Changes in adverse pregnancy outcomes in women with advanced maternal age (AMA) after the enactment of China’s universal two-child policy

Li, Hui; Nawsherwan, Nawsherwan; Fan, Cuifang; Yin, Shanshan; Haq, Ijaz ul; Mubarik, Sumaira; Nabi, Ghulam; Khan, Suliman; Hua, Liang

doi:10.1038/s41598-022-08396-6

Cited by 24 publications

(16 citation statements)

References 56 publications

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“…We observed a higher risk ratio for perinatal mortality, IUGR, and fetal distress in the period 2017-2019. The increased risk of adverse perinatal outcomes in the period 2017-2019 would be explained by the announcement of China's universal two-child policy (2015), the increased trend of women with AMA, the higher incidence rate of C-section, HDP, abnormal placentation, and multiparity 37 . The new China's universal two-child policy may have increased the tendencies toward fertility desires among older women.…”

Section: Discussionmentioning

confidence: 99%

Secular trends and age-period-cohort effect on adverse perinatal outcomes in Hubei, China (2011–2019)

Shi

Ahmed

et al. 2022

Sci Rep

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The increasing trend in the incidence of adverse perinatal outcomes is a public health concern globally as well as in China. However, the causes of the increasing trend are not well understood. The present tertiary-hospital-based retrospective study (2011–2019) aims to determine the secular trends and age-period-cohort effect on adverse perinatal outcomes in Hubei, China. The age-standardized incidence rates of adverse perinatal outcomes significantly decreased such as preterm births by 22% [AAPC − 3.4% (95% CI − 7.8, − 1.2)], low birth weight (LBW) by 28.5% [AAPC − 4.7% (95% CI − 6.0, − 3.3)], and fetal distress by 64.2% [AAPC − 14.0% (95% CI − 17.8, − 10.0)] during 2011–2019. Both extremes of maternal age groups (18–20 years and 42–44 years) had a higher risk ratio for adverse perinatal outcomes including preterm birth, perinatal mortality, LBW, low ponderal index (LPI), low Apgar score, and congenital defect compared to the reference age group (30–32 years). A higher risk ratio for perinatal mortality, intrauterine growth restriction (IUGR), and fetal distress and a lower risk ratio for preterm births and LBW were observed in the period 2017–2019. Both the young cohort (1997–1999) and the old cohort (1976–1969) had a higher risk ratio for preterm birth, perinatal mortality, macrosomia, and congenital defect compared to the reference cohort (1982–1984). In conclusion, some of the adverse perinatal outcomes incidence significantly decreased in the last 9 years in Hubei. However, extremes of maternal age groups and both young and old cohorts were associated with a higher risk of preterm birth, perinatal mortality, and congenital defect.

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Section: Discussionmentioning

confidence: 99%

Secular trends and age-period-cohort effect on adverse perinatal outcomes in Hubei, China (2011–2019)

Shi

Ahmed

et al. 2022

Sci Rep

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“…Most participants agreed that in the inner setting, insu cient sta ng and implementation time were the main barriers. In China, since the endorsement of the two-child policy in 2016, the number of advanced maternal age has increased (29,30). There is no doubt that the workload of nurses continues to increase, resulting in a lack of time to learn and implement the guidelines.…”

Section: Discussionmentioning

confidence: 99%

Barrier identification and implementation strategy integration in the guidelines of optimal postpartum care for advanced maternal age in China: a study based on the CFIR-ERIC implementation strategy matching tool

Deng

Yang

Wang

et al. 2022

Preprint

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Background Due to advanced maternal age facing great risks of fertility, such as gestational hypertension, postpartum haemorrhage, miscarriage, etc., we must attach importance to postpartum care. Guidelines for optimal postpartum care are available. It is of great significance to identify potential barriers and tailor practical implementation strategies before implementing the guidelines. The purpose of this study aimed to use the implementation science methods to develop implementation strategies that could promote the implementation of postpartum care guidelines in clinical practice. Methods Purposive sampling was used to recruit 13 obstetric nurses who had previously participated in the implementation of the postnatal care guidelines for semi-structured interviews. The Consolidated Framework for Implementation Research (CFIR) of 39 structures guided us in collecting and analysing interview data to identify barriers. We then determined implementation strategies by using Consolidated Framework for Implementation Research–Expert Recommendations for Implementing Change (CFIR-ERIC) Implementation Strategy Matching Tool and taking into account the local context. Results The interview content was categorized, coded, and explained, and finally ten barriers were identified, including Evidence Strength & Quality, Complexity, Patient Needs & Resources, Compatibility, Structural Characteristics, Access to knowledge and information, Learning Climate, Knowledge & Beliefs about the Intervention, Self-efficacy, Key Stakeholders. Under the guidance of the CFIR-ERIC Implementation Strategy Matching Tool, some implementation strategies were developed to address these barriers for clinical nurses and the needs of patients and their families, which include conducting educational meetings, developing educational materials for nurses and patients, obtaining feedback from women and their families to meet their needs, rationalize implementation time, improve clinical assessment tools, streamline guideline-based workflows. Conclusion We can apply the CFIR-ERIC Implementation Strategy Matching Tool to select the best implementation strategies to address the barriers based on CFIR and promote the implementation of optimal postpartum care guidelines for advanced maternal age.

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“…The C-section is also quite common in China [ 5 ]. After the implementation of the two-child policy in this country, the incidence of placenta accreta has increased dramatically in recent years [ 6 ]. At present, caesarean section is the main option for the termination of pregnancy in a case of abnormally implanted placenta, which is invasive and traumatic, making postoperative recovery slow and difficult [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…After the implementation of the two-child policy in this country, the incidence of placenta accreta has increased dramatically in recent years [ 6 ]. At present, caesarean section is the main option for the termination of pregnancy in a case of abnormally implanted placenta, which is invasive and traumatic, making postoperative recovery slow and difficult [ 6 ]. Consequently, post caesarean care is becoming increasingly significant and challenging for obstetrics care centres in China [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Embedding evidence of early postoperative off-bed activities and rehabilitation in a real clinical setting in China: an interrupted time-series study

et al. 2022

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Background Patients should be encouraged to mobilize with 24 h of caesarean section. However, the time of the first off-bed activity after surgery is usually 24 ~ 48 h in China. Due to the lack of knowledge of early off-bed activities, lack of attention to medical pain, and the absence of systematic evidence for the clinical transformation process. the aim of this study was showed that the application of evidence needs to be embedding in the real setting to construct the localization plan and achieve the effective result. Methods To establish evidence of the benefits of early postoperative off-bed activities on patients’ well-being based on a literature review. An interrupted time series analysis was used to evaluate the effectiveness of the intervention. The first and third periods were both five months (from February 1st, 2019 to January 31st, 2020), with a two-month interrupted time (from July 1st, 2019 to August 31st, 2019). Results Eight clinical practices were retrieved from the literature and incorporated into the intervention. A total of 465 patients were included: 226 patients before and 239 patients after implementing the intervention. The average onset time of postoperative off-bed activities was significantly earlier after the intervention than before the intervention (20.01 vs. 31.89 h after the operation, P < 0.001). The 24-h off-bed rate increased from 30.94% before to 91.21% after the intervention (P < 0.001). The average pain score of patients decreased from 5.23 points before to 3.82 points after the intervention (P = 0.032). The average postoperative hospital stay was shortened from 5.06 days before to 3.51 days after the intervention (P < 0.001). In addition, the incidence rates of postoperative ileus (POI) and infection decreased from 5.38% and 2.65% before to 1.67% and 0.84% after the intervention, respectively (P < 0.001). Conclusions We established an evidence-based nursing intervention. Evaluation of the effect of evidence-based practices should be considered in the clinical setting and include preoperative health education, effective analgesia management, and safety management.

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Changes in adverse pregnancy outcomes in women with advanced maternal age (AMA) after the enactment of China’s universal two-child policy

Cited by 24 publications

References 56 publications

Secular trends and age-period-cohort effect on adverse perinatal outcomes in Hubei, China (2011–2019)

Secular trends and age-period-cohort effect on adverse perinatal outcomes in Hubei, China (2011–2019)

Barrier identification and implementation strategy integration in the guidelines of optimal postpartum care for advanced maternal age in China: a study based on the CFIR-ERIC implementation strategy matching tool

Embedding evidence of early postoperative off-bed activities and rehabilitation in a real clinical setting in China: an interrupted time-series study

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