Objective. To examine the association of maternal glycemia during pregnancy and after delivery with anthropometry in the offspring of mothers with gestational diabetes mellitus (GDM). Methods. A total of 1,263 GDM mothers and their children finished the health survey at 1–5 years after delivery. Results. Offspring of GDM mothers who were diagnosed with diabetes during pregnancy had higher prevalence of overweight, higher mean weight for height Z scores, and higher mean BMI for age Z scores at 1–5 years old than the offspring of GDM mothers who were diagnosed with impaired glucose tolerance (IGT) during pregnancy. Offspring of GDM mothers who developed diabetes 1–5 years after delivery had higher mean values of Z scores for weight for height and BMI for age at 1–5 years old than the offspring of GDM mothers who had normal glucose or prediabetes after delivery. Conclusions. Offspring of GDM mothers who were diagnosed with diabetes during pregnancy or after delivery had an increased risk of childhood overweight or weight gain at 1–5 years old compared with children of GDM mothers with IGT during pregnancy or with normal glucose or prediabetes after delivery. The prevalence of overweight/obesity has increased markedly in the last 20 years in all age groups including children younger than 5 years of age , 2. ReceGestational diabetes mellitus (GDM) is a risk factor which leads to certain adverse pregnancy outcome and it affects about 7% of pregnancies in the US . OverallTianjin is the fourth largest city in Northern China with over 13 million residents, and 4.3 million residents live in six central urban districts. All pregnant women who live in six urban districts have participated in the universal screening for GDM since 1999 , 13 by uA total of 4,644 pregnant women who were diagnosed with GDM from 2005 to 2009 and their children in six urban districts were eligible for the TGDMPP, and 1,263 GDM women and their children had completed the baseline survey for the TGDMPP from August 2009 to July 2011   12, 15––15–17. TAt baseline survey, all GDM mothers and their children completed a self-administered questionnaire and underwent a physical examination that included anthropometric and blood pressure measurements, a 2-hour glucose 75 g OGTT (mothers only), and a fasting blood draw at the Tianjin Women's and Children's Health Center. Women were divided into three groups based on their glucose levels after delivery: normal glucose (plasma fasting glucose <5.6 mmol/L and 2-hour glucose <7.8 mmol/L), prediabetes (plasma fasting glucose 5.6–6.9 mmol/L and/or 2 h glucose 7.8–11.0 mmol/L), and diabetes (plasma fasting glucose ≥7 mmol/L or 2-hour glucose ≥11.1 mmol/L) . Health At baseline survey, a questionnaire was completed by all GDM mothers. The questionnaire included questions on the mother's sociodemographics ; history of GDM ; family history of chronic diseases; medical history ; pregnancy outcomes ; dietary habits (a self-administered food frequency questionnaire (FFQ) to measure the frequency and quantity of intake of 33 major food groups and beverages during the past year) ; alcoholWe also asked the GDM children's parents in advance to bring the child's birth certificate and filled in a self-administered questionnaire about the child's birth date, sex, gestational weeks of birth, birth weight, birth recumbent length, and Apgar score (above questions related to birth were copied from birth certificate), as well as the mode and duration of infant feeding , health characteristics , dietary habits , and other lifestyle habits . This questionnaire has been used in a longitudinal study in the same area of Tianjin –25.Z scores for weight for age, height for age, weight for length and BMI for age, and prevalence of childhood overweight or obesity were calculated based on the standards for the WHO growth reference [Z score), and overweight was defined as a BMI more than or equal to the 85th percentiles for age and gender specific distribution (≥1.035 Z score) [Z scores for birth weight for gestational age and birth length for gestational age were calculated using our own study population means and standard deviations  in 2009–2011 [For GDM mothers, body weight, height, waist and hip circumferences, and blood pressure were measured using the standardized protocol according to the WHO MONICA project . Childreeference . ChildreZ score) . Preterm009–2011 . A smallt-test and chi-square test. General linear models were used to compare the differences in Z scores for weight for age, height for age, weight for height, and BMI for age, changes in Z scores for weight for age and weight for height from birth to age of 1–5 years, and prevalence of overweight according to different maternal glucose (OGTT) concentrations at 26–30 gestational weeks and after 1–5 years of delivery. Logistic regression was used to compare the relative risk of overweight according to different maternal glucose concentrations at 26–30 gestational weeks and 1–5 years after delivery. All analyses were adjusted for maternal age, prepregnancy BMI, weight gain during pregnancy, family history of diabetes, marital status, education, income, gestational age at delivery, and infant feeding. To explore the potential mediating effort, in multivariable model 2, we additionally adjusted for birth weight for gestational age Z score or birth weight for length for gestational age Z score in the analysis of change in weight for age Z score and weight for height Z score. All statistical analyses were performed with PASW for Windows, version 20.0 .The general characteristics of both GDM mothers and children according to different maternal glucose concentrations (OGTT) at 26–30 gestational weeks and 1–5 years after delivery (mean 2.26 years after delivery) were compared using Z scores of birth weight for gestational age and birth weight for length for gestational age than those of GDM mothers with normal glucose after delivery.Of 1,263 women who were diagnosed with GDM from 2005 to 2009, 1157 were diagnosed with IGT and 106 with diabetes based on their OGTT glucose concentrations at 26–30 gestational weeks. After a mean 2.26-year (27.2 months) delivery of 1263 GDM mothers, 83 were diagnosed with type 2 diabetes (6.6%) and 400 with prediabetes (31.7%). GDM women with diagnosed diabetes during pregnancy or after delivery were slightly older, their prepregnancy and current BMI and fasting and 2-hour glucose in the OGTT at 26–30 gestational weeks were higher, and they had less gestational weight gain as compared with GDM women with IGT during pregnancy or with normal glucose after delivery . The offZ scores, BMI for age Z scores, changes in Z score for weight for height from birth to age of 1–5 years, and prevalence of childhood overweight [Z scores for weight for height and BMI for age at 1–5 years than the offspring of GDM mothers who were with normal glucose or prediabetes after delivery  and diabetes status 1–5 years after delivery (nondiabetes and diabetes) with anthropometry in offspring of GDM mothers . OffspriZ scores for weight for height and BMI for age at 1–5 years old than the offspring of GDM mothers who were diagnosed with IGT during pregnancy or who were with normal glucose or prediabetes after delivery. Offspring of GDM mothers who were diagnosed with diabetes at 26–30 gestational weeks had an increased risk of overweight at 1–5 years old compared with those children of GDM mothers with IGT during pregnancy.The present study indicated that the offspring of GDM mothers who were diagnosed with diabetes at 26–30 gestational weeks or 1–5 years after delivery had higher mean values of GDM is increasingly common around the world. The exposure to diabetes during pregnancy has been found as an important prenatal predictor of obesity from childhood to younger adults . HoweverZ scores of weight for height and BMI for age, higher mean values of changes in Z scores for weight for height from birth to age of 1–5 years, and higher prevalence of childhood overweight than the offspring of GDM mothers who were diagnosed with IGT during pregnancy. Offspring of GDM mothers who were diagnosed with diabetes after delivery had higher mean values of Z scores for birth weight for gestational age, birth length for gestational age, weight for height, and BMI for age at 1–5 years old than the offspring of GDM mothers who were with normal glucose or prediabetes after delivery. These findings suggest that maternal high glucose status during pregnancy in GDM mothers and diabetes diagnoses in GDM mothers after delivery are very important risk factors for children's later overweight risk. The major reasons of diabetes diagnoses in GDM mothers after delivery as a risk factor for their children being overweight are that these GDM mothers already had higher levels of prepregnancy BMI and fasting and 2-hour glucose in the OGTT at 26–30 gestational weeks compared with GDM women who did not develop diabetes after delivery  recommended new criteria to define GDM with a much lower cutoff point for the fasting glucose than previous criteria for diagnosis of GDM and an additional measurement of 1-hour glucose . Since wIn summary, we found that offspring of GDM mothers diagnosed with diabetes during pregnancy or 1–5 years after delivery are associated with an increased risk of childhood overweight or weight gain compared with those of GDM mothers with IGT during pregnancy or with normal glucose after delivery. These findings suggest that maternal glucose status during pregnancy in GDM women and diabetes diagnoses in GDM mothers after delivery might lead to their children being overweight. More studies are needed to confirm our finding because we did not include a non-GDM control group.


Preterm birth is an unresolved global health issue. The etiologies of preterm birth are complex and multifactorial. To examine risk factors related to preterm birth, a matched case–control study was conducted in a hospital in Beijing, China where little data on preterm birth have been published in the scientific literature.A 1:1 matched case–control study was conducted in 172 pairs of women with preterm birth (case group) and term delivery (control group). Eligible subjects were interviewed in person by well-trained investigators using a questionnaire. Information on obstetric diagnosis and newborns were abstracted from inpatients’ medical records. Univariate and multivariate conditional logistic regression models were used to measure the associations between related factors and preterm birth.Univariate analysis showed that 6 of 12 factors were associated with preterm birth. Multivariate results showed that gestational hypertension (OR = 7.76), low gestational weight gain (OR = 3.02), frequent prenatal care (OR = 0.16), balanced diet (OR = 0.36), and high gestational weight gain (OR = 0.41) were associated with preterm birth.This study provides information on preterm birth in Beijing, China, and it also lends support to existing evidence about the role of maternal nutritional status, prenatal care and gestational hypertension as risk factors for preterm birth. Preterm birth is defined as childbirth occurring at less than 37 completed weeks of gestation, or fewer than 259 days since the first day of a woman’s last menstrual period. Preterm birth is an unresolved global health issue. This condition is also the largest contributor to neonatal mortality and the second largest contributor to all under-5 mortalities, 2. BesiThere are many maternal or fetal characteristics that are associated with preterm birth, including maternal demographic characteristics, nutritional status, history of pregnancy, present characteristics of pregnancy, psychological characteristics, adverse behavior, infection, uterine contractions and cervical length, and biological and genetic markers, 11. DesResearch on risk factors related to preterm birth in China, where there is a high number of preterm births annually, is scarce. As the capital of China, Beijing has special characteristics in economics, education, culture, and health care. Only one study has reported risk factors for preterm birth in Beijing. TherefoThis study was designed as a 1:1 matched case–control study.This study was conducted in Beijing Haidian Maternal and Child Health Care Hospital (Haidian MCH) during July 2010 to December 2011. Haidian MCH is one of the largest maternity hospitals in Beijing urban area. Haidian MCH has approximately 12,000 annual deliveries, accounting for approximately 8% of the total delivery number in Beijing. Almost all of the population that is served by Haidian MCH is from urban areas. In Beijing, the general model of maternity health care is that once a woman selects a hospital for her delivery at the beginning of pregnancy, her entire maternity health care service from pregnancy to delivery will be performed at this hospital. Therefore, almost all of our subjects received their maternity health care service in Haidian MCH from the beginning of pregnancy.Cases were defined as women who delivered a live singleton newborn between 28 and 36 weeks of gestation, and birth weight was less than 2500 g. Controls were women who delivered a live singleton newborn at term (37–41 weeks of gestation) with a normal birth weight (3000–4000 g). An eligible control was matched to a case by delivery date (within 3 days), maternal age (within 3 years), and newborn’s sex. Exclusion criteria were as follows: (1) women refused to participate; (2) women had an acute or serious chronic disease; (3) preterm birth due to medical intervention because of pregnancy complications; and (4) the newborn had a birth defect.After obtaining informed consent, the eligible subjects were interviewed in person by well-trained investigators using a questionnaire. Questionnaire information included demographic characteristics, history of disease, reproductive history, lifestyle and nutritional status during pregnancy, and reproductive tract infection during pregnancy. After the questionnaire-based interview, information on each subject’s obstetric diagnosis during pregnancy and delivery , and their newborns  was abstracted from inpatients’ medical records by trained investigators.Newborns were weighed by nurses within 1 hour of delivery on a calibrated electronic balance. Gestational age at delivery was calculated according to the confirmed last menstrual period. If women who had a poor recall of the last menstrual period, the earliest ultrasonographic measurement was used to estimate the gestational age.Because most of subjects were from the urban area of Beijing, China, they generally had a higher educational level than other areas. Therefore, education was categorized as “lower education”  and “higher education” (including university or graduate education).2 and ≥ 20 m2 per person.With regard to the family conditions of subjects, family income was categorized as < 1000 dollars and ≥ 1000 dollars per month. Average living space was classified as < 20 mAccording to the national guideline of maternity health care and the fact that most pregnant women in large cities in China have frequent prenatal examinations during pregnancy, in this study, prenatal care visits were defined as < eight times and ≥ eight times. Other maternal health factors were all categorized according to subjects’ answers to the questionnaires. The diagnoses of gestational hypertension and diabetes mellitus were abstracted from inpatients’ medical records.2. Pre-pregnancy BMI was classified into three categories[Body mass index (BMI) was defined as body weight divided by the square of height in kg/mtegories: < 18.5,All of the study protocols were reviewed and approved by the Ethics Committee for Human Subjects Studies of the National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention.All analyses were performed with the statistical package SAS version 8.2 . The paired-sample t-test was used for comparison of continuous variables. For categorical variables, univariate conditional logistic regression was used to determine the odds ratio (OR). Adjusted ORs for preterm birth were determined by multiple conditional logistic regression. A probability value of P < 0.05 was considered statistically significant, and ORs and 95% confidence intervals (95% CIs) are presented.A total of 172 case–control pairs were analyzed in this study. Characteristics of the subjects are shown in Table As shown in Table As shown in Table Table The results of multiple conditional logistic regression analysis are shown in Table Preterm birth is a major public health issue and the most important clinical problem in obstetrics and neonatal medicine. The recent published global action report on preterm birth clearly outlines that prevention of preterm birth must be accelerated through family planning, improved quality of care before and during pregnancy and between pregnancies, and strategic investments in research and innovation, 15.The etiology of preterm birth is still largely unknown. There are likely to be multifactorial etiologies of preterm birth, each with a distinct biological pathway. The etiologies differ according to gestational age, ethnicity, and characteristics unique to each population. Each pathway to preterm birth may be also influenced by gene-environment interactions and genetic variability, 11. RecMaternal nutritional status before and during pregnancy is important for the health of women and their growing fetus. In the present study, the definition of a balanced diet was simple. A balanced diet before and during pregnancy was associated with a decreased risk of preterm birth, which is similar to another study in Beijing. With reWith regard to the effect of gestational weight gain on preterm birth, we found that low weight gain was a risk factor of preterm birth, whereas high weight gain was a protective factor of preterm birth compared with normal gestational weight gain. This finding is consistent with other studies, 21. NorIn our study, women with frequent prenatal care were less likely to have preterm birth, which is compatible with previous studies, 24. EffSimilar to previous studies, 26, ourIn our study, some related factors, such as gestational diabetes mellitus, reproductive tract infection during pregnancy, education, family income, and living space, were not significantly associated with preterm birth. Although the etiology of preterm birth remains unclear, the different habits and demographic characteristics of the population may in part explain the discrepancies with previous studies.There are some limitations in this study. First, our findings may be limited by recall bias during the interview for the questionnaire. Second, in our study, to enable more homogeneity of spontaneous preterm infants, cases were defined as women who delivered a live singleton newborn between 28 and 36 weeks of gestation and birth weight was less than 2500 g. Therefore, children who were born before 28 weeks of gestation or weighed more than 2500 g were excluded, even though technically, these newborns were preterm. Finally, because of the limited sample size, our study did not classify preterm birth by sub-categories according to different gestational ages. Therefore, factors of different sub-categories that affect preterm birth need to be further studied.This study lends support to existing evidence regarding the role of maternal nutritional status before and during pregnancy, prenatal care, and gestational hypertension as risk factors for preterm birth. Although our findings may not be generalized beyond a hospital population and require further exploration and validation, they should serve as the first step in identifying risk factors in Beijing, China.


In high‐income populations, evidence suggests that socioeconomic disadvantage early in life is correlated with reproductive strategy. Children growing up in unfavorable rearing environments tend to experience earlier sexual maturity and first births. Earlier first births may be associated with higher fertility, but links between socioeconomic disadvantage and larger family size have rarely been tested. The pathways through which early disadvantage influences reproduction are unknown. We test whether physiological factors link childhood adversity to age at first birth and total children.Using data from the Newcastle Thousand Families Study, a 1947 British birth cohort, we developed path models to identify possible physiological traits linking childhood socioeconomic status, and poor housing standards, to two reproductive outcomes: age at first birth and total children. We explored birth weight, weight gain after birth, childhood illnesses, body mass index at age 9, age at menarche, and adult height as possible mediators.We found direct, negative effects of socioeconomic status (SES) and housing on age at first birth, and of housing on fertility. Although we found links between childhood disadvantage and menarche and height, neither of these were significantly correlated with either reproductive outcome. Age at first birth completely mediates the relationship between childhood adversity and total fertility, which we believe has not been empirically demonstrated before.While there are some links between childhood adversity and child health, we find little evidence that physiological pathways, such as child health and growth, link early childhood adversity to reproductive outcomes in this relatively well‐nourished population. Am. J. Hum. Biol. 28:356–363, 2016. © 2015 The Authors American Journal of Human Biology Published by Wiley Periodicals, Inc. It is well documented that in high‐income populations, childhood adversity influences reproductive strategy in later life by accelerating events such as timing of puberty and first birth  and sub‐standard housing conditions at birth. We analyze these two separate factors in an attempt to tease apart whether, and how, specific elements of childhood adversity may influence later outcomes and through which pathways.In high‐income settings, lower SES is correlated with shortened life expectancy, mediated by poverty, poor education, unemployment, behaviors associated with increased health risks , and actual poor health (even in childhood)  and age at menarche. Similarly, childhood health should have an impact on adult height. Heavier birth weight has previously been shown to predict taller adult height . This initially included weekly visits by health visitors and the study field workers, enabling an in‐depth assessment of the child's health and social circumstances including information on the parents and the state of the housing the child inhabited. During later years, the children were intermittently followed up until age 15, creating a longitudinal study. In 1996‐1998, when the respondents were aged 49 to 51 years, another follow‐up traced 89% of the original surviving sample : 574 (55%), 316 of whom were women, returned questionnaires supplying retrospective health and demographic information. These participants are representative of the original cohort sample, for a detailed cohort profile see Pearce et al (The Newcastle Thousand Families Study (NTFS) came about in response to the relatively high infant mortality rate in Newcastle upon Tyne prior to the Second World War, compared to most other parts of the United Kingdom. For every thousand live births, 62 infant deaths were recorded in 1939. The study was postponed because of the war, but in 1947, the study began. All but four of the 1146 children born in Newcastle upon Tyne in May and June of that year were recruited and followed intensely for the first five years of the child's life  as children who share a womb are small at birth, may have subsequent health problems, and are not statistically independent data points. We dropped men from the sample, as we only have puberty data for women. We also eliminated all those women who did not provide information on age at first birth, total number of live births, and number of surviving children in 1997 (about 25% of those who were traced), which left us with a sample size of 251 women. Although the sample is not big, the NTFS provides comprehensive health histories of the participants which allows for more detailed analysis than usual and has information on completed fertility due to the long length of follow‐up.In the present study, we eliminated twins  was used to deal with missing data from endogenous variables and to keep our sample size as high as possible. Similarly, number of children is also a count variable that should be modelled using Poisson regression, however, we are treating it as continuous because using FIML does not allow for modelling different error distributions within SEM and we would rather retain the maximum sample size allowed by the data. Our model fit statistic is presented as a coefficient of determination (CD), interpreted much like an RWe conducted three path analyses: (1) showing the proposed pathways between early life adversity and age at first birth, (2) the same diagram, but with paths leading to total numbers of children, and (3) including both reproductive outcomes in sequence with age at first birth predicting total numbers of children.Both measures of childhood socioeconomic disadvantage are positively correlated with one another, although the correlation coefficients are fairly low. This suggests that, while they are each measures of childhood adversity, they capture different aspects of such hardship. Our two reproductive outcomes are negatively correlated (earlier births = more children), which we would expect if they are both measures of a faster life history strategy. In this bivariate matrix, there are few correlations between our measures of childhood adversity and child health and growth; although lower social class is correlated with lower BMI at age 9 and with earlier menarche. Correlation coefficients also tend to be very small, suggesting the lack of statistical significance is not due to small sample sizes.all chronologically logical variables, but only those that are significant are shown, to simplify presentation of the models. Full models with both significant and nonsignificant estimates are provided in the Supporting Information Tables S1a, S1b, and S1c.Figures Our model supports previous studies demonstrating that childhood adversity is correlated with earlier first births. Low social class and poor housing conditions are both directly linked to age at first birth. No pathways through the mediating variables are indicated in our model, however. Low occupational status is linked to earlier age at menarche, both directly and through BMI, but there is then no correlation between age at menarche and age at first birth. Birth weight, directly and via weight gain, illnesses during infancy, and age at menarche are all correlated with adult height in the predicted directions , but height also does not appear to be associated with age at first birth.Here we found a direct positive effect of poor housing on total fertility (surviving children), but not of social class, and again we find no pathways through which childhood adversity may link to this reproductive outcome Fig. .In the third model, we included both age at first birth and total surviving children and demonstrate a relationship between these two variables Fig. . The effOverall, we have confirmed previous results showing a correlation between greater socioeconomic disadvantage in childhood and earlier first births. We further find evidence that women who suffered greater childhood adversity also had higher numbers of children, but that this relationship is fully mediated by age at first birth. As far as we are aware, this has not been tested before. However, we do not find convincing evidence that these effects are mediated through childhood physiological factors . Disadvantaged SES results in lower BMI at age nine, and earlier age at menarche, although higher BMI is associated with earlier menarche. In other words, the effect of social class on age at menarche is only slightly tempered by BMI, suggesting that SES is not indicative of nutritional status in this sample and may be a better indicator of psychosocial stress. Post‐war food rationing may partly explain this. The British public experienced controlled access to meat, dairy, and sugar (among other things) right up until 1954 and as such nutritional status became less SES‐dependent. The direct effect of SES on reproductive outcomes, therefore, is likely to indicate a stronger role of the social dimension of SES.Later menarche is nevertheless associated with taller stature, possibly indicating a prolonged childhood, if adult height is a product of a longer childhood growth period. It is puzzling, therefore, that we find no correlations between age at menarche or adult height, and age at first birth or total number of children. It is possible that the relationship between longer childhood and later reproduction is not physiological and may instead be driven by psychological or behavioral characteristics or indeed, that there are interactions between two or more of those factors. Investment in embodied capital, which is not physiological , could be one such trait (unmeasured in this study, although only around 10% of British women born in 1947 completed tertiary‐level education (Ratcliffe & Smith The psychological literature suggests that psychosocial stress may be an important mechanism linking early adversity with later reproductive outcomes (Belsky et al. Some evidence has shown that early‐maturing women have higher fecundity (Udry & Cliquet None of our proposed mediating variables correlated with either reproductive outcome, although we can see from Figure If childhood adversity affects lifetime health, which in turn affects longevity, we would expect early reproduction to be the adaptive response due to the individual's life expectancy being limited (Nettle et al., We found direct links between childhood social class, and childhood housing conditions, and age at first birth. We also show that even in a sample with access to effective contraception, age at first birth completely mediates the relationship between early life adversity and total numbers of children. As far as we are aware, this has not been shown before. It is surprising that age at menarche, and attained adult height, was not significantly associated with either age at first birth or total reproductive output as these factors are often taken to be part of a single life history trajectory. It is possible that psychosocial traits are more important mediators in the relationship between childhood adversity and reproduction than are physiological ones, at least in relatively well‐nourished population such as the one we study, and we encourage further research using data that are able to test this hypothesis. This study highlights the importance of uncovering the pathways between early life conditions and reproductive outcomes in later life because it is still unclear if all reproduction‐related outcomes, and their antecedents, are indeed part of a life‐history suite of events, as predicted by LHT.Supporting InformationClick here for additional data file.


To determine the live birth and cumulative live birth rates of expected poor ovarian responders according to the Bologna criteria and to compare their outcomes with those of expected normal respondersRetrospective analysisUniversity infertility clinicA total of 1,152 subfertile women undergoing their first in vitro fertilization (IVF) cycleWomen were classified into 4 groups according to the Bologna criteria for comparisonLive birth and cumulative live birth ratesWomen with expected poor response (POR) had the lowest live birth rate than the other 3 groups . Cumulative live birth rates were significantly lower in those with expected POR than those with expected normal ovarian response (NOR) . In the subgroup analysis, the cumulative live birth rates in expected PORs were significantly lower in those who had ≤3 oocytes retrieved  whereas the live birth rates in fresh cycle did not differ .Women who were expected POR according to the Bologna criteria had lower live birth and cumulative live birth than expected NOR but they still can achieve reasonable treatment outcomes and IVF treatment should not be precluded. Unfortunately early reports suggest that the incidence of poor ovarian response (POR) ranges from 9% to 24% in women undergoing ovarian stimulation for IVF [The success of  for IVF . POR rem for IVF .One of the limitations in interpreting the relevant literature is the huge discrepancy in the definitions used for POR . The EurIn a realistic approach, the term POR should refer to the ovarian response and therefore, one stimulated cycle is considered essential for the diagnosis of POR. However, the trend of delaying first pregnancies has led many women to present to their first IVF treatment at an advanced age. Aging results in a physiological decline in the ovarian follicle pool and the prevalence of POR is known to increase with age . OvarianThe purposes of the present study were (i) to explore the live birth and cumulative live birth rates for Bologna expected poor ovarian responders undergoing first cycle of IVF treatment; and (ii) to compare the results with those with expected normal ovarian response and those with poor ovarian reserve  alone.This was a retrospective study carried out at the Centre of Assisted Reproduction and Embryology, The University of Hong Kong—Queen Mary Hospital, Hong Kong. Clinical details of all treatment cycles were prospectively entered into a computerized database, which were checked for accuracy and completeness on a regular basis and were retrieved for analysis. Ethical approval was obtained from the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster for this retrospective study. Written informed consent was obtained from women for the use of their clinical records.We analyzed data of subfertile women who underwent first IVF/intracytoplasmic sperm injection (ICSI) cycles between January 2007 and December 2009. Women with incomplete records and cycles carried out for pre-implantation genetic diagnosis or those using donor oocytes were excluded.Women were divided into four groups for comparison: (i) Expected normal ovarian response (ENOR); (ii) Expected poor ovarian response (EPOR); (iii) Bologna 1; (iv) Bologna 3. ENOR was those aged <40 with normal ORT and no history of ovarian surgery/endometrioma. EPOR was defined according to the Bologna criteria as women with advanced maternal age (≥40 years) or history of ovarian surgery/endometrioma together with an abnormal ORT. Bologna 1 referred to those women aged ≥40 or had history of ovarian surgery/endometrioma but normal ORT while Bologna 3 referred to those aged < 40 and no history of ovarian surgery/endometrioma but had an abnormal ORT.The ESHRE consensus group defined abnormal ORT as AFC of <5–7 or AMH of <0.5–1.1 ng/ml . The abiin vitro either by conventional insemination or ICSI depending on semen parameters. Fresh embryo transfer (ET) was carried out with replacement of at most two embryos of the best quality available two days after retrieval. Excess good quality embryos were also cryopreserved on the day of ET. Pregnancies were confirmed by positive urine hCG tests and transvaginal ultrasonographic evidence of a gestational sac.Details of the stimulation cycle have been previously reported . All womThe details of the freezing and thawing protocols were reported previously . The froClinical information including age, body mass index, basal serum levels of AMH, and AFC were collected. Cycle characteristics such as days of stimulation, total dosage of gonadotrophin, number of oocytes retrieved, and number of transferrable embryos, and cycle cancellation rate due to poor response were recorded.Clinical pregnancy was defined as the presence of a gestational sac by ultrasonography, whereas miscarriage rate per clinical pregnancy was defined as the proportion of patients who failed to continue development to 20 weeks of gestation in all clinical pregnancies. Pregnancy outcome was collected from all pregnant women by postal questionnaire or by phone. Live birth was defined as the delivery of a fetus with signs of life after 24 completed weeks of gestational age.The main outcome measures were live birth and one-cycle cumulative live birth rates. Only women who completed replacement of all available frozen embryos were included for analysis of the cumulative live birth rate. In addition, within the group of EPOR, live birth and cumulative live birth rates were analyzed according to the number of oocytes retrieved at the threshold of three (≤3 and >3 oocytes retrieved), since this threshold is one of the Bologna criteria.t test, as appropriate. The chi-squared test and Fisher’s exact test were used for the comparisons of categorical variables. Statistical analysis was carried out using the Statistical Program for Social Sciences . The two-tailed value of P<0.05 was considered statistically significant.For each group of women, categorical data are presented by number of cases and percentages. Continuous data are presented as median with interquartile range. Statistical analysis was performed using Mann-Whitney test, Kruskal-Wallis test or Student’s A total of 1,156 women underwent the first IVF cycle during the study period and four were excluded because of incomplete data. The prevalence of ENOR and EPOR among them was 48.8% (562/1152) and 13.9% (160/1152) respectively. Eighty-two of them (7.1%) fulfilled Bologna criteria 1 alone and 348 (30.2%) fulfilled Bologna criteria 3 alone.The baseline characteristics were presented in The cycle characteristics and reproductive outcomes were shown in Overall, 1,038 women completed replacement of all available frozen embryos. The cumulative live birth rate of EPOR group was significantly lower than ENOR group . Those fulfilling Bologna 1 had similar cumulative live birth rate to ENOR  but higher than EPOR (p = 0.01). Those fulfilling Bologna 3 had significantly lower cumulative live birth rate than ENOR  but higher than EPOR (p = 0.04).In the EPOR group, 142 out of 160 women had fresh embryo transfer and 134 had completed transfer of all available embryos. Further analysis according to ovarian response showed that the live birth rates in EPOR did not significantly differ between poor response (≤3 oocytes retrieved) and normal response (>3 oocytes retrieved) as shown in Multivariable logistic regression analysis revealed that age and number of embryos replaced were significantly associated with the live birth rate with OR 0.87 (95% CI 0.83–0.92) and OR 4.13 (95% CI 2.05–8.28) respectively, after adjusting for other characteristics including EPOR/ENOR classification, AFC, AMH, and body mass index. Likewise, age and total number of transferrable embryos were significant independent predictors of cumulative live birth rates with OR 0.87 (95% CI 0.82–0.92) and OR 1.32 (1.23–1.41) respectively.The aim of this study was to examine the implications of expected poor ovarian response as defined by the Bologna criteria for women undergoing their first IVF/ICSI treatment, in particular live birth and cumulative live birth rates, which are the most relevant information for women and their clinicians. Our results showed that EPOR were not uncommon among women pursuing IVF/ICSI treatment (13.9%) and it highlighted the poorer prognosis of EPOR in terms of reproductive outcomes when compared to ENOR, but nonetheless they achieved live birth and cumulative live birth rates of 23.8% and 35.8% respectively. Multivariate logistic regression model revealed that EPOR/ENOR was not a significant predictor of live birth or cumulative live birth after adjusting for age, AFC, AMH, body mass index and number of embryos transferred in the fresh cycle / total number of transferrable embryos. Only age and number of embryos were significant predictors of such outcome.The prevalence of poor ovarian responders varies depending on the definitions of poor response. In general, poor ovarian responders (who did not meet the Bologna criteria) are reported to have low pregnancy rate and low live birth rate –13. The The median number of oocytes retrieved in Polyzos’s retrospective study  was 3 asThe risk of POR generally increases with age  and in wOur study is limited by its retrospective design and therefore there were several baseline characteristics that significantly differed among the groups. In the study design we defined Bologna 1 based on the women’s age, presence of endometrioma and ovarian cystectomy, as these were the easily identifiable risk factors. However, our study failed to address other risk factors for POR including any genetic or acquire conditions possibly linked to a reduced ovarian reserve, as criticized by some authors . It is pDespite using the Bologna criteria as suggested by the ESHRE group which aimed to establish ‘minimal criteria’ to select a homogeneous population of women in terms of oocytes quantity, our results in terms of reproductive outcomes were significantly different from Polyzos group due to the reasons stated above . They deIn conclusion, our retrospective data, for the first time, suggested that women who were expected POR according to the Bologna criteria had poorer prognosis in terms of (cumulative) live birth than expected NOR but they still can achieve reasonable treatment outcomes and should not be precluded from attempting IVF.


In a periodic operation test over Ce2(WO4)3/CeO2 catalyst, C2 selectivity exceeded 60% during three redox cycles. However, Ce2(WO4)3/CeO2 catalyst without the electric field showed low activity, even at 1073 K: CH4 Conv., 6.0%; C2 Sel., 2.1%. A synergetic effect between the Ce2(WO4)3 structure and electric field created the reactive oxygen species for selective oxidation of methane. Results of XAFS, in-situ Raman and periodic operation tests demonstrated that OCM occurred as the lattice oxygen in Ce2(WO4)3 (short W–O bonds in distorted WO4 unit) was consumed. The consumed oxygen was reproduced by a redox mechanism in the electric field.We examined oxidative coupling of methane (OCM) over various Ce–W–O catalysts at 423 K in an electric field. Ce The United States and China have recently started to extract large amounts of shale gas. Nevertheless, the state of natural gas, especially methane, at room temperature and atmospheric pressures is gaseous. Therefore, it is transported using gas pipelines or LNG systems. Small and medium-sized natural gas fields have difficulty using such methods. Therefore, efficient conversion of methane to valuable chemicals and fuels is necessary for such cases. Methane conversion processes are categorized into two methods: selective oxidation of methane to useful hydrocarbons or oxygenates, and production of syngas by steam reforming, dry reforming, or partial oxidation of methane. We specifically examined direct catalytic methane conversion to C2 selectivity decreases because gas-phase non-selective and sequential oxidation with oxygen to form CO and CO2 is unavoidable at such high temperatures. Therefore, it is extremely difficult to obtain high C2 yield with OCM.Because of its stable tetrahedral structure, methane activation requires temperatures higher than 973 K. Furthermore, the reactivity of ethylene is higher than that of methane. Consequently, C2O3 (Sr/La = 1/20) catalyst112O3 catalyst showed high C2 selectivity (49.0%), CH4 conversion remained low (8.9%) in the electric field with imposition of 3.0 mA of current. Further catalyst development is necessary for OCM in an electric field at low temperatures.To resolve the difficulties described above, we adopted a non-conventional catalytic system, a catalytic reaction in an electric field, in anticipation of methane activation at low temperatures. Results show that various low-temperature catalytic reactions such as methane steam reforming678912O40]n− (X: P (n = 3), Si (n = 4), etc.). Keggin-type HPAs and the substituted Keggin-type HPAs show unique redox and catalytic properties1516171819202122et al.2425263OH (oxidant: O2 and N2O) over HPAs/SiO2, but the conversion of methane was low . Mizuno et al.2829302 over Cs2.5Fe0.08H1.26PVMo11O40. The yield of acrylic acid was 13% at 653 K. For the partial oxidation of methane, the conversion of methane was 0.2%; the catalyst showed almost no activity. Mizuno et al. concluded that the order of C–H bond strength is C3H8 < C2H6 < CH4 and that the difference in the activity for lower alkane conversions is attributable to the C–H bond strength.As described in this paper, we specifically examined Ce–W–O system oxide catalysts, including Keggin-type heteropoly acids (HPAs) as catalysts, for improving OCM activity in the electric field. HPAs are inorganic metal-oxide anion clusters having multi-electronic redox properties1312O40/CeO2 catalyst showed high OCM activity only in the electric field. The structure was changed to Ce2(WO4)3/CeO2. 2) The Ce2(WO4)3 structure, which functioned as an active site structure for selective oxidation of methane, worked only in an electric field. 3) Short W–O bonds of the distorted WO4 unit in Ce2(WO4)3 was an active site in the electric field; OCM occurred by a redox mechanism.Based on the discussion presented above, we investigated application of the electric field to Ce–W–O system catalysts including HPAs for low-temperature methane conversion. Important findings included the following: 1) 40 wt%TBA-PW12O40/CeO2 (TBA: tetrabutylammonium) without an electric field was conducted at 573–1073 K  without the electric field, even at the high temperatures of 1073 K.First, catalytic oxidative coupling of methane (OCM) over various Ce–W–O oxide system catalysts including 40 wt%TBA-PW3–1073 K . TBA-PW112O40/CeO2 catalyst  in the electric field. Bare CeO2 catalyst showed high CH4 conversion (28.2%), but CeO2 contributed to complete oxidation of methane to produce CO2 with 98% selectivity in the electric field. Results show that the OCM activity of TBA-PW12O40/CeO2 was derived from the supported TBA-PW12O40. However, bare TBA-PW12O40 was unsuitable for imposing the electric field because of its electric conductivity.Next, we evaluated the effects of an electric field on OCM activity over various catalysts including TBA-PWcatalyst  and S3. 12O40 and CeO2. After reaction, the peaks corresponding to TBA-PW12O40 disappeared. New peaks, which were attributable to WO3 and Ce2(WO4)3, appeared. Therefore, it is likely that these oxides contribute to OCM activity.As-made and after-reaction samples were characterized with Raman, XRD, and FT-IR . As-made12O40/CeO2 catalyst at 573–1073 K without an electric field was conducted after reaction with an electric field  to form the oxides described above 3 and WO3 during OCM with an electric field. The formed oxides might play an important role for OCM with an electric field. Therefore, OCM activities over Ce2(WO4)3/CeO2, WO3/CeO2, Ce2(WO4)3, and WO3 catalysts were investigated in the electric field. Structures of the supported and the unsupported oxide catalysts were confirmed using Raman and XRD measurements (2(WO4)3/CeO2, WO3/CeO2 and Ce2(WO4)3 showed OCM activity, although WO3 showed no OCM activity. Actually, Ce2(WO4)3/CeO2 showed the following for Ttc of 649 K: CH4 Conv., 13.6%; C2 Sel., 39.0%. For Ttc of 634 K, WO3/CeO2 showed the following: CH4 Conv., 14.3%; C2 Sel., 32.4%. Also, Ce2(WO4)3 showed the following for Ttc of 659 K: CH4 Conv., 9.7%; C2 Sel.: 41.2%. Additionally, WO3 catalyst showed no OCM activity even at almost the same temperature (around 650 K) or at almost the same input power (around 2.5 W) as the other catalysts (2(WO4)3/CeO2 catalyst showed the higher OCM activity than TBA-PW12/CeO2 catalyst at almost the same input power (2.6–2.7 W)  .2(WO4)3/CeO2, WO3/CeO2, Ce2(WO4)3, and WO3 catalysts before and after reaction with electric field were analyzed using Raman spectroscopy and XRD (2(WO4)3/CeO2, Ce2(WO4)3, and WO3 after reaction with the electric field were not markedly different from as-made. However, the spectrum of WO3/CeO2 after reaction with an electric field differed considerably from as-made. The Raman spectrum showed that W species in WO3/CeO2 changed to Ce2(WO4)3 from WO3 after reaction in the electric field. 2(WO4)3 proceeded as a solid–solid reaction between CeO2 and WO3 in the reaction with an electric field3/CeO2, one can infer that the Ce2(WO4)3 formed on WO3/CeO2 activated methane and that it showed OCM activity. Therefore, activity tests and characterizations demonstrated that the active site structure for OCM with the electric field was Ce2(WO4)3. Moreover, the active site structure, Ce2(WO4)3, showed stable OCM activity for at least one hour (The structures of Ce and XRD . As showone hour .2(WO4)3/CeO2 catalyst was conducted without an electric field. Results of activity tests (573–1073 K) are presented in 4 Conv., 6.0%; C2 Sel., 2.1%) that were much lower than those in the reaction with the electric field at external temperature of 423 K : CH4 Conv., 13.6%; C2 Sel., 39.0%. These results demonstrate that Ce2(WO4)3/CeO2 catalyst can produce reactive oxygen species and activate methane only when an electric field is applied.To elucidate the contribution of the active site to OCM activity, OCM at 573–1073 K over Ce2(WO4)3/CeO2 at 423, 673, and 873 K with the electric field (3.0 mA). C2 selectivity and C2 yield decreased in association with increasing furnace temperature. This reduction caused by combustion of C2 species with O2 in gas phase because O2 conversion increased in proportion to increasing temperature. Therefore, OCM in the gas phase is not promoted by Joule heating from the electric field. The effect of Joule heating by an electric field is unimportant in the system. In other words, because the catalyst was able to activate methane at a low gas-phase temperature, C2 selectivity was high in the OCM with the electric field at low temperature. The same trend was obtained in the case of electric power fixing to normalize the electric factor  on OCM activity over Ce2(WO4)3/CeO2 in the electric field was investigated. As presented in 4 conversion and O2 conversion increased and C2 selectivity decreased concomitantly with increasing contact time. The decrease of C2 selectivity resulted from combustion of C2 hydrocarbons with O2 in gas phase.Next, to clarify the reaction mechanism, the influence of contact time 3/CeO2 in the electric field . As shown in 4 conversion approaches 0%, C2H4 and C2H6 selectivity increase and C2H2 selectivity decreases. In the range of very low CH4 conversion, production of C2H4 and C2H6 were the main reactions. One can infer that methyl radical and carbene were produced on the catalyst surface in the electric field. Accordingly, Ce2(WO4)3 can extract one or two H atoms from CH4 and produced methyl radical and carbene. However, C2H2 selectivity increased concomitantly with increased CH4 conversion up to 15% and then decreased. These results suggest that C2H2 was generated through oxidative dehydrogenation of C2H4 or through coupling of CH species, which was formed from CH4 with electric energy2.2(WO4)3/CeO2 catalyst was conducted with the electric field. Results of activity tests are presented in 2 selectivity was higher than 60% and that it was maintained during three cycles. When increasing the CH4 conversion by increasing the contact time, C2 selectivity was higher than 65% and was maintained during three cycles. However, in the periodic operation test without an electric field at 1073 K, C2 selectivity was very low; CO and CO2 were mainly formed (2(WO4)3 and electric field created the reactive oxygen species for selective oxidation of methane and activated methane because the active site structure for OCM with the electric field was Ce2(WO4)3.To confirm that reactive oxygen species are formed on the catalyst surface in the electric field, the periodic operation test at 473 K over Cey formed . These r2WO4-Mn2O3/SiO2 catalyst has high OCM activity24 unit is proposed as the active site of Na2WO4-Mn2O3/SiO2. This W–O bond is observed at 927 cm−1 in Raman spectrum2(WO4)3 structure reveals that it has WO4 units of two kinds. Both are physically distorted. It is likely that W–O bonds in Ce2(WO4)3/CeO2 work as an active site for OCM in the electric field. Comparison of Ce2(WO4)3 with Na2WO4 reveals that Ce2(WO4)3 has a stable structure and short W–O bonds in the distorted WO4 unit, which are observed at 949 cm−1 and 931 cm−1in-situ Raman measurements over Ce2(WO4)3/CeO2 in the electric field to clarify the W–O bond behavior in the electric field. 4 unit are summarized in 2(WO4)3/CeO2 with an electric field (−1. The shift and broadening of the W–O peaks were attributed to the electric field because the spectrum without electric field after imposing electric field in CH4 + O2 flow (2(WO4)3/CeO2 structure was distorted and that the W–O bonds were weakened by the electric field. It acted as the reactive oxygen suitable for selective oxidation of methane to C2 hydrocarbons. For comparison, the Raman spectrum over Ce2(WO4)3/CeO2 at 603–703 K without an electric field 3 from XAFS measurements, the catalyst after 1 cycle in periodic operation test in the electric field showed a smaller coordination number than in the as-made material and after O2 supply in the periodic operation test in the electric field. This result supports our inference that surface oxygen of Ce2(WO4)3 activated by the electric field was consumed by methane. Therefore, results of XAFS, in-situ Raman, and periodic operation tests demonstrated that OCM which occurred as lattice oxygen in Ce2(WO4)3 (short W–O bonds in distorted WO4 unit) was consumed and reproduced by the redox mechanism. A possible reaction mechanism is described in 3+ ↔ Ce4+ + e‒) might be also responsible for the OCM reaction.Next, XAFS spectra were recorded. The results are presented in 12O40/CeO2 in the electric field was conducted. The catalyst showed high OCM activity, although the catalyst showed extremely low OCM activity, even at the high temperature of 1073 K without an electric field. After reaction with the electric field, Raman spectra confirmed that the structure of TBA-PW12O40/CeO2 catalyst was changed to Ce2(WO4)3/CeO2.Oxidative coupling of methane (OCM) over 40 wt%TBA-PW2(WO4)3/CeO2, WO3/CeO2, Ce2(WO4)3, and WO3 catalysts in an electric field (3.0 mA) were investigated to clarify the structure of the active site. Ce2(WO4)3/CeO2, WO3/CeO2 and Ce2(WO4)3 catalysts showed OCM activity; WO3 showed no OCM activity. After reaction with the electric field, Raman spectra showed that W species in WO3/CeO2 changed to Ce2(WO4)3 from WO3. Therefore, the active site structure for OCM with the electric field was Ce2(WO4)3.Then, OCM activities over Ce2(WO4)3/CeO2 catalyst showed extremely low OCM activity at 1073 K. In the periodic operation test over Ce2(WO4)3/CeO2 catalyst, C2 selectivity was higher than 60% and was maintained during three cycles. Therefore, synergic effects of Ce2(WO4)3 and the electric field created the reactive oxygen species suitable for selective oxidation of methane, activated methane, and progressed OCM only when an electric field was applied.Also, Cein-situ Raman and periodic operation test demonstrated that OCM occurred using the lattice oxygen of Ce2(WO4)3 (short W–O bonds in distorted WO4 unit), which were consumed and reproduced by the redox mechanism in the electric field.Results of XAFS, n[PWx12-VxO40] , were prepared according to the published procedure with some modifications363738see3  was used as supplied. All other chemicals were reagent-grade; they were used as supplied.Tetrabutylammonium (TBA) salt of Keggin-type HPAs (denoted as TBA-HPAs), such as (TBA)2 (JRC-CEO-1) catalysts were prepared by impregnation with acetone as the impregnation solvent. The loading amount of TBA-HPAs was 40 wt%. First, acetone (30 mL) and CeO2 (0.6 g) were added to a 300 mL eggplant flask and were stirred for 2 h using a rotary evaporator. Subsequently, TBA-HPAs (0.4 g) dissolved into acetone (10 mL) were added to the flask and were stirred for 2 h again. The resulting suspension was dried. Then the resulting solid was dried overnight at 393 K.Keggin-type TBA-HPAs supported on CeO3/CeO2 catalyst containing 11.9 wt% W was prepared using impregnation with water as the impregnation solvent, as described in a previous report4)6H2W12O40·H2O) was used as a precursor. After impregnation, the resulting suspension was dried. Then the resulting solid was dried at 393 K overnight, followed by calcination for 3 h in air at 773 K under a ramping rate of 0.5 K min−1.WO2(WO4)3/CeO2 catalyst containing 11.9 wt% W was prepared by impregnating CeO2 with an aqueous solution of ammonium metatungstate hydrate using a similar method to that for WO3/CeO2, except that the calcination temperature was 1173 K32. As a reference, unsupported Ce2(WO4)3 was prepared using a complex method combining ethylenediamine tetraacetic acid and citrate ions, as described in previous reports40Ce4: O2: Ar = 25: 15: 60, total flow rate: 100 SCCM). The effect of contact time (W/FCH4) was investigated by changing the total flow rate. The standard W/FCH4 was 1.6 gcat h mol−1. For the reaction in the electric field, two stainless steel electrodes (2.0 mm o.d.) were inserted contiguously into the catalyst bed in the reactor. The electric field was controlled using a constant current  with a DC power supply. The imposed voltage depended on the electric properties of the catalyst. Current and voltage profiles were measured using an oscilloscope . The reactor temperature was set to 423 K to avoid the condensation of water produced by the reactions, except for reactions that used no electric field. Product gases after passing a cold trap were analyzed using GC-FID  with a Porapak N packed column and methanizer , and using a GC-TCD  with a molecular sieve 5A packed column. The respective calculation formulae for conversion, C2 yield, C2 selectivity, and Faradaic number in this study are shown below (eqs 2–6).Catalytic activity tests were conducted with a fixed bed flow-type reactor equipped with a quartz tube (4.0 mm i.d.). A schematic image of the reaction system is presented in x and desorbed CH4 were detected at 5 min after from oxygen+Ar supply and no products were detected at 12 min after from methane + Ar supply). Gas flow was O2: Ar = 1: 10, total 55 mL min−1  and CH4: Ar = 1: 10 or 1: 2, total 55 or 75 mL min−1 (for oxidation of supplied methane by surface oxygen species). The reactor temperature was fixed at 473 K. The imposed current was set at 3.0 or 7.0 mA.A periodic operation test was conducted to elucidate surface active species on the catalyst in the following steps. In the first step, oxygen and Ar were supplied to the reactor with an electric field for 10 min for oxidation of the catalyst surface. For the second step, residual oxygen in the gas phase of the reactor was removed with Ar purge for 5 min. For the third step, methane and Ar were supplied to the reactor with an electric field for 12 min to evaluate the oxidation catalysis of the surface oxygen species on the catalyst. As the final step, Ar purge was conducted for 20 min to remove all residual gases. The steps described above were repeated for three cycles. Product gases were analyzed at 5 min after oxygen+Ar supply, and at 2 and 12 min after methane +Ar supply  after pre-treatment at 473 K in N2 atmosphere for 2 h. Results of BET measurements are presented in 3-edge X-ray absorption fine structure (XAFS) spectra were recorded on BL14B2 in SPring-8 . Catalysts treated in the reaction condition were ground into powder and were pressed into pellets. Then, pellets were packed into gas-barrier bags. The pellets were diluted with BN to adjust for XAFS measurement. EXAFS analysis and curve fitting were performed using software .FT–IR spectra were recorded on a spectrometer  using a KBr pelletizing method. Raman spectra were recorded on a Raman spectrometer . The crystalline structure was characterized using powder X-ray diffraction  operating at 40 kV and 40 mA with Cu-Kα radiation. The specific surface area of the catalyst was measured using NIn-situ Raman measurements in the electric field were conducted using a Raman spectrometer with a hand-made glass reactor and gold wire electrodes (see 4(0.995%) + Ar and/or O2(99.9%)). The electric field was imposed using a constant current at 6.0 mA.odes see . The reaRaman spectra for catalyst heated at reaction temperature (603–703 K) without an electric field were also observed to elucidate the effect of Joule heating on the catalyst structure. A Ni-Cr wire was inserted into the sample for heating by resistance heating.How to cite this article: Sugiura, K. et al. Low-temperature catalytic oxidative coupling of methane in an electric field over a Ce-W-O catalyst system. Sci. Rep.6, 25154; doi: 10.1038/srep25154 (2016).


An extensive assessment investigating the association between sex differences and neonatal outcomes is lacking. In the current study, we estimated the correlation of gender with adverse birth outcomes in a large cohort population.National population-based data containing maternal and neonatal information in 2001 to 2010 were derived from the Health Promotion Administration, Taiwan. Singletons without high-risk pregnancy were further analyzed for the sex ratio of live births in relation to neonatal outcomes—including preterm birth, birth weight, neonatal death, delivery mode, and congenital anomaly. A multivariate logistic regression model was used to adjust for possible confounders.p < 0.001). Among multiple births, the incidence of stillbirths was significantly higher in males than in females (p < 0.05). The sex ratio at gestational age (GA) <37 weeks was 1.332, and it declined proportionally with a rise in the GA to 0.899 at GA of ≥41 weeks. In contrast, the sex ratio was 0.850 at birth weight <3000 g, and it rose proportionally with a rise in the birth weight to 1.902 at birth weight ≥4000 g (macrosomia). Operative delivery was more common in males than in females (p < 0.001). The regression analysis showed greater risks of preterm birth, macrosomia, operative delivery, neonatal death, and congenital anomaly among male newborns.In total, 2,123,100 births were valid for the analysis. Overall, the sex ratio at birth  was 1.096. Compared to multiple births, the sex ratio was significantly higher with singleton births (Male gender carried higher risks of adverse neonatal outcomes, including preterm birth, macrosomia, operative delivery, neonatal death, and congenital anomaly. The data have clinical implications on health surveillance for plotting strategies in response to the unbalanced sex ratio in relation to the boy preference. Males at birth outnumber females throughout the world . The aveAlthough a number of studies investigated the association between sex differences and adverse pregnancy outcomes –18, littThe targets of this population-based study were all births from 1 January 2001 to 31 December 2010 in Taiwan. Maternal and neonatal data were derived from the birth notification system, a database established by the Health Promotion Administration, Ministry of Health and Welfare, Taiwan . MedicalNeonatal outcomes were assessed by the following seven parameters: multiple birth, stillbirth, neonatal death, congenital anomaly, gestational age (GA), delivery mode, and birth weight (low birth weight and macrosomia). Stillbirth was defined as the death of a fetus in the ≥20th week of gestation [All births with an identified gender were included when estimating correlations of the sex ratio with stillbirths and multiple births. Otherwise, cases of stillbirths, high risk pregnancy, or multiple births were excluded when measuring correlations of the sex ratio with the following five outcomes: GA, birth weight, neonatal death, congenital anomaly, and delivery mode. High-risk pregnancy was defined as maternal conditions that threaten the health or life of the mother or her fetus, such as anemia (hematocrit <30 % or hemoglobin <10 g/dL), cardiac disease, pulmonary disease, diabetes, syphilis, polyhydramnios (amniotic fluid index (AFI) ≥24 cm or deepest vertical pool (DP) ≥8 cm) or oligohydramnios (AFI ≤5 cm or DP ≤1 cm), hemoglobinopathy, chronic hypertension, pregnancy-induced hypertension, toxemia, pre-eclampsia, cervical incompetence, Rh disease, renal disease, having a preemie or a baby with birth weight ≥ 4000 g or <2500 g.p < 0.05. The odds ratio (OR) and 95 % confidence intervals (CI) were expressed after adjusting for the control variables.Statistical analyses were conducted using a commercially available program . We first applied a chi-squared test to determine whether sex ratio was associated with neonatal outcomes—including GA, birth weight (low birth weight and macrosomia), neonatal death, congenital anomaly, and delivery mode  –18, 21. Data on 2,123,781 births were collected in Taiwan from 2001 to 2010   Fig. .Fig. 2Sep < 0.05) . The sex ratio was 0.846 at birth weight <3000 g, and then it rose proportionally with an increase in the birth weight to 1.922 (the highest) at birth weight ≥4000 g.The sex ratio by birth weight is demonstrated in Fig. p < 0.001). The incidence of low birth weight infants declined from GA of 29 weeks (100 %) to the lowest level at GA of 41 weeks (0.69 %), and then rose at GA of ≥42 weeks (1.29 %)  than males 4.71 %) ( % (p < 0p < 0.001). The incidence of macrosomia increased proportionally from GA of 33 weeks (0 %) to the highest level at GA of ≥42 (8.40 %)  than females 1.56 %) (.56 % (p p < 0.001). The sex ratio of neonatal death according to gestational age is illustrated in Fig. p < 0.001).Overall, 68.7 % of neonatal death occurred within 7 days of life . There was an increasing risk of neonatal death among males compared to females, including early death and late death . The incidence of congenital anomaly declined with an increase in the GA to the lowest level at GA of 39 weeks (0.43 %), and then gradually increased to 0.79 % at GA ≥42 weeks  than females (0.46 %) p < 0.00. The incp < 0.05), urogenital (p < 0.001), and musculoskeletal (p < 0.001) systems .The sex ratios were significantly higher for neonates with abnormality in the craniofacial . In addition, the sex ratio of neonates with operative delivery  was higher than that of neonates without operative delivery (p < 0.001). The sex ratio by operative vaginal delivery is further illustrated in Fig. p < 0.001). In addition, forceps were more often used in males than females (p < 0.001).CS was more common in males (33.2 %) than females (31.6 %) , macrosomia , neonatal death , CS , and congenital anomaly  were more common in males than females. In contrast, low birth weight infants were less common in males than females .This study depicts that the sex differences are associated with neonatal outcomes, including GA, birth weight, neonatal death, congenital anomaly, and delivery mode. Our survey was based on a national population-based data registry between 2001 and 2010 to investigate the correlation of sex with neonatal outcomes. Our study eliminated high-risk pregnancy to avoid the possible bias from maternal factors. In addition, we used a logistic regression analysis to minimize the effects of confounders from neonatal factors. The data demonstrate that male gender is at greater risks for the following five neonatal outcomes: preterm birth, macrosomia, congenital anomaly, neonatal death, and operative delivery .First, our results indicate an increasing risk of preterm birth with male gender, which is similar with a couple of investigations , 17. In Second, macrosomia was more common in male neonates. In contrast, low birth weight was more common in female neonates. These findings are largely consistent with previous studies showing a higher risk of macrosomia and a low risk of small for GA among male infants , 17, 23.Third, male neonates possess a greater risk of congenital anomaly. Our study further illustrated that a greatest risk on urogenital anomaly, followed by the musculoskeletal and craniofacial systems. The findings were largely in accordance with a number of studies reporting an elevated risk of congenital anomalies in males –27.Fourth, operative deliveries were more common in male neonates, which is consistent with many studies , 28, 29.Fifth, neonatal death was more common in males , 35. In Our study indicated that multiple births have a lower sex ratio than singletons, which was consistent with results from the previous studies , 38, 39.In our study, the sex ratio was higher than the average ratio in Western countries . SelectiThere are limitations to this study. First, our study did not investigate the effects of assisted reproductive technologies. Nevertheless, there is no evidence to show any correlations of assisted reproductive technologies with the sex ratio in Taiwan , 50. SecWe identified male gender as an independent risk factor for adverse neonatal outcomes—including preterm birth, macrosomia, operative delivery, neonatal death, and congenital anomaly. The present study is consistent with the hypothesis that males are more vulnerable than females in the fetal environment. The data have clinical implications for health surveillance for plotting strategies in response to an unbalanced sex ratio. Parents with a preference for boys should take the greater risk of adverse neonatal outcomes with male gender into consideration.


Home birth is available to women in Canada who meet eligibility requirements for low risk status after assessment by regulated midwives. While UK researchers have reported lower costs associated with planned home birth, there have been no published studies of the costs of home versus hospital birth in Canada.Costs for all women planning home birth with a regulated midwife in British Columbia, Canada were compared with those of all women who met eligibility requirements for home birth and were planning to deliver in hospital with a registered midwife, and with a sample of women of similar low risk status planning birth in the hospital with a physician. We calculated costs of physician service billings, midwifery fees, hospital in-patient costs, pharmaceuticals, home birth supplies, and transport. We compared costs among study groups using the Kruskall Wallis test for independent groups.In the first 28 days postpartum, we report a $2,338 average savings per birth among women planning home birth compared to hospital birth with a midwife and $2,541 compared to hospital birth planned with a physician. In longer term outcomes, similar reductions were observed, with cost savings per birth at $1,683 compared to the planned hospital birth with a midwife, and $1,100 compared to the physician group during the first eight weeks postpartum. During the first year of life, costs for infants of mothers planning home birth were reduced overall. Cost savings compared to planned hospital births with a midwife were $810 and with a physician $1,146. Costs were similarly reduced when findings were stratified by parity.Planned home birth in British Columbia with a registered midwife compared to planned hospital birth is less expensive for our health care system up to 8 weeks postpartum and to one year of age for the infant. Recent large population-based studies using standardized third-party ascertainment of outcomes have affirmed the safety of planned home vs. planned hospital birth attended by regulated midwives or physicians among selected women.–4 The deThe only Canadian evaluation of costs of out of hospital birth to date evaluated free standing birth centres in Quebec. This stuThe current study undertakes a government payer perspective to compare costs of planned home birth attended by regulated midwives with those of planned hospital births attended by regulated midwives and by physicians. Details of the study are presented elsewhere. In briefLinked data was obtained for this study from Population Data BC. Population Data BC is a health data resource linking heath data through a unique 10-digit personal health number assigned to all subscribers of the British Columbia Medical Services Plan (MSP). All BC residents must enroll with MSP. Personal health numbers for individuals designated to each of our study cohorts defined from the BC Perinatal Data Registry were linked to five health data registries: Medical Services Plan Payment Information; and its This study was undertaken with approval from the University of British Columbia Research Ethics Board, the Children's and Women's Health Centre of British Columbia Research Review Committee, the British Columbia Ministry of Health Services, and the British Columbia College of Pharmacists.The Medical Services Plan (MSP) Payment Information file contains data on services provided by fee-for-service practitioners to individuals covered by MSP, BC’s universal insurance program . We assiMode of emergency transport, air or ground, was obtained from BC Ambulance Service data files obtained by Population Data BC. In consultation with BC Ambulance Service, , ambulance costs were attributed as follows: $500 for ground, $1000 for air, and $1500 for a combination of air and ground. If transport included both mother and baby, the cost is listed for the infant only.The Discharge Abstract Database houses data on discharges, transfers and deaths of in-patients and day surgery patients from acute care hospitals in BC. The hospitalization cost was derived by multiplying the In-Patient Resource Intensity Weight (P-RIW) by the Cost Per Weighted Case (CPWC) for the corresponding site and fiscal year. The RIW measures the intensity of resources used based on patient diagnosis, surgical procedure performed and the case mix group assigned to the individual patient. Case mix is an inpatient grouping methodology used in Canada to create discrete clusters of patients using clinical, administrative and resource consumption data. The case mix group takes into consideration the patient’s age, health status, and discharge status. The result is groups of patients that are clinically similar and/or homogeneous with respect to hospital resources used. The CanaPharmaNet records all prescriptions dispensed by British Columbia pharmacists in an outpatient setting. PharmaNet is administered by the British Columbia Ministry of Health for residents of BC. PharmaNet records include the ingredient cost, professional fees, and third-party costs (administrative costs of adjudicators/employers). Records also include non-drug items such as diabetic test strips. Cost data was not available for residents paid through federal plans, including federal police officers, veterans or individuals funded through Indian Affairs, but ‘quantity dispensed’ and ‘days supply’ was available and corresponding costs were estimated from provincial costs for these entities.To capture costs associated with the intrapartum period, we included costs from all data sources for the 48 hour period before the date and time of birth for the mother. In our first analysis, we included maternal costs until and including 28 days postpartum to correspond to the completion of the neonatal period for the baby . Our second framework for comparison was the postpartum period for the mother, defined as 8 weeks or 56 days, and the first year of life or 365 days for the infant . To exclude births by non-BC residents, all mothers included had to be registered with the provincial medical services plan during the follow-up period.We excluded from our analysis, 217 mother-baby pairs in which the babies had one or more ICD-10 codes for congenital malformations. After removal of one birth with data entry errors, and 19 births in hospitals where the cost per weighted case (CPWC) was not available, the study population comprised records related to 9,864 live births.We compared costs among study groups using the non-parametric Kruskal Wallis test for independent samples, as distributions were not normally distributed. We report mean costs per group, and groups stratified by parity. The data were analysed using SAS software In total our study sample included 9864 women: all women who planned a home birth with a regulated midwife (n = 2243); all planned hospital midwife-attended births meeting the eligibility requirements for home birth (n = 3610) and a sample of women planning hospital birth with a physician, also meeting eligibility requirements for home birth and matched on age category, parity, and restricted to hospitals in which midwives had admitting privileges (n = 4011). Comparison groups were similar with respect to age, lone parent status, income quintile, BMI, use of substances and gestational age at start of prenatal care .During the initial 28 days postpartum, average costs per mother were significantly reduced among women planning home birth compared to hospital birth, planned either with a midwife or a physician . CompareOur findings were similar among nulliparous women, for whom overall average costs among women planning home birth were significantly reduced by $2,122 and $2,518 for planned hospital birth with a midwife and physician respectively . Among mDuring the first 56 days, corresponding to the eight week postpartum period, maternal costs for women planning home birth were significantly reduced overall and for sub-categories of hospital and pharmaceutical costs. Costs for transport were higher in the home birth group. Costs savings per birth were $1,683 compared to the planned hospital birth with a midwife, and $1,100 compared to the physician group .For nulliparous women these cost savings were $1,514 and $1,133 and for multiparous women $1,679 and $1,095. .During the first year of life, costs for infants of mothers planning home birth were reduced overall, and for physician fees and pharmaceutical costs compared to both planned hospital cohorts. Cost savings compared to planned hospital births with a midwife were $810 and with a physician $1,146 .Costs were similarly reduced when findings were stratified by parity. Cost savings among infants of primiparous women were $749 and $1,095 for hospital births planned with a midwife and physician respectively and for infants of multiparous women were $802 and $1,186 .Our study demonstrates a significant cost savings for planned home birth in British Columbia with a regulated midwife compared to planned hospital birth, either with a regulated midwife or with a physician. As expected, transport costs were higher for mothers in the home birth group, but provider fees, hospital costs and pharmaceutical costs were lower for both mothers and infants. We would expect hospital costs to be lower since most women in the planned home birth would not be admitted to hospital. Provider fees and pharmaceutical costs are reduced in both midwifery cohorts compared to the physician group and likely reflect both the reduced rates of interventions among women receiving care by midwives, and, since these differences persist beyond 28 days, self-selection to planned home birth of women who are particularly healthy and do not wish to have pharmacological interventions during labour and birth. This is the first study of home birth to extend analysis of cost to the conclusion of the postpartum period for mothers and to one year for infants. This is noteworthy because “hidden” risks of home birth, that is morbidity manifesting beyond the immediate postpartum period, if it existed, would be reflected in higher costs during the prolonged period of observation in this study. However, delayed morbidity does not appear to be a consequence of home birth.Due to differences in how costs are assigned across studies and countries, our findings may be cautiously compared to those of Hendrix et al. in the Netherlands, comparing costs of births to nulliparous women planning birth at home with a regulated midwife versus women planning birth in short stay units attended by either midwives or family practice physicians. The studA cost analysis of home birth from Washington State, USA during the same time period as ours, reported cost savings of $2,971 for planned home births attended by licensed midwives vs. planned hospital births resulting in vaginal delivery attended by midwives and $5, 550 for hospital births attended by midwives resulting in cesarean delivery. These differences, which correspond only to the intrapartum period, are larger than ours, but again must be viewed cautiously as costs in a Canadian context do not necessarily align well with costs (or charges) reported in US studies.A British study reporting on 142 of 147 regional health authorities (“trusts”) estimated costs for provider fees and salaries, hospital, transport and pharmaceutical costs from finance departments of participating trusts, consultations with midwives, and national sources of data. The mean savings for home births  during the intrapartum period versus obstetrical units was £564.6 ($1073.93 Cdn).Strengths of our study include complete ascertainment of planned home and of hospital births attended by midwives in an entire province. The same midwives attend both home and hospital birth in British Columbia since they are required to offer eligible women the choice of either setting. Our comparison of home vs. hospital in the midwifery groups therefore reflects a true comparison of place of birth un-confounded by type of caregiver. Both midwifery groups and our random sample of physician-attended birth were of comparable low risk status. We report costs assigned to individual hospitals within each study year, accounting for potential confounding by hospital size and location. In addition, our period of observation was longer than reported in the literature to date. Our study is limited by our inability to ascertain actual transport costs, although the proportion of costs for transportation was less than one percent of all costs. More importantly, our hospital costing data is limited to membership in case mix groups rather than individual costs as individual costing data is not collected by hospitals in BC. The number of case mix groups that can be assigned to mothers is 25 and to infants 31, however, indicating a wide range of designations for complexity. We were also unable to include costs incurred due to lost productivity, although it might reasonably be expected that differences between our groups would not be observed. In addition, our data do not include costs from long term morbidity such as neurological sequelae that may not have manifested in the first year of life.We conclude that planned home birth in British Columbia with a registered midwife compared to birth planned for hospital with a registered midwife or a physician is less expensive for our health care system for mothers up to 8 weeks postpartum and infants up to one year of age. Our findings should reassure health planners and policy makers that there are not deferred excess costs associated with planned home birth with a registered midwife and encourage home birth in similar settings as a choice for healthy women.S1 Fig(PDF)Click here for additional data file.


In this report we describe the case of anextremely low birth weight infant due to preeclampsia, who was conceived by  Preeclampsia is a multiple organ system diseasethat is unique to pregnancy and is often associatedwith significant maternal and neonatal mortalityand morbidity . The vasSince women who conceive using assisted reproductivetechniques may undergo personal suffering,high financial burdens and psychologicalstress, the preservation of the fetuses or infants ingood physical and psychological health would bea vital issue for these challenged patients. On theother hand, with recent advances in maternal-fetalmedicine and enhanced neonatal intensive care,the survival rates of the extremely low birth weightinfants have been improved .in vitro fertilization in the Royan Infertility Centre,Tehran, Iran, and is in complete physical and mentalhealth after a one-year follow-up.Here we report the case of a very low birth weightinfant due to preeclampsia, who was conceived byA 33 year-old woman with a history of primary infertilitywas referred to Royan Infertility centre,Tehran, Iran. Evaluation of her partner confirmedazospermia, which led to testicular sperm extraction(TESE) and diagnosis of male factor infertility.The woman then underwent an IVF trial.in vitro fertilization (IVF) cycle was startedusing a GnRH-a long protocol . Follicle number and growthwere monitored by transvaginal ultrasound scans.Oocyte retrieval was performed transvaginallyand nineteen oocytes were obtained. Nine oocyteswere fertilized using intracytoplasmic sperm injection(ICSI). Ultimately three embryos at thefour-cell stage, AB grade, were transferred intothe uterine cavity and the remaining embryos werecryopreserved. An ultrasound scan was performed32 days after embryo transfer and a gestational sacwith a regular fetal heart rate was seen.The first Two months later the next ultrasound evaluationat 15 weeks gestation revealed a fetus with twoweeks’ growth retardation, severe reduction of amnioticfluid, and a 29 mm cervical canal length wasrecorded. Meanwhile, due to male sperm analysisresults which demonstrated azospermia and a historyof two mentally retarded children from theman’s previous marriage, the woman underwentamniocentesis for chromosomal evaluation and anormal 46xx fetus was recorded.At 27 weeks of gestation, she was referred to thehospital with chief complaints of high blood pressure (180/110 mmHg), edema of the lower extremities(++), proteinuria (++) and sudden weightgain. She was diagnosed with severe preeclampsiaand fetal growth retardation was noted. She receivedroutine therapies  and with respectto anticipation of preterm delivery, four doses ofbetamethasone were given to enhance fetal lungmaturity.Finally, the patient underwent an elective cesareandelivery at 27 weeks’ gestation and a 580 g femaleinfant with Apgar scores three and five at one andfive minutes, was born. The infant was admitted tothe Neonatal Intensive Care Unit and underwentintubation and mechanical ventilation for poor respiratoryeffort. Then she was prescribed one doseof Survanta for lung maturity improvement and after24 hours, the respirator was separated. She wasadministered Ampicillin and Amikacin but due toleukocytosis and positive C-reactive protein (CRP)on day three, Vancomycin and Cefotaxime werereplaced. She also received 400 mg/kg intravenousimmunoglobulin (IVIG) daily for three consecutivedays and the results of complete blood count(CBC) and CRP tests were maintained within thenormal ranges.The echocardiogram on day three revealed evidenceof patent ductus arteriosus (PDA), which resultedin an occasional drop in heart rate. With administrationof oral Ibuprofen, improvement wasachieved as observed in the next echo. The cranialultrasound scan was normal in the first week of lifeand no evidence of intraventricular haemorrhage(IVH) or other pathology was found. Ophthalmologicexamination at the age of one month didnot show evidence of retinopathy of prematurity(ROP).Three months after birth, the infant was dischargedhealthy. All examinations of the neonate were recordedas normal without any complications suchas ROP or IVH. The infant was in complete physicaland mental health, weighing 7800 g and alldevelopmental skills were age-appropriate after aone-year follow-up.Very low birth weight (VLBW) infants are at increasedrisk of growth failure with uncertain prognosisafter discharge from the Neonatal IntensiveCare Unit (NICU) because they frequently have aprotracted and complicated neonatal course .According to initial reports regarding trends inmortality and morbidity for very low birth weightinfants between 1991 and 1999, there have beenmajor changes in both obstetric and neonatal careduring the 1990s. These changes were associatedwith significant decreases in mortality and pneumothoraxbetween 1991 and 1995. From 1995to 1999, mortality remained relatively constant,whereas pneumothorax rates actually increased.IVH also decreased significantly over the nineyear period . SimilarMeanwhile, case reports of extremely low birthweight infants were published in 1992, 1993 and2001, which indicate that the survival of infantswith birth weights below 400 g is possible withoutprofound handicapping -10. A reHowever, the evolution of antenatal and neonatalintensive care therapy including antenatal or postnatalsteroid use and new methods of respiratorysupport, has resulted in dramatic improvements inthe survival of extremely low birth weight infants, 12.Since preterm birth and delivery of low birthweight infants is mostly inevitable in preeclampticmothers, considerable attention to these mothersand babies is essential to decrease the mortalityand morbidity rates. It is noteworthy that with currentimprovements in neonatal care and medicine,survival of the EXLBW infants has been moreachievable. However, conduction of further prospectivestudies, particularly regarding the longtermfollow-up of extremely low birth weightinfants and evaluation of subsequent cognitiveabilities at school age, is recommended.