Objective To measure the association of China’s universal two child policy, announced in October 2015, with changes in births and health related birth characteristics. Design National, descriptive before-and-after comparative study. Setting Every county in 28 of 31 provinces of mainland China. Participants Births included in two national databases: 67 786 749 births from county level monthly aggregated data between January 2014 and December 2017; and 31 786 279 deliveries from individual level delivery information records between January 2015 and December 2017. Main outcome measures Monthly mean number of births and mean proportion of multiparous mothers and mothers aged 35 and over, preterm deliveries, and caesarean deliveries. Results The study had two phases: the baseline period (up to and including June 2016, nine months after the policy announcement) and the effective period (from July 2016 to December 2017). The estimated number of additional births attributable to the new policy between July 2016 and December 2017 was 5.40 million (95% confidence interval 4.34 to 6.46). The monthly mean percentage of multiparous mothers and mothers aged 35 and over increased by 9.1 percentage points (95% confidence interval 6.4 to 11.7) and 5.8 percentage points (5.2 to 6.4), respectively. This increase in older mothers, however, was not associated with a concurrent increase in the overall rate of preterm birth. The monthly mean caesarean delivery rate among multiparous mothers increased by 1.2 percentage points (0.8 to 1.6) from 39.7% to 40.9%, and decreased by 3.0 percentage points (−3.5 to −2.5) among nulliparous mothers from 39.6% to 36.6%. Conclusions Since its announcement in October 2015, the universal two child policy has been associated with a rise in births in China and with changes in health related birth characteristics: women giving birth have been more likely to be multiparous, and more likely to be aged 35 and over. No evidence of concurrent worsening outcomes (that is, premature births) was seen.

This study uses China’s National Maternal and Child Health Statistics data set to characterize trends in cesarean delivery rates overall and by urban and rural

Jan Blustein and Jianmeng Liu examine the evidence linking caesarean delivery with childhood chronic disease and say that guidelines on delivery should be reviewed with these risks in mind Caesarean delivery can improve maternal and child health, and even save lives. But the past two decades have brought a sharp growth in caesareans in many nations, raising concerns about unnecessarily high rates. Caesarean delivery on maternal request is relatively rare in the UK (1-2% of births) and US (3% of births). But in some middle income countries the rate is high and growing (20% of births in southeastern China in 2006), making it an emerging global public health concern. Another contributor to the rising rates is repeat caesarean. Although this is not necessarily medically indicated in women with otherwise low obstetrical risk, among US births to women with prior caesarean in 2006, over 90% were caesarean deliveries. Prospective parents want a delivery that is safe for the baby.1 In emergencies, or when a fetal or maternal indication is present, the choice is clear. But in cooler moments, such as repeat or maternal choice of caesarean, it makes sense to consider the risks and benefits of caesarean versus vaginal delivery, just as we would for other medical treatments. Both modes of delivery are associated with well known acute risks. For the neonate, for example, a caesarean is associated with increased risk of admission to a neonatal intensive care unit and vaginal delivery with a greater likelihood of cephalohaematoma. To date, concerns around long term child health have largely focused on neurological impairment. But recent research points to latent risks for chronic disease: children delivered by caesarean have a higher incidence of type 1 diabetes, obesity, and asthma. We argue that a detailed assessment of these risks should be taken into …

About 3 million stillbirths and 3 million early neonatal deaths occurred worldwide in 2004, 98% of which were in less developed countries.¹ A high perinatal mortality rate was reported in rural China in 2000.² Potential preventable causes of stillbirths and early neonatal deaths are maternal anemia and related micronutrient deficiencies.³ Quiz Ref ID Aside from perinatal folic acid supplements to prevent neural tube defects, multiple health organizations recommend pregnant women routinely receive iron–folic acid supplements to prevent anemia.⁴ Meta-analyses of randomized controlled trials (RCTs) indicate that daily prenatal iron–folic acid supplementation prevents iron deficiency and anemia.^5,6 The effect of prenatal iron–folic acid supplementation on perinatal mortality and other maternal and infant outcomes remains unclear, particularly among nonanemic women. Thus, some question the added benefit of prophylactic iron supplementation.⁷

Adverse pregnancy outcomes remain a major global health threat [1,2]. They occur due to several factors, with maternal age being the most relevant one [3–5]; however, evidence on its association with pregnancy outcome is currently unsatisfactory for clinical consultation [3,6,7]. Previous studies used 35 years as the threshold of advanced maternal age, despite a lack […]