The Sex Ratio at Birth for 5,338,853 Deliveries in China from 2012 to 2015: A Facility-Based Study

Huang, Yan; Wen, Tian; Mu, Yi; Li, Xiaohong; Liu, Zheng; Wang, Yanping; Li, Mingrong; Li, Qi; Dai, Li; Liang, Juan; Zhu, Jun

doi:10.1371/journal.pone.0167575

Cited by 19 publications

(17 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The NMNMSS is a well established surveillance system with rigorous quality controls, 29 47 but data and analytical limitations need to be acknowledged. Firstly, this is not an intervention study and it is not possible to attribute the decline in caesarean sections to one particular policy.…”

Section: Discussionmentioning

confidence: 99%

Relaxation of the one child policy and trends in caesarean section rates and birth outcomes in China between 2012 and 2016: observational study of nearly seven million health facility births

Liang

et al. 2018

BMJ

Self Cite

162

185

View full text Add to dashboard Cite

ObjectiveTo examine how the relaxation of the one child policy and policies to reduce caesarean section rates might have affected trends over time in caesarean section rates and perinatal and pregnancy related mortality in China.DesignObservational study.SettingChina’s National Maternal Near Miss Surveillance System (NMNMSS).Participants6 838 582 births at 28 completed weeks or more of gestation or birth weight ≥1000 g in 438 hospitals in the NMNMSS between 2012 and 2016.Main outcome measuresObstetric risk was defined using a modified Robson classification. The main outcome measures were changes in parity and age distributions and relative frequency of each Robson group, crude and adjusted trends over time in caesarean section rates within each risk category (using Poisson regression with a robust variance estimator), and trends in perinatal and pregnancy related mortality over time.ResultsCaesarean section rates declined steadily between 2012 and 2016 (crude relative risk 0.91, 95% confidence interval 0.89 to 0.93), reaching an overall hospital based rate of 41.1% in 2016. The relaxation of the one child policy was associated with an increase in the proportion of multiparous births (from 34.1% in 2012 to 46.7% in 2016), and births in women with a uterine scar nearly doubled (from 9.8% to 17.7% of all births). Taking account of these changes, the decline in caesarean sections was amplified over time (adjusted relative risk 0.82, 95% confidence interval 0.81 to 0.84). Caesarean sections declined noticeably in nulliparous women (0.75, 0.73 to 0.77) but also declined in multiparous women without a uterine scar (0.65, 0.62 to 0.77). The decrease in caesarean section rates was most pronounced in hospitals with the highest rates in 2012, consistent with the government’s policy of targeting hospitals with the highest rates. Perinatal mortality declined from 10.1 to 7.2 per 1000 births over the same period (0.87, 0.83 to 0.91), and there was no change in pregnancy related mortality over time.ConclusionsChina is the only country that has succeeded in reverting the rising trends in caesarean sections. China’s success is remarkable given that the changes in obstetric risk associated with the relaxation of the one child policy would have led to an increase in the need for caesarean sections. China’s experience suggests that change is possible when strategies are comprehensive and deal with the system level factors that underpin overuse as well as the various incentives at work during a clinical encounter.

show abstract

Section: Discussionmentioning

confidence: 99%

Relaxation of the one child policy and trends in caesarean section rates and birth outcomes in China between 2012 and 2016: observational study of nearly seven million health facility births

Liang

et al. 2018

BMJ

Self Cite

162

185

View full text Add to dashboard Cite

show abstract

“…To account for this, we weighted the proportion of stillbirths in the surveillance system’s sampling distribution of the population according to China’s 2010 census, as detailed in other publications. 2 , 15 …”

Section: Methodsmentioning

confidence: 99%

Hypertensive disorders in pregnancy and stillbirth rates: a facility-based study in China

Xiong

Liang

et al. 2018

Bull. World Health Organ.

Self Cite

View full text Add to dashboard Cite

ObjectiveTo assess the association between hypertensive disorders in pregnancy and the stillbirth rate.MethodsWe obtained all data from China’s National Maternal Near Miss Surveillance System for 2012 to 2016. Associations between hypertensive disorders in pregnancy and stillbirths, stratified by fetus number and gestational age, were assessed using Poisson regression analysis with a robust variance estimator.FindingsFor the period, 6 970 032 births, including 66 494 stillbirths, were reported to the surveillance system. The weighted stillbirth rate in women with a hypertensive disorder in pregnancy was 21.9 per 1000 births. The risk was higher in those who had received few antenatal care visits or who were poorly educated. For singleton pregnancies, the adjusted risk ratio (aRR) for a stillbirth among women with hypertensive disorders in pregnancy compared with normotensive women was 3.1 (95% confidence interval, CI: 2.85–3.37). The aRR for hypertensive disorder subtypes was: 6.66 (95% CI: 5.57–7.96) for superimposed preeclampsia; 4.15 (95% CI: 3.81–4.52) for preeclampsia or eclampsia; 2.32 (95% CI: 1.87–2.88) for chronic hypertension; and 1.21 (95% CI: 1.08–1.36) for gestational hypertension. For multiple pregnancies, the association between stillbirths and hypertensive disorders in pregnancy was not significant, except for superimposed preeclampsia (aRR: 1.95; 95% CI: 1.28–2.97).ConclusionTo minimize the incidence of stillbirths, more attention should be paid to chronic hypertension and superimposed preeclampsia in singleton pregnancies and to superimposed preeclampsia in multiple pregnancies. Better quality antenatal care and improved guidelines are needed in China.

show abstract

“…-1,10 [10]. В 90-х годах XX в. рост СПР был отмечен в некоторых странах Кавказа (Азербайджане, Армении и Грузии) [11,12] [13].…”

Section: медицинские показания к выбору пола плодаunclassified

Assisted reproductive technologies and legal aspects of sex selection

Хаят

Kurilo

Черных

2019

Androl. genit. hir.

View full text Add to dashboard Cite

show abstract

The Sex Ratio at Birth for 5,338,853 Deliveries in China from 2012 to 2015: A Facility-Based Study

Cited by 19 publications

References 14 publications

Relaxation of the one child policy and trends in caesarean section rates and birth outcomes in China between 2012 and 2016: observational study of nearly seven million health facility births

Relaxation of the one child policy and trends in caesarean section rates and birth outcomes in China between 2012 and 2016: observational study of nearly seven million health facility births

Hypertensive disorders in pregnancy and stillbirth rates: a facility-based study in China

Assisted reproductive technologies and legal aspects of sex selection

Contact Info

Product

Resources

About