Early-term birth and its association with universal two-child policy: a national cross-sectional study in China

Abstract

ObjectiveTo describe the epidemiology of early-term birth (ETB) at the national level in China, and explore the association and mediating factors between ETB and policy between universal two-child policy and ETB, so as to explain the potential reason for such a relationship and provide evidence for future ETB interventions in the era of the new birth control policy.DesignCross-sectional study.ParticipantsThe cross-sectional study used data from China Labour and Delivery Survey between 2015 and 2016. A total of 75 132 survey data collected from 89 hospitals in 25 provinces were included in the analysis. We further explored the association between the universal two-child policy and ETB.ResultsThe weighted incidence of ETB was 30.1 per 100 all births (95% CI 30.06% to 30.14%) or 29.88 per 100 live births (95% CI 29.97% to 30.05%) between 2015 and 2016 in China. There was an association between the universal two-child policy and ETB (relative risk, RR 1.19, 95% CI 1.15 to 1.23), which was not mediated by maternal age (RR 1.17, 95% CI 1.13 to 1.22), previous uterine scars (RR 1.18, 95% CI 1.14 to 1.22), parity (RR 1.19, 95% CI 1.15 to 1.24) and other measured conditions (each p<0.05). Stratified analysis showed that the association between universal two-child policy and ETB were the strongest in multiparous young women or women without previous uterine scars (each p<0.05), and disappeared in all women of advanced maternal age (each p>0.05).ConclusionThe incidence of ETB was high in China when compared with most of reported countries, and there might be a link between two-child policy and ETB. Obstetric practice such as selective induced labour and caesarean section should be revised with ETB risks in mind, when ETB is more likely to happen under the universal two-child policy. Preventing ETB should not be neglected in multiparous young women or those without previous uterine scars under the new policy.

Changes in the characteristics and outcomes of pregnant women who delivered prior to and after China’s universal two-child policy: A real-world retrospective study, 2010-2021

“…Recently, a signi cantly increased risk of preterm birth was reported in the TCP period. Zhang [13] observed that more pregnant women, who delivered before 37 gestational weeks suffered from complications, including preeclampsia, oligohydramnios and placenta previa, during the TCP period. In contrast to previous studies [7] , we found no signi cant difference in the risk of preterm birth in pregnancies among women with AMA during the TCP period.…”

Dynamics of parainfluenza virus among hospitalized children with acute respiratory tract infection under two‐child policy and COVID‐19 pandemic in Hubei Province, China, 2014–2022

“…After the announcement in October 2015, the universal two‐child policy has been associated with a rise in births and that women giving birth have been more likely to be aged 35 years and over 9 . Whether the universal two–child policy would cause adverse outcomes has not been clear, 9,10 though, a national cross‐sectional study in China by Zhang et al showed that ETB was found to be more likely to happen under the universal two‐child policy, 11 and a wide range of adverse pregnancy outcomes have been proved to be associated with women of advanced maternal age including ETB and low birth weight and macrosomia which make these newborns more vulnerable to pathogen infections due to the less developmental immature immune system (e.g., lower level of immunoglobulins, antimicrobial peptides and proteins, and complement proteins) responsible for eliminating the pathogens 12,24–26 . Besides, Yuan et al reported that the incidence of obstetric infection increased nearly twice after the universal two‐child policy, which might also increase the risk of infection of the newborns 27 .…”

“…Since the announcement in October 2015 and implementation in January 2016 in China, the universal two‐child policy has been associated with a rise in births and that women giving birth have been more likely to be aged 35 years and over 9 . Whether the universal two–child policy would cause adverse outcomes remained unclear, 9,10 however, one study has reported an association between the universal two‐child policy and early‐term birth (ETB) 11 . ETB could lead to immunocompromise due to the lower levels of soluble factors in premature children such as immunoglobulins, antimicrobial peptides, and proteins and complement proteins, and so forth which are responsible for eliminating the pathogens 12 …”

“…9 Whether the universal two-child policy would cause adverse outcomes remained unclear, 9,10 however, one study has reported an association between the universal twochild policy and early-term birth (ETB). 11 ETB could lead to immunocompromise due to the lower levels of soluble factors in premature children such as immunoglobulins, antimicrobial peptides, and proteins and complement proteins, and so forth which are responsible for eliminating the pathogens. 12 The coronavirus disease 2019 (COVID-19) pandemic and subsequent implementation of nonpharmaceutical interventions (NPIs) such as cessation of global travel, mask use and physical distancing etc.…”

“…After the announcement in October 2015, the universal two-child policy has been associated with a rise in births and that women giving birth have been more likely to be aged 35 years and over 9. Whether the universal two-child policy would cause adverse outcomes has not been clear,9,10 though, a national cross-sectional study in China byZhang et al showed that ETB was found to be more likely to happen under the universal two-child policy,11 and a wide range of adverse pregnancy outcomes have been proved to be associated with women of advanced maternal age including ETB and low birth weight andF I G U R E 2 The heat map of positive rates of different types of parainfluenza virus (PIV) among all children. (A) PIV.…”