| BackgroundA change in the child policy could trigger a new baby boom with changes in health related birth characteristics: more women aged 35 and over giving birth,but advanced maternal age have more risks of many maternal complications.While,its impacts on delivery characteristics in Southwestern China are still to be estimated.ObjectiveTo retrospectively investigate the changes in pregnancy outcomes of mothers and fetus who were delivered in our department before and after the change in China's fertility policy.MethodsThe clinical data of pregnant women with a gestational week ? 28 weeks who were delivered in our department from January 2012 to December 2018 were collected and grouped according to the time of fertility policy change:(1)Group A,one child policy: from January 1st,2012 to July 31 st,2014;(2)Group B,selective two child policy: fromAugust 1st,2014 to June 30 th,2016;(3)Group C,universal two child policy: from July 1st,2016 to the end of 2018.Comparing the three groups trends in the increase of childbirth,cesarean section rate,IVF-ET rate and sex ratio of newborns;exploring the age distribution of women in each group and the proportion of pregnant women;comparing the changes in pregnancy outcomes in each group.ResultsA total of 49,561 clinical data of mothers(48827 fetus)were included in this study,of which 14,778 women in group A had a cesarean delivery rate of 59.51%;14,376 women in group B had a cesarean delivery rate of50.94%;20,407 pregnant women in group C with a cesarean delivery rate of 55.08%.The annual delivery volume showed a significant increase,while the proportion of young mothers decreased significantly(0.58% vs0.42% vs 0.31%),the proportion of elderly mothers increased significantly(10.17% vs10.44% vs 15.05%),and the proportion of multipara also increased significantly(16.06% vs21.83% vs 34.00%)(P <0.05).Compared the three groups,the cesarean section rate showed a downward trend.The IVF-ET rates among the three groups A,B,and C were 1.10%,1.12%,and1.39%,showing an upward trend(P <0.05).There is no trend difference between the three groups of newborn sex ratio.In addition,The prevalence of preeclampsia,premature delivery,postpartum hemorrhage,fetal growth restriction,and fetal macrosomia were generally decreasing(P <0.05),ICUreferral rate(0.79% vs 0.49% vs 0.40%)also showed a significant downward trend(P <0.05);but the incidence of multiple pregnancies,dangerous placenta previa,premature rupture of membranes and placental abruption showed an overall upward trend(P <0.05);the incidence of ICP,GDM,AFLP,APIP,fetal abnormalities and severe neonatal asphyxia were no statistic difference.ConclusionWith the adjustment of China's fertility policy,the number of births in our department increased year by year,reaching its peak in 2016,and the cesarean delivery rate has a downward trend.This may depend on the choice of the first delivery method caused by the change in the desire to reproduce again under the control of fertility policy Change.At the same time,the incidence of preeclampsia,premature delivery,postpartum hemorrhage,fetal macrosomia,fetal growth restriction,maternal ICU referral rate was all decreasing.However,with the increase in the proportion of women with advanced maternal age and multipara,the incidence of dangerous placenta previa has increased significantly,which deserves the attention of obstetric workers. |
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