Frontiers in public health · 2025
The incidence, characteristics, and complications of pregnant women who delivered stillbirths under different child policies in central China.
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Xiong Lili, Xie Donghua, Jiang Qingyun, Fang Junqun
Аннотация
BACKGROUND: China's evolving fertility policies (one-child to three-child) have shaped maternal and neonatal outcomes, but specific gaps in stillbirth epidemiology during policy transitions.
METHODS: This retrospective cohort study analyzed 721,860 singleton pregnancies in 2011-2023, from 18 maternal near-miss surveillance hospitals in Hunan. Stillbirth rates were assessed across four policy periods: one-child (2011-2013), partial two-child (2013-2015), universal two-child (2016-2020), and three-child (2021-2023). Multivariable logistic regression identified risk factors, adjusting for fertility policy period, maternal demographics and maternal comorbidities. Trends over time were analyzed using segmented regression models.
RESULTS: The overall stillbirth rate was 7.02‰ (95% confidence interval [CI]: 6.82-7.21), declining significantly from 9.62‰ during the one-child policy to 5.73‰ (95%CI: 5.25-6.23) under the three-child policy (t = -4.22, p < 0.01). Key risk factors included maternal age < 24 years (adjusted odds ratio [aOR] = 1.77, 95%CI:1.63-1.92), multiparity (aOR = 1.27-2.82. p < 0.01), non-rural hospital delivery (aOR = 4.00-11.13, p < 0.01), education ≤9 years (aOR = 1.51-2.20, p < 0.01), not being married (aOR = 2.92-5.60, p < 0.01), and comorbidities: severe preeclampsia (aOR = 3.80, 95%CI: 3.36-4.29), chronic hypertension (aOR = 2.67, 95%CI: 2.09-3.37), placental abruption (aOR = 5.06, 95%CI: 4.11-6.16), and placenta previa (aOR = 1.55, 95%CI: 1.29-1.84). Paradoxically, prenatal diabetes was associated with reduced stillbirth risk (aOR = 0.86, 95%CI: 0.77-0.95). Temporal shifts revealed elevated stillbirth rates among advanced-age mothers pre-2016 versus rising rates in women <24 years post-policy liberalization. Only the partial two-child policy period (aOR = 1.15, 95%CI: 1.05-1.25) was associated with the risk of stillbirth.
CONCLUSION: China's fertility policy transitions correlate with dynamic stillbirth epidemiology, emphasizing age- and parity-specific vulnerabilities. Targeted interventions for high-risk subgroups, especially younger, less well-educated, multiparous women, and those with hypertensive or placental disorders, are critical amid ongoing implementation of the three-child policy.
METHODS: This retrospective cohort study analyzed 721,860 singleton pregnancies in 2011-2023, from 18 maternal near-miss surveillance hospitals in Hunan. Stillbirth rates were assessed across four policy periods: one-child (2011-2013), partial two-child (2013-2015), universal two-child (2016-2020), and three-child (2021-2023). Multivariable logistic regression identified risk factors, adjusting for fertility policy period, maternal demographics and maternal comorbidities. Trends over time were analyzed using segmented regression models.
RESULTS: The overall stillbirth rate was 7.02‰ (95% confidence interval [CI]: 6.82-7.21), declining significantly from 9.62‰ during the one-child policy to 5.73‰ (95%CI: 5.25-6.23) under the three-child policy (t = -4.22, p < 0.01). Key risk factors included maternal age < 24 years (adjusted odds ratio [aOR] = 1.77, 95%CI:1.63-1.92), multiparity (aOR = 1.27-2.82. p < 0.01), non-rural hospital delivery (aOR = 4.00-11.13, p < 0.01), education ≤9 years (aOR = 1.51-2.20, p < 0.01), not being married (aOR = 2.92-5.60, p < 0.01), and comorbidities: severe preeclampsia (aOR = 3.80, 95%CI: 3.36-4.29), chronic hypertension (aOR = 2.67, 95%CI: 2.09-3.37), placental abruption (aOR = 5.06, 95%CI: 4.11-6.16), and placenta previa (aOR = 1.55, 95%CI: 1.29-1.84). Paradoxically, prenatal diabetes was associated with reduced stillbirth risk (aOR = 0.86, 95%CI: 0.77-0.95). Temporal shifts revealed elevated stillbirth rates among advanced-age mothers pre-2016 versus rising rates in women <24 years post-policy liberalization. Only the partial two-child policy period (aOR = 1.15, 95%CI: 1.05-1.25) was associated with the risk of stillbirth.
CONCLUSION: China's fertility policy transitions correlate with dynamic stillbirth epidemiology, emphasizing age- and parity-specific vulnerabilities. Targeted interventions for high-risk subgroups, especially younger, less well-educated, multiparous women, and those with hypertensive or placental disorders, are critical amid ongoing implementation of the three-child policy.