Early preeclampsia is associated with significant placental hypoperfusion. We explore the diagnostic value of placental diffusion-derived vessel density (DDVD), a biomarker derived from diffusion-weighted magnetic resonance imaging, which measures in vivo vessel microperfusion, in the differential diagnosis of normal and early preeclampsia pregnancies.
This was a prospective study involving 29 controls and 17 singleton pregnancies affected by early preeclampsia. Nineteen pregnancies from 28 to 34 weeks of gestational age were included from the normal group for a comparison with the early preeclampsia group. Using a 3.0 T magnetic resonance imaging scanner, diffusion-weighted images were obtained with the diffusion weighting b values of 0, 20, and 40 s/mm2. DDVDmean was the mean of DDVDb0b20 and DDVDb0b40, while DDVDb0b20 and DDVDb0b40 refer to the diffusion-derived vessel density values computed from b=0 and 20 s/mm2 images, and from b=0 and 40 s/mm2 images, respectively. The correlation between DDVDmean and gestational age was examined using a linear regression model. The area under the curve of the DDVDmean for early preeclampsia pregnancies detection was calculated by the receiver operating characteristic analysis.
As gestational age increased, DDVDmean linearly decreased. DDVDmean was significantly decreased in the early preeclampsia pregnancies compared with the normal pregnancies (52.72±46.73 versus 213.34±93.50 au/pixel; P<0.001). The area under the curve (DDVDmean) for discriminating between normal and early preeclampsia pregnancies regardless of fetal growth restriction was 0.954, and the area under the curve was 1.000 when early preeclampsia pregnancies without fetal growth restriction were excluded.
DDVDmean, an in vivo vessel microperfusion measure, allowed total separation of normal and early preeclampsia pregnancies.

Preeclampsia is a common disease in pregnant women that can only be diagnosed from 20 weeks after fertilization. Developing early diagnosis markers is urgent and would be helpful in selecting appropriate treatment strategies. The present study aimed to identify the differential expression profiles of microRNAs in the plasma between patients with preeclampsia and normal pregnancies using microarray methods. Using quantitative polymerase chain reaction (qPCR), the differentially expressed microRNAs (miRNAs or miRs) identified from the microarray analysis were validated. A total of 3 miRNAs, including hsa-miR-1304-5p, hsa-miR-320a and hsa-miR-5002-5p, were upregulated in the plasma of patients with preeclampsia pregnancies. Examination of the functions of these miRNAs demonstrated that they were involved in cell proliferation, indicating that preeclampsia affected this pathway. In addition, 26 downregulated miRNAs were identified by microarray methods. The functions of these miRNAs included immune regulation, vascular development, cancer pathology and pathology of other disease (tuberculosis, oligozoospermia, psoriasis and Alzheimer\'s disease). Using qPCR, the most differentially expressed miRNAs were confirmed to be hsa-miR-1304-5p, hsa-miR-320a and hsa-miR-5002-5p, which were upregulated, as well as hsa-miR-188-3p, hsa-miR-211-5p, hiv1-miR-TAR-3p, hsa-miR-4432 and hsa-miR-4498 that were significantly downregulated in the plasma of preeclampsia patients. The present findings may be useful in the development of early diagnosis markers and treatment targets for preeclampsia.

OBJECTIVE: What is the intention to have a second child among women attending outpatient gynecology clinics in three major cities in China?
CONCLUSIONS: In total, 69.3% of the participants expressed the intention to have a second child and this was related to infertility status, pronatalist attitudes, and sociodemographic factors.
BACKGROUND: In 2016, the new universal two-child policy was introduced in China enabling all Chinese couples to have a second child. A government-led national survey revealed that the majority of women included under the policy would be 35 years old and older and thus would be at higher risk of infertility. Previous studies found that fertility intention differs by infertility status.
UNASSIGNED: A cross-sectional survey was performed to examine the intention of having a second child and its associated factors among infertile and fertile women attending gynecology outpatient clinics in three major cities in China. Clinical nurses approached eligible women in person while waiting for their consultations. Recruitment and data collection were conducted from April to August 2016.
METHODS: The survey involved four gynecology outpatient clinics in Beijing, Shenzhen, and Hohhot. Married women aged 20-45 years who were seeking outpatient gynecology care for non-malignant problems were invited to participate.
RESULTS: Data from 974 women were included in the analysis. A total of 69.3% of the women expressed the intention to have a second child, and infertile women were more likely to want a second child compared to fertile women (76.6% vs 61.9%, respectively; P < 0.001). Greater ideal parity facilitated the intention for a second child in both groups, while pronatalist attitudes (meaning that they preferred to have their first childbirth at a younger age and attached greater significance to traditional childbearing beliefs), unexplained infertility, presence of a living child and religious affiliation were associated with greater intention among infertile women. In contrast, in the fertile group, older age, full-time work and lower confidence in achieving parity goals diminished the intention for a second child. Although infertile women displayed greater agreement with pronatalist attitudes and desired a higher ideal parity, they had less confidence in achieving their parity goals than their fertile counterparts.
CONCLUSIONS: In addition to self-report and self-selection bias, our participants were recruited from urbanized areas and were more educated than the general population. Owing to the extremely busy environment in the clinics, difficulties were encountered in keeping track of the number of women whom the nurses approached, and the response rate was therefore unavailable.
CONCLUSIONS: With the introduction of the universal two-child policy, there is a need to enhance fertility awareness and to encourage reproductive life planning, as well as to lower the cost of childcare, in order to increase the birth rate in China. Effort is required to make childbearing more compatible with current employment, career and educational development, the burdens of family care (e.g. for elderly parents), social environments and cultural expectations. This is particularly relevant for families who already have a child, as our findings show that their hesitation toward a second child was largely related to difficulties with extra childcare within the woman\'s current work and family life.
BACKGROUND: This study did not receive any funding. The authors declared no competing interests.
BACKGROUND: Not applicable.

Although there are potential mechanisms of female hormones in depression, conflicting results still exist in epidemiological studies. This study aimed to determine whether reproductive history, an important indicator of estrogen exposure across the lifetime, is associated with risk of depressive symptoms in postmenopausal women.
We analyzed the baseline data from Zhejiang Ageing and Health Cohort Study including 5537 postmenopausal women. Depressive symptoms were assessed through the application of Patient Health Questionnaire-9 scale (PHQ-9). Logistic regression models, controlling for an extensive range of potential confounders, were generated to examine the association between reproductive history and risk of depressive symptoms in later life.
Longer reproductive period (Odds Ratio (OR) = 0.972, 95% Confidence Interval (CI) 0.955-0.989), regular menstrual cycle (OR = 0.723, 95% CI 0.525-0.995), later age at first gave birth (OR = 0.953, 95% CI 0.919-0.988) were significantly associated with a reduced risk of late-life depressive symptoms. Among women with regular menstrual cycle, longer cycle length increased the risk (OR = 1.050, 95% CI 1.016-1.085). Meanwhile, more full-term pregnancies and more incomplete pregnancies were related to higher prevalence of depressive symptoms. Women who underwent tubal sterilization as only type of contraceptive surgery were found less likely to suffer depressive symptoms in later life (OR = 0.433, 95% CI 0.348-0.538).
Cross-sectional data could not make a causation conclusion.
Our results indicated that reproductive factors were significantly associated with risk of depressive symptoms in postmenopausal women. Further longitudinal studies are needed.

OBJECTIVE: This secondary analysis aimed to identify the incidence and risk factors associated with monozygotic twins (MZTs) after assisted reproductive technology (ART).
METHODS: In this retrospective cohort observational study, the treatment cycles were compared between MZT and non-MZT pregnancies using logistic regression analyses. Of the 11,501 patients with 13,225 pregnancies, 166 MZTs were diagnosed (1.44% in ART pregnant patients; 1.25% in pregnant cycles).
RESULTS: Results of the logistic analysis revealed that embryo stage at transfer and number of good-quality embryos were independent predictive factors for MZTs. The thresholds for two factors were 3.5 and 3.5. The efficacy of embryo stage at transfer and number of good-quality embryos for MZTs were evaluated using receiver-operating characteristic curves. The areas under the curve (AUCs) for these two parameters were 0.708 and 0.633, respectively. Adding number of good quality embryos increased the discriminative ability of the model (AUC = 0.745).
CONCLUSIONS: The incidence of MZTs, subsequent to ART, is quite high. Extended culture (≥3.5 days), together with the number of good-quality embryos (≥3.5), conferred the greatest risk of producing MZTs.

BACKGROUND: Epidemiological studies suggest that proxies of higher lifetime estrogen exposure are associated with better cognitive function in postmenopausal women, but this has not been found consistently.
OBJECTIVE: To determine whether reproductive history, an important modifier of estrogen exposure across the lifetime, is associated with risk of cognitive impairment in postmenopausal women.
METHODS: We analyzed the baseline data from Zhejiang Major Public Health Surveillance Program (ZPHS) including 4,796 postmenopausal women. Cognitive impairment was assessed through the application of Mini-Mental State Examination questionnaire. Logistic regression models, controlled for an extensive range of potential confounders, were generated to examine the associations between women\'s reproductive history and risk of cognitive impairment in their later life.
RESULTS: The length of reproductive period was inversely associated with risk of cognitive impairment (p = 0.001). Odds ratio (OR) of cognitive impairment were 1.316 (95% CI 1.095∼1.582) for women with 5 or more times of full-term pregnancies, compared with those with 1∼4 times of full-term pregnancies. Women without incomplete pregnancy had a significant higher risk of cognitive impairment (OR = 1.194, 95% CI 1.000∼1.429), compared with the reference (1∼2 times of incomplete pregnancies). Oral contraceptive use (OR = 0.489, 95% CI 0.263∼0.910) and intrauterine device (IUD) use (OR = 0.684, 95% CI 0.575∼0.815) were associated with significantly reduced risk of cognitive impairment.
CONCLUSIONS: Our results indicated that shorter reproductive period, higher number of full-term pregnancies and no incomplete pregnancy history were associated with an increased risk of cognitive impairment. In contrast, oral contraceptive and IUD use corresponded to reduced risk of cognitive impairment.