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ImportanceMaternal hepatitis B virus (HBV) infection during early pregnancy has been related to congenital heart diseases (CHDs) in offspring. However, no study to date has evaluated the association of maternal preconception HBV infection with CHDs in offspring.ObjectiveTo explore the association of maternal preconception HBV infection with CHDs in offspring.Design, Setting, and ParticipantsThis retrospective cohort study used nearest-neighbor (1:4) propensity score matching of 2013 to 2019 data from the National Free Preconception Checkup Project (NFPCP), a national free health service for childbearing-aged women who plan to conceive throughout mainland China. Women aged 20 to 49 years who got pregnant within 1 year after preconception examination were included, and those with multiple births were excluded. Data were analyzed from September to December 2022.ExposuresMaternal preconception HBV infection statuses, including uninfected, previous, and new infection.Main Outcomes and MeasuresThe main outcome was CHDs, which were prospectively collected from the birth defect registration card of the NFPCP. Logistic regression with robust error variances was used to estimate the association between maternal preconception HBV infection status and CHD risk in offspring, after adjusting for confounding variables.ResultsAfter matching with a 1:4 ratio, there were 3 690 427 participants included in the final analysis, where 738 945 women were infected with HBV, including 393 332 women with previous infection and 345 613 women with new infection. Approximately 0.03% (800 of 2 951 482) of women uninfected with HBV preconception and women newly infected with HBV carried an infant with CHDs, whereas 0.04% (141 of 393 332) of women with HBV infection prior to pregnancy carried an infant with CHDs. After multivariable adjustment, women with HBV infection prior to pregnancy had a higher risk of CHDs in offspring compared with women who were uninfected (adjusted relative risk ratio [aRR], 1.23; 95% CI, 1.02-1.49). Moreover, compared with couples who were uninfected with HBV prior to pregnancy (680 of 2 610 968 [0.026%]), previously infected women with uninfected men (93 of 252 919 [0.037%]) or previously infected men with uninfected women (43 of 95 735 [0.045%]) had a higher incidence of CHDs in offspring and were significantly associated with a higher risk of CHDs in offspring (previously infected women with uninfected men: aRR, 1.36; 95% CI, 1.09-1.69; previously infected men with uninfected women: aRR, 1.51; 95% CI, 1.09-2.09) with multivariable adjustment, while no significant association was observed between maternal new HBV infection and CHDs in offspring.Conclusions and RelevanceIn this matched retrospective cohort study, maternal preconception previous HBV infection was significantly associated with CHDs in offspring. Moreover, among women with HBV-uninfected husbands, significantly increased risk of CHDs was also observed in previously infected women prior to pregnancy. Consequently, HBV screening and getting HBV vaccination-induced immunity for couples prior to pregnancy are indispensable, and those with previous HBV infection prior to pregnancy should also be taken seriously to decrease the CHDs risk in offspring.

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.

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Background:Studies have reported that prophylactic continuous infusion of phenylephrine during spinal anesthesia for cesarean section can decrease the spread of local anesthetics. We investigated the ED50 of intrathecal hyperbaric ropivacaine in parturient women undergoing cesarean section under prophylactic infusion of phenylephrine.Methods:Sixty parturient women were allocated into 2 groups in this prospective study. Group P received 0.5 mL kg−1 h−1 of phenylephrine (5 mg/50 mL) at the start of intrathecal injection, and Group C (control group) received the same volume of saline. The dose of intrathecal ropivacaine for each subject was decided through up-down allocation method. The initial dose was set as 7.5 mg. Successful anesthesia was defined as the level of T6 or above achieved within 15 minutes after intrathecal injection and no additional epidural drug or venous analgesia to complete operation. The Massey formula was applied to calculate the ED50 of intrathecal ropivacaine in both groups.Results:The ED50 of hyperbaric ropivacaine determined by up-and-down method was 7.2 mg (95% confidence interval (CI), 6.8–7.6 mg) in the Group P, and 6.8 mg (95% CI, 6.4–7.2 mg) in the Group C, there was significant difference between the 2 groups (P < .5). The ED50 of intrathecal ropivacaine increases compared with Group C when phenylephrine is prophylactic infused to prevent spinal induced hypotension in cesarean section.Conclusion:The ED50 of intrathecal hyperbaric ropivacaine is 7.2 mg when phenylephrine is prophylactic infused to prevent spinal induced hypotension in cesarean section, and more ropivacaine demands on spinal anesthesia for cesarean section (www.chictr.org.cn, registration number: ChiCTR-RIC-17011650).

What is already known about this topic?Hematological parameters may indicate the presence of chronic low-grade inflammation and increasing viscosity, which are involved in the pathological processes of gestational diabetes mellitus (GDM). However, the association between several hematological parameters in early pregnancy and GDM has yet to be elucidated. What is added by this report?Hematological parameters in the first trimester, particularly red blood cell (RBC) count and systematic immune index, have a significant impact on GDM incidence. The neutrophils (NEU) count in the first trimester was particularly pronounced for GDM. The upward trend of RBC, white blood cell (WBC), and NEU counts was consistent across all GDM subtypes. What are the implications for public health practice? Early pregnancy hematological parameters are associated with the risk of GDM.