Huijing Shi’s research while affiliated with Fudan University and other places

Per- and polyfluoroalkyl substances (PFAS) have been recently identified as contaminants of concern for human health, yet their influence of birth and child growth is not well understood, notably under gestational diabetes mellitus. Here we measured PFAS concentrations in cord blood serum of 532 mother–child pairs under gestational diabetes mellitus and in 532 pairs without gestational diabetes mellitus, by high-performance liquid chromatography coupled to triple quadrupole tandem mass spectrometry. We analyzed birth outcomes and child growth up to two years of age using generalized linear models, generalized estimation equations, and quantile g-computation models. Results show that PFAS, including perfluorooctanoic acid, perfluorooctanesulfonic acid, perfluorohexanesulfonic acid, perfluorodecanoic acid, and 6:2 chlorinated polyfluorinated ether sulfonate, adversely affected birth outcomes. Both individual and mixed PFAS exposure delayed early child growth. Under gestational diabetes mellitus, prenatal PFAS exposure was highly associated with weight-for-length Z-scores and body mass index-for-age Z-scores.

Lifestyle behaviors, defined as a combination of dietary behavior, physical activity (PA), screen time (ST), and sleep duration indicators, are strongly associated with blood pressure (BP) in students. Our aim was to characterize the joint trajectories of lifestyle behaviors among middle school students and evaluate their association with BP. Data were obtained from the monitoring dataset on common diseases and health factors among students in Jiading District, Shanghai, China, conducted from 2019 to 2023. Lifestyle behavior data were collected annually from middle school students aged 12–18 years through questionnaires covering dietary behavior score, PA, ST, and sleep duration. Students’ BP was measured in 2023. Joint trajectories of lifestyle behaviors were determined using group-based multi-trajectory modeling. Associations between lifestyle trajectories and students’ BP were examined using multiple linear regression and modified Poisson regression. A total of 1378 middle school students (759 [58.98%] boys, median age 14.36 years [IQR: 13·30–13.28]) with lifestyle behaviors data assessed at least three times were included, and they were categorized into four joint lifestyle trajectories as follows: “remain unhealthy with low PA and increasing ST” (n = 141, 10.46%), “remain unhealthy with only low PA” (n = 305, 22.63%), “change towards unhealthy with decreasing sleep duration” (n = 776, 57.57%), and “relatively healthy” (n = 126, 9.35%). After adjusting for important confounders, the “remain unhealthy with low PA and increasing ST” group was associated with higher diastolic BP (DBP) [β: 3.49, 95% CI: 0.55–6.44] and higher mean arterial pressure (MAP) [β: 3.19, 95% CI: 0.37–6.01] in students compared with the “relatively healthy” group. Additionally, compared with the “relatively healthy” group, students in the “remain unhealthy with low PA and increasing ST” group had a 1.12-fold increase in the risk of hypertension (risk ratios: 1.12, 95% CI: 1.03–1.24). All trend p values in DBP, MAP, and hypertension from the “relatively healthy” group to the “remain unhealthy with low PA and increasing ST” group were less than 0.05. Four distinct lifestyle trajectories were identified among middle school students. Students who remained in the “unhealthy with low PA and increasing ST” lifestyle trajectory were associated with later elevations in BP.

Background Providing responsive caregiving might benefit children’s cognitive and emotional development, but the role of infancy responsive caregiving trajectory is unclear. This birth cohort study aimed to examine the effect of infancy responsive caregiving trajectory on children’s emotional and behavioral problems (EBPs) at 2 and 3–5 years old. Methods A total of 2321 mother-child dyads from Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC) were included in this study. Responsive caregiving was assessed using questionnaires at 2-, 6-, and 12-month old. The Strength and Difficulties Questionnaire (SDQ) was used to assess children’s EBPs. Group-based trajectory model (GBTM) was used to identify responsive caregiving trajectory. Ordered logistic regression was fitted to analyse the association of responsive caregiving trajectories and children’s EBPs. Results The study participants were categorized into four trajectory groups: Increasing group (n = 26, 1.12%), Fluctuating group (n = 366, 15.77%), Decline group (n = 125, 5.39%), And normal group (n = 1804, 77.73%). Compared to children in normal group, children in decline group had significantly increased risk of emotional symptoms, conduct problems, peer problems and prosocial behavior problems at 2 years old (aOR = 3.49, 2.70, 3.67 and 1.96), also conduct problems and hyperactivity at 3–5 years old (aOR = 1.96, 1.85). Children in fluctuating group had increased risk of hyperactivity and prosocial behavior problems at 2 years old (aOR = 1.81, 1.63), and prosocial behavior problems at 3–5 years old (aOR = 1.41). While, children increasing group did not show any increased risks of EBPs at 2 and 3–5 years old. Conclusions Consistently decreasing, low-level fluctuations in responsive caregiving during infancy could increase the risks of children’s EBPs. Maintaining consistent and stable level of responsive caregiving during infancy had beneficial effects on children’s emotional development.

The American Heart Association has updated its definition of cardiovascular health (CVH) with a new framework known as Life's Essential 8 (LE8). Although gestational CVH assessment has been recommended, its significance based on LE8 for birth outcomes is unknown. We thus evaluated the status of gestational CVH based on LE8 in 3036 pregnant women of the Shanghai Maternal-Child Pairs Cohort and the population of China Maternal Nutrition and Health Sciences Survey, and also examined the association between gestational CVH and child birth outcomes. We found that only a small proportion (12.84%) had high CVH, while 1.98% had low CVH in this cohort study. In adjusted models, a 10-point increase in the gestational CVH score, indicating a more favorable score, was associated with lower neonatal size such as birth weight (β: − 37.05 [95% confidence interval: − 52.93, − 21.16]), birth length (− 0.12[− 0.22, − 0.01]), weight-for-height z-score (− 0.07[− 0.12, − 0.03]), body mass index z-score (− 0.09 [− 0.13, − 0.04]), length-for-age Z-score (− 0.03 [− 0.06, − 0.01]), and weight-for-age z-score (− 0.08 [− 0.12, − 0.05]). Also, a 10-point increase in the gestational CVH score was associated with the lower risk of large for gestational age (LGA) (0.82 [0.73, 0.92]) and macrosomia infant (0.75 [0.64, 0.88]). CVH categories showed similar results. That is, better maternal CVH status in pregnancy was associated with lower neonatal size and lower risks for LGA and macrosomia in newborns.

Objective Maternal cardiometabolic health (MCMH) may have critical effects on offspring lifetime cardiometabolic health (CMH), whereas evidence on the relationship between MCMH during pregnancy and children CMH (CCMH) at ages 3∼6 years remains unknown. Method The study included 1478 mother-child dyads from the Shanghai Maternal-Child Pairs Cohort study. MCMH was examined at a mean of 27.8 (24-36) weeks’ gestation based on 8 metrics of the “Life Essential 8” framework involving prepregnancy body mass index, total cholesterol, glucose level, blood pressure, physical activity, sleep, diet quality, and nicotine exposure. CCMH was examined at the age of 3 to 6 based on 5 metrics including body mass index, physical activity, sleep health, diet quality, and nicotine exposure. To validate the robustness of the main analysis, 499 children were selected to reevaluate CCMH by 6 metrics (adding blood pressure) for sensitivity analysis. Results Among 1478 mother-child dyads, the mean (SD) MCMH during pregnancy and CCMH scores were 67.07 (SD 8.82) and 73.80 (SD 10.75), respectively. After adjusting important confounders, each 10-point increase in (more favorable) MCMH score was significantly associated with a higher CCMH score [β: .85; 95% confidence interval (CI): .22, 1.47]. Subgroup analysis showed similar results in girls but not in boys. For cardiometabolic risk factors in children, the risk of overweight/obesity and hypertension in children decreased with increased MCMH score [overweight/obesity, relative risks (RRs): .98, 95% CI: .96, .99; hypertension, RRs: .66, 95% CI: .47, .92]. Sensitivity analysis showed similar results. Conclusion Better MCMH in pregnancy was associated with better CCMH at ages 3∼6 years.

Background Although school screenings identify children with vision problems and issue referrals for medical treatment at an ophthalmic hospital, the effectiveness of this approach remains unverified. Objective To investigate the impact of ophthalmic clinical services on the onset and progression of myopia in preschool children identified with vision impairment. Methods Using data from the Shanghai Child and Adolescent Large-scale Eye Study (SCALE), this retrospective cohort study evaluated the visual development of children from three districts—Jing’an, Minhang, and Pudong—which are representative of geographic diversity and economic disparity in Shanghai’s 17 districts. Initially, in 2015, the study encompassed 14,572 children aged 4–6 years, of whom 5,917 needed a referral. Our cohort consisted of 5,511 children who had two or more vision screenings and complete personal information over the follow-up period from January 2015 to December 2020. We divided these children into two groups based on their initial spherical equivalent (SE): a High-risk group (SE > -0.5 D) and a Myopia group (SE ≤ -0.5 D). Within each of these groups, we further categorized children into Never, Tardily, and Timely groups based on their referral compliance to compare the differences in the occurrence and progression of myopia. Cox proportional models were applied to estimate hazard ratios (HRs) for myopia incidence per person-years of follow-up in High-risk group. Generalized additive models(GAM) was used to calculating the progression for annual spherical equivalent changes in all children. Results Of the 5,511 preschool children (mean age, 5.25 years; 52.24% male) who received a referral recommendation, 1,327 (24.08%) sought clinical services at an ophthalmic hospital. After six years of follow-up, 65.53% of children developed myopia. The six-year cumulative incidence of myopia in the Never, Tardily, and Timely groups was 64.76%, 69.31%, and 57.14%, respectively. These percentages corresponded to hazard ratios (HRs) of 1.31 (95% CI, 1.10–1.55) for the Tardily group and 0.55 (95% CI, 0.33–0.93) for the Timely group, compared with the Never group. The HRs were adjusted for age, sex, and SE at study entry. Interestingly, the Timely group showed significantly less SE progression than the other groups (P < 0.001), and SE progression was higher in the High-risk group (-0.33 ± 0.37D/year) than in children with myopia (-0.08 ± 0.55D/year). Conclusion Timely utilization of ophthalmic clinical services among children aged 4 to 6 years who fail school vision screenings can significantly reduce the incidence of myopia and slow SE progression.

To assess if the impacts of prenatal maternal stress (PNMS) on neonatal physical development including birth weight and body length vary by trimesters, and to explore the mediating effect of sleep quality in the relationships. A total of 2778 pregnant women were included from the Shanghai Maternal‐Child Pairs Cohort. PNMS and sleep quality were measured in the first trimester (12–16 gestational weeks) and third trimester (32–36 gestational weeks) using the Life Event Scale for Pregnant Women (LESPW) and Pittsburgh Sleep Quality Index, respectively. And total LESPW scores were classified into three groups: high stress (≥75th percentile), medium stress (≥25th and <75th percentile), and low stress (<25th percentile). Multiple linear and logistic regressions were employed to examine the associations between PNMS and birth weight, and bootstrap were utilized to explore the mediating effects of maternal sleep. Higher (adjusted odds ratio, aOR = 1.521; 95% confidence interval (CI), 1.104–2.096) and medium (aOR = 1.421; 95% CI, 1.071–1.885) PNMS and stress from subjective events (aOR = 1.334; 95% CI, 1.076–1.654) in the first trimester were significantly associated with elevated risk for large for gestational age. Maternal severe negative objective events stress (OE3) in the third trimester were negatively associated with birth weight ( β = −0.667; 95% CI, −1.047∼−0.287), and maternal sleep latency during this period acted as a mediator in the association (indirect effect: β = −0.0144; 95% CI, −0.0427∼−0.0003). Besides, a significant negative correlation between total LESPW score ( β = −0.022; 95% CI, −0.038∼−0.006; per 100 score) and body length in the third trimester was also observed. The impact of PNMS on neonatal birth weight varies by stress types and exposure timing. Prolonged maternal sleep latency in the third trimester correlated with lower birth weight, and mediating the link of OE3 and birth weight, which might indicate a critical period of vulnerability to the effects of PNMS on neonatal physical development.