Changes in maternal age and prevalence of congenital anomalies during the enactment of China's universal two-child policy (2013–2017) in Zhejiang Province, China: An observational study

Abstract

Background China implemented a partial two-child policy (2013) followed by a universal two-child policy (2015), replacing the former one-child policy mandated by the government. The changes affect many aspects of China's population as well as maternal and infant health, but their potential impact on birth defects (BDs) remains unknown. In this study, we investigated the associations of these policy changes with BDs in Zhejiang Province, China. Methods and findings We used data from the BD surveillance system in Zhejiang Province, China, which covers 90 hospitals in 30 urban districts and rural counties, capturing one-third of the total births in this province. To fully consider the time interval between conception and delivery, we defined the one-child policy period as data from 2013 (births from October 2012 to September 2013), the partial two-child policy period as data from 2015 (births from October 2014 to September 2015), and the universal two-child policy period as data from 2017 (births from October 2016 to September 2017). Data from 2009 and 2011 were also used to show the changes in the proportion of births to women with advanced maternal age (35 years and older) prior to the policy changes. Main outcome measures were changes in the proportion of mothers with advanced maternal age, prevalence of BDs, rankings of BD subtypes by prevalence, prenatal diagnosis rate, and live birth rate of BDs over time. A total of 1,260,684 births (including live births, early fetal losses, stillbirths, and early neonatal deaths) were included in the analyses. Of these, 644,973 (51.16%) births were to women from urban

Epidemiology, prenatal diagnosis, and neonatal outcomes of congenital heart defects in eastern China: a hospital-based multicenter study

“…However, better CHD screening, technology, and follow-up may also have contributed to the increase observed in both Guangdong Province in China and in Europe [15,25]. Since birth policy adjustment, changes of maternal characteristics could also partly explain the upward trend of total CHD [22]. There was a strengthen in neonatal CHD screening strategy in 2018 in China, and the incidence of CHD increased then compared with 2017 and before.…”

Induction of labour in mid-trimester pregnancy using double-balloon catheter placement within 12 hours versus within 12-24 hours

“…Zhang X et al [15] analyzed 1,260,684 births from the surveillance system in Zhejiang province, China, and found that the rate of birth defects during 2013, 2015, and 2017 was 245.95, 264.86, and 304.36 per 10,000 births, respectively, and there was age-related anomalies after the release of China's new two-child policy. There were many clinical problems during induced labor need to be solved, especially complete placenta previa [16], and immature cervical condition [2]. More and more women in developing countries choose to postpone pregnancy [17], and studies have found an association between elder pregnant women and a high risk of chromosomal abnormalities, miscarriages and preterm birth with gestation of less than 34 weeks.…”

Epidemiology, Prenatal Diagnosis, and Neonatal Outcomes of Congenital Heart Defects in Eastern China: A Hospital-Based Multicenter Study

“…In our view, we also could not ignore the influences from changes of maternal characteristics with birth policy shifts. Particularly, women with advanced age increased significantly throughout the period [21].…”

“…Throughout the period of birth policy adjustment, we noticed significant changes of childbearing women and the strengthen of congenital anomalies prevention. However, CHD has remained as the leading malformation with increasing trend [21]. Zhejiang Province is located in eastern China and total population is approximately 57 million [22].…”