Department of Internal Medicine, Health Science Center, Ningbo University, Ningbo city, Zhejiang province, China.
Center for Reproductive Medicine, Ningbo Women and Children's Hospital, Ningbo city, Zhejiang province, China.
J Glob Health. 2024 Mar 22;14:04069. doi: 10.7189/jogh.14.04069.
China's fertility policy has dramatically changed in the past decade with the successive promulgation of the partial two-child policy, universal two-child policy and three-child policy. The trajectories of maternal and neonatal health accompanied the changes in fertility policy are unknown.
We obtained data of 280 203 deliveries with six common pregnancy complications and thirteen perinatal outcomes between 2010 and 2021 in eastern China. The average annual percent change (AAPC) was calculated to evaluated the temporal trajectories of obstetric characteristics and adverse outcomes during this period. Then, the autoregressive integrated moving average (ARIMA) models were constructed to project future trend of obstetric characteristics and outcomes until 2027.
The proportion of advanced maternal age (AMA), assisted reproduction technology (ART) treatment, gestational diabetes mellitus (GDM), anaemia, thrombocytopenia, thyroid dysfunction, oligohydramnios, placental abruption, small for gestational age (SGA) infants, and congenital malformation significantly increased from 2010 to 2021. However, the placenta previa, large for gestational age (LGA) infants and stillbirth significantly decreased during the same period. The AMA and ART treatment were identified as independent risk factors for the uptrends of pregnancy complications and adverse perinatal outcomes. The overall caesarean section rate remained above 40%. Importantly, among multiparas, a previous caesarean section was found to be associated with a significantly reduced risk of hypertensive disorders of pregnancy (HDP), premature rupture of membranes (PROM), placenta previa, placental abruption, perinatal asphyxia, LGA infants, stillbirths, and preterm births. In addition, the ARIMA time series models predicted increasing trends in the ART treatment, GDM, anaemia, thrombocytopenia, postpartum haemorrhage, congenital malformation, and caesarean section until 2027. Conversely, a decreasing trend was predicted for HDP, PROM, and placental abruption premature, LGA infants, SGA infants, perinatal asphyxia, and stillbirth.
Maternal and neonatal adverse outcomes became more prevalent from 2010 to 2021 in China. Maternal age and ART treatment were independent risk factors for adverse obstetric outcomes. The findings offered comprehensive trajectories for monitoring pregnancy complications and perinatal outcomes in China, and provided robust intervention targets in obstetric safety. The development of early prediction models and the implementation of prevention efforts for adverse obstetric events are necessary to enhance obstetric safety.
中国的生育政策在过去十年中发生了重大变化，相继颁布了单独二孩政策、全面二孩政策和三孩政策。伴随生育政策变化的母婴健康轨迹尚不清楚。
我们获取了 2010 年至 2021 年中国东部地区 280203 例有 6 种常见妊娠并发症和 13 种围产儿结局的分娩数据。采用平均年度百分比变化（AAPC）评估该时期产科特征和不良结局的时间轨迹。然后，构建自回归积分移动平均（ARIMA）模型，预测 2027 年前产科特征和结局的未来趋势。
高龄产妇（AMA）、辅助生殖技术（ART）治疗、妊娠期糖尿病（GDM）、贫血、血小板减少、甲状腺功能障碍、羊水过少、胎盘早剥、小于胎龄儿（SGA）和先天性畸形的比例从 2010 年至 2021 年显著增加。然而，同期胎盘前置、巨大儿（LGA）和死胎显著减少。AMA 和 ART 治疗被确定为妊娠并发症和不良围产儿结局上升的独立危险因素。总体剖宫产率仍高于 40%。重要的是，在多产妇中，既往剖宫产与妊娠期高血压疾病（HDP）、胎膜早破（PROM）、胎盘前置、胎盘早剥、围产儿窒息、LGA 婴儿、死胎和早产的风险显著降低相关。此外，ARIMA 时间序列模型预测到 2027 年，ART 治疗、GDM、贫血、血小板减少、产后出血、先天性畸形和剖宫产率将呈上升趋势。相反，HDP、PROM 和胎盘早剥早产、LGA 婴儿、SGA 婴儿、围产儿窒息和死胎的预测趋势呈下降趋势。
2010 年至 2021 年，中国母婴不良结局更为普遍。产妇年龄和 ART 治疗是不良产科结局的独立危险因素。研究结果为中国监测妊娠并发症和围产儿结局提供了全面的轨迹，并为产科安全提供了有力的干预目标。有必要开发早期预测模型并实施预防不良产科事件的措施，以提高产科安全性。
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