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Agarwal GS, Agrawal AK, Singhal D, Bawiskar D, Shedge SS. Pregnancy-Induced Hypertension Pathophysiology and Contemporary Management Strategies: A Narrative Review. Cureus 2024; 16:e63961. [PMID: 39105037 PMCID: PMC11299475 DOI: 10.7759/cureus.63961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 07/06/2024] [Indexed: 08/07/2024] Open
Abstract
In the case of PIH, the history is the story of gradually developing awareness and the gradual formation of requisite knowledge. The development of the sphygmomanometer, or blood pressure cuff, in the late 1700s, provided the basis for modern systematic blood pressure reporting for Gravid patients. In the following years and over a few decades, the relationship between high blood pressure and these complications, such as preeclampsia and eclampsia, became clearer. The hypertensive disease was categorized by the American Committee on Maternal Welfare in 1952, which included PIH, chronic hypertension, and preeclampsia. Today, attention is being paid to the identification of such factors, the search for ways to enhance the treatment of diseases, methods for their diagnosis, and the enhancement of pregnancy outcomes. Pregnancy can cause high blood pressure in two of the following ways: preeclampsia and gestational hypertension. These conditions are both part of something called pregnancy-induced hypertension (PIH). In the world, most problems for moms and babies during pregnancy come from PIH. To help both mom and baby, we need to know a lot about what causes it, how to manage it, and how to watch the baby carefully. Aspects like immune responses, the environment, and genes all mix to cause PIH. They make the placenta not work right. When the cells that help the placenta grow don't do their job well, when blood vessels are stiff, when there's too much stress on the body, or when there's not a good balance of chemicals that help build blood vessels, things can get bad. Blood vessels all over the body squeeze tight, blood flow goes down, and blood pressure goes up. That can make a lot of organs stop working right and stop the baby from healthy growth. Various studies concluded that PIH severely limits the blood flow to the placenta and thus contributes to reduced fetal growth. It showed that compared to other hospitals, women who experience PIH are more likely to give birth early before the baby is ready, that is, before 37 weeks, and may cause further health complications to the baby. This normally makes the offspring have low birth weight and exposes them to many complications in infancy and the future in case they are born to mothers with PIH. In severe cases, PIH may lead to the death of the infant either by stillbirth or immediately after birth. The researchers have noted several predisposing factors to PIH, which include histories of elevated blood pressure, diabetes, being overweight or obese, and having a family history of PIH. Educating women about the presence of PIH and its causes can help them consult health facilities early, thus helping leaders in achieving better pregnancy results.
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Affiliation(s)
- Garima S Agarwal
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anil K Agrawal
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Daksh Singhal
- Psychiatry, Raja Rajeshwari Medical College, Bangalore, IND
| | - Dushyant Bawiskar
- Sports Physiotherapy, Abhinav Bindra Targeting Performance, Bangalore, IND
| | - Saylee S Shedge
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Guo J, Zheng X, Du X, Li W, Lu L. BMA-based Mendelian randomization identifies blood metabolites as causal candidates in pregnancy-induced hypertension. Hypertens Res 2024:10.1038/s41440-024-01787-4. [PMID: 38951678 DOI: 10.1038/s41440-024-01787-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/25/2024] [Accepted: 06/15/2024] [Indexed: 07/03/2024]
Abstract
Pregnancy-induced hypertension (PIH), a prominent determinant of maternal mortality and morbidity worldwide, is hindered by the absence of efficacious biomarkers for early diagnosis, contributing to suboptimal outcomes. Here, we explored potential causal relationships between blood metabolites and the risk of PIH using Mendelian randomization (MR). We employed a two-sample univariable MR approach to empirically estimate the causal relationships between 249 circulating metabolites and PIH. Inverse variance weighted, MR-egger, weight median, simple mode, and weighted mode methods were used for causal estimates. The exposure-to-outcome directionality was confirmed with the MR Steiger test. The Bayesian model averaging MR (MR-BMA) method was applied to detect the predominant causal metabolic traits with alignment for pleiotropy effects. In the primary analysis, analyzing 249 metabolites, we identified 25 causally linked to PIH, including 11 lipid-related traits and 6 associated with fatty acid (un)saturation. Importantly, MR-BMA analyses corroborated the total concentration of branched-chain amino acids(total-BCAA) to be the highest rank causal metabolite, followed by leucine (Leu), phospholipids to total lipids ratio in medium LDL (M-LDL-PL-pct), and Val (all P < 0.05). The directionality of causality predicted by univariable MR and MR-BMA for these metabolites remained consistent. This study highlights the causal connection between metabolites and PIH risk. It highlighted BCAAs as the strongest causal candidates warranting further investigation. Since PIH typically occurs in the second and third trimesters, extending these findings could inform earlier strategies to reduce its risk. Directed acyclic graph of the MR framework investigating the causal relationship between metabolites and PIH. MR: Mendelian randomization; GIVs: genetic instrument variables; SNPs: single-nucleotide polymorphism; IVW: inverse variance weighted; WM: weighted median; PIH: pregnancy-induced hypertension; SM: significant metabolite; MR-BMA: Bayesian model averaging MR.
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Affiliation(s)
- Jun Guo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230001, Anhui, China
- Department of Radiology, The First Affiliate Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, China
| | - Xiaofei Zheng
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xue Du
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230001, Anhui, China
| | - Weisheng Li
- Department of gynaecology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China.
| | - Likui Lu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230001, Anhui, China.
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Bordaeva OY, Derevyanchuk EG, Alset D, Amelina MA, Shkurat TP. The prevalence and linkage disequilibrium of 21 genetic variations related to thrombophilia, folate cycle, and hypertension in reproductive age women of Rostov region (Russia). Ann Hum Genet 2024; 88:171-181. [PMID: 37942947 DOI: 10.1111/ahg.12539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
Several maternal genetic variations are known to play an important role during pregnancy since they can affect mother health and/or fetal growth. The frequency of these variants is variable among different populations. This study aimed to investigate thrombophilia, folate metabolism and hypertension genetic variants in reproductive age women of Rostov region (Russia) and then assess their linkage disequilibrium (LD) and heterogeneity among populations. A total of 3108 reproductive age women were included (33.75 ± 5.13 years). Twenty-one genetic variants were detected with RT-PCR. LD was tested according to (D') coefficient and p value. The highest frequency of mutant allele in studied population was as follows: PAI-1 rs1799768, MTRR rs1801394, AGT rs699, and AGTR2 rs1403543. We showed a high possibility of coinheritance of MTHFR rs1801133 with rs1801131 and AGT rs699 with rs4762 (D'=0.992 and 0.999, respectively). In addition, comparative analysis showed F7 rs6046, FGB rs1800790, MTR rs1805087, and AGT rs699 significantly more frequent among Rostov females by 1.3-1.5 times than European. MTHFR rs1801133, ADD1 rs4961, AGTR2 rs1403543, NOS3 rs2070744, and rs1799983 were with higher frequencies in Europeans than those in the studied group. Our data could be used as a reference for further associative studies of targeted genetic variations in different pregnancy complications specifically in this population.
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Affiliation(s)
| | | | - Dema Alset
- Southern Federal University, Rostov-on-Don, Russian Federation
| | | | - Tatiana Pavlovna Shkurat
- Southern Federal University, Rostov-on-Don, Russian Federation
- Medical Center "Nauka", Rostov-on-Don, Russian Federation
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Soeprijadi RS, Andarini S, Hariyanti T, Wayan Arsana Wiyasa I. Lactogenesis factors in the Asian population. Clin Chim Acta 2024; 554:117784. [PMID: 38272252 DOI: 10.1016/j.cca.2024.117784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
The increasing incidence of disrupted lactogenesis in Asian populations underscores the importance of timely identification and efficient intervention. This study acknowledges the influence of ethnicity on genetic variations and aims to investigate the genetic mechanisms that contribute to lactogenesis in individuals of Asian descent. This study examines the possibilities of genetic screening as a means of applying preventive measures, with a particular focus on epigenetic techniques. Additionally, the analysis looks into the underlying mechanisms involved in milk production. This review discusses the intricate mechanisms underlying breast milk production and the potential influence of genetic variables on lactogenesis. Specifically, it explores the association between lactogenesis issues and genetic conditions such as depression, obesity, gestational hypertension, and gestational diabetes. These genetic factors could potentially be found by genetic screening as contributors to disruption in lactogenesis. This study aims to promote future investigation in the subject of genetic testing and its potential association with lactogenesis issues, despite the current scarcity of direct research on this topic. The statement posits that the progress made in genetic testing has the potential to provide novel insights into the timely identification and treatment of disrupted lactogenesis.
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Affiliation(s)
- Raden Slamet Soeprijadi
- Doctoral Study Program in Medical Science, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia.
| | - Sri Andarini
- Department of Public Health, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia.
| | - Tita Hariyanti
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia.
| | - I Wayan Arsana Wiyasa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia.
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Yi L, Min JT, Jun CL, Long HX, Khoo HE, Ying ZJ, Le SJ. Buffalo yogurt fermented with commercial starter and Lactobacillus plantarum originating from breast milk lowered blood pressure in pregnant hypertensive rats. J Dairy Sci 2024; 107:62-73. [PMID: 37709021 DOI: 10.3168/jds.2023-23566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 08/13/2023] [Indexed: 09/16/2023]
Abstract
Nutritional therapy, which may have advantages over medication, is being investigated as a novel treatment for pregnancy-induced hypertension. Several studies have shown that probiotic yogurt supplementation during pregnancy has beneficial effects on maternal and fetal health. In this study, fermented buffalo milk was produced with yogurt culture and Lactobacillus plantarum B, a probiotic isolated from healthy breast milk with high angiotensin-converting enzyme inhibitory activity. The fermentation conditions under which the angiotensin-converting enzyme (ACE) inhibitory activity reached 84.51% were optimized by the response surface method as follows: 2 × 106 cfu/mL of L. plantarum B, yogurt culture 2.5 × 105 cfu/mL, and 8 h at 37°C. The distribution of ACE inhibitory peptides from fermented buffalo milk and fermented cow milk were further analyzed by liquid chromatography-mass spectrometry. By searching according to the structural features of ACE inhibitory peptides, 29 and 11 peptides containing ACE inhibitory peptide features were found in fermented buffalo milk and fermented cow milk, respectively. To investigate the in vivo antihypertensive activity of fermented buffalo milk, 18 pregnant rats were divided into 3 groups (n = 6 in each group) and administered 10 mL of normal saline, yogurt (20 mg/kg), or labetalol hydrochloride (4 mg/kg) daily from the beginning of pregnancy to parturition. To induce hypertension, methyl nitrosoarginine (125 mg/kg) was injected subcutaneously every day from d 15 of pregnancy to the day of delivery. Blood pressure was not significantly changed in the yogurt and labetalol groups after induction of hypertension and was lower compared with the normal saline group, but there was no difference between the yogurt and labetalol groups. This implied that the buffalo yogurt had a preventive and antihypertensive effect in the pregnancy-induced hypertensive rat model. Further studies to determine the mechanism of action, as well as a randomized control trial, are warranted.
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Affiliation(s)
- Liang Yi
- South Asia Branch of National Engineering Center of Dairy for Maternal and Child Health, Guilin University of Technology, Guilin 541004, China
| | - Jiang Tie Min
- South Asia Branch of National Engineering Center of Dairy for Maternal and Child Health, Guilin University of Technology, Guilin 541004, China.
| | - Chen Li Jun
- National Engineering Center of Dairy for Maternal and Child Health, Beijing Sanyuan Foods Co. Ltd., Beijing 100163, China
| | - He Xiao Long
- South Asia Branch of National Engineering Center of Dairy for Maternal and Child Health, Guilin University of Technology, Guilin 541004, China
| | - Hock Eng Khoo
- South Asia Branch of National Engineering Center of Dairy for Maternal and Child Health, Guilin University of Technology, Guilin 541004, China
| | - Zhao Jun Ying
- National Engineering Center of Dairy for Maternal and Child Health, Beijing Sanyuan Foods Co. Ltd., Beijing 100163, China
| | - Song Jia Le
- Department of Nutrition and Food Hygiene, School of Public Health, Guilin Medical University, Guilin, Guangxi 541004, China
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Nádasy GL, Balla A, Szekeres M. From Living in Saltwater to a Scarcity of Salt and Water, and Then an Overabundance of Salt-The Biological Roller Coaster to Which the Renin-Angiotensin System Has Had to Adapt: An Editorial. Biomedicines 2023; 11:3004. [PMID: 38002004 PMCID: PMC10669630 DOI: 10.3390/biomedicines11113004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Angiotensin II (Ang II) is a hormone with much more complex actions than is typical for other agonists with heterotrimeric G protein-coupled receptors (GPCRs) [...].
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Affiliation(s)
- György L. Nádasy
- Department of Physiology, Faculty of Medicine, Semmelweis University, 37-47 Tűzoltó Street, 1094 Budapest, Hungary; (G.L.N.); (A.B.)
| | - András Balla
- Department of Physiology, Faculty of Medicine, Semmelweis University, 37-47 Tűzoltó Street, 1094 Budapest, Hungary; (G.L.N.); (A.B.)
- Laboratory of Molecular Physiology, Eötvös Loránd Research Network, Research Centre for Natural Sciences, 2 Magyar Tudósok Körútja, 1117 Budapest, Hungary
| | - Mária Szekeres
- Department of Physiology, Faculty of Medicine, Semmelweis University, 37-47 Tűzoltó Street, 1094 Budapest, Hungary; (G.L.N.); (A.B.)
- Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, 17 Vas Street, 1088 Budapest, Hungary
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Zhang S, Hu H, Liu X, Liu Z, Mao Y, Li Z, Huang K, Chen M, Gao G, Hu C, Zhang X. The impact of household fuel usage on adverse pregnancy outcomes in rural Ma'anshan City, Anhui Province: a birth cohort study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:100950-100958. [PMID: 37644269 DOI: 10.1007/s11356-023-29543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Abstract
The combustion of cooking fuels generates detrimental gases significantly impacting human health, particularly for vulnerable populations like expectant mothers. Prenatal exposure of such hazardous emissions raises the probability of adverse pregnancy outcomes, including preterm birth (PTB) and low birth weight (LBW). Our research aims to explore the association between cooking fuel utilization and adverse birth outcomes in rural Ma'anshan, Anhui Province. A prospective cohort study was executed, employing the Maternal and Infant Health Assessment questionnaire to classify fuels into clean (natural gas, electricity) and polluting energy sources (coal, coal gas, firewood). Multivariate logistic regression models were conducted to evaluate the association between fuel consumption and postpartum maternal and infant outcomes. Among the 442 surveyed pregnant women, 38.2% (N=169) utilized polluting fuels. After adjusting for covariates such as age and BMI, the relative risks of preterm birth, low birth weight, and postpartum hemorrhage in the polluting fuel group compared to the clean fuel group were OR: 3.27, 95% CI: 1.34, 8.00; OR: 3.50, 95% CI: 1.12, 10.90; and OR: 3.18, 95% CI: 1.06, 9.46, respectively. These results indicate that the usage of polluting fuels during pregnancy may heighten the risk of adverse birth outcomes. Consequently, additional research is advised to mitigate the harmful emissions generated by cooking fuels and advocate for clean energy adoption, enhancing maternal and infant well-being.
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Affiliation(s)
- Sun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Huiyu Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xuejie Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Zheye Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Yicheng Mao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Zhenhua Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Kai Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
- The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Maolin Chen
- Department of Gynecology and Obstetrics, Ma'anshan Maternal and Child Health Hospital, Ma'anshan, 243000, China
| | - Guopeng Gao
- Department of Child Health Care, Ma'anshan Maternal and Child Health Hospital, Ma'anshan, 243000, China
| | - Chengyang Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
- Department of Humanistic Medicine, School of Humanistic Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xiujun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei, 230032, China.
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Zhang P, Zhong X. Analysis of risk factors and construction of nomograph model for critical condition of patients with hypertension during pregnancy. BMC Pregnancy Childbirth 2023; 23:576. [PMID: 37563557 PMCID: PMC10413762 DOI: 10.1186/s12884-023-05860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE This study aims to construct the risk prediction nomogram model of critical condition in patients with hypertension during pregnancy and to verify its evaluation effect. METHODS A total of 531 patients with hypertension during pregnancy were randomly grouped into 427 model group and 104 validation group. The model group patients included 59 cases of critical group and 368 cases of non-critical group according to the occurrence of critical situation. Multivariate Logistic regression analysis was conducted to determine the risk factors of critical condition in patients with hypertension during pregnancy, and R software was used to construct the nomogram model. Moreover, the prediction efficiency of the model was evaluated. RESULTS The proportions of patients aged over 30 years, with an educational background of junior high school or below, a family history of hypertension, anemia during pregnancy, and a lower erythrocyte count were significantly higher in the critical group compared to the non-critical group (P < 0.05). Age > 30 years old, educational background of junior high school and below, family history of hypertension, anemia during pregnancy, and red blood cell count were independent risk factors for the occurrence of critical condition in patients with hypertension during pregnancy (P < 0.05). The prediction model formula Z = 1.857×Age + 1.167×Education + 1.601×Family history of hypertension + 1.815×Pregnancy anemia + 3.524×Red blood cell count+(-19.769). The area under the curve (AUC) of the nomogram in the modeling group for predicting the risk of critical situations was 0.926 (95% CI = 0.887 ~ 0.964), indicating excellent discrimination. The calibration curve closely resembled the ideal curve, demonstrating good agreement between the predicted and actual values. The AUC of the validation group's nomogram to predict the risk of critical situation was 0.942 (95% CI = 0.872 ~ 0.998), with good discrimination. The calibration curve was close to the ideal curve, and the actual value was in good agreement with the predicted value. CONCLUSION The nomograph model can predict the risk of critical condition in patients with hypertension during pregnancy and screen high-risk population.
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Affiliation(s)
- Pingping Zhang
- Department of Gynaecology and Obstetrics, Wenzhou Central Hospital, No.252, Baili East Road, Lucheng District, Wenzhou City, 325000, Zhejiang Province, China
| | - Xiwen Zhong
- Department of Gynaecology and Obstetrics, Wenzhou Central Hospital, No.252, Baili East Road, Lucheng District, Wenzhou City, 325000, Zhejiang Province, China.
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