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The policy of Universal Salt Iodization (USI) could reduce population’s thyroid volume (TVOL) in iodine deficiency areas. Conversely, the improved growth and developmental status of children might increase the TVOL accordingly. Whether the decreased TVOL by USI conceals the increase effect of height and weight on TVOL is unclear. The aim of this study was to analyse the association between height, weight, iodine supplementation and TVOL. Five national Iodine Deficiency Disorder surveys were matched into four pairs according to the purpose of analysis. County-level data of both detected by paired surveys were incorporated, 1: 1 random pairing method was used to match counties or individuals. The difference of TVOL between different height, weight, different iodine supplementation measures groups and the association between TVOL and them were studied. The mean height and weight of children aged 8-10 years increased from 129.9cm and 26.9kg in 2002 to 136.2cm and 32.1kg in 2019; while the median TVOL decreased from 3.10ml to 2.61ml. Iodine supplementation measures can affect TVOL; after exclude iodine effects, the median TVOL was increased with the height and weight. On the other side, after excluding the influence of height and weight, the median TVOL remained decreased. Only age, weight and salt iodine were significant associated with TVOL in multiple linear models. Development of height and weight in children is the evidence of improved nutrition. The decreased TVOL caused by iodized salt measures conceals the increase effect of height and weight on TVOL. Age, weight, and salt iodine affect TVOL significantly.
Schizophrenia is a severe and complex psychiatric disorder that needs treatment based on extensive experience. Antipsychotic drugs have already become the cornerstone of the treatment for schizophrenia; however, the therapeutic effect is of significant variability among patients, and only around a third of patients with schizophrenia show good efficacy. Meanwhile, drug-induced metabolic syndrome and other side-effects significantly affect treatment adherence and prognosis. Therefore, strategies for drug selection are desperately needed. In this study, we will perform pharmacogenomics research and set up an individualised preferred treatment prediction model.
We aim to create a standard clinical cohort, with multidimensional index assessment of antipsychotic treatment for patients with schizophrenia.
This trial is designed as a randomised clinical trial comparing treatment with different kinds of antipsychotics. A total sample of 2000 patients with schizophrenia will be recruited from in-patient units from five clinical research centres. Using a computer-generated program, the participants will be randomly assigned to four treatment groups: aripiprazole, olanzapine, quetiapine and risperidone. The primary outcomes will be measured as changes in the Positive and Negative Syndrome Scale of schizophrenia, which reflects the efficacy. Secondary outcomes include the measure of side-effects, such as metabolic syndromes. The efficacy evaluation and side-effects assessment will be performed at baseline, 2 weeks, 6 weeks and 3 months.
This trial will assess the efficacy and side effects of antipsychotics and create a standard clinical cohort with a multi-dimensional index assessment of antipsychotic treatment for schizophrenia patients.
This study aims to set up an individualized preferred treatment prediction model through the genetic analysis of patients using different kinds of antipsychotics.
Ludwigia prostrata Roxb. is a problematic weed in rice fields in China, and acetolactate synthase (ALS)-inhibiting herbicides (e.g., bensulfuron-methyl) are widely used for the management of broadleaf weeds. Recently, a L. prostrata biotype (JS-R) that failed to be controlled with ALS-inhibiting herbicides was found in Jiangsu Province, China. This study aims to determine the level and molecular mechanism of resistance to bensulfuron-methyl in this JS-R biotype, and evaluate the cross-resistance spectrums to other ALS-inhibiting herbicides. The dose-response assays indicated that the JS-R L. prostrata biotype had evolved 21.2-fold resistance to bensulfuron-methyl compared to the susceptible biotype (JS-S). ALS gene sequencing revealed that a nucleotide mutation (CCA to TCA) at codon 197, resulting in a Pro-197-Ser mutation, was detected in the resistant plants. Moreover, the JS-R biotype contained the Pro-197-Ser resistance mutation showed cross-resistance to pyrazosulfuron-ethyl (12.0-fold), but was sensitive to penoxsulam, bispyribac-sodium and imazethapyr, which may serve as alternative herbicides to control the resistant L. prostrata biotype. This is the first confirmation of a L. prostrata biotype resistant to bensulfuron-methyl due to a Pro-197-Ser resistance mutation in the ALS gene.
To assess changes in dietary patterns among youths in China after COVID-19 lockdown.
This study was based on the COVID-19 Impact on Lifestyle Change Survey (COINLICS), a national retrospective survey established in early May 2020. The questionnaire was distributed through social media platforms. The sociodemographic information and routine dietary patterns before and after lockdown of participants were investigated. t tests and χ2 tests were used to compare the differences in consumption patterns of twelve major food groups and beverages between sex and across educational levels before and after lockdown. Factor analysis was employed to obtain the main dietary patterns.
A total of 10 082 youths.
A significant decrease was observed in the average weekly frequency of rice intake, while significant increases were observed in the frequency of intake of wheat products, other staple foods, fish, eggs, fresh vegetables, preserved vegetables, fresh fruit and dairy products (all P values < 0·01). Heterogeneities of average weekly frequency existed between sex and across educational levels to different extents. The three main dietary patterns derived were loaded most heavily on dairy products, rice and wheat products, separately; the rice pattern became more dominant than the wheat products pattern after lockdown. The frequency of sugar-sweetened beverage consumption had decreased, while the frequency of other beverages had increased.
Our timely survey would inform policymakers and health professionals of these significant changes in youths’ dietary patterns after lockdown, with heterogeneities observed to different extents between sex and across educational levels, for better policy-making and public health practice.
This paper studies the periodic trajectories of a novel age-structured prey–predator system with Michaelis–Menten functional response including delays and asymmetric diffusion. To begin with, the system is turned into an abstract non-densely defined Cauchy problem, and a time-lag effect in their interaction is investigated. Next, we acquire that this system appears a periodic orbit near the positive steady state by employing the method of integrated semigroup and the Hopf bifurcation theory for semilinear equations with non-dense domain, which is also the main result of this article. Finally, in order to illustrate our theoretical analysis more vividly, we make some numerical simulations and give some discussions.
Anaemia is a global public health problem affecting women worldwide, and reproductive-age women are at increased risk. We conducted a population-based cross-sectional study analysing the prevalence of overall anaemia and anaemia according to severity in Chinese pre-pregnant women to update current knowledge on anaemia epidemiology. Based on the National Free Preconception Check-up Projects supported by the Chinese government, 5 679 782 women participating in this project in 2017 were included in the present study. The cyanmethemoglobin method was applied to assess Hb concentrations. Univariate and multivariate logistic regressions were applied for associated factors. The prevalence of anaemia among Chinese pre-pregnant women was 21·64 % (mild: 14·10 %, moderate: 7·17 % and severe : 0·37 %). The prevalence of overall and severe anaemia was the highest in Tibet and the lowest in Beijing among thirty-one provinces. Women’s age, region, ethnic origin, educational level, occupation and pregnancy history were all correlated with anaemia. Women with B blood type (adjusted OR (aOR) = 0·89), higher BMI (overweight: aOR = 0·84; obesity: aOR = 0·70) and alcohol consumption (aOR = 0·69) were less likely to have anaemia, while those with rhesus negative blood type (aOR = 1·10), history of anaemia (aOR = 2·60), older age at menarche (aOR = 1·19), heavy menstrual blood loss (aOR = 1·39), longer menstrual period (aOR = 1·09) and shorter menstrual cycle (aOR = 1·08) were more likely to suffer from anaemia. Meat or egg eaters were not significantly associated with severe anaemia. Anaemia is of moderate public health significance among Chinese pre-pregnant women. Interventions should be considered to prevent anaemia to the greatest extent possible to avoid potential harm in this population.
This chapter analyzes the progress that Chinese universities and public research institutes have made in the fields of research and education as well as the factors that hinder the growth of knowledge transfer from universities and public research institutes to firms in China. The chapter describes how the role of universities and public research institutes in China has evolved in recent decades with the transition to a market economy. It reviews the laws and policies governing knowledge transfer activities in China. It examines the various channels of knowledge transfer that universities and public research institutes in China use to transfer technology such as making new knowledge publicly available at no cost and through cooperative arrangements, including contract research and collaboration, licensing, and establishing spinoff enterprises. The chapter concludes that while Chinese universities and public research institutes have been dramatically transformed in order to meet government policy goals of producing cutting-edge scientific and technological developments to support economic and social advancement since the 1980s, there are challenges in the areas of limited licensing opportunities for leading technologies, lack of long-term financial support, ambiguous corporate governance and regulations, and underdeveloped intermediary agencies resulting in high transaction costs that remain to be addressed.
We elucidate the effect of the secondary baroclinic vorticity (SBV) on the Richtmyer–Meshkov instability (RMI) accelerated by a weak incident shock and develop a vortex-based model for spike and bubble growth rates. Two major mechanisms of the single-mode RMI, the primary baroclinic vorticity (PBV) and the pressure perturbation, are distinguished by simplified models with the vortex-surface field. We find that the effect of the pressure perturbation can be neglected in the present RMI, and the growth of the interface or vortex surface is first driven by the PBV. Subsequently, the SBV, generated by the misalignment between the density gradient across the interface and the pressure gradient produced by the PBV-induced velocity, leads to the nonlinear growth of the interface with the generation of spikes and bubbles. Inspired by this mechanism, we develop a predictive model of spike and bubble growth rates using the motion of viscous vortex rings. The circulation of the vortex ring is modelled with the SBV effect. This model is validated by five data sets of direct numerical simulations and experiments of the single-mode RMI with various initial conditions.
Manure and chemical fertilizers have different effects on soil properties, the nitrogen cycle, and crop yield. This study aimed to investigate the effects of different fertilizer applications under the same N input on soil physicochemical properties and soil bacterial communities and to explain the contributions of soil properties to grain yield. Manure substitution of chemical fertilizer was conducted in leaching monitoring systems. The study began in 2009 and sampling was carried out in 2014 and 2016. Three fertilizer treatments with the same total N, P, and K application rates and one control treatment were designed as follows: (1) CK, without nitrogen fertilizer; (2) 100%U, whole nitrogen coming from urea; (3) 100%M, whole nitrogen coming from composted cattle manure; and (4) 50%U + 50%M, half nitrogen from composted cattle manure and half nitrogen from urea. Soil organic carbon (SOC) content was positively correlated with total N (TN), NO3−–N, and NH4+–N contents, the mean weight diameter of soil aggregates, and the Shannon diversity index of bacteria, whereas SOC content was not significantly correlated with grain yield. NO3−–N content was positively correlated with grain yield. Substituting half the amount of chemical fertilizer with manure as a nitrogen source improved soil stability, increased bacterial diversity, and enhanced nitrogen supply, while reducing nitrogen loss from ammonia volatilization and nitrogen leaching. Substituting half the amount of chemical fertilizer with manure as a nitrogen source was a more sustainable way to increase grain yield through a sustainable nitrate supply and to reduce N loss.
The treatment of relapsed/refractory multiple myeloma (RRMM), a common hematological malignancy, remains a great challenge in China, partially due to the limited accessibility to novel agents and inadequate public health insurance coverage. Ixazomib, a novel oral proteasome inhibitor (PI), was approved by the China Food and Drug Administration (CFDA) for RRMM in 2018. While bortezomib, a traditional PI, is the recommended agent in the clinical guideline for MM. Here, we compared their costs and effectiveness.
RRMM patients who has received an ixazomib-based regimen (at least 2 cycles) were analyzed. Using a propensity score matching method, we generated a control group of RRMM patients who received the bortezomib-based regimen. The criteria included the number of treatment lines, age, and the revised international staging system stage (R-ISS) which representing the disease stage for myeloma, and paired at a ratio of 1:2 (allowing one control to match multiples). The difference in hospitalization stay, grade 3/4 adverse events rates, overall response rate (ORR), mortality during treatment, and treatment costs was then compared.
Nineteen patients received ixazomib and twenty-seven that received bortezomib were included. The ixazomib-group demonstrated a shorter hospital stay (9 days versus 27 days, p < 0.001), lower grade 3–4 adverse events rates (42.1% versus 55.6%, p < 0.001), higher ORR (63.2% versus 48.1%, p = 0.228), and lower mortality rate during treatment (0% versus 7.4%, p = 0.169) than that of bortezomib-group. The ixazomib group had lower total costs (127,620CNY versus 156,424CNY [18,033USD versus 22,103USD], p > 0.05), lower drug costs (98,376CNY versus 103,307CNY [13,901USD versus 14,598USD], p > 0.05), and the lower costs of supportive treatment (5,507CNY versus 14,701 CNY [778USD versus 2,077USD], p < 0.001). Only in terms of self-funded costs, the bortezomib-based regimen was significantly lower (37,127CNY versus 11,521CNY [5,246USD versus 1,628USD], p < 0.001).
Compared with the bortezomib-based regimen, the ixazomib-based regimen has better therapeutic effects on MM patients while saving costs. Hence, it may be preferable for use in the treatment of RRMM in China.
As the growing number of cases is draining the limited court resources in China, how to scientifically measure the reasonable saturated workload of judges has become an urgent issue. This issue is the prerequisite of other important topics such as determination of judges’ quotas, measurement of the actual workload of a trial team, performance evaluation of judges, and resource allocation within courts. Data-driven measurement of the actual workload of China’s judges depends on various factors such as local economic development, public transportation, case-load in the past, and staffing of assistant positions. Therefore, traditional approaches that depend only on a single element, such as cause of action, do not work well. We proposed a modelling framework based on big-data and machine-learning technology to more accurately measure the actual workload of judges. This framework extracts the core elements of judicial cases, assigns target workload to the cases based on feedback from judges and analyzing case samples to create a standard training dataset, and trains machine-learning models using the data. A preliminary case-weight calculation model is built using the framework. Besides, the model is continuously evaluated and improved by comparing its output with the actual demand in a court through methods such as sampling, questionnaires, and expert evaluation.
A recently developed pneumonia caused by SARS-CoV-2 has quickly spread across the world. Unfortunately, a simplified risk score that could easily be used in primary care or general practice settings has not been developed. The objective of this study is to identify a simplified risk score that could easily be used to quickly triage severe COVID-19 patients. All severe and critical adult patients with laboratory-confirmed COVID-19 on the West campus of Union Hospital, Wuhan, China, from 28 January 2020 to 29 February 2020 were included in this study. Clinical data and laboratory results were obtained. CURB-65 pneumonia score was calculated. Univariate logistic regressions were applied to explore risk factors associated with in-hospital death. We used the receiver operating characteristic curve and multivariate COX-PH model to analyse risk factors for in-hospital death. A total of 74 patients (31 died, 43 survived) were finally included in the study. We observed that compared with survivors, non-survivors were older and illustrated higher respiratory rate, neutrophil-to-lymphocyte ratio, D-dimer and lactate dehydrogenase (LDH), but lower SpO2 as well as impaired liver function, especially synthesis function. CURB-65 showed good performance for predicting in-hospital death (area under curve 0.81, 95% confidence interval (CI) 0.71–0.91). CURB-65 ⩾ 2 may serve as a cut-off value for prediction of in-hospital death in severe patients with COVID-19 (sensitivity 68%, specificity 81%, F1 score 0.7). CURB-65 (hazard ratio (HR) 1.61; 95% CI 1.05–2.46), LDH (HR 1.003; 95% CI 1.001–1.004) and albumin (HR 0.9; 95% CI 0.81–1) were risk factors for in-hospital death in severe patients with COVID-19. Our study indicates CURB-65 may serve as a useful prognostic marker in COVID-19 patients, which could be used to quickly triage severe patients in primary care or general practice settings.
In this paper, dual-band and tri-band bandpass filters (BPFs) with fully independent and controllable passbands based on multipath-embedded resonators are presented. The dual-band BPF consists of two double open-ended stub-loaded terminal-shorted resonators (DOESL-TSRs) with a common via-hole connected along the symmetric plane of the filter. Based on DOESL-TSRs, a triple open-ended stub-loaded terminal-shorted resonator (TOESL-TSR) is proposed in the design of tri-band BPFs. The resonant characteristics of DOESL-TSR/TOESL-TSR are analyzed by the numerical calculation method. The measured results of the dual-band BPF show that the center frequencies (CFs) are located at 2.595 and 5.75 GHz, respectively, with 3 dB fraction bandwidth (FBWs) of 15 and 12.8%. The measured CFs of the tri-band BPF are located at 2.545, 3.775, and 5.95 GHz, respectively, with 3 dB FBWs of 9.8, 9.3, and 5.5%. Both of the filters exhibit the merits of fully independent and controllable passbands, high selectivity, and compact size.
No studies have reported on how to relieve distress or relax in medical health workers while wearing medical protective equipment in coronavirus disease 2019 (COVID-19) pandemic. The study aimed to establish which relaxation technique, among six, is the most feasible in first-line medical health workers wearing medical protective equipment.
This was a two-step study collecting data with online surveys. Step 1: 15 first-line medical health workers were trained to use six different relaxation techniques and reported the two most feasible techniques while wearing medical protective equipment. Step 2: the most two feasible relaxation techniques revealed by step 1 were quantitatively tested in a sample of 65 medical health workers in terms of efficacy, no space limitation, no time limitation, no body position requirement, no environment limitation to be done, easiness to learn, simplicity, convenience, practicality, and acceptance.
Kegel exercise and autogenic relaxation were the most feasible techniques according to step 1. In step 2, Kegel exercise outperformed autogenic relaxation on all the 10 dimensions among the 65 participants while wearing medical protective equipment (efficacy: 24 v. 15, no space limitation: 30 v. 4, no time limitation: 31 v. 4, no body position requirement: 26 v. 4, no environment limitation: 30 v. 11, easiness to learn: 28 v. 5, simplicity: 29 v. 7, convenience: 29 v. 4, practicality: 30 v. 14, acceptance: 32 v. 6).
Kegel exercise seems a promising self-relaxation technique for first-line medical health workers while wearing medical protective equipment among COVID-19 pandemic.
Bile acids (BA) have emerged as signalling molecules regulating intestinal physiology. The importance of intestinal microbiota in production of secondary BA, for example, lithocholic acid (LCA) which impairs enterocyte proliferation and permeability, triggered us to determine the effects of oral probiotics on intestinal BA metabolism. Piglets were weaned at 28 d of age and allocated into control (CON, n 14) or probiotic (PRO, n 14) group fed 50 mg of Lactobacillus plantarum daily, and gut microbiota and BA profile were determined. To test the potential interaction of LCA with bacteria endotoxins in inducing damage of enterocytes, IPEC-J2 cells were treated with LCA, lipopolysaccharide (LPS) and LCA + LPS and expressions of genes related to inflammation, antioxidant capacity and nutrient transport were determined. Compared with the CON group, the PRO group showed lower total LCA level in the ileum and higher relative abundance of the Lactobacillus genus in faeces. In contrast, the relative abundances of Bacteroides, Clostridium_sensu_stricto_1, Parabacteroides and Ruminococcus_1, important bacteria genera in BA biotransformation, were all lower in the PRO than in the CON group. Moreover, PRO piglets had lower postprandial glucagon-like peptide-1 level, while higher glucose level than CON piglets. Co-administration of LPS and LCA led to down-regulated expression of glucose and peptide transporter genes in IPEC-J2 cells. Altogether, oral L. plantarum altered BA profile probably by modulating relative abundances of gut microbial genera that play key roles in BA metabolism and might consequently impact glucose homoeostasis. The detrimental effect of LCA on nutrient transport in enterocytes might be aggravated under LPS challenge.
For the guarantee of the long-distance transport of the bunches of China Initiative Accelerator Driven System (CIADS), a new scheme is proposed that extra magnetic field is used in the accelerator-target coupling section before the windowless target to minimize the self-modulation (SM) mechanism. Particle-in-cell simulations are carried out to study the influence of the solenoidal magnetic field on the self-modulation mechanism when long proton bunches move in the background plasmas. The long proton bunches used in the simulations are similar to these in the linear accelerator of CIADS. It is found that the presence of the solenoidal magnetic field will significantly inhibit the self-modulation process. For the strong magnetic field, the longitudinal separation and transverse focusing of the long bunches disappear. We attribute these phenomena to the reason that the strong solenoidal magnetic field restricts the transverse movement of plasma electrons. Thus, there are not enough electrons around the bunch to compensate the space charge effect. Moreover, without transverse current, the longitudinal pinched effect disappears, and the long bunch can not be separated into small pulses anymore.
Amid rapid population ageing and the high-speed progress of information and communications technology, use of smart electronics can improve older people's quality of life by helping them to stay connected, active and independent, which may, in turn, increase their overall happiness and sense of social belonging. Taking a gender perspective, this paper aims to understand variations in digital exclusion among older people. Using data from the 2016 China Longitudinal Ageing Social Survey, it finds that digital exclusion seems to vary by gender, with rural female older people being most excluded, possibly because they have the lowest capital endowment. The gender difference in the digital divide is even more salient with all other things being equal. Digital exclusion in the information era may further exacerbate gender inequality, particularly for those who are already most vulnerable. Since digital inclusion is somewhat inherent in the concept of intelligent old-age support, it should be considered an urgent necessity to help older people, especially rural women, become familiar with smart electronic products.
The extent of intertidal flats in the Yellow Sea region has declined significantly in the past few decades, resulting in severe population declines in several waterbird species. The Yellow Sea region holds the primary stopover sites for many shorebirds during their migration to and from northern breeding grounds. However, the functional roles of these sites in shorebirds’ stopover ecology remain poorly understood. Through field surveys between July and November 2015, we investigated the stopover and moult schedules of migratory shorebirds along the southern Jiangsu coast, eastern China during their southbound migration, with a focus on the ‘Critically Endangered’ Spoon-billed Sandpiper Calidris pygmaea and ‘Endangered’ Nordmann’s Greenshank Tringa guttifer. Long-term count data indicate that both species regularly occur in globally important number in southern Jiangsu coast, constituting 16.67–49.34% and 64.0–80.67% of their global population estimates respectively, and it is highly likely that most adults undergo their primary moult during this southbound migration stopover. Our results show that Spoon-billed Sandpiper and Nordmann’s Greenshank staged for an extended period of time (66 and 84 days, respectively) to complete their primary moult. On average, Spoon-billed Sandpipers and Nordmann’s Greenshanks started moulting primary feathers on 8 August ± 4.52 and 27 July ± 1.56 days respectively, and their moult durations were 72.58 ± 9.08 and 65.09 ± 2.40 days. In addition, some individuals of several other shorebird species including the ‘Endangered’ Great Knot Calidris tenuirostris, ‘Near Threatened’ Bar-tailed Godwit Limosa lapponica, ‘Near Threatened’ Eurasian Curlew Numenius arquata and Greater Sand Plover Charadrius leschenaultii also underwent primary moult. Our work highlights the importance of the southern Jiangsu region as the primary moulting ground for these species, reinforcing that conservation of shorebird habitat including both intertidal flats and supratidal roosting sites in this region is critical to safeguard the future of some highly threatened shorebird species.
Major depressive disorder (MDD) is a prevalent mental disorder characterized by impairments in affect, behaviour and cognition. Previous studies have indicated that the anterior cingulate cortex (ACC) may play an essential role in the pathophysiology of depression. In this study, we systematically identified changes in functional connectivity (FC) for ACC subdivisions that manifest in MDD and further investigated the relationship between these changes and the clinical symptoms of depression.
Sub-regional ACC FC was estimated in 41 first-episode medication-naïve MDD patients compared to 43 healthy controls. The relationships between depressive symptom severity and aberrant FC of ACC subdivisions were investigated. In addition, we conducted a meta-analysis to generate the distributions of MDD-related abnormal regions from previously reported results and compared them to FC deficits revealed in this study.
In MDD patients, the subgenual and perigenual ACC demonstrated decreased FC with the posterior regions of the default network (DN), including the posterior inferior parietal lobule and posterior cingulate cortex. FC of these regions was negatively associated with the Automatic Thoughts Questionnaire scores and largely overlapped with previously reported abnormal regions. In addition, reduced FC between the caudal ACC and precuneus was negatively correlated with the Hamilton Anxiety Scale scores. We also found increased FC between the rostral ACC and dorsal medial prefrontal cortex.
Our findings confirmed that functional interaction changes in different ACC sub-regions are specific and associated with distinct symptoms of depression. Our findings provide new insights into the role of ACC sub-regions and DN in the pathophysiology of MDD.
Evidence on the relationship between maternal Hb concentration and spontaneous abortion (SA) risk is limited and conflicting. The purpose of the study was to evaluate whether maternal preconception anaemia or high Hb concentration is associated with risk of SA.
A population-based cohort study established between 2013 and 2017.
Local maternal and child care service centres in each county.
In total, 3 971 428 women aged 20–49 years, who participated in National Free Pre-Pregnancy Checkups Project from 2013 to 2016 and successfully got pregnant before 2017 in rural China.
A total of 101 700 (2·56 %) women were recorded having SA, with highest SA rate in women with severe anaemia (4·58 %). Compared with women with Hb of 110–149 g/l, the multivariable-adjusted OR for SA was 1·52 (95 % CI: 1·25, 1·86) for women with Hb < 70 g/l, 0·92 (0·84, 1·01) for 70–99 g/l, 0·80 (0·77, 0·83) for 100–109 g/l, 1·11 (1·08, 1·15) for 150–159 g/l, 1·12 (1·04, 1·20) for 160–169 g/l and 1·02 (0·93, 1·12) for ≥ 170 g/l, respectively. An approximate U-shaped curve for the risk of SA with Hb concentrations was observed when Hb concentrations less than 145 g/l, above which the association plateaued (Pnon-linear < 0·001).
Severe anaemia and high Hb concentration before pregnancy were associated with an increased risk of SA. Women with mild anaemia prior to pregnancy had lower risk of SA. Underlying mechanisms need to be further studied.