Birth and birth-related obstetrical characteristics in southwestern China associated with the current adjustment of family planning policy: a 7-year retrospective study

The mediating effects of gestational diabetes mellitus and hypertensive disorders of pregnancy between maternal advanced age, previous caesarean section and the risk of small- or large-for-gestational-age newborns: a multicentric prospective cohort study in southern China

Background

Maternal obstetric characteristics have a key role in determining the occurrence of pregnancy-related disorders and subsequent neonatal outcomes. We aimed to investigate the mediating impact of gestational diabetes mellitus (GDM) and hypertensive disorder of pregnancy (HDP) on the relationship between maternal advanced age, previous caesarean section, and the risk of either large for gestational age (LGA) or small for gestational age (SGA) infants.

Methods

We used data from a prospective multicentre cohort study conducted through China's National Maternal Near-miss Surveillance System from January 2012 to December 2021. We performed univariate and multivariate logistic regression analyses to examine the connections between maternal advanced age, previous caesarean section, GDM and HDP, and the risks of LGA and SGA, as well as mediation analyses to assess the mediating effect of GDM and/or HDP on the relationship between maternal advanced age, previous caesarean section, and the risks of LGA and SGA.

Results

We included 482 458 women in our study, of whom13.5% were classified as advanced age, 51.4% as multipara, and 16.3% had a history of uterine scarring. Following adjustments for covariates, we found statistically significant associations between maternal advanced age and GDM (adjusted odds ratio (aOR) = 1.79; 95% confidence interval (CI) = 1.75, 1.83), maternal advanced age and HDP (aOR = 1.93; 95% CI = 1.86, 2.01), previous caesarean section and GDM (aOR = 1.13, 95% CI = 1.11, 1.16), previous caesarean section and HDP (aOR = 1.24; 95% CI = 1.20, 1.28), GDM and LGA (aOR = 1.32; 95% CI = 1.30, 1.35), and HDP and SGA (aOR = 3.93; 95% CI = 3.75, 4.12). The influence of maternal advanced age on SGA was significantly mediated by HDP, accounting for 68.96% of the mediation effect. Furthermore, GDM and HDP served as significant mediators in the relationship between previous caesarean section and the risks of LGA and SGA, with mediation proportions of 5.62% and 4.49%, respectively.

Conclusions

We found HDP has a mediating role in the impact of maternal advanced age and previous caesarean section individually on SGA risk, while GDM acts as a mediator in the connection between previous caesarean section and LGA risk.

Effect of trapezoidal excision combined with modified embedded vertical mattress suture technique on postoperative scar formation after cesarean section

To study the impact of modified embedded vertical mattress suture technique in conjunction with trapezoidal resection on the formation of scars after cesarean section. This retrospective study involved 339 pregnant women who had cesarean sections at the Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University from September 2020 to August 2023. Among them, 150 patients who received traditional subcutaneous fat layer discontinuous suture during September 2020 and June 2022 were assigned to the control group, and 152 patients who received improved buried vertical mattress suture technique and trapezoidal resection between July 2022 and August 2023 were assigned to the observation group. The therapeutic effect, surgical parameters and cosmetic effects in the two groups were compared. The suture time of the observation group was longer than that of the control group (t=27.858, P<0.001). The grade A healing rate (96.05%) and cosmetic satisfaction rate (94.08%) in the observation group were significantly higher than those (76.00% and 74.00%) in the control group (all P<0.001); while the incidences of suture reaction (12.05%), complication (1.96%), and hypertrophic scar (5.26%) were significantly lower than those in the control group (38.00%, 22.00%, and 27.33%, respectively) (all P<0.001). The visual analogue scale (VAS) score in the observation group was lower than that of the control group (intergroup effect: F=1434.000, P<0.001; time effect: F=91.091, P<0.001; interaction effect: F=2.409, P=0.091). The postoperative VSS score and scar width in the observation group were lower than those in the control group (all P<0.001). Multivariate analysis showed that complications (P=0.006) and suture method (P=0.016) were independent influencing factors for the occurrence of hypertrophic scars in pregnant women. Trapezoidal resection combined with improved buried vertical mattress suture technique can promote incision healing, reduce suture reaction, incision pain, adverse complications and the incidence of hyperplastic scar, and improve the cosmetic effect of surgery.

Changes in Maternal Socio-Demographic Characteristics and Pregnancy Outcomes Across Monitoring Regions - Six Provinces, China, 2016-2022

What is already known about this topic?

In recent years, there has been a significant increase in the proportion of women of advanced maternal age (AMA), accompanied by a rise in adverse pregnancy outcomes in certain regions of China.

What is added by this report?

From 2016 to 2022, there was an observed increase in the proportion of AMA, educational levels, and incidences of preterm birth and low birth weight (LBW) in both primiparous and multiparous women. Concurrently, there was a declining trend in the rate of cesarean deliveries and the incidence of macrosomia among multiparous women.

What are the implications for public health practice?

In addition to focusing on health management for AMA individuals, proactive steps should be undertaken to enhance the quality of medical services and promote childbirth at optimal ages, thereby reducing the incidence of adverse pregnancy outcomes.

The possible impact of the universal two-child policy on pregnancy outcomes

PURPOSE

The implementation of the universal two-child policy contributes to adverse pregnancy outcomes, but how the policy change leads to adverse pregnancy outcomes is not well elaborated. In this study, we aimed to compare maternal characteristics and complications, accessed the change in the proportion of maternal characteristics and maternal complications, and evaluated the mediation of maternal characteristics on maternal complications.

METHODS

Demographic and clinical data of three-level sample facilities were extracted from China's National Maternity Near Miss Obstetrics Surveillance System from Jan 1, 2012 to May 31, 2021. The associations between the universal two-child policy and maternal risk factors, the universal two-child policy and maternal complications, and maternal risk factors and maternal complications were evaluated using multivariate logistic regression analyses, with odds ratios (ORs) and 95% confidence intervals (CIs). Mediation analysis was used to estimate the potential mediation effects on the associations between the policy and maternal complications. Population-attributable fractions (PAF) were conducted to quantify the maternal complications burden attributable to the implementation of the universal two-child policy.

RESULTS

In the context of the universal two-child policy, the incidence of maternal near miss, antepartum or intrapartum complication, and post-partum complication increased at municipal- and county-level sample facilities. After adjusting for covariables, there were significant associations between the universal two-child policy and maternal risk factors (P < 0.001), the universal two-child policy and an increased risk of maternal complications (P < 0.001), and maternal risk factors and maternal complications(P < 0.001). The effects of the universal two-child policy on maternal near miss and medical disease were significantly mediated by maternal risk factors with mediation proportions of 19.77% and 4.07% at the municipal-level sample facility, and mediation proportions for 2.72% at the county-level sample facility on medical disease. The universal two-child policy contributed 19.34%, 5.82%, 8.29%, and 46.19% in the incidence of the maternal near miss, antepartum or intrapartum complication, post-partum complication, and medical disease at municipal-level sample facility, respectively. The corresponding PAF% at county-level sample facility was 40.49% for maternal near miss, 32.39% for the antepartum or intrapartum complication, 61.44% for post-partum complication, and 77.72% for medical disease. For provincial-level sample facility, the incidence of maternal near miss, antepartum or intrapartum complications, and medical diseases decreased (P < 0.05) and no statistically significant difference occurred in the incidence of post-partum complications.

CONCLUSIONS

In the context of the universal two-child policy, the incidence of maternal near miss, antepartum or intrapartum complication, and post-partum complication increased at municipal- and county-level sample facility. Maternal risk factors may play a mediating role in the effect of policy change and maternal complications. Provincial hospitals have been able to improve the quality of perinatal health care and reduce adverse pregnancy outcomes by adjusting their obstetric service strategies in the context of the new birth policy.

The effect of China's many-child policy on the number of births and the prevalence of serious teratogenic and disabling defects in Hunan Province

BACKGROUND

To research the effect of China's many-child policy on the number of births and the prevalence of serious teratogenic and disabling defects (STDDs) in Hunan province.

METHODS

We performed an observational study based on the Birth Defect (BD) Surveillance System of Hunan Province and chose STDD case cards. From 2012-2022, we defined the following 4 periods: the one-child policy (OCP) (2012.01-2013.12), partial two-child policy (PTCP) (2014.1-2015.12), universal two-child policy (UTCP) (2016.1-2020.12), and the early stage of the three-child policy (ETCP) (2021.1-2022.12). Crude odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to examine the association of policy changes with STDDs. Crame'r's V was calculated to estimate the effect sizes. Joinpoint regression analysis and annual percent change (APC) were used for each segment of the trend.

RESULTS

A total of 1,652,079 births were included in this analysis. Joinpoint regression analysis showed that the number of perinatal births increased from 2012 to 2017, with APC = 9.52 (95% CI: 7.2 to 11.8), and decreased from 2017 to 2022, with an APC = -10.04 (95% CI: -11.9 to -8.1). The number of mothers over 30 years old gradually increased, from 25.54% during the OCP period to 54.05% during the ETCP period (Ptrend < 0.001). With policy changes, the total prevalence of STDDs increased from 28.10 per 10,000 births during the period of OCP into 46.77 per 10,000 births during the ETCP period by 66.44%. The live birth prevalence of STDDs increased only during the ETCP period (PTCP: OR = 1.27, 95% CI: 0.99-1.24, p = 0.057, UTCP: OR = 1.22, 95% CI: 0.99-1.52, p = 0.067, ETCP: OR = 1.75, 95% CI: 1.37-2.24, p < 0.001). Over the past ten years, there was a decrease in the gestational age at diagnosis (*F = 772.520, p < 0.001), from 24.49 ± 5.65 weeks in 2012 to 20.77 ± 5.17 weeks in 2022. From 2012 to 2022, the percentage of deaths within 7 days decreased with APC = -18.85 (95% CI: -26.4- -10.5, P > 0.05).

CONCLUSION

Many-child policies were associated with a moderate increase in fertility especially for women in urban areas and older women. However, they have lost the ability to control birth since 2017. The total prevalence of STDDs increased over the entire period, but the live birth prevalence increased only during the ETCP period. The gestational age at diagnosis decreased and the percentage of deaths within 7 days decreased.

Effects of using epidural analgesia during delivery on maternal and infant outcomes

OBJECTIVES

To estimate the impact of epidural analgesia (EA) during delivery on maternal and infant outcomes.

DESIGN

This study was a prospective cohort study.

PARTICIPANTS

In total, 159 pregnant women in Women and Children's Hospital, School of Medicine, Xiamen university from Nov. 2019 to May 2020. Patients were randomly divided into EA group (n=80) and no analgesia group (n=79).

METHODS

The duration of labor, levels of umbilical arterial blood gas [pH and partial pressure oxygen (PaO2)], VAS, adverse events were evaluated to compare differences between EA group and no analgesia group, respectively.

RESULTS

The duration of the first stage of labor was shorted in the total stage (P=0.002) and the first stage of labor (P=0.001) in EA group compared with no analgesia group. The second stage of labor and third stage of labor, levels of umbilical arterial blood gas and 1min Apgar score in neonates were similar in EA and no analgesia groups (All P>0.05). After adjusting age, pre-pregnancy BMI, and past and present medical history, the VAS was low in EA group compared with no analgesia group when the uterine orifice was completely open [odds ratio (OR)=0.001, 95% confidence interval (CI):0.001-0.002], 8h post-delivery (OR=0.508, 95%CI:0.264-0.977) and 24h post-delivery (OR=0.321, 95%CI:0.167-0.617). EA increased the proportion of adverse events occurring 5 min post-delivery (χ2=10.137, P=0.001), while decreased the proportion of adverse events occurring 24h post-delivery (χ2=4.750, P=0.029).

LIMITATIONS

In terms of the effects of EA on neonates, we only measured the 1 min Apgar score of neonates.

CONCLUSIONS

EA might be a promising pain relief method for pregnant women. The results of our study might give a reference for the use of EA during delivery in clinic.

The global burden and trends of maternal sepsis and other maternal infections in 204 countries and territories from 1990 to 2019

BACKGROUND

Maternal sepsis and other maternal infections (MSMI) have considerable impacts on women's and neonatal health, but data on the global burden and trends of MSMI are limited. Comprehensive knowledge of the burden and trend patterns of MSMI is important to allocate resources, facilitate the establishment of tailored prevention strategies and implement effective clinical treatment measures.

METHODS

Based on data from the Global Burden of Disease database, we analysed the global burden of MSMI by the incidence, death, disability-adjusted life year (DALY) and maternal mortality ratio (MMR) in the last 30 years. Then, the trends of MSMI were assessed by the estimated annual percentage change (EAPC) of MMR as well as the age-standardized rate (ASR) of incidence, death and DALY. Moreover, we determined the effect of sociodemographic index (SDI) on MSMI epidemiological parameters.

RESULTS

Although incident cases almost stabilized from 1990 to 2015, the ASR of incidence, death, DALY and MMR steadily decreased globally from 1990 to 2019. The burden of MSMI was the highest in the low SDI region with the fastest downward trends. MSMI is still one of the most important causes of maternal death in the developed world. Substantial diversity of disease burden and trends occurred in different regions and individual countries, most of which had reduced burden and downward trends. The MMR and ASR were negatively correlated with corresponding SDI value in 2019 in 204 countries/territories and 21 regions.

CONCLUSION

These findings highlight significant improvement in MSMI care in the past three decades, particularly in the low and low-middle SDI regions. However, the increased burden and upward trends of MSMI in a few countries and regions are raising concern, which poses a serious challenge to maternal health. More tailored prevention measures and additional resources for maternal health are urgently needed to resolve this problem.

Maternal Pre-Pregnancy Obesity Combined With Abnormal Glucose Metabolism Further Increases Adverse Pregnancy Outcomes in Chinese Pregnant Women

AIMS

Our aim was to evaluate the separate and combined effects of maternal pre-pregnancy obesity and gestational abnormal glucose metabolism (GAGM) on adverse perinatal outcomes.

METHODS

A total of 2,796 Chinese pregnant women with singleton delivery were studied, including 257 women with pre-pregnancy obesity alone, 604 with GAGM alone, 190 with both two conditions, and 1,745 with neither pre-pregnancy obesity nor GAGM as control group. The prevalence and risks of adverse pregnancy outcomes were compared among the four groups.

RESULTS

Compared with the normal group, pregnant women with maternal pre-pregnancy obesity alone, GAGM alone, and both two conditions faced significantly increased risks of pregnancy-induced hypertension (PIH) (odds ratio (OR) 4.045, [95% confidence interval (CI) 2.286-7.156]; 1.993 [1.171-3.393]; 8.495 [4.982-14.485]), preeclampsia (2.649 [1.224-5.735]; 2.129 [1.128-4.017]; 4.643 [2.217-9.727]), cesarean delivery (1.589 [1.212-2.083]; 1.328 [1.095-1.611]; 2.627 [1.908-3.617]), preterm delivery (1.899 [1.205-2.993]; 1.358 [0.937-1.968]; 2.301 [1.423-3.720]), macrosomia (2.449 [1.517-3.954]; 1.966 [1.356-2.851]; 4.576 [2.895-7.233]), and total adverse maternal outcomes (1.762 [1.331-2.332]; 1.365 [1.122-1.659]; 3.228 [2.272-4.587]) and neonatal outcomes (1.951 [1.361-2.798]; 1.547 [1.170-2.046]; 3.557 [2.471-5.122]). Most importantly, there were no obvious risk differences in adverse pregnancy outcomes between maternal pre-pregnancy obesity and GAGM group except PIH, but pregnant women with both obesity and GAGM exhibited dramatically higher risks of adverse pregnancy outcomes than those with each condition alone.

CONCLUSIONS

Maternal pre-pregnancy obesity and GAGM were independently associated with increased risks of adverse pregnancy outcomes. The combination of pre-pregnancy obesity and GAGM further worsens adverse pregnancy outcomes compared with each condition alone.