Trends in the Incidence of High-Risk Newborns Based on a New Conceptual Framework — Beijing Municipality, China, 2013–2022

Yongxian Zhao¹; Zhaoxia Jia¹; Lei Wang¹; Qingqing Wu¹; Moning Guo²; Dong Han²; Lili Huang¹; Junhua Wang¹; Di Zhang¹; Zhao Wang¹; Minghui Wu^1,#

1. Beijing Obstetrics and Gynecology Hospital, Capital Medical University; Beijing Maternal and Child Health Care Hospital, Beijing, China;

2. Beijing Municipal Health Big Data and Policy Research Center, Beijing, China.

^# Corresponding author: Minghui Wu, wuminghui@mail.ccmu.edu.cn.

To assess the incidence and risk factor for high-risk neonates in Beijing over the past decade, using a novel assessment framework known as the Small and Vulnerable Newborn (SVN). This retrospective cohort study analyzed birth registration data from the Beijing Maternal and Child Information System spanning the years 2013 to 2022. Under the new SVN framework, neonates considered high-risk include premature infants, infants with low birth weight, and those who are small for their gestational age. Given the potential overlap among these categories, the SVN categorizes them into three mutually exclusive groups: term infants small for gestational age (term-SGA), preterm infants small for gestational age (preterm-SGA), and preterm infants not small for gestational age (preterm-nonSGA). A total of 2,005,408 newborns were registered in Beijing from 2013 to 2022. The average incidence rates for premature birth, low birth weight, and small for gestational age (SGA) were 6.35%, 4.80%, and 4.51%, respectively, while the overall incidence of Small and Vulnerable Newborns (SVN) was 9.94%. Over the past decade, the incidence of SVN associated with preterm birth exhibited an upward trend, with preterm-SGA increasing from 0.80% in 2013 to 1.11% in 2022 and preterm-nonSGA rising to 0.80% in 2022. Conversely, the full-term-related incidence of SVN showed a decreasing trend, from 4.60% in 2013 to 3.51% in 2022. Logistic regression analysis revealed that full-term SVN did not significantly correlate with maternal age, but it was associated with multiple pregnancies (AOR=6.98, 95% CI: 6.79, 7.17) and first-time mothers (AOR=2.11, 95% CI: 2.07, 2.15). Additionally, SVN associated with preterm birth was significantly linked to multiple pregnancies (preterm-nonSGA: AOR=17.15, 95% CI: 16.83, 17.48; preterm-SGA: AOR=32.75, 95% CI: 31.70, 33.84) and advanced maternal age (≥40 years) (preterm-nonSGA: AOR=1.88, 95% CI: 1.82, 1.95; preterm-SGA: AOR=2.17, 95% CI: 2.01, 2.33). In conclusion, the new SVN framework can more accurately evaluate the number of high-risk newborns; over the past decade in Beijing, the incidence of SVN associated with preterm birth has exhibited a growing trend, whereas the SVN rate linked to full-term deliveries has demonstrated a decreasing trend. Furthermore, in preventing full-term SVN, attention should be focused on multiple pregnancies and first-time mothers; and in preventing preterm SVN, special consideration should be given to advanced maternal age as well as multiple pregnancies.

基于一种新的高危新生儿评估框架研究急高危新生儿发病率变化趋势 — 中国北京市，2013–2022年

赵永鲜¹；贾朝霞¹；王蕾¹；吴青青¹；郭默宁²；韩冬²；黄丽丽¹；王军华¹；张娣¹；王朝¹；武明辉^1#；

1.首都医科大学附属北京妇产医院群体信息科/北京妇幼保健院，北京，中国；

2.北京市卫生健康大数据与政策研究中心数据资源与统计部，北京，中国。

^#通信作者：武明辉，wuminghui@mail.ccmu.edu.cn。

本研究使用新的高危儿评估框架 — 脆弱儿（small and vulnerable newborn，SVN），评估北京市近十年高危新生儿的发病及影响因素。本研究为回顾性队列研究，对北京市妇幼信息系统中采集的2013至2022年的出生登记数据进行分析。新框架中SVN将早产儿、低出生体重儿以及小于胎龄儿纳入其中，考虑到三者间存在交叉，新框架中特将SVN分为互斥的三类:足月小于胎龄儿（term-SGA），早产小于胎龄儿（preterm-SGA）和早产适于胎龄儿（preterm-nonSGA）。2013年至2022年共计登记出生新生儿2,005,408例，早产、低出生体重及小于胎龄儿平均发病率分别为6.35%、4.80%以及4.51%，SVN的发病率为9.94%。十年间，早产相关的SVN均呈上升趋势（preterm-SGA：2013年，0.80%；2022年，1.11%。preterm-nonSGA：2013年，4.43%；2022年，6.34%），而足月相关的SVN发病率呈下降趋势（2013年，4.60%；2022年，3.51%）。logistic回归模型分析显示，足月相关的SVN与母亲年龄之间无明显相关性，但与多胎妊娠（AOR=6.98, 95% CI: 6.79, 7.17）和初产妇（AOR=2.11, 95% CI: 2.07, 2.15）之间存在关联；早产相关的SVN与多胎妊娠（preterm-nonSGA：AOR=17.15, 95% CI: 16.83, 17.48；preterm-SGA：AOR=32.75, 95% CI: 31.70, 33.84）和≥40岁超高龄妊娠相关联（preterm-nonSGA：AOR=1.88, 95% CI: 1.82, 1.95；preterm-SGA：AOR=2.17, 95% CI: 2.01, 2.33）。结论显示SVN新框架可更加准确的评估高危新生儿数量。十年间北京市早产相关的SVN呈上升趋势，足月相关的SVN呈下降趋势。此外，预防足月相关的SVN需关注多胎妊娠和初产妇，预防早产相关的SVN在关注多胎妊娠的同时，还需关注超高龄妊娠。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.169

Changes in Maternal Socio-Demographic Characteristics and Pregnancy Outcomes Across Monitoring Regions — Six Province, China, 2016–2022

Yuting Qiao¹; Jiangli Di^1,#; Aiqun Huang¹; Huanqing Hu¹; Sidi Chen¹; Wei Zhao¹

1. National Center for Women and Children’s Health, National Health Commission of the People’s Republic of China, Beijing, China.

^# Corresponding author: Jiangli Di, dijiangli@chinawch.org.cn.

This study aimed to analyze trends in maternal socio-demographic characteristics and pregnancy outcomes across surveillance sites in China to enhance obstetric management and elevate medical service quality. We conducted a retrospective analysis of case monitoring data from 253,389 pregnant women who underwent antenatal examinations and delivered in surveillance areas from 2016 to 2022. Chi-square tests were utilized to assess differences in maternal socio-demographic characteristics and pregnancy outcomes between primiparas and multiparas. Trend tests were applied for univariate analysis of annual trends in these variables. From 2016 to 2022, the proportion of women of advanced maternal age (AMA, ≥35 years) was 10.6%, with a significantly higher proportion among multiparas (16.0%) compared to primiparas (3.9%). Most primiparas had at least a college education (43.6%), while the largest educational group among multiparas had only junior high school education (39.5%). There was a gradual increase in the proportion of AMA, education levels, and the incidences of preterm birth and low birthweight among both groups. Conversely, there was a decreasing trend in cesarean delivery rates and the incidence of macrosomia among multiparas. Perinatal healthcare professionals and obstetricians should focus on enhancing management for AMAs, improving the quality of healthcare services, and promoting childbirth at an optimal age to mitigate adverse pregnancy outcomes.

监测地区孕产妇社会人口学特征及妊娠结局的变化研究 — 中国6省份,2016-2022年

乔玉婷¹，狄江丽^1#，黄爱群¹，胡焕青¹，赵薇¹

1.国家卫生健康委妇幼健康中心，北京，中国。

^#通信作者：狄江丽, Dijiangli@chinawch.org.cn。

了解2016-2022年我国监测地区产妇的社会人口学特征以及妊娠结局的变化趋势，为加强产科管理、提高医疗服务质量提供依据。抽取2016–2022年我国孕产妇及新生儿健康监测地区6省10个县接受产检并分娩的253,389名产妇的个案监测数据进行回顾性分析。采用χ²检验比较初产妇和经产妇的社会人口学特征和妊娠结局的差异，采用趋势χ²检验分析初产妇和经产妇每年的社会人口学特征和妊娠结局变化趋势。2016–2022年，高龄孕产妇比例为10.6%，且经产妇中高龄产妇比例（16.0%）明显高于初产妇（6.9%）。初产妇中本科及以上学历占比最高，为43.6%，经产妇中，初中学历占比最高，为39.5%。初产妇和经产妇的高龄（年龄≥35岁）比例以及受教育水平均呈逐年升高趋势，而分娩早产儿和低出生体重儿的比例均呈逐年下降趋势。经产妇的剖宫产率以及分娩巨大儿的比例呈逐年下降趋势。孕产期保健人员和产科医生应加强对高龄孕产妇的管理，提高医疗服务质量，并鼓励妇女适龄生育，以减少不良妊娠结局的发生。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.170

Fertility Intentions Among Reproductive-Age Women — Three Provinces, China, 2023

Yuting Qiao¹; Jiangli Di^1,#; Sidi Chen¹; Huanqing Hu¹

1. National Center for Women and Children’s Health, National Health Commission of the People’s Republic of China, Beijing, China.

^# Corresponding author: Jiangli Di, Dijiangli@chinawch.org.cn.

To investigate the fertility intentions of reproductive-age women in China and identified associated factors to inform supportive policy development. The study was a cross-sectional survey. From August to September 2023, 8,002 women aged 20–49 years were recruited through multi-stage stratified random cluster sampling from urban and rural areas across eastern, central, and western China.  A questionnaire assessed fertility intentions, and logistic regression analysis identified influencing factors. While 80.0% of childless women intended to have children, only 31.9% of one-child women and 11.3% of two-child women desired a second or third child, respectively.  Factors associated with a higher intention to have a second child among one-child women included agricultural Hukou registration, age <30 years, remarriage, and receiving financial assistance for their first delivery. Among two-child women, a higher intention to have a third child was associated with agricultural Hukou registration, high-middle income, self-employment, and having two daughters. These findings highlight a generally low willingness to have more children and emphasize the need for supportive policies and a favorable fertility environment to encourage births in China.

育龄妇女生育意愿调查 —中国3省份，2023年

乔玉婷¹，狄江丽^1#，陈思迪¹，胡焕青¹

1.国家卫生健康委妇幼健康中心，北京，中国。

^#通信作者：狄江丽，Dijiangli@chinawch.org.cn。

了解我国育龄妇女的生育意愿现状及影响因素，为完善生育支持性政策提供依据。采用横断面调查方法，于2023年8至9月，在我国东、中、西部地区随机抽取3个省6个市县作为调查地区，采取多阶段分层随机抽样方法抽取8002名 20-49岁育龄妇女作为调查对象。通过问卷调查了解妇女的生育意愿，并采用logistic回归模型分析其影响因素。80%未生育的妇女有生育意愿；31.9%已有1个孩子的妇女有再生育第2个孩子的意愿；11.3%已有2个孩子的妇女有再生育第3个孩子的意愿。农村户籍、年龄<30岁、再婚以及第一次分娩时费用有所减免的已有1个孩子的妇女更愿意生育第2个孩子。农村户籍、中等收入、个体经营者、有2个女儿的已有2个孩子的妇女更愿意生育第3个孩子。我国育龄妇女再生育意愿并不乐观。为更好地激发育龄妇女的生育意愿，有必要进一步完善生育支持性政策，为育龄妇女创造一个更有利的生育环境。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.171

Reproductive Characteristics and Trends of Major Pregnancy Outcomes of Women at Different Parities — Beijing Municipality, China, 2013–2022

Zhaoxia Jia¹; Yongxian Zhao¹; Lei Wang¹; Qingqing Wu¹; Moning Guo²; Jianpeng Zheng²; Lili Huang¹; Junhua Wang¹; Zhao Wang¹; Di Zhang¹; Minghui Wu^1,#

1. Department of information and statistics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China;

2. Department of data resources and statistics, Beijing Municipal Health Big Data and Policy Research Center, Beijing, China.

^# Corresponding author: Minghui Wu, wuminghui@mail.ccmu.edu.cn.

This study analyzed the delivery characteristics and pregnancy outcomes of 1,963,445 permanent residents who gave birth in Beijing from 2013 to 2022.  The study population was divided into primiparous (P1), second-time delivering (P2), and third or more times delivering (P≥3) groups. Differences in delivery characteristics among the three groups were compared, and annual percentage change (APC) was used to analyze trends in the main pregnancy outcomes. The majority of women in both the P1 and P2 groups had a bachelor's degree or higher, while the P≥3 group primarily comprised women with a junior high school education or below.  The proportion of births to women with non-local residence registration increased with the overall increase in births. The highest proportion of professional and technical personnel was found in the P1 and P2 groups, while the P≥3 group had the highest proportion of unemployed/freelancers. Among women under 35 years old, the P1 group had the lowest proportion of C-sections, with a trend of decreasing first and then increasing over the past decade, followed by the P≥3 and P2 groups. However, among women aged 35 and above, the P1 group had the highest proportion of C-sections, followed by the P2 and P≥3 groups. In both the <35 and ≥35 age groups, the proportions of preterm birth and low birth weight have risen to varying degrees over the past decade, while the incidences of macrosomia have shown declining trends. This study, encompassing nearly all childbirth information in Beijing over the past decade, provides a solid basis for developing targeted perinatal health care measures. Notably, women with multiple births had relatively high proportions of non-local residence registration, low education level, and unemployment/freelancing, as well as higher incidence rates of preterm birth and macrosomia. Therefore, targeted healthcare services should be prioritized for this group to improve birth outcomes.

不同产次产妇生育特征和主要妊娠结局的变化趋势 — 中国北京市，2013-2022年

贾朝霞¹；赵永鲜¹；王蕾¹；吴青青¹；郭默宁²；郑建鹏²；黄丽丽¹；王军华¹；王朝¹；张娣¹；武明辉^1#；

1.首都医科大学附属北京妇产医院 群体信息科/北京妇幼保健院，北京，中国；

2.北京市卫生健康大数据与政策研究中心 数据资源与统计部；北京，中国。

^#通信作者：武明辉，wuminghui@mail.ccmu.edu.cn。

本研究分析北京市近十年不同产次产妇的生育特征及其主要妊娠结局的变化。纳入2013–2022年北京市1,963,445例常住产妇，将其分为初产妇组(P1), 第二次分娩产妇组(P2)和三次及以上分娩产妇组 (P≥3)。比较三组产妇生育特征的差异，并采用年度变化百分比 (annual percentage change, APC)分析三组主要妊娠结局的趋势。P1和P2组中本科及以上学历的产妇比例居多，而P≥3组以初中及以下学历的产妇占多数。随着生育次数增加，外地户籍的比例也依次增加。P1和P2组中专业技术人员比例最高，而P≥3组中无业/自由职业者比例最高。在<35岁的产妇中，剖宫产率以P1组最低，且近十年呈现先下降后上升的趋势，其次是P≥3组和P2组，而在≥35岁的产妇中P1组的剖宫产率是最高的，其次是P2组和P≥3组。无论是＜35岁还是≥35岁组产妇中，近十年三组的早产率和低出生体重发生率均有不同程度的上升，但巨大儿发生率呈现不同程度的下降趋势。本研究对北京近十年全市的分娩信息进行分析，为制定有针对性的围产保健措施提供了坚实的依据。在多次分娩产妇中，外地户籍、低教育水平和无业/自由职业者的比例相对较高，早产和巨大儿的发生率也较高，因此，应更多关注这一群体并提供针对性的保健服务以改善出生结局。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.172

Development of a Multiplex Real-Time Quantitative PCR Assay for Detecting Vaginal Microbiota in Chinese Women — China, 2021–2022

Xiaolei Wang^1,2,3,4; Yuanyuan Zhang^2,3,4; Tingting Liu^2,3,4; Chuan Song^2,3,4; Xiaoyu Xue^2,5; Jun Liu^4,6,#; Hongxin Zhao^1,4,#

1. Clinical Center for HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China;

2. Beijing Institute of Infectious Diseases, Beijing, China;

3. Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China;

4. National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China;

5. Beijing Ditan Hospital, Peking University, Beijing, China;

6. Department of Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, China.

^# Corresponding authors: Hongxin Zhao: Drzhao66@ccmu.edu.cn; Jun Liu: liu2998022@163.com.

The Nugent score, limited by subjectivity and personnel requirements, lacks accuracy. Establishing a precise and simple molecular test is therefore essential for detecting vaginal microbiota and evaluating vaginal health. This study evaluated the vaginal health of Chinese women using quantitative polymerase chain reaction (qPCR) targeting L. crispatus, L. iners, G. vaginalis, A. vaginae, and Megasphaera phylotype-1, with BV-related bacteria sharing a fluorescent channel. The diagnostic accuracy of the qPCR assay was evaluated and validated using 16S rDNA sequencing as a reference standard. Both qPCR and 16S rDNA sequencing showed a 90.5% concordance in segregating vaginal community state type (CST), as illustrated through heatmaps and principal coordinates analysis. Spearman correlation analysis showed strong correlations between the two methods in calculating the relative abundance of L. crispatus (CST I), L. iners (CST III), and BV-related bacteria (CST IV), with coefficients of 0.865, 0.837, and 0.827, respectively. Receiver operating characteristic analysis showed the qPCR assay had significant diagnostic accuracy.

开发用于检测中国女性阴道菌群的多重实时荧光定量PCR检测方法 — 中国，2021–2022

王晓蕾^1,2,3,4; 张媛媛^2,3,4; 刘婷婷^2,3,4; 宋川^2,3,4; 薛晓雨^2,5; 刘军^4,6,#; 赵红心^1,4,#

1. 首都医科大学附属北京地坛医院艾滋病临床中心，北京，中国；

2. 北京市感染性疾病研究中心，北京，中国；

3. 新发突发传染病研究北京市重点实验，首都医科大学附属北京地坛医院，北京，中国；

4. 国家传染病医学中心(北京)，首都医科大学附属北京地坛医院，北京，中国；

5. 北京大学地坛医院教学医院，北京，中国；

6. 首都医科大学附属北京地坛医院妇产科，北京，中国。

^#通讯作者：赵红心: Drzhao66@ccmu.edu.cn; 刘军: liu2998022@163.com。

Nugent评分因其主观性和技术人员要求的限制缺乏准确性。因此，建立一个精确且简便的分子检测方法对于检测阴道微生物进而评估阴道健康至关重要。使用多重定量聚合酶链式反应（quantitative polymerase chain reaction, qPCR）检测L. crispatus、L. iners、G. vaginalis、A. vaginae和Megasphaera phylotype-1，其中与细菌性阴道病相关的细菌共享一个荧光通道。以16S rDNA扩增子测序作为参考标准，从而评估和验证多重qPCR检测的诊断准确性。在评估阴道群落状态类型（community state type, CST）上，多重qPCR和16S rDNA扩增子测序呈现出90.5%的一致性，并使用热图和主坐标分析进一步印证。Spearman相关分析显示，两种方法在计算L. crispatus（CST I）、L. iners（CST III）和BV相关细菌（CST IV）的相对丰度上具有较强的相关性，其相关系数分别为0.865、0.837和0.827。使用受试者工作特征曲线评估多重qPCR检测CST I、CST III、CST IV的准确性，其曲线下面积分别为0.967、0.815和0.950，具有较强的预测能力。多重qPCR检测方法是一种高度准确的工具，可以通过单次qPCR扩增实验评估阴道健康。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.173