There is an increasing prevalence of women who tend to delay childbirth until a very advanced age. However, there is sparse data regarding very advanced maternal age (vAMA) and the interplay between vAMA and assisted reproductive technology (ART) on adverse perinatal outcomes. The study aimed to assess the risk of adverse maternal and neonatal outcomes of vAMA women (≥43 years), and to investigate the effect of maternal age on adverse maternal and neonatal outcomes in ART pregnancies. Data was obtained from a population-based retrospective cohort of women who delivered in Ontario, Canada, between April 1st, 2012 and March 31st, 2015. The adjusted relative risks (ARR) and 95% confidence intervals (CI) for adverse maternal and neonatal outcomes were estimated by using multivariate log-binomial regression models among age groups. All models were stratified by the utilization of ART (ART and spontaneous conceptions). Women at vAMA had a higher risk of composite outcome comprised of preeclampsia, intrauterine growth retardation, stillbirth, and placental abruption than the younger counterparts (ARR = 1.38, 95% CI: 1.23–1.55 compared to mothers aged 20–34; ARR = 1.26, 95% CI: 1.12–1.42 compared to mothers aged 35–42). Increased risk of the primary outcome in ART compared to spontaneous conception was only observed in women aged 20–34 years (ARR = 1.24, 95% CI: 1.14–1.35). For women conceived with ART, the risk for the primary outcome significantly increased in women at vAMA (ARR = 1.29, 95% CI: 1.01–1.65 compared to mothers aged 20–34; ARR = 1.36, 95% CI: 1.06–1.74 compared to mothers aged 35–42). Women at vAMA have higher risks of adverse maternal and neonatal outcomes. Although the utilization of ART may carry an independent role for adverse perinatal outcomes, it does not further enhance the adverse effect of vAMA.

Background: The association of sleep onset time and duration with cardiometabolic health is not well characterized. Methods and Results: This study included 6696 adults aged 20 to 80 years from the NHANES (National Health and Nutrition Examination Study) 2015 to 2018. Participants were categorized into 9 groups according to the cross‐tabulation of sleep onset time (<22:00 [early], 22:00–23:59 [optimal], and ≥24:00 [late]) and duration (<7 hours [insufficient], 7–8 hours [sufficient], and ≥9 hours [excessive]), with optimal sleep onset time and sufficient duration as the reference. The primary outcomes included hypertension, hypertriglyceridemia, low high‐density lipoprotein cholesterol, hyperglycemia, central obesity, and metabolic syndrome. Inappropriate sleep onset time and sleep duration were associated with increased odds of hypertension, hypertriglyceridemia, and metabolic syndrome, especially among participants aged 40 to 59 years. Compared with men reporting optimal onset and sufficient duration, men reporting optimal onset with excessive duration (odds ratio [OR]: 2.01 [95% CI, 1.12–3.58]) and late onset with insufficient duration (OR, 1.74 [95% CI, 1.13–2.68]) had higher odds of metabolic syndrome. Compared with women reporting optimal onset and sufficient duration, women reporting optimal onset and insufficient duration (OR, 1.61 [95% CI, 1.11–2.32]) and early onset and excessive duration (OR, 2.16 [95% CI, 1.30–3.57]) had higher odds of hypertension, and women reporting late onset and excessive duration (OR, 5.64 [95% CI, 1.28–6.77]) were at the highest odds of hypertriglyceridemia. Conclusions: Late sleep onset as well as insufficient or excessive sleep duration are associated with adverse cardiometabolic outcomes, particularly in participants aged 40 to 59 years.

Differentiating biliary atresia from other causes of neonatal cholestasis is challenging, particularly when cytomegalovirus (CMV) and biliary atresia occur simultaneously. We aimed to elucidate whether CMV infection would affect the differential diagnosis of biliary atresia and intrahepatic cholestasis. This retrospective study was conducted among patients with neonatal cholestasis admitted to three tertiary hospitals between January 2010 and August 2019. The clinical characteristics, laboratory, and imaging findings were recorded. On the basis of the CMV serology results, the infants were classified into CMV-IgM (+) and CMV-IgM (-) groups. The clinical differences and diagnostic performances of routine predictors between biliary atresia and intrahepatic cholestasis were analyzed in each group. Finally, we compared the diagnostic performances of various tests in the two groups. A total of 705 patients with neonatal cholestasis were enrolled: 215 (30.5%) patients were positive for CMV-IgM, among whom 97 had biliary atresia and 118 had CMV hepatitis; 490 infants were CMV-IgM (-), among whom 240 had biliary atresia and 250 had intrahepatic cholestasis. The diagnostic performances of stool color, direct bilirubin level, γ-glutamyl transpeptidase level, abnormal gallbladder, triangular cord sign, and hepatobiliary scintigraphy between CMV hepatitis and CMV-IgM (+) biliary atresia were similar to those between CMV-IgM (-) biliary atresia and CMV-IgM (-) intrahepatic cholestasis groups. Our large-scale study showed a high prevalence of CMV infection in patients with neonatal cholestasis in China. The presence of CMV infection did not affect the routine predictors to discriminate biliary atresia and intrahepatic cholestasis.

Cardiometabolic risk factors (CMRFs) related to metabolic dysfunction-associated steatotic liver disease (MASLD) comprised overweight/obesity, impaired glucose metabolism, hypertension, hypertriglyceridemia and low high-density lipoprotein cholesterol. We aimed to describe the overlap prevalence and synergistic interaction of the five CMRFs on MASLD and liver fibrosis. Using data of 2017–2020 National Health and Nutrition Examination Survey, we included non-pregnant participants aged ≥ 20 years who completed vibration-controlled transient elastography examinations and had sufficient information to determine their metabolic status. Logistic and generalized linear regression models were performed to assess synergistic interaction between CMRFs on MASLD and identify the contributions to liver fibrosis. The overall estimated prevalence of MASLD was about 33.1%. More than 80% of patients had three or more CMRFs. For MASLD, synergistic interaction between pairs of overweight/obesity and other four CMRFs were higher than it between other CMRFs’ pairs [attributable proportion(AP): 40–50% vs 20–30%]. For liver fibrosis, overweight/obesity and impaired glucose metabolism or hypertension had significant synergistic interactions (AP: 50% or 30%, respectively). We identified 27 out of 31 possible CMRF combinations. Combinations including dyslipidemia were more frequent in men than women (77% vs 59%). Combinations including hypertension were less in Mexican Americans than other ethnicities (25% vs 45–57%). Most combinations with three or more CMRFs, regardless of overlap type, had significant associations with elevated liver stiffness value. CMRF overlap was quite common and had additive interaction in patients with MASLD. Overlapping number may be more important than combination type in liver fibrosis development.

Context: Childhood obesity increases the risk of chronic disease in adulthood. Objective: To construct an early predictive model for a growth trajectory that is highly related to childhood overweight/obesity. Design: Prospective cohort study. Settings: Shanghai Birth Cohort (SBC) and US Collaborative Perinatal Project (CPP). Participants: A total of 848 mother-child pairs in the SBC (2013-2016) and 22 691 pairs in the CPP (1959-1965) with 2- and 7-year follow-up, respectively. Main Outcome Measures: A high-risk postnatal growth trajectory intimately associated with childhood overweight/obesity and its predictive model. Results: We demonstrated that the shifts of postnatal body mass index (BMI) percentile had been completed around 1 year of age and identified a high-risk growth trajectory that was closely related to overweight/obesity [odds ratio 6.5 (95% CI 5.9, 7.2)] at 7 years old. Children with this trajectory presented with a consistent BMI around the 85th percentile after the age of 1 year. It could be recognized early after birth using a predictive model with 4 metabolites (tyrosine, glycine, octenoylcarnitine, and stearoylcarnitine), combined with sex, birth weight, and maternal prepregnancy BMI. The model had an area under the receiver operating characteristic curve of 0.869 (95% CI 0.779, 0.932), a sensitivity of 83.3% (95% CI 51.6%, 97.9%), and a specificity of 81.1% (95% CI 70.3%, 89.3%) in the validation data set. Conclusion: Children with postnatal high-risk growth trajectories were significantly associated with subsequent overweight/obesity at 7 years old. Metabolite profiles at birth combined with clinical measures were able to predict at-risk children before overweight/obesity occurrence.

We aimed to examine the effects of various severities of hypertensive disorders in pregnancy on birthweight, blood pressure (BP), and body mass index in offspring at age 7. In the China Labor and Delivery Survey and the United States Collaborative Perinatal Project (CPP), the relationship of the severity of hypertensive disorders and nutritional and cardiovascular outcomes in offspring was assessed using a multivariable logistic and general linear regression model. In both datasets, those with gestational hypertension were more likely to deliver large for gestational age (LGA) and macrosomia (adjusted odds ratios (aOR) ranged from 1.29 to 1.91), as well as low birth weight (LBW) neonates (aOR ranged from 1.23 to 3.56), compared with normotensive mothers. In the CPP, when gestational hypertension was further stratified into mild and severe, only those with mild gestational hypertension (the mild group) were more likely to deliver macrosomia and LGA (aOR ranged from 1.25 to 1.32). Others (severe gestational hypertension and preeclampsia/eclampsia) were closely related to LBW and small for gestational age (aOR ranged from 1.27 to 2.77). Moreover, children of mothers in the mild group tended to be overweight/obese and had elevated diastolic BP. We concluded that the severity of hypertensive disorders had different effects on birthweight, childhood overweight, and BP.