Analysis of prenatal diagnosis before and after implementation of the two-child policy in northeastern China

Abstract

The universal two-child policy has now been fully implemented in China. This change requires adaptations to maternal care and childcare systems, but the features of prenatal diagnosis before and after implementation of the policy have not been reported.We conducted a retrospective study of 6736 prenatal cytogenetic diagnoses performed on amniotic fluid cells over a 4-year period, including 2 years before and after implementation of the second child policy. Amniotic fluid cells collected through amniocentesis were cultured, harvested, and stained for chromosome analysis using standard laboratory protocols.The study included 3222 pregnant women referred before implementation of the policy, which we used as a control group, and 3514 pregnant women referred after policy implementation as an investigational study group. There were significantly fewer pregnant women aged <25 years in the investigational group than in the control group (P < .001). There were no significant between-group differences for other pregnant women aged >31 years and 27–28 years old (P > .05). A total of 358 cases with chromosomal abnormalities were diagnosed, including 129 (4%, 129/3222) in the control group which was significantly lower than the 229 (6.5%, 229/3514) in the study group (P < .001). In particular, significantly more trisomy 21 cases were observed in the study group than in the control group (120 vs 59). More pregnant women underwent non-invasive prenatal testing (NIPT) in the study group (46%) than in the control group (20%). In the study group, the average age of pregnant women who underwent NIPT was significantly higher than that of women who did not receive NIPT (P < .05). However, there were no significant between-group differences for the control group (P > .05).The number of cases with chromosomal abnormalities increased in northeastern China in the 2 years after implementation of the two-child policy. The number of pregnant women of advanced maternal age did not increase significantly, perhaps because of the widespread application of NIPT. However, the number of fetuses with Down syndrome increased significantly, suggesting that prenatal screening and diagnosis should be strengthened.

Association of China’s two-child policy with changes in number of births and birth defects rate, 2008–2017

“…The trends of monthly percentage of birth defects did not change significantly during the partial two-child and universal two-child policy periods. This may be due to the enhanced public awareness of prenatal diagnosis that have been developed by the Chinese government to enhance prenatal screening and universal folic acid supplement use [ 26 ]. The top three subtypes of birth defects were the musculoskeletal system (Q65-Q79), the circulatory system (Q20-Q28), and the eye, ear, face, and neck system (Q10-Q18) during all periods.…”

Psychometric Assessment of the Mandarin Version of the Decisional Conflict Scale with Pregnant Women Making Prenatal Test Decisions

“… 3 Down syndrome can be prevented by screening and diagnostic tests available in many countries, including mainland China. 4 , 5 In mainland China, all pregnant women are offered screening for Down syndrome. 6 Women who book before 13 +6 weeks and accept Down syndrome screening are offered the serum biomarkers (PPAP-A, and free β-HCG) to determine risk.…”

Clinical Application of Chromosomal Microarray Analysis in Pregnant Women with Advanced Maternal Age and Fetuses with Ultrasonographic Soft Markers

“…In the past several decades, AMA has been an independent clinical indication of invasive prenatal diagnosis. For the past few years, the proportion of AMA pregnant woman has increased rapidly because of the full implementation of the universal two-child policy in China [ 2 ]. Abnormal chromosome numbers and the majority of structural chromosomal aberrations can be identified by conventional karyotyping.…”