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Objective To estimate the proportion of married women in China who intend to become pregnant given the country's pronatalist population policy and to investigate fecundity, with an emphasis on the influence of socioeconomic factors. Methods A nationally representative survey of 12 815 married women aged 20 to 49 years (mean: 36.8 years) was conducted during 2019 and 2020. All completed questionnaires, 10 115 gave blood samples and 11 710 underwent pelvic ultrasound examination. Fertility intention was the desire or intent to become pregnant combined with engagement in unprotected sexual intercourse. We defined infertility as the failure to achieve pregnancy after 12 months or more of unprotected intercourse. We considered an anti-Mullerian hormone level < 1.1 ng/ mL and an antral follicular count < 7 as indicating an abnormal ovarian reserve. Findings Fertility intentions were reported by 11.9% of women overall but by only 6.1% of current mothers (weighted percentages). Fertility intention was significantly less likely among women in metropolises (odds ratio, OR: 0.38; 95% confidence interval, CI: 0.31-0.45) and those with a higher educational level (OR: 0.74; 95% CI: 0.62-0.88). Overall, 18.0% had experienced infertility at any time and almost 30% had an abnormal ovarian reserve on assessment. An abnormal ovarian reserve and infertility were less likely in women in metropolises (P < 0.05) but more likely in obese women (P < 0.05). Conclusion The willingness of Chinese married women to give birth remained low, even with relaxation of the one-child policy. Abstracts in [phrase omitted], Francais, [phrase omitted] and Espanol at the end of each article. [phrase omitted] Objectif Determiner le pourcentage de femmes mariees prevoyant de tomber enceintes en Chine compte tenu de la politique demographique pronataliste du pays, et etudier la fecondite a la lumiere des facteurs socioeconomiques. Methodes Une enquete representative a l'echelle nationale portant sur 12 815 femmes mariees agees de 20 a 49 ans (moyenne: 36,8 ans) a ete organisee entre 2019 et 2020. Toutes les participantes ont rempli des questionnaires, 10 115 d'entre elles ont fourni des echantillons de sang et 11 710 ont subi une echographie pelvienne. L'intention de grossesse correspondait au desir ou a la volonte de tomber enceinte, combinee a des rapports sexuels non proteges. Nous avons defini l'infertilite comme l'incapacite a concevoir un enfant apres minimum 12 mois de rapports sexuels non proteges. Enfin, nous avons considere qu'un taux d'hormones antimullerienne < 1,1 ng/mL et un compte folliculaire antral < 7 indiquaient une reserve ovarienne anormale. Resultats Au total, 11,9% des femmes ont exprime leur desir de grossesse, mais seulement 6,1% de celles etant deja meres (pourcentages ponderes). Cette intention etait nettement moins marquee chez les femmes residant en metropole (odds ratio, OR: 0,38; intervalle de confiance de 95%, IC: 0,31-0,45) et chez celles affichant un niveau d'education plus eleve (OR: 0,74; IC de 95%: 0,62-0,88). Globalement, 18,0% ont connu l'infertilite a un moment donne et 30% presentaient une reserve ovarienne anormale lors de l'examen. Les phenomenes de reserve ovarienne anormale et d'infertilite etaient moins susceptibles de se manifester chez les femmes residant en metropole (P < 0,05) mais plus susceptibles chez les femmes obeses (P < 0,05). Conclusion En Chine, rares sont les femmes mariees a vouloir procreer, meme avec l'assouplissement de la politique de l'enfant unique. Objetivo Estimar el porcentaje de mujeres casadas en China que tienen intencion de quedarse embarazadas dada la politica demografica pronatalista del pais e investigar la fecundidad, haciendo enfasis en la influencia de los factores socioeconomicos. Metodos Durante 2019 y 2020, se realizo una encuesta representativa a nivel nacional de 12 815 mujeres casadas de entre 20 y 49 anos (media: 36,8 anos). Todas las participantes completaron cuestionarios, 10 115 aportaron muestras de sangre y 11 710 se sometieron a un examen de ultrasonido pelvico. La intencion de fertilidad fue el deseo o la intencion de quedar embarazada combinada con la participacion en relaciones sexuales sin proteccion. Se definio la infertilidad como la no consecucion de un embarazo tras 12 meses o mas de relaciones sexuales sin proteccion. Asimismo, se considero que un nivel de hormona antimulleriana Resultados El 11,9% de las mujeres informo de su intencion de fertilidad, pero solo el 6,1% de las madres actuales (porcentajes ponderados). La intencion de fertilidad era significativamente menos probable entre las mujeres de las metropolis (razon de posibilidades, OR: 0,38; intervalo de confianza del 95%, IC: 0,31-0,45) y las que tenian un nivel educativo mas alto (OR: 0,74; IC del 95%: 0,62-0,88). En general, el 18,0% habia experimentado infertilidad en algun momento y casi el 30% tenia una reserva ovarica anormal en la evaluacion. La reserva ovarica anormal y la infertilidad eran menos probables en las mujeres de las metropolis (p, Introduction Fertility rates have been on the decline globally, with recent reports predicting that 23 countries will observe the halving of their population by the end of the century. (1) [...]

Background The cesarean section (CS) rate has risen globally during the last two decades. Effective and feasible strategies are needed to reduce it. The aim of this study was to assess the CS rate change after a two-stage intervention package that was designed to reduce the overall CS rate in Guangzhou, China. Methods and findings This intervention package was implemented by the Health Commission of Guangzhou Municipality in 2 stages (October 2010-September 2014 and October 2014-December 2016) and included programs for population health education, skills training for healthcare professionals, equipment and technical support for local healthcare facilities, and capacity building for the maternal near-miss care system. A retrospective repeated cross-sectional study was conducted to evaluate influences of the intervention on CS rates. A pre-intervention period from January 2008 to September 2010 served as the baseline. The primary outcome was the CS rate, and the secondary outcomes included maternal mortality ratio (MMR) and perinatal mortality rate (PMR), all obtained from the Guangzhou Perinatal Health Care and Delivery Surveillance System (GPHCDSS). The Cochran-Armitage test was used to examine the trends of the overall CS rate, MMR, and PMR across different stages. Segmented linear regression analysis was used to assess the change of the CS rate over the intervention period. A total of 1,921,932 records of births and 108 monthly CS rates from 2008 to 2016 were analyzed. The monthly CS rate declined across the intervention stages (Z = 75.067, p < 0.001), with an average rate of 42.4% at baseline, 39.8% at Stage 1, and 35.0% at Stage 2. The CS rate declined substantially among nulliparous women who delivered term singletons, with an accelerating decreasing trend observed across Stage 1 and Stage 2 (the difference in slopes: -0.09 [95% CI -0.16 to -0.02] between Stage 1 and baseline, p = 0.014; -0.11 [95% CI -0.20 to -0.02] between Stage 1 and Stage 2, p = 0.017). The CS rate in the remaining population increased during baseline and Stage 1 and subsequently decreased during Stage 2. The sensitivity analysis suggested no immediate impact of the universal two-child policy on the trend of the CS rate. The MMR (Z = -4.368, p < 0.001) and PMR (Z = -13.142, p < 0.001) declined by stage over the intervention period. One of the main limitations of the study is the lack of a parallel control group. Moreover, the influence of temporal changes in the study population on the CS rate was unknown. Given the observational nature of the present study, causality cannot be confirmed. Conclusions Apparent decline in the overall CS rate was observed in Guangzhou, China, after the implementation of a two-stage intervention package. The decline was most evident among nulliparous women who delivered term singletons. Despite some limitations for causal inference, Guangzhou's experience in controlling the CS rate by implementing composite interventions with public health education and perinatal healthcare service improvement could have implications for other similar areas with high rates of CS., Author(s): Xiaoyan Xia 1,2,3, Zehong Zhou 1, Songying Shen 1, Jinhua Lu 1,2, Lifang Zhang 1,2, Peiyuan Huang 1, Jia Yu 2, Li Yang 4, Ping Wang 4, Kin-bong Hubert [...]

Objective: To investigate the association between preconception thyroid stimulating hormone (TSH) level and time to pregnancy within a community-based population.Design: A community-based cohort study.Setting: Two free preconception check-up centers.Patient(s): Women who enrolled in the National Free Preconception Check-up Projects from January 1, 2018 to December 31, 2018 in Tianhe and Zengcheng districts of Guangzhou city.Intervention(s): None.Main Outcome Measure(s): Time to pregnancy.Result(s): A total of 1,478 women were eligible for the analysis; of these, 1,401 had a preconception TSH level within the range of 0.50 and 5.59 mIU/L (2.5th-97.5th percentiles) were taken as target study population. Among them, 968 (69.1%) couples achieved pregnancy within the first 6 months and 1,082 (77.2%) within 12 months. Dichotomized by the recommended cut-off value of 2.5 mIU/L, the percentage of women conceived in the high TSH level category (2.50-5.59 mIU/L) was comparable to that of the low category (0.50-2.49 mIU/L) (79.0% vs. 78.1%), with a crude fecundity odd ratio of 0.99 (95% confidence interval at 0.87-1.13). No statistically significant difference was observed after the adjustment in all models. Continuous TSH level was further examined, and the nonlinear association between TSH level and fecundity odds ratios was of no statistical significance.Conclusion(s): Preconception TSH level was not associated with fecundity in a healthy community-based population. Women attempting pregnancy with a TSH level ≥ 2.5 mIU/L can be reassured that they are unlikely to have an increased time to pregnancy. [ABSTRACT FROM AUTHOR]