PMID- 32928217 OWN - NLM STAT- MEDLINE DCOM- 20210211 LR - 20210211 IS - 1741-7015 (Electronic) IS - 1741-7015 (Linking) VI - 18 IP - 1 DP - 2020 Sep 15 TI - The trend of caesarean birth rate changes in China after 'universal two-child policy' era: a population-based study in 2013-2018. PG - 249 LID - 10.1186/s12916-020-01714-7 [doi] LID - 249 AB - BACKGROUND: The universal two-child policy in China which was announced in October 2015 might affect the caesarean birth rate. Few studies reported the caesarean birth rate affected by the policy especially after the universal two-child policy period. This study aimed to demonstrate the caesarean birth rate changes before and after the universal two-child policy and further elaborate the underlying influencing factors. METHODS: This nationwide, retrospective, population-based study was based on National Free Pre-Pregnancy Check-ups Project (NFPCP). Couples planning to conceive in next 6 months were encouraged to participate in NFPCP. Baseline information was collected using a standardized questionnaire with a face-to-face interview, and medical examinations were conducted. Two rounds of follow-up interviews were then conducted by trained nurses to update pregnancy status and outcomes. NFPCP participants who completed deliveries before December 31, 2018, were included in the current study. We used marginal effect of year to examine the trend of caesarean birth rate over time and interrupted time series (ITS) analysis to determine impacts of the universal two-child policy on the trend of caesarean birth rate. RESULTS: A total of 9,398,045 participants were included in the final analysis. High-risk factors to increase caesarean birth rate were identified. In the current study, the standardized caesarean birth rate declined from 34.1% in 2013 to 31.8% in 2015 and increased to 35.6% in 2018. ITS analysis showed the caesarean birth rate decreased by 0.1% (95% CI 0.1-0.1) per month before the release of universal two-child policy, 1.3% (95% CI 0.6-2.1%) absolute drop during the policy release month, and increased by 0.2% (95% CI 0.1-0.2%) per month after the policy implementation. For the period after the policy release, the increasing trends were observed in rural participants and urban primiparas. The prevalence of caesarean birth rates within China varied regionally. CONCLUSIONS: The decreasing trend of caesarean birth rate was reported after immediate release of the universal two-child policy. An increasing trend of caesarean birth rate was observed 2-3 years after the policy. It reminds us that the caesarean birth rate control is a long-lasting process and all the strategies need to be continually reinforced. FAU - Yan, Jie AU - Yan J AD - Department of Obstetrics and Gynecology, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, 100034, China. AD - China DOHaD Research Centre, China DOHaD Research Centre, National Human Genetic Resources Centre, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. FAU - Wang, Long AU - Wang L AD - China DOHaD Research Centre, China DOHaD Research Centre, National Human Genetic Resources Centre, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. AD - National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. AD - School of Public Health, Lanzhou University, No. 199 Donggang Road (West), Chengguang District, Lanzhou, 730000, China. FAU - Yang, Ying AU - Yang Y AD - China DOHaD Research Centre, China DOHaD Research Centre, National Human Genetic Resources Centre, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. yangying@nrifp.org.cn. AD - National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. yangying@nrifp.org.cn. AD - Graduate School of Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing, 100005, China. yangying@nrifp.org.cn. FAU - Zhang, Ya AU - Zhang Y AD - National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. FAU - Zhang, Hongguang AU - Zhang H AD - National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. FAU - He, Yuan AU - He Y AD - National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. FAU - Peng, Zuoqi AU - Peng Z AD - National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. FAU - Wang, Yuanyuan AU - Wang Y AD - National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. FAU - Wang, Qiaomei AU - Wang Q AD - Department of Maternal and Child Health, National Health Commission of the PRC, No. 1 Xizhimenwai Road (South), Xicheng District, Beijing, 100044, China. FAU - Shen, Haiping AU - Shen H AD - Department of Maternal and Child Health, National Health Commission of the PRC, No. 1 Xizhimenwai Road (South), Xicheng District, Beijing, 100044, China. FAU - Zhang, Yiping AU - Zhang Y AD - Department of Maternal and Child Health, National Health Commission of the PRC, No. 1 Xizhimenwai Road (South), Xicheng District, Beijing, 100044, China. FAU - Yan, Donghai AU - Yan D AD - Department of Maternal and Child Health, National Health Commission of the PRC, No. 1 Xizhimenwai Road (South), Xicheng District, Beijing, 100044, China. FAU - Ma, Xu AU - Ma X AD - China DOHaD Research Centre, China DOHaD Research Centre, National Human Genetic Resources Centre, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. genetic88@126.com. AD - National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. genetic88@126.com. AD - Graduate School of Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing, 100005, China. genetic88@126.com. FAU - Yang, Huixia AU - Yang H AUID- ORCID: 0000-0001-6472-5770 AD - Department of Obstetrics and Gynecology, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, 100034, China. yanghuixia@bjmu.edu.cn. AD - China DOHaD Research Centre, China DOHaD Research Centre, National Human Genetic Resources Centre, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. yanghuixia@bjmu.edu.cn. LA - eng GR - 2016YFC1000307/National Key Research and Development Program of China/International GR - 2018-I2M-1-004/CAMS Innovation Fund for Medical sciences/International GR - 2016000021223ZK20/Beijing Talents Foundation from organization department of Beijing municipal committee of the CPC/International PT - Historical Article PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200915 PL - England TA - BMC Med JT - BMC medicine JID - 101190723 SB - IM MH - Adult MH - Birth Rate/*trends MH - Cesarean Section/*statistics & numerical data MH - China/epidemiology MH - Female MH - History, 21st Century MH - Humans MH - Longitudinal Studies MH - Policy MH - Pregnancy MH - Retrospective Studies MH - Young Adult PMC - PMC7491061 OTO - NOTNLM OT - Caesarean birth rate OT - National Free Pre-Pregnancy Check-ups Project (NFPCP) OT - Universal two-child policy COIS- The authors declare no conflicts of interest. EDAT- 2020/09/16 06:00 MHDA- 2021/02/12 06:00 PMCR- 2020/09/15 CRDT- 2020/09/15 05:34 PHST- 2020/02/08 00:00 [received] PHST- 2020/07/20 00:00 [accepted] PHST- 2020/09/15 05:34 [entrez] PHST- 2020/09/16 06:00 [pubmed] PHST- 2021/02/12 06:00 [medline] PHST- 2020/09/15 00:00 [pmc-release] AID - 10.1186/s12916-020-01714-7 [pii] AID - 1714 [pii] AID - 10.1186/s12916-020-01714-7 [doi] PST - epublish SO - BMC Med. 2020 Sep 15;18(1):249. doi: 10.1186/s12916-020-01714-7.