detail, the level of antibody formation at different times following each dose of HepB in hospitalized children, particularly in the age group up to one year after vaccination. For the subjects of this study, we prefer to believe that the proportion of HBsAb non-response should be less than 5% after full immunization with HepB, provided that the appropriate time for blood collection is chosen.
The purpose of this study was to analyse the clinical characteristics of patients with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) PCR re-positivity after recovering from coronavirus disease 2019 (COVID-19). Patients (n = 1391) from Guangzhou, China, who had recovered from COVID-19 were recruited between 7 September 2021 and 11 March 2022. Data on epidemiology, symptoms, laboratory test results and treatment were analysed. In this study, 42.7% of recovered patients had re-positive result. Most re-positive patients were asymptomatic, did not have severe comorbidities, and were not contagious. The re-positivity rate was 39%, 46%, 11% and 25% in patients who had received inactivated, mRNA, adenovirus vector and recombinant subunit vaccines, respectively. Seven independent risk factors for testing re-positive were identified, and a predictive model was constructed using these variables. The predictors of re-positivity were COVID-19 vaccination status, previous SARs-CoV-12 infection prior to the most recent episode, renal function, SARS-CoV-2 IgG and IgM antibody levels and white blood cell count. The predictive model could benefit the control of the spread of COVID-19.
Microplastics (MPs) pollution has been a hot research topic in recent years. MPs are ubiquitous throughout the ecological environment and are eventually accumulated in organisms through inhalation or ingestion. However, given that MPs are inert pollutants, their effects on organisms are not clear. In previous study, we have investigated the effects of polyethylene terephthalate MPs on physiology of Drosophila. What is the effect of polypropylene microplastics (PP-MPs)? The results of our experiments show that being exposed to high concentration of PP-MPs have significant effect on Drosophila. PP-MPs exposure can significantly increase locomotor activity and shorten the time of group sleep in Drosophila. In the presence of high concentrations of PP-MPs, the triglyceride content was reduced in females and their ability of egg production was affected. However, there was no significant effect on the level of protein and carbohydrate, or on the food intake. Our experimental results can provide some preliminary data for assessing the potential hazard of PP-MPs to other organisms.
The random fiber laser (RFL) has been an excellent platform for exploring novel optical dynamics and developing new functional optoelectronic devices. However, it is challenging for RFLs to regulate their emission into regular narrow pulses due to their intrinsic randomness. Here, through engineering the laser configuration (cavity Q value, gain distribution and nonlinearity), we demonstrate that narrow (~2.5 ns) pulses with record peak power as high as 64.3 kW are achieved from a self-Q-switched random ytterbium fiber laser. Based on high intracavity intensity and efficient interplay of multiple nonlinear processes (stimulated Brillouin scattering, stimulated Raman scattering and four-wave mixing), an over-one-octave visible-near-infrared (NIR) Raman-frequency comb is generated from single-mode silica fibers for the first time. After spectrally filtering the Raman peaks, wavelength-tunable pulses with durations of several hundreds of picoseconds are obtained. Such a high-peak-power random Q-switched fiber laser and wide frequency comb in the visible-NIR region can find applications in diverse areas, such as spectroscopy, biomedical imaging and quantum information.
To investigate the association between folate levels and the risk of gestational diabetes mellitus (GDM) risk during the whole pregnancy.
Design:
In this retrospective cohort study of pregnant women, serum folate levels were measured before 24 gestational weeks (GW). GDM was diagnosed between 24th and 28th GW based on the criteria of the International Association of Diabetes and Pregnancy Study Groups. General linear models were performed to examine the association of serum folate with plasma glucose (i.e. linear regressions) and risk of GDM (i.e. log-binomial regressions) after controlling for confounders. Restricted cubic spline regression was conducted to test the dosage–response relationship between serum folate and the risk of GDM.
Setting:
A sigle, urban hospital in Shanghai, China.
Participants:
A total of 42 478 women who received antenatal care from April 2013 to March 2017 were included.
Results:
Consistent positive associations were observed between serum folate and plasma glucose levels (fasting, 1-h, 2-h). The adjusted relative risks (RR) and 95 % CI of GDM across serum folate quartiles were 1·00 (reference), 1·15 (95 % CI (1·04, 1·26)), 1·40 (95 % CI (1·27, 1·54)) and 1·54 (95 % CI (1·40, 1·69)), respectively (P-for-trend < 0·001). The positive association between serum folate and GDM remained when stratified by vitamin B12 (adequate v. deficient groups) and the GW of serum folate measurement (≤13 GW v. >13 GWs)
Conclusions:
The findings of this study may provide important evidence for the public health and clinical guidelines of pregnancy folate supplementation in terms of GDM prevention.