1.Abibliometric analysis of the current state of research on project management practices in hospital management
Dechao CHEN ; Yufeng SHI ; Lu YE ; Zhiming YANG ; Liming HE ; Lisha WU ; Guiyang ZHOU
Modern Hospital 2024;24(1):117-119,122
Objective To explore the research dynamics and hotspots of project management in the field of hospital man-agement,and analyze the contents that still need to be improved,so as to provide references for the subsequent research,and provide hospital managers with practical experience in hospital management.Methods Based on the PubMed database,we used the citexs data analysis platform to analyze the literature and big data from January 2012 to December 2022 on the application of project management in the field of hospital management.Results The effective literature was retrieved from 4236 articles,and the analysis found thatthe annualnumberofpublicationsinthisfield hasbeenincreasing,2021 sawthe highestannualnumberof 573 articles,and the fastest growth rate was 20.36% in 2017.The country with the most publications is the United States(1 546 articles,36.5% ),the research institution with the most publications is Monash University,Australia,the journal with the most publications is BMJ Open(124 articles),and the key words with the highest frequency of occurrence in the retrieved literature are quality improvement,primary care improvement,covid-19,telemedicine.Conclusion The research in this field has been rapidly developed and is in a fast rising phase.In almost every organization and industry,the share of project management or"projectization"is increasing,and project management has become an important part of hospital management research and prac-tice.In the context of building a modern hospital management system,the application of project management to hospital manage-ment is an effective means of improving the level of fine hospital management.
2.A bibliometric analysis of exploring the optimization path and theoretical basis of the management sys-tem of traditional Chinese medicine nursing technology in medical institutions
Xin CAO ; Yufeng SHI ; Lu YE ; Zhiming YANG ; Liming HE ; Guiyang ZHOU
Modern Hospital 2024;24(3):384-390
Objective To sort out and summarize the research hotspots and trends of Chinese medicine nursing technolo-gy at the present stage.Methods We searched the research literature on TCM nursing technology included in China Knowledge,Wanfang,and Wipu build-up to November 30,2023,and used CiteSpace 6.1.R6 software to perform co-occurrence analysis of research institutions and keyword clustering,timeline,and emergence analysis.Results A total of 5 771 documents were in-cluded,with a general upward trend in the number of publications,peaking at 692 publications in 2021.5 206 documents from 673 journals were included in the research literature,of which 19 journals had ≥50 publications(35.47%).2 087 research or-ganizations were involved,of which 27 had ≥20 publications(13.24%).Involving 9 484 authors,there were a total of 8 au-thors ≥5 in the cluster,indicating the existence of stable teamwork in the cluster.The keyword co-occurrence analysis yielded the research hotspots of TCM nursing technology as TCM nursing,training,nursing management,clinical efficacy,complica-tions,and quality of life.Conclusion Based on the econometrics and visualization analysis of the literature on TCM nursing technology,we explored the research hotspots and trends in this field,and provided two theoretical paths for medical institution managers to construct and optimize the management system of TCM nursing technology:to standardize the TCM nursing technology in hospitals and establish a clinical access management system;and based on the multidimensional management method,to inno-vate the training system of TCM nursing technology.
3.Interpretation and Elaboration for the ARRIVE Guidelines 2.0—Animal Research: Reporting In Vivo Experiments (V)
Zhengwen MA ; Xiaying LI ; Xiaoyu LIU ; Yao LI ; Jian WANG ; Jin LU ; Guoyuan CHEN ; Xiao LU ; Yu BAI ; Xuancheng LU ; Yonggang LIU ; Yufeng TAO ; Wanyong PANG
Laboratory Animal and Comparative Medicine 2024;44(1):105-114
Improving the reproducibility of biomedical research results is a major challenge. Transparent and accurate reporting of the research process enables readers to evaluate the reliability of the research results and further explore the experiment by repeating it or building upon its findings. The ARRIVE 2.0 guidelines, released in 2019 by the UK National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs), provide a checklist that is applicable to any in vivo animal research report. These guidelines aim to improve the standardization of experimental design, implementation, and reporting, as well as enhance the reliability, repeatability, and clinical translation of animal experimental results. The use of the ARRIVE 2.0 guidelines not only enriches the details of animal experimental research reports, ensuring that information on animal experimental results is fully evaluated and utilized, but also enables readers to understand the content expressed by the author accurately and clearly, promoting the transparency and completeness of the fundamental research review process. At present, the ARRIVE 2.0 guidelines have been widely adopted by international biomedical journals. This article is based on the best practices following the ARRIVE 2.0 guidelines in international journals, and it interprets, explains, and elaborates in Chinese the fifth part of the comprehensive version of the ARRIVE 2.0 guidelines published in PLoS Biology in 2020 (the original text can be found at
4.Prevention of Adverse Pregnancy Outcomes in High-Risk Pregnant Women with Gestational Diabetes Mellitus by Combining Nutritional Interventions in Early Pregnancy with Traditional Chinese Medicine Physical Dialectics
Yufeng GUO ; Yuxia ZHANG ; Junwen LU ; Chengyao LIU ; Lijun ZHOU ; Hong DING
Journal of Practical Obstetrics and Gynecology 2024;40(10):833-840
Objective:To assess the effects of nutritional interventions combined with Traditional Chinese Med-icine(TCM)physical dialectics on the development of gestational diabetes mellitus(GDM),dietary status during pregnancy,and maternal and infant outcomes in high-risk pregnant women in early pregnancy.Methods:298 high-risk pregnant women with GDM in early pregnancy(gestational week≤14 weeks)registered in the Obstet-rics Department of Urumqi Maternal and Child Health Hospital from 1st December 2022 to 30th March 2023 were selected as the study subjects and randomly divided into the intervention group(149 cases)and the control group(149 cases).During 14 to 23+6 weeks of pregnancy,TCM constitution nutritional intervention was carried out for pregnant women in the intervention group,and routine guidance and healthy dietary education was carried out in the control group.The incidence of GDM in the two groups was compared at 24-28 weeks of pregnancy,and the relationship between early pregnancy nutritional intervention combined with TCM constitution and the risk of GDM was analysed in subgroups using logistic regression and likelihood ratio test.The dietary situation,biochemical in-dexes and delivery outcomes after the intervention were compared at 32-36 weeks of pregnancy.Results:①The incidence of GDM in the intervention group was significantly lower than that in the control group(14.09%vs.23.49%,P<0.05).The effect of the TCM constitution based nutritional intervention on the risk probability of GDM was statistically significant only among pregnant women with different ranges of gestational weight gain(GWG)(P=0.018).Among them,pregnant women with GWG lower than the recommended range had a reduced risk of GDM after intervention(OR 0.27,95%Cl 0.10-0.68,P=0.008).② After intervention,the evaluation index of di-etary balance index of pregnant women in the intervention group was better than that of the control group(P<0.05),and the intake of cereals and potatoes,vegetables,and water of pregnant women in late pregnancy in the intervention group was higher than that of the control group(P<0.05).③The levels of triglycerides,total choles-terol,low-density lipoprotein,glycated haemoglobin,uric acid and creatinine of pregnant women in the intervention group were lower than those of the control group in late pregnancy(P<0.05).GWG,gestational age at delivery,the rate of low-birth-weight,and the neonatal 1-minute Apgar scores were all better than those of the control group(P<0.05.Conclusions:Nutritional interventions in early pregnancy combined with TCM constitution can sig-nificantly reduce the incidence of GDM in high-risk pregnant women and the chances of low-birth-weight babies.Obstetrics outpatient clinics can actively develop extensive collaboration with TCM and clinical nutrition depart-ments to reduce adverse pregnancy outcomes for both mother and fetus.
5.Prevention of Adverse Pregnancy Outcomes in High-Risk Pregnant Women with Gestational Diabetes Mellitus by Combining Nutritional Interventions in Early Pregnancy with Traditional Chinese Medicine Physical Dialectics
Yufeng GUO ; Yuxia ZHANG ; Junwen LU ; Chengyao LIU ; Lijun ZHOU ; Hong DING
Journal of Practical Obstetrics and Gynecology 2024;40(10):833-840
Objective:To assess the effects of nutritional interventions combined with Traditional Chinese Med-icine(TCM)physical dialectics on the development of gestational diabetes mellitus(GDM),dietary status during pregnancy,and maternal and infant outcomes in high-risk pregnant women in early pregnancy.Methods:298 high-risk pregnant women with GDM in early pregnancy(gestational week≤14 weeks)registered in the Obstet-rics Department of Urumqi Maternal and Child Health Hospital from 1st December 2022 to 30th March 2023 were selected as the study subjects and randomly divided into the intervention group(149 cases)and the control group(149 cases).During 14 to 23+6 weeks of pregnancy,TCM constitution nutritional intervention was carried out for pregnant women in the intervention group,and routine guidance and healthy dietary education was carried out in the control group.The incidence of GDM in the two groups was compared at 24-28 weeks of pregnancy,and the relationship between early pregnancy nutritional intervention combined with TCM constitution and the risk of GDM was analysed in subgroups using logistic regression and likelihood ratio test.The dietary situation,biochemical in-dexes and delivery outcomes after the intervention were compared at 32-36 weeks of pregnancy.Results:①The incidence of GDM in the intervention group was significantly lower than that in the control group(14.09%vs.23.49%,P<0.05).The effect of the TCM constitution based nutritional intervention on the risk probability of GDM was statistically significant only among pregnant women with different ranges of gestational weight gain(GWG)(P=0.018).Among them,pregnant women with GWG lower than the recommended range had a reduced risk of GDM after intervention(OR 0.27,95%Cl 0.10-0.68,P=0.008).② After intervention,the evaluation index of di-etary balance index of pregnant women in the intervention group was better than that of the control group(P<0.05),and the intake of cereals and potatoes,vegetables,and water of pregnant women in late pregnancy in the intervention group was higher than that of the control group(P<0.05).③The levels of triglycerides,total choles-terol,low-density lipoprotein,glycated haemoglobin,uric acid and creatinine of pregnant women in the intervention group were lower than those of the control group in late pregnancy(P<0.05).GWG,gestational age at delivery,the rate of low-birth-weight,and the neonatal 1-minute Apgar scores were all better than those of the control group(P<0.05.Conclusions:Nutritional interventions in early pregnancy combined with TCM constitution can sig-nificantly reduce the incidence of GDM in high-risk pregnant women and the chances of low-birth-weight babies.Obstetrics outpatient clinics can actively develop extensive collaboration with TCM and clinical nutrition depart-ments to reduce adverse pregnancy outcomes for both mother and fetus.
6.Prevention of Adverse Pregnancy Outcomes in High-Risk Pregnant Women with Gestational Diabetes Mellitus by Combining Nutritional Interventions in Early Pregnancy with Traditional Chinese Medicine Physical Dialectics
Yufeng GUO ; Yuxia ZHANG ; Junwen LU ; Chengyao LIU ; Lijun ZHOU ; Hong DING
Journal of Practical Obstetrics and Gynecology 2024;40(10):833-840
Objective:To assess the effects of nutritional interventions combined with Traditional Chinese Med-icine(TCM)physical dialectics on the development of gestational diabetes mellitus(GDM),dietary status during pregnancy,and maternal and infant outcomes in high-risk pregnant women in early pregnancy.Methods:298 high-risk pregnant women with GDM in early pregnancy(gestational week≤14 weeks)registered in the Obstet-rics Department of Urumqi Maternal and Child Health Hospital from 1st December 2022 to 30th March 2023 were selected as the study subjects and randomly divided into the intervention group(149 cases)and the control group(149 cases).During 14 to 23+6 weeks of pregnancy,TCM constitution nutritional intervention was carried out for pregnant women in the intervention group,and routine guidance and healthy dietary education was carried out in the control group.The incidence of GDM in the two groups was compared at 24-28 weeks of pregnancy,and the relationship between early pregnancy nutritional intervention combined with TCM constitution and the risk of GDM was analysed in subgroups using logistic regression and likelihood ratio test.The dietary situation,biochemical in-dexes and delivery outcomes after the intervention were compared at 32-36 weeks of pregnancy.Results:①The incidence of GDM in the intervention group was significantly lower than that in the control group(14.09%vs.23.49%,P<0.05).The effect of the TCM constitution based nutritional intervention on the risk probability of GDM was statistically significant only among pregnant women with different ranges of gestational weight gain(GWG)(P=0.018).Among them,pregnant women with GWG lower than the recommended range had a reduced risk of GDM after intervention(OR 0.27,95%Cl 0.10-0.68,P=0.008).② After intervention,the evaluation index of di-etary balance index of pregnant women in the intervention group was better than that of the control group(P<0.05),and the intake of cereals and potatoes,vegetables,and water of pregnant women in late pregnancy in the intervention group was higher than that of the control group(P<0.05).③The levels of triglycerides,total choles-terol,low-density lipoprotein,glycated haemoglobin,uric acid and creatinine of pregnant women in the intervention group were lower than those of the control group in late pregnancy(P<0.05).GWG,gestational age at delivery,the rate of low-birth-weight,and the neonatal 1-minute Apgar scores were all better than those of the control group(P<0.05.Conclusions:Nutritional interventions in early pregnancy combined with TCM constitution can sig-nificantly reduce the incidence of GDM in high-risk pregnant women and the chances of low-birth-weight babies.Obstetrics outpatient clinics can actively develop extensive collaboration with TCM and clinical nutrition depart-ments to reduce adverse pregnancy outcomes for both mother and fetus.
7.Prevention of Adverse Pregnancy Outcomes in High-Risk Pregnant Women with Gestational Diabetes Mellitus by Combining Nutritional Interventions in Early Pregnancy with Traditional Chinese Medicine Physical Dialectics
Yufeng GUO ; Yuxia ZHANG ; Junwen LU ; Chengyao LIU ; Lijun ZHOU ; Hong DING
Journal of Practical Obstetrics and Gynecology 2024;40(10):833-840
Objective:To assess the effects of nutritional interventions combined with Traditional Chinese Med-icine(TCM)physical dialectics on the development of gestational diabetes mellitus(GDM),dietary status during pregnancy,and maternal and infant outcomes in high-risk pregnant women in early pregnancy.Methods:298 high-risk pregnant women with GDM in early pregnancy(gestational week≤14 weeks)registered in the Obstet-rics Department of Urumqi Maternal and Child Health Hospital from 1st December 2022 to 30th March 2023 were selected as the study subjects and randomly divided into the intervention group(149 cases)and the control group(149 cases).During 14 to 23+6 weeks of pregnancy,TCM constitution nutritional intervention was carried out for pregnant women in the intervention group,and routine guidance and healthy dietary education was carried out in the control group.The incidence of GDM in the two groups was compared at 24-28 weeks of pregnancy,and the relationship between early pregnancy nutritional intervention combined with TCM constitution and the risk of GDM was analysed in subgroups using logistic regression and likelihood ratio test.The dietary situation,biochemical in-dexes and delivery outcomes after the intervention were compared at 32-36 weeks of pregnancy.Results:①The incidence of GDM in the intervention group was significantly lower than that in the control group(14.09%vs.23.49%,P<0.05).The effect of the TCM constitution based nutritional intervention on the risk probability of GDM was statistically significant only among pregnant women with different ranges of gestational weight gain(GWG)(P=0.018).Among them,pregnant women with GWG lower than the recommended range had a reduced risk of GDM after intervention(OR 0.27,95%Cl 0.10-0.68,P=0.008).② After intervention,the evaluation index of di-etary balance index of pregnant women in the intervention group was better than that of the control group(P<0.05),and the intake of cereals and potatoes,vegetables,and water of pregnant women in late pregnancy in the intervention group was higher than that of the control group(P<0.05).③The levels of triglycerides,total choles-terol,low-density lipoprotein,glycated haemoglobin,uric acid and creatinine of pregnant women in the intervention group were lower than those of the control group in late pregnancy(P<0.05).GWG,gestational age at delivery,the rate of low-birth-weight,and the neonatal 1-minute Apgar scores were all better than those of the control group(P<0.05.Conclusions:Nutritional interventions in early pregnancy combined with TCM constitution can sig-nificantly reduce the incidence of GDM in high-risk pregnant women and the chances of low-birth-weight babies.Obstetrics outpatient clinics can actively develop extensive collaboration with TCM and clinical nutrition depart-ments to reduce adverse pregnancy outcomes for both mother and fetus.
8.Prevention of Adverse Pregnancy Outcomes in High-Risk Pregnant Women with Gestational Diabetes Mellitus by Combining Nutritional Interventions in Early Pregnancy with Traditional Chinese Medicine Physical Dialectics
Yufeng GUO ; Yuxia ZHANG ; Junwen LU ; Chengyao LIU ; Lijun ZHOU ; Hong DING
Journal of Practical Obstetrics and Gynecology 2024;40(10):833-840
Objective:To assess the effects of nutritional interventions combined with Traditional Chinese Med-icine(TCM)physical dialectics on the development of gestational diabetes mellitus(GDM),dietary status during pregnancy,and maternal and infant outcomes in high-risk pregnant women in early pregnancy.Methods:298 high-risk pregnant women with GDM in early pregnancy(gestational week≤14 weeks)registered in the Obstet-rics Department of Urumqi Maternal and Child Health Hospital from 1st December 2022 to 30th March 2023 were selected as the study subjects and randomly divided into the intervention group(149 cases)and the control group(149 cases).During 14 to 23+6 weeks of pregnancy,TCM constitution nutritional intervention was carried out for pregnant women in the intervention group,and routine guidance and healthy dietary education was carried out in the control group.The incidence of GDM in the two groups was compared at 24-28 weeks of pregnancy,and the relationship between early pregnancy nutritional intervention combined with TCM constitution and the risk of GDM was analysed in subgroups using logistic regression and likelihood ratio test.The dietary situation,biochemical in-dexes and delivery outcomes after the intervention were compared at 32-36 weeks of pregnancy.Results:①The incidence of GDM in the intervention group was significantly lower than that in the control group(14.09%vs.23.49%,P<0.05).The effect of the TCM constitution based nutritional intervention on the risk probability of GDM was statistically significant only among pregnant women with different ranges of gestational weight gain(GWG)(P=0.018).Among them,pregnant women with GWG lower than the recommended range had a reduced risk of GDM after intervention(OR 0.27,95%Cl 0.10-0.68,P=0.008).② After intervention,the evaluation index of di-etary balance index of pregnant women in the intervention group was better than that of the control group(P<0.05),and the intake of cereals and potatoes,vegetables,and water of pregnant women in late pregnancy in the intervention group was higher than that of the control group(P<0.05).③The levels of triglycerides,total choles-terol,low-density lipoprotein,glycated haemoglobin,uric acid and creatinine of pregnant women in the intervention group were lower than those of the control group in late pregnancy(P<0.05).GWG,gestational age at delivery,the rate of low-birth-weight,and the neonatal 1-minute Apgar scores were all better than those of the control group(P<0.05.Conclusions:Nutritional interventions in early pregnancy combined with TCM constitution can sig-nificantly reduce the incidence of GDM in high-risk pregnant women and the chances of low-birth-weight babies.Obstetrics outpatient clinics can actively develop extensive collaboration with TCM and clinical nutrition depart-ments to reduce adverse pregnancy outcomes for both mother and fetus.
9.Prevention of Adverse Pregnancy Outcomes in High-Risk Pregnant Women with Gestational Diabetes Mellitus by Combining Nutritional Interventions in Early Pregnancy with Traditional Chinese Medicine Physical Dialectics
Yufeng GUO ; Yuxia ZHANG ; Junwen LU ; Chengyao LIU ; Lijun ZHOU ; Hong DING
Journal of Practical Obstetrics and Gynecology 2024;40(10):833-840
Objective:To assess the effects of nutritional interventions combined with Traditional Chinese Med-icine(TCM)physical dialectics on the development of gestational diabetes mellitus(GDM),dietary status during pregnancy,and maternal and infant outcomes in high-risk pregnant women in early pregnancy.Methods:298 high-risk pregnant women with GDM in early pregnancy(gestational week≤14 weeks)registered in the Obstet-rics Department of Urumqi Maternal and Child Health Hospital from 1st December 2022 to 30th March 2023 were selected as the study subjects and randomly divided into the intervention group(149 cases)and the control group(149 cases).During 14 to 23+6 weeks of pregnancy,TCM constitution nutritional intervention was carried out for pregnant women in the intervention group,and routine guidance and healthy dietary education was carried out in the control group.The incidence of GDM in the two groups was compared at 24-28 weeks of pregnancy,and the relationship between early pregnancy nutritional intervention combined with TCM constitution and the risk of GDM was analysed in subgroups using logistic regression and likelihood ratio test.The dietary situation,biochemical in-dexes and delivery outcomes after the intervention were compared at 32-36 weeks of pregnancy.Results:①The incidence of GDM in the intervention group was significantly lower than that in the control group(14.09%vs.23.49%,P<0.05).The effect of the TCM constitution based nutritional intervention on the risk probability of GDM was statistically significant only among pregnant women with different ranges of gestational weight gain(GWG)(P=0.018).Among them,pregnant women with GWG lower than the recommended range had a reduced risk of GDM after intervention(OR 0.27,95%Cl 0.10-0.68,P=0.008).② After intervention,the evaluation index of di-etary balance index of pregnant women in the intervention group was better than that of the control group(P<0.05),and the intake of cereals and potatoes,vegetables,and water of pregnant women in late pregnancy in the intervention group was higher than that of the control group(P<0.05).③The levels of triglycerides,total choles-terol,low-density lipoprotein,glycated haemoglobin,uric acid and creatinine of pregnant women in the intervention group were lower than those of the control group in late pregnancy(P<0.05).GWG,gestational age at delivery,the rate of low-birth-weight,and the neonatal 1-minute Apgar scores were all better than those of the control group(P<0.05.Conclusions:Nutritional interventions in early pregnancy combined with TCM constitution can sig-nificantly reduce the incidence of GDM in high-risk pregnant women and the chances of low-birth-weight babies.Obstetrics outpatient clinics can actively develop extensive collaboration with TCM and clinical nutrition depart-ments to reduce adverse pregnancy outcomes for both mother and fetus.
10.Prevention of Adverse Pregnancy Outcomes in High-Risk Pregnant Women with Gestational Diabetes Mellitus by Combining Nutritional Interventions in Early Pregnancy with Traditional Chinese Medicine Physical Dialectics
Yufeng GUO ; Yuxia ZHANG ; Junwen LU ; Chengyao LIU ; Lijun ZHOU ; Hong DING
Journal of Practical Obstetrics and Gynecology 2024;40(10):833-840
Objective:To assess the effects of nutritional interventions combined with Traditional Chinese Med-icine(TCM)physical dialectics on the development of gestational diabetes mellitus(GDM),dietary status during pregnancy,and maternal and infant outcomes in high-risk pregnant women in early pregnancy.Methods:298 high-risk pregnant women with GDM in early pregnancy(gestational week≤14 weeks)registered in the Obstet-rics Department of Urumqi Maternal and Child Health Hospital from 1st December 2022 to 30th March 2023 were selected as the study subjects and randomly divided into the intervention group(149 cases)and the control group(149 cases).During 14 to 23+6 weeks of pregnancy,TCM constitution nutritional intervention was carried out for pregnant women in the intervention group,and routine guidance and healthy dietary education was carried out in the control group.The incidence of GDM in the two groups was compared at 24-28 weeks of pregnancy,and the relationship between early pregnancy nutritional intervention combined with TCM constitution and the risk of GDM was analysed in subgroups using logistic regression and likelihood ratio test.The dietary situation,biochemical in-dexes and delivery outcomes after the intervention were compared at 32-36 weeks of pregnancy.Results:①The incidence of GDM in the intervention group was significantly lower than that in the control group(14.09%vs.23.49%,P<0.05).The effect of the TCM constitution based nutritional intervention on the risk probability of GDM was statistically significant only among pregnant women with different ranges of gestational weight gain(GWG)(P=0.018).Among them,pregnant women with GWG lower than the recommended range had a reduced risk of GDM after intervention(OR 0.27,95%Cl 0.10-0.68,P=0.008).② After intervention,the evaluation index of di-etary balance index of pregnant women in the intervention group was better than that of the control group(P<0.05),and the intake of cereals and potatoes,vegetables,and water of pregnant women in late pregnancy in the intervention group was higher than that of the control group(P<0.05).③The levels of triglycerides,total choles-terol,low-density lipoprotein,glycated haemoglobin,uric acid and creatinine of pregnant women in the intervention group were lower than those of the control group in late pregnancy(P<0.05).GWG,gestational age at delivery,the rate of low-birth-weight,and the neonatal 1-minute Apgar scores were all better than those of the control group(P<0.05.Conclusions:Nutritional interventions in early pregnancy combined with TCM constitution can sig-nificantly reduce the incidence of GDM in high-risk pregnant women and the chances of low-birth-weight babies.Obstetrics outpatient clinics can actively develop extensive collaboration with TCM and clinical nutrition depart-ments to reduce adverse pregnancy outcomes for both mother and fetus.

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