Maternal and Child Health Specialty

Maternal and Child Health Specialty

I. Institutional Introduction

The Maternal and Child Health Specialty is the top-level department of the city’s maternal and child health network. It undertakes professional guidance, technical training, supervision and quality control in obstetrics, paediatrics and maternal and child health for 12 district-level maternal and child health institutions, 152 midwifery institutions and 197 community health service centres/township health centres across the city. Under the leadership of the Guangzhou Municipal Health and Family Planning Commission and the Guangzhou Women and Children’s Medical Centre, and through monitoring and research, it analyses the health status of women and children throughout the city, assesses the problems existing in the supply of and demand for maternal and child health services, provides a scientific basis for government decision-making, implements the relevant measures and continuously improves its work, leading the city’s maternal and child health institutions to attain the health-related indicators of the Guangzhou Women’s Development Programme and the Children’s Development Programme.

II. Main Achievements

(1) In-depth research to provide an accurate reference basis for scientific decision-making. Through carrying out research on the control and reduction of maternal and infant mortality and on service demand in Guangzhou, it provides a basis for maternal and child health decision-making across the city.

(2) Scientific management to continuously improve the effectiveness of maternal and child health work. Since 2012, taking the implementation of the Guangzhou Maternal and Infant Well-being Action Plan as an opportunity, it has built a new regional system for the rescue and treatment of critically ill pregnant women and children, effectively raising the success rate of rescue; the city’s maternal mortality ratio and infant mortality rate fell from 15.2/100,000 and 4.04‰ in 2010 to 7.34/100,000 and 3.30‰ in 2014 respectively; by means of the one-hundred-day assistance programme and the training of key professionals, it has guided primary-level midwifery institutions in standardised development and consolidated the foundation of obstetric and paediatric services.

(3) Consolidating grassroots work and faithfully safeguarding the health of women and children. It vigorously promotes the extension of public health services to the grassroots level and guides community health service centres/township health centres to provide free cervical cancer and breast cancer screening for more than 70,000 rural women every year; to provide standardised perinatal care and postpartum home visit services for more than 100,000 pregnant and postpartum women; and to provide systematic health care services for more than 800,000 children under 7 years of age.

(4) Forging ahead and rapidly enhancing the team’s working capacity. Promoting disciplinary development through scientific research, the team persists in studying the latest developments at the daily morning shift handover; since 2011 it has been awarded 6 provincial-level research projects and 7 major projects of the Municipal Science and Information Technology Bureau, with cumulative research funding of more than 13 million; it has received more than 70 persons for advanced training from primary-level medical institutions and undergraduate interns from Sun Yat-sen University, Southern Medical University and other institutions. Over the past 5 years it has held 37 categories and 235 sessions of maternal and child health training courses, training more than 20,000 person-times. It has completed 26 national and provincial continuing education projects and 16 municipal-level ones, making its contribution to the advancement of the maternal and child health profession.

III. Honours Obtained

In 2012 it was awarded the titles of “Advanced Collective in the Implementation of the Women’s and Children’s Development Plan of Guangdong Province, 2006-2010” and “Advanced Collective in the Implementation of the Women’s and Children’s Development Plan of Guangzhou Municipality, 2001-2010”; in 2012 it received the honour of “Medical Key Discipline of the 12th Five-Year Plan” of Guangdong Province; in 2014 it received the titles of “Women’s Civilised Post” of Guangzhou Municipality and “Women’s Civilised Post” of Guangdong Province.

Study Protocol for Analysis on Prevalence and Related Factors for Adverse Birth Outcomes in Guangzhou, China

Background

Maternal and children health in China have been improved dramatically during last several decades, especially in Guangzhou that experiencing rapid economic development and social transition. The maternal and infant mortality rates have fallen significantly in Guangzhou following a series of strengthened maternal and child health programs. As one of the important indicators of prenatal and postnatal health, small for gestational age (SGA) or large for gestational age (LGA) means a higher risk of infant mortality and morbidity in later life. The surveillance for changing of birth weight and trends in SGA or LGA births in Guangzhou is important.

On the other hand, China’s family planning policy has also changed from one-child for one couple in the late 1970s to conditional two-child policy, and to a general two-child policy in 2015. Problems caused by this policy adjustment may emerge soon after a boom of the second child, such as upward inter-pregnancy intervals (IPIs) and maternal age, which may have adverse effects on maternal and newborns’ health including preterm birth, low birth weight, SGA and perinatal death. Little was known about the effects of policy adjustment on perinatal outcomes in Chinese population.

Objectives

A retrospective cohort study was conducted to examine the trends in birth weight z-score, prevalence of SGA and LGA among singleton births from 2001 to 2015 based on the INTERGROWTH-21st birth weight standard, and to investigate the effects of policy adjustment on preterm birth, SGA and LGA during the period of 2000-2015 in Guangzhou, China, and to determine maternal age and the optimal IPIs among Chinese pregnant women.

Data source

The delivery information was abstracted from the Guangzhou Perinatal Health Care and Delivery Surveillance System (GPHCDSS), which in brief is the electronic database that covers over 97% of deliveries in Guangzhou from 2000. GPHCDSS routinely collected data on maternal characteristic, conditions during pregnancy and birth characteristics. All of these information was approved of usage after application according to corresponding standard procedure.

Within this surveillance system, 2,419,184 babies were born in Guangzhou between 2000 and 2015. There were 2,329,389 were singleton live birth during this period, among which 227,352 women were multiple pregnancies.

Statistical strategies

We applied the international standard for newborn weight, proposed by the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) to define small-for-gestational-age (SGA) and large-for-gestational-age (LGA) infants and calculate birth weight z-score. As regard to preterm delivery, it is defined as gestational age less than 37 completed weeks. Preterm birth (PTB) was further subdivided into early PTB (24 to 31 weeks), middle PTB (32 to 33 weeks) and late PTB (34 to 36 weeks). The inter-pregnancy intervals (IPI) were calculated from the records as the time in months between the first delivery date and date of conception for the second pregnancy. This international standard of INTERGROWTH-21st project provides an opportunity for the comparisons in different time periods or among different populations.

We first attempt to examine trends in birth weight z-score, prevalence of SGA and LGA among singleton births form 2001 to 2015 based on the INTERGROWTH-21st birth weight standard. Then we will further explore these trends by maternal characteristics to identify subgroups that need more attentions. Next, we will ascertain the effect of inter-pregnancy intervals (IPI) on perinatal outcomes, like SGA, LGA and preterm birth as mentioned above. Stratified analysis by maternal age at second pregnancy was also explored.

Expectations of results

(1) As the dramatic improvement in women and children’s health care service in China during the last decade, we expected to find that the prevalence of SGA and LGA would decline.

(2) On the base of physiology, the relationship between IPI and perinatal outcomes should U-shaped, with both shorter and longer IPI associated with increased risk of SGA, AGA and preterm birth.