Aims/hypothesis: The study aimed to explore the association between maternal glucose levels in pregnancy and offspring’s metabolism and adiposity at approximately 18 years of age. Methods: Pregnant women from the Hong Kong Field Centre enrolled in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study underwent a 75 g OGTT at 24–32 gestational weeks. Offspring’s metabolic and adiposity traits were assessed at 18 years postpartum. Associations were evaluated using multiple linear regression and logistic regression. Results: Among the 506 mother–child pairs followed up to 18 years, maternal fasting plasma glucose (FPG) in pregnancy was positively associated with offspring’s FPG (β = 0.06 [95% CI 0.02, 0.09]), while maternal 1 h plasma glucose (PG) showed a positive association with offspring’s FPG (β = 0.05), 30 min PG (β = 0.21) and 2 h PG (β = 0.14). All maternal glycaemic levels were associated with an increased risk of offspring being overweight/obese, particularly maternal 1 h PG (OR 1.50 [95% CI 1.17, 1.93]). Offspring of mothers with gestational diabetes mellitus showed a higher prevalence of abnormal glucose tolerance (11.86% vs 7.97%), impaired fasting glucose (1.89% vs 0.49%) and impaired glucose tolerance (10.34% vs 7.13%) than offspring of mothers with normal glucose tolerance, although these associations did not reach statistical significance in fully adjusted models, underscoring the benefit of considering maternal glucose as a continuous trait. Conclusions/interpretation: Maternal glucose levels in pregnancy showed a long-term association with offspring’s metabolic health into young adulthood, with continuous associations across the full maternal glucose spectrum, suggesting a graded effect of maternal hyperglycaemia on offspring’s metabolic risk. Graphical

Sexually active young people face an increasing public health burden of unintended pregnancies and sexually transmitted diseases due to improper contraception. However, environmental and social factors related to young people’s contraception remain unclear. To identify the key factors, we applied ensemble machine learning methods to the data of 12,280 heterosexual Chinese college students who reported sexual intercourse experience in the National College Student Survey on Sexual and Reproductive Health in 2020 (NCSS-SRH 2020). In the order of variable importance, convenient access to contraceptives, certain attitudes towards sex, sexual health knowledge level, being an only-child, and purchasing a bachelor’s or master’s degree were positively associated with a high frequency of contraceptive use. In contrast, smoking, free access to contraceptives, a specific attitude towards marriage, and negotiation with a sexual partner were negatively associated with a higher frequency of contraceptive use. Our analysis provides insights into young people’s contraceptive use under a typically conservative culture of sexuality. Compared to previous studies, we thoroughly investigated internal and external factors that might impact young people’s decision on contraception while having sex. Under a conservative culture of sexuality, the effects of the external factors on young people’s contraception may outweigh those of the internal factors.

BACKGROUND: This study aims to develop a prediction model to identify individuals at risk of hypertensive disorders of pregnancy (HDPs), including gestational hypertension and preeclampsia, by integrating epigenetic biomarkers and clinical factors in the first trimester of pregnancy. METHODS: A 2-stage nested case-control study, matched by age and body mass index, was conducted with 618 pregnant women in China, with peripheral blood samples collected in the first trimester to evaluate the average methylation levels of differentially methylated regions (DMRs) between controls and HDP cases. In stage 1 (discovery set), 24 controls and 27 cases were used to identify the differential DMRs. In stage 2, 294 controls and 273 cases were used to validate the previously identified DMRs. DMRs selected from the intersectional results of lasso regression, XGBoost, random forest, and Shapley Additive Explanations models were further combined with women’s clinical risk factors to construct prediction models using logistic regression. RESULTS: In stage 1, 52 differential DMRs were identified with a false-positive rate <0.05. In stage 2, 12 differential DMRs were consistently observed, and 3 DMRs located in the CTSA , HMGB1 , and miR1908/FADS2 genes were selected to construct a prediction model for HDPs. After combining the selected DMRs with clinical factors, the model achieved an area under the curve of 0.863 (95% CI, 0.826–0.901) in the training set and 0.757 (95% CI, 0.686–0.828) in the test set. CONCLUSION: Findings of this study offer potential opportunities to identify high-risk patients with HDP in early pregnancy through DMRs identified in peripheral blood and provide new insights into the epigenetic cause of HDP.

Background: In addition to hyperglycemia, women with hypoglycemia identified during pregnancy have a higher risk of adverse pregnancy outcomes. However, there is limited evidence of the association between prepregnant hypoglycemia and adverse pregnancy outcomes in women without pre-existing diabetes. This study aims to explore the association between maternal preconception hypoglycemia and adverse pregnancy outcomes among childbearing-aged women in China. Methods and findings: This was a retrospective cohort study of the National Free Preconception Checkup Project (NFPCP), including women who were aged 20–49, successfully conceived within one year without multiple gestations, and had complete information on pregnancy outcomes. Maternal fasting plasma glucose (FPG) concentrations were analyzed in the preconception examination stage, and women were divided into normal (FPG 3.9 to <5.6 mmol/L) and hypoglycemia (FPG < 3.9 mmol/L) groups. Adverse pregnancy outcomes included medical abortion, miscarriage or early stillbirth, preterm birth (PTB), macrosomia, low birth weight (LBW), large for gestational age (LGA), small for gestational age (SGA), birth defects, and perinatal death. Baseline characteristics of the two groups were balanced using inverse probability treatment weighting (IPTW) based on propensity scores. Both multivariable-adjusted and IPTW odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the association between preconception hypoglycemia and adverse pregnancy outcomes. Models adjusted for maternal age, ethnicity, educational level, occupation, region of gross domestic product, smoking, passive smoking, alcohol consumption, maternal preconception body mass index (BMI), parity, history of adverse pregnancy outcome, preconception medicine use, folic acid intake, diabetes, hypertension, anemia, thyroid disorder, liver disorder, and infection. ORs of adverse pregnancy outcomes with preconception hypoglycemia stratified by BMI were also reported. Among 4,866,919 women who participated in NFPCP during 2013–2016, 239,128 (4.91%) had preconception hypoglycemia. Compared to the normal group, women with preconception hypoglycemia had increased IPTW-multivariate adjusted ORs of PTB by 10% (95% CI [1.08, 1.12], P < 0.001), LBW by 8% (95% CI [1.03, 1.12], P = 0.001), SGA by 7% (95% CI [1.05, 1.08], P < 0.001), and birth defects by 21% (95% CI [1.06, 1.37], P = 0.004), while the ORs of medical abortion decreased by 6% (95% CI [0.91, 0.98], P = 0.002), miscarriage or early stillbirth by 5% (95% CI [0.92, 0.97], P < 0.001), macrosomia by 12% (95% CI [0.86, 0.90], P < 0.001), and LGA by 12% (95% CI [0.86, 0.89], P < 0.001) if mothers had a preconception hypoglycemia. The associations of maternal preconception hypoglycemia and adverse pregnancy outcomes varied among BMI groups. Among underweight women, preconception hypoglycemia was associated with a lower risk of medical abortion, miscarriage or early stillbirth, LGA, and PID, while overweight women had a lower risk of macrosomia and LGA. Moreover, a higher risk of miscarriage or early stillbirth and PTB was observed in obesity and underweight, respectively, in association with preconception hypoglycemia. Main limitations in the current study included the limited generalizability in other countries with varying disparities in healthcare and the lack of information on certain potential confounders (such as gestational complications and whether they received any related intervention after preconception examination). Conclusion: Preconception hypoglycemia was significantly associated with adverse pregnancy outcomes, and maternal preconception BMI could modify the association. In addition to paying attention to women with preconception hyperglycemia, our findings call for increased concern for women with hypoglycemia in preconception glycemic screening, with consideration of modified effects by preconception BMI, which might be worth exploring as a means to reduce adverse pregnancy outcomes.