Background:With an increasing proportion of multiparas,proper interpregnancy intervals(IPIs)are urgently needed.However,the association between IPIs and adverse perinatal outcomes has always been debated.This study ai...Background:With an increasing proportion of multiparas,proper interpregnancy intervals(IPIs)are urgently needed.However,the association between IPIs and adverse perinatal outcomes has always been debated.This study aimed to explore the association between IPIs and adverse outcomes in different fertility policy periods and for different previous gestational ages.Methods:We used individual data from China’s National Maternal Near Miss Surveillance System between 2014 and 2019.Multivariable Poisson models with restricted cubic splines were used.Each adverse outcome was analyzed separately in the overall model and stratified models.The stratified models included different categories of fertility policy periods(2014-2015,2016-2017,and 2018-2019)and infant gestational age in previous pregnancy(<28 weeks,28-36 weeks,and≥37 weeks).Results:There were 781,731 pregnancies enrolled in this study.A short IPI(≤6 months)was associated with an increased risk of preterm birth(OR[95%CI]:1.63[1.55,1.71]for vaginal delivery[VD]and 1.10[1.03,1.19]for cesarean section[CS]),low Apgar scores and small for gestational age(SGA),and a decreased risk of diabetes mellitus in pregnancy,preeclampsia or eclampsia,and gestational hypertension.A long IPI(≥60 months)was associated with an increased risk of preterm birth(OR[95%CI]:1.18[1.11,1.26]for VD and 1.39[1.32,1.47]for CS),placenta previa,postpartum hemorrhage,diabetes mellitus in pregnancy,preeclampsia or eclampsia,and gestational hypertension.Fertility policy changes had little effect on the association of IPIs and adverse maternal and neonatal outcomes.The estimated risk of preterm birth,low Apgar scores,SGA,diabetes mellitus in pregnancy,and gestational hypertension was more profound among women with previous term births than among those with preterm births or pregnancy loss.Conclusion:For pregnant women with shorter or longer IPIs,more targeted health care measures during pregnancy should be formulated according to infant gestational age in previous pregnancy.展开更多
The coronavirus disease 2019(COVID-19)caused by coronavirus SARS-CoV-2 infection has become a global pandemic due to the high viral transmissibility and pathogenesis,bringing enormous burden to our society.Most patien...The coronavirus disease 2019(COVID-19)caused by coronavirus SARS-CoV-2 infection has become a global pandemic due to the high viral transmissibility and pathogenesis,bringing enormous burden to our society.Most patients infected by SARS-CoV-2 are asymptomatic or have mild symptoms.展开更多
What is already known about this topic?An association between prenatal heatwave exposure and the risk of preterm birth was found.However,the disparities in heatwave-related preterm birth across different climate types...What is already known about this topic?An association between prenatal heatwave exposure and the risk of preterm birth was found.However,the disparities in heatwave-related preterm birth across different climate types have not been examined.What is added by this report?This nationwide case-crossover study investigated the association between heatwave exposure and preterm birth across different Köppen-Geiger climate types.Among pregnant women residing in the arid-desertcold climate type,exposure to compound heatwaves was found to be associated with a significantly higher risk of preterm birth{adjusted odds ratios(AORs)ranged from 1.55[95%confidence interval(CI):1.21-1.97]to 2.11(95%CI:1.35-3.31)}.In contrast,among pregnant women residing in the tropical monsoonal climate type,exposure to daytime-only heatwaves was associated with an increased risk of preterm birth[AORs ranged from 1.25(95%CI:1.03-1.51)to 1.37(95%CI:1.05-1.77)].展开更多
Objective:To analyze the temporal trends of maternal mortality ratio(MMR)due to obstetric hemorrhage and its specific causes in Chinese mainland from 2000 to 2019,to identify whether the rate of change has accelerated...Objective:To analyze the temporal trends of maternal mortality ratio(MMR)due to obstetric hemorrhage and its specific causes in Chinese mainland from 2000 to 2019,to identify whether the rate of change has accelerated or slowed down during this period,and to find the prior cause of obstetric hemorrhage that needs to be intervened in the future.Methods:Individual information on maternal deaths and total number of live births from 336 surveillance sites across 31 provinces in Chinese mainland was collected from the National Maternal and Child Health Surveillance System between 2000 and 2019.Maternal death was defined according to the World Health Organization’s criterion.The final underlying cause of death was confirmed by the national review and was coded according to International Classification of Diseases-10.Linear trends for changes in characteristics of maternal deaths were assessed using linear or logistic models with the year treated as a continuous variable.The MMR and 95%confidence intervals(CI)for regions or causes were estimated by Poisson’s distribution.Joinpoint regression was used to assess the accurate temporal patterns.Results:The national MMR due to obstetric hemorrhage was 18.4 per 100,000 live births(95%CI:15.0–22.2)in 2000.It peaked in 2001(22.1 per 100,000 live births,95%CI:18.3–26.4)and was lowest in 2019(1.6 per 100,000 live births,95%CI:1.0–2.3).For specific regions,the MMR due to obstetric hemorrhage in rural areas and western regions both experienced a slight rise,followed by a rapid decline,and then a slow decline.For specific causes,no change point was found in joinpoint analysis of the national MMR caused by placenta previa,postpartum uterine atony,and retained placenta(the annual percent change was12.0%,10.5%,and21.0%,respectively).The MMR caused by postpartum hemorrhages(PPH)significantly declined by 8.0%(95%CI:1.9–13.6)per year from 2000 to 2007.The annual percent change of MMR caused by PPH accelerated further to25.0%between 2007 and 2011,and then decreased to7.8%between 2011 and 2019.The proportion of maternal deaths due to antepartum hemorrhages increased from 7.6%(8/105)in 2000 to 14.3%(4/28)in 2019.The changes in the proportion of causes were different for maternal deaths due to PPH.The proportion of postpartum uterine atony increased from 39.0%(41/105)in 2000 to 60.7%(17/28)in 2019,and the proportion of uterine rupture also increased from 12.3%(13/105)in 2000 to 14.3%(4/28)in 2019.However,the proportion of retained placenta decreased from 37.1%(39/105)in 2000 to 7.1%(2/28)in 2019.Conclusion:Over the last 20 years,the intervention practice in China has proved that targeted interventions are beneficial in reducing the MMR due to obstetric hemorrhage.However,the MMR has reached a plateau and is likely to increase for some specific causes such as uterine rupture.China needs to develop more effective interventions to reduce maternal deaths due to obstetric hemorrhage,especially for postpartum uterine atony and uterine rupture.展开更多
基金supported by grants from the National Key Research and Development Program of China(Nos.2022YFC2704600,2022YFC2704605,2019YFC1005100)National Health Commission of the People’s Republic of China,the China Medical Board(No.11-065)+1 种基金WHO(No.CHN-12-MCN-004888)UNICEF(No.2016EJH016)
文摘Background:With an increasing proportion of multiparas,proper interpregnancy intervals(IPIs)are urgently needed.However,the association between IPIs and adverse perinatal outcomes has always been debated.This study aimed to explore the association between IPIs and adverse outcomes in different fertility policy periods and for different previous gestational ages.Methods:We used individual data from China’s National Maternal Near Miss Surveillance System between 2014 and 2019.Multivariable Poisson models with restricted cubic splines were used.Each adverse outcome was analyzed separately in the overall model and stratified models.The stratified models included different categories of fertility policy periods(2014-2015,2016-2017,and 2018-2019)and infant gestational age in previous pregnancy(<28 weeks,28-36 weeks,and≥37 weeks).Results:There were 781,731 pregnancies enrolled in this study.A short IPI(≤6 months)was associated with an increased risk of preterm birth(OR[95%CI]:1.63[1.55,1.71]for vaginal delivery[VD]and 1.10[1.03,1.19]for cesarean section[CS]),low Apgar scores and small for gestational age(SGA),and a decreased risk of diabetes mellitus in pregnancy,preeclampsia or eclampsia,and gestational hypertension.A long IPI(≥60 months)was associated with an increased risk of preterm birth(OR[95%CI]:1.18[1.11,1.26]for VD and 1.39[1.32,1.47]for CS),placenta previa,postpartum hemorrhage,diabetes mellitus in pregnancy,preeclampsia or eclampsia,and gestational hypertension.Fertility policy changes had little effect on the association of IPIs and adverse maternal and neonatal outcomes.The estimated risk of preterm birth,low Apgar scores,SGA,diabetes mellitus in pregnancy,and gestational hypertension was more profound among women with previous term births than among those with preterm births or pregnancy loss.Conclusion:For pregnant women with shorter or longer IPIs,more targeted health care measures during pregnancy should be formulated according to infant gestational age in previous pregnancy.
基金The work was supported by grants from The Science Technology and Innovation Committee of Shenzhen Municipality[JCYJ20180507181627057 to M.-L.H.,JGSS20200225152648408,20220606141401003 to Y.H.]RGC General Research Fund of Hong Kong Special Administrative Region[11104020]and Strategic funds from City University of Hong Kong to M.-L.H.
文摘The coronavirus disease 2019(COVID-19)caused by coronavirus SARS-CoV-2 infection has become a global pandemic due to the high viral transmissibility and pathogenesis,bringing enormous burden to our society.Most patients infected by SARS-CoV-2 are asymptomatic or have mild symptoms.
基金Project on Mechanism-Based Precise and Integrated Strategies for Preventing and Managing Preterm Birth(2022YFC2704600,2022YFC2704605)funded by The National Key Research and Development Program of China.Public Health Issues Arising from Climate Change(grant 202046)+1 种基金funded by the Chinese Ministry of Ecology and Environment.Project on the Establishment of China-ASEAN Science and Technology Cooperation Center for Public Health(KY202101004)funded by The National Key Research and Development Program of China.
文摘What is already known about this topic?An association between prenatal heatwave exposure and the risk of preterm birth was found.However,the disparities in heatwave-related preterm birth across different climate types have not been examined.What is added by this report?This nationwide case-crossover study investigated the association between heatwave exposure and preterm birth across different Köppen-Geiger climate types.Among pregnant women residing in the arid-desertcold climate type,exposure to compound heatwaves was found to be associated with a significantly higher risk of preterm birth{adjusted odds ratios(AORs)ranged from 1.55[95%confidence interval(CI):1.21-1.97]to 2.11(95%CI:1.35-3.31)}.In contrast,among pregnant women residing in the tropical monsoonal climate type,exposure to daytime-only heatwaves was associated with an increased risk of preterm birth[AORs ranged from 1.25(95%CI:1.03-1.51)to 1.37(95%CI:1.05-1.77)].
基金supported by the Key Research and Development Projects,Science&Technology Department of Sichuan Province(grant no.2022YFS0042).
文摘Objective:To analyze the temporal trends of maternal mortality ratio(MMR)due to obstetric hemorrhage and its specific causes in Chinese mainland from 2000 to 2019,to identify whether the rate of change has accelerated or slowed down during this period,and to find the prior cause of obstetric hemorrhage that needs to be intervened in the future.Methods:Individual information on maternal deaths and total number of live births from 336 surveillance sites across 31 provinces in Chinese mainland was collected from the National Maternal and Child Health Surveillance System between 2000 and 2019.Maternal death was defined according to the World Health Organization’s criterion.The final underlying cause of death was confirmed by the national review and was coded according to International Classification of Diseases-10.Linear trends for changes in characteristics of maternal deaths were assessed using linear or logistic models with the year treated as a continuous variable.The MMR and 95%confidence intervals(CI)for regions or causes were estimated by Poisson’s distribution.Joinpoint regression was used to assess the accurate temporal patterns.Results:The national MMR due to obstetric hemorrhage was 18.4 per 100,000 live births(95%CI:15.0–22.2)in 2000.It peaked in 2001(22.1 per 100,000 live births,95%CI:18.3–26.4)and was lowest in 2019(1.6 per 100,000 live births,95%CI:1.0–2.3).For specific regions,the MMR due to obstetric hemorrhage in rural areas and western regions both experienced a slight rise,followed by a rapid decline,and then a slow decline.For specific causes,no change point was found in joinpoint analysis of the national MMR caused by placenta previa,postpartum uterine atony,and retained placenta(the annual percent change was12.0%,10.5%,and21.0%,respectively).The MMR caused by postpartum hemorrhages(PPH)significantly declined by 8.0%(95%CI:1.9–13.6)per year from 2000 to 2007.The annual percent change of MMR caused by PPH accelerated further to25.0%between 2007 and 2011,and then decreased to7.8%between 2011 and 2019.The proportion of maternal deaths due to antepartum hemorrhages increased from 7.6%(8/105)in 2000 to 14.3%(4/28)in 2019.The changes in the proportion of causes were different for maternal deaths due to PPH.The proportion of postpartum uterine atony increased from 39.0%(41/105)in 2000 to 60.7%(17/28)in 2019,and the proportion of uterine rupture also increased from 12.3%(13/105)in 2000 to 14.3%(4/28)in 2019.However,the proportion of retained placenta decreased from 37.1%(39/105)in 2000 to 7.1%(2/28)in 2019.Conclusion:Over the last 20 years,the intervention practice in China has proved that targeted interventions are beneficial in reducing the MMR due to obstetric hemorrhage.However,the MMR has reached a plateau and is likely to increase for some specific causes such as uterine rupture.China needs to develop more effective interventions to reduce maternal deaths due to obstetric hemorrhage,especially for postpartum uterine atony and uterine rupture.
