PMID- 37951872
OWN - NLM
STAT- MEDLINE
DCOM- 20231113
LR  - 20231122
IS  - 1471-2458 (Electronic)
IS  - 1471-2458 (Linking)
VI  - 23
IP  - 1
DP  - 2023 Nov 11
TI  - The effect of China's many-child policy on the number of births and the 
      prevalence of serious teratogenic and disabling defects in Hunan Province.
PG  - 2226
LID - 10.1186/s12889-023-16583-x [doi]
LID - 2226
AB  - BACKGROUND: To research the effect of China's many-child policy on the number of 
      births and the prevalence of serious teratogenic and disabling defects (STDDs) in 
      Hunan province. METHODS: We performed an observational study based on the Birth 
      Defect (BD) Surveillance System of Hunan Province and chose STDD case cards. From 
      2012-2022, we defined the following 4 periods: the one-child policy (OCP) 
      (2012.01-2013.12), partial two-child policy (PTCP) (2014.1-2015.12), universal 
      two-child policy (UTCP) (2016.1-2020.12), and the early stage of the three-child 
      policy (ETCP) (2021.1-2022.12). Crude odds ratios (ORs) and 95% confidence 
      intervals (CIs) were calculated to examine the association of policy changes with 
      STDDs. Crame'r's V was calculated to estimate the effect sizes. Joinpoint 
      regression analysis and annual percent change (APC) were used for each segment of 
      the trend. RESULTS: A total of 1,652,079 births were included in this analysis. 
      Joinpoint regression analysis showed that the number of perinatal births 
      increased from 2012 to 2017, with APC = 9.52 (95% CI: 7.2 to 11.8), and decreased 
      from 2017 to 2022, with an APC = -10.04 (95% CI: -11.9 to -8.1). The number of 
      mothers over 30 years old gradually increased, from 25.54% during the OCP period 
      to 54.05% during the ETCP period (P(trend) < 0.001). With policy changes, the 
      total prevalence of STDDs increased from 28.10 per 10,000 births during the 
      period of OCP into 46.77 per 10,000 births during the ETCP period by 66.44%. The 
      live birth prevalence of STDDs increased only during the ETCP period (PTCP: 
      OR = 1.27, 95% CI: 0.99-1.24, p = 0.057, UTCP: OR = 1.22, 95% CI: 0.99-1.52, 
      p = 0.067, ETCP: OR = 1.75, 95% CI: 1.37-2.24, p < 0.001). Over the past ten 
      years, there was a decrease in the gestational age at diagnosis (*F = 772.520, 
      p < 0.001), from 24.49 +/- 5.65 weeks in 2012 to 20.77 +/- 5.17 weeks in 2022. From 
      2012 to 2022, the percentage of deaths within 7 days decreased with APC = -18.85 
      (95% CI: -26.4- -10.5, P > 0.05). CONCLUSION: Many-child policies were associated 
      with a moderate increase in fertility especially for women in urban areas and 
      older women. However, they have lost the ability to control birth since 2017. The 
      total prevalence of STDDs increased over the entire period, but the live birth 
      prevalence increased only during the ETCP period. The gestational age at 
      diagnosis decreased and the percentage of deaths within 7 days decreased.
CI  - (c) 2023. The Author(s).
FAU - Xie, Donghua
AU  - Xie D
AD  - Department of Information Management, Maternal and Child Health Hospital of Hunan 
      Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China.
AD  - NHC Key Laboratory of Birth Defect for Research and Prevention (Hunan Provincial 
      Maternal and Child Health Care Hospital), 58 Xiangchun Road, Changsha, Hunan, 
      410078, China.
FAU - Wei, Jianhui
AU  - Wei J
AD  - Xiangya School of Public Health, Central South University, Changsha, China.
FAU - Wang, Aihua
AU  - Wang A
AD  - Department of Information Management, Maternal and Child Health Hospital of Hunan 
      Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China.
FAU - Xiong, Lili
AU  - Xiong L
AD  - Department of Information Management, Maternal and Child Health Hospital of Hunan 
      Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China.
FAU - Zou, Kehan
AU  - Zou K
AD  - Department of Information Management, Maternal and Child Health Hospital of Hunan 
      Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China.
FAU - Xie, Zhiqun
AU  - Xie Z
AD  - Department of Information Management, Maternal and Child Health Hospital of Hunan 
      Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China. 1072391426@qq.com.
FAU - Fang, Junqun
AU  - Fang J
AD  - Department of Information Management, Maternal and Child Health Hospital of Hunan 
      Province, 58 Xiangchun Road, Changsha, Hunan, 410078, China. 40112079@qq.com.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20231111
PL  - England
TA  - BMC Public Health
JT  - BMC public health
JID - 100968562
RN  - 0 (Teratogens)
SB  - IM
MH  - Pregnancy
MH  - Humans
MH  - Female
MH  - Aged
MH  - Adult
MH  - *Teratogens
MH  - Prevalence
MH  - Fertility
MH  - *Family Planning Policy
MH  - China/epidemiology
PMC - PMC10640731
OTO - NOTNLM
OT  - Many-child policies
OT  - Number of births
OT  - Prevalence of serious teratogenic and disabling defects
COIS- The authors declare no competing interests.
EDAT- 2023/11/12 00:42
MHDA- 2023/11/13 06:43
PMCR- 2023/11/11
CRDT- 2023/11/11 23:14
PHST- 2022/11/15 00:00 [received]
PHST- 2023/08/22 00:00 [accepted]
PHST- 2023/11/13 06:43 [medline]
PHST- 2023/11/12 00:42 [pubmed]
PHST- 2023/11/11 23:14 [entrez]
PHST- 2023/11/11 00:00 [pmc-release]
AID - 10.1186/s12889-023-16583-x [pii]
AID - 16583 [pii]
AID - 10.1186/s12889-023-16583-x [doi]
PST - epublish
SO  - BMC Public Health. 2023 Nov 11;23(1):2226. doi: 10.1186/s12889-023-16583-x.