Improving Equitable Access to Antenatal Care in China: Challenges and Potential Innovative Approaches

Yue Dai¹, Xinrui Shi^1,2, Owais Tariq³, Lingyun Jiang⁴, Jialu Qu⁵, Yan Wei^1,#, Jinkou Zhao^6,7,8,#, Nicolas Ray⁹

1. School of Public Health, Fudan University, Shanghai, China;

2. Department of LIME, Karolinska Institute, Stockholm, Sweden;

3. School of Public Health, Southeast University, Nanjing City, Jiangsu Province, China;

4. School of Nursing, Fudan University, Shanghai, China;

5. ENT Institute and Otorhinolaryngology Department, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China;

6. Shanghai Institute of Infectious Diseases and Biosecurity, Fudan University, Shanghai, China;

7. Fudan Institute for Advanced Studies in Global Health, Fudan University, Shanghai, China;

8. The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland;

9. Institute of Global Health, University of Geneva, Geneva, Switzerland.

^# Corresponding author: Jinkou Zhao, jinkou.zhao@theglobalfund.org; Yan Wei, yanwei@fudan.edu.cn.

Achieving equitable antenatal care (ANC) is fundamental to China's 'Healthy China 2030' agenda and its universal health coverage (UHC) commitments. Despite measurable national progress, substantial urban-rural and regional disparities in ANC access persist, driven by a complex interplay of financial, geographic, institutional, and digital barriers that disproportionately affect rural, low-income, and migrant populations. This analysis examines the current landscape of ANC in China, identifying core structural challenges including the enduring legacy of the hukou (household registration) system, a widening digital divide, and the maldistribution of healthcare resources. We contend that piecemeal interventions are insufficient to address these deeply rooted inequities. Instead, this Viewpoint advances an integrated 'spatial-technology-institutional' strategy that synergizes innovations across three mutually reinforcing domains: optimizing tiered healthcare delivery through smart payment reforms, deploying geospatial tools for evidence-based resource allocation, constructing an inclusive digital ANC ecosystem, and establishing sustainable talent incentive mechanisms for grassroots healthcare workers. By implementing this coordinated, multi-pronged approach, China can systematically dismantle geographic inequities in maternal health and ensure equitable ANC access for all women.

改善中国孕期保健服务的公平可及性：挑战与创新路径

戴越¹，时馨蕊^1,2, Owais Tariq³，蒋凌云⁴，屈佳璐⁵，魏艳^1,#，赵金扣^6,7,8,#，Nicolas Ray⁹

1. 公共卫生学院，复旦大学，上海，中国；

2. 卡罗琳斯卡医学院，斯德哥尔摩，瑞典

3. 公共卫生学院，东南大学，南京市，江苏省，中国；

4. 护理学院，复旦大学，上海，中国；

5. 复旦大学附属眼耳鼻喉科医院，复旦大学，上海，中国；

6. 上海市重大传染病和生物安全研究院，复旦大学，上海，中国；

7. 全球健康治理高等研究院，复旦大学，上海，中国；

8. 抗击艾滋病、结核病和疟疾全球基金，日内瓦，瑞士；

9. 全球健康研究所，日内瓦大学，日内瓦，瑞士。

^# 通信作者: 赵金扣，jinkou.zhao@theglobalfund.org; 魏艳，yanwei@fudan.edu.cn。

保障孕期保健服务的公平可及是我国落实《健康中国 2030 规划纲要》、实现全民健康覆盖目标的基石。尽管我国孕期保健服务水平在国家层面已有一定提升，但在不同地区及城乡之间，孕期保健的可及性仍存在显著差异，其根源在于经济、地理、机制及数字化障碍多重因素相互交织，这对农村、低收入及流动人口群体的服务可及性造成了不同程度的制约。本研究从户籍制度、数字鸿沟、资源配置等维度，剖析我国孕期保健服务的发展现状，发现当前孕期保健服务体系呈分布不良状态，碎片化施策难以取得实效。本文并据此提出整合性发展战略，通过协同推进空间、技术与政策层面的创新予以破解：优化分级医疗体系并推进智能支付改革；依托地理空间工具优化资源配置布局；构建包容性的数字产前保健生态系统；建立基层医务工作者长效人才激励机制。通过实施这一多管齐下的协同战略，我国有望逐步缩小孕产妇健康服务的地域差异，最终实现全民公平享有孕期保健服务的目标。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2026.042

Longitudinal Trajectories of Growth and Development in HIV-Exposed Uninfected Children from a Long-Term Birth Cohort — 8 Regions, 3 PLADs, China, 2017–2024

Xinwei Li¹, Yanli Cao², Jiahan Zou², Chenxi Zhu², Xiaoyan Wang³, Ailing Wang³, Qian Wang^3,#

1. Hengshui Health Technology Vocational College, Hengshui City, Hebei Province, China;

2. Chinese Center for Disease Control and Prevention & Chinese Academy of Preventive Medicine, Beijing, China;

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

^# Corresponding author: Qian Wang, qianawang@ncwchnhc.org.cn.

The global implementation of prevention of mother-to-child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) programs, combined with continuous advances in antiretroviral therapy (ART), has substantially strengthened the reproductive confidence of women living with HIV. As a result, the number of HIV-infected pregnant women and their infants has risen considerably worldwide, and approximately 4,000 HIV-exposed infants are born in the country each year. Children's growth and development is a complex, multidimensional process shaped by the interplay between intrinsic genetic determinants and a broad range of external environmental influences. Nevertheless, the existing literature has predominantly focused on vertical transmission outcomes, with comparatively limited attention paid to the growth trajectories and developmental status of HIV-exposed children. This study conducted a prospective cohort study in 8 regions across Yunnan, Guangxi and Xinjiang, enrolling a total of 1,227 mother-child pairs, including 411 pairs in the exposed group and 816 pairs in the control group. The study found that the malnutrition rate of HIV-exposed uninfected children reached 12.00%, which was higher than that of children in the control group. Multivariate analysis was used to explore the factors influencing malnutrition among HIV-exposed children. A household per capita monthly income of more than 3,000 yuan was identified as a protective factor, while a maternal history of stillbirth, neonatal low birth weight, and female sex were risk factors. Specifically, the risk of malnutrition in children with low birth weight increased by 37.7%. The findings of this study provide a scientific basis for promoting the growth and development of HIV-exposed children and reducing the disease burden of mother-to-child HIV transmission.

长期出生队列中艾滋病病毒暴露但未感染儿童的生长发育纵向轨迹研究 — 8 区域，3省份，中国，2017–2024 年

李昕薇¹；曹艳利²；邹佳函²；朱晨曦²；王潇滟³；王爱玲³；王前^3,#

1. 衡水健康科技职业学院，衡水市，河北省，中国；

2. 中国疾病预防控制中心（中国预防医学科学院），北京，中国；

3. 妇幼健康中心，中华人民共和国国家卫生健康委员会，北京，中国。

^# 通信作者：王前，qianawang@ncwchnhc.org.cn。

随着全球预防艾滋病母婴传播工作的推进以及抗逆转录病毒治疗的发展，HIV 感染女性的生育信心显著提升，全球 HIV 感染孕产妇及婴儿数量持续增加，我国每年约有4000 名 HIV 暴露新生儿出生。儿童生长发育是受内在遗传因素与广泛外部环境因素共同作用的复杂、多维度过程。然而，现有研究多聚焦于是否发生母婴传播，对HIV暴露儿童的生长发育状况关注相对有限。本研究选取了云南、广西、新疆三个省份的8 个区域开展前瞻性队列研究，共纳入1,227 对母子对，其中暴露组411对、对照组816对，研究发现HIV 暴露未感染儿童营养不良率达12.00%，高于对照组儿童。通过多因素分析探索影响HIV暴露儿童营养不良的因素，其中家庭人均月收入超 3,000 元是保护因素，而母亲有死胎史、新生儿低出生体重、性别为女为危险因素，低出生体重儿童营养不良的风险增加了37.7%。本研究结果为HIV暴露儿童生长发育、减轻HIV母婴传播疾病负担提供了科学依据。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2026.043

Shifting Patterns of Anemia Prevalence and Severity Among Urban Women — China, 2019–2024

Xiaoxi Liu^1,&; Yaxin Xing^2,&; Sailimai Man^3,4,5,6,&; Heling Bao¹; Yining Zu³; Canqing Yu^4,5,6,7; Jun Lv^4,5,6,7; Linhong Wang⁸; Bo Wang^3,4,7,#; Liming Li^4,5,6,7,#; Hui Liu^1,#
1. Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China;

2. Peking Union Medical College, Beijing, China;

3. Meinian Institute of Health, Beijing, China;

4. Meinian Public Health Institute, Health Science Center, Peking University, Beijing, China;

5. Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China;

6. Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China;

7. Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China;

8. National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention & Chinese Academy of Preventive Medicine, Beijing, China.

^& Joint first authors.

^# Corresponding authors: Hui Liu, liuhui@pumc.edu.cn; Liming Li, lmlee@bjmu.edu.cn; Bo Wang, paul@meinianresearch.com.

Anemia represents a major health burden among women globally and poses a critical challenge to achieving international targets for reducing anemia prevalence in women of reproductive age and eliminating malnutrition by 2030. Despite its public health significance, temporal trends in anemia prevalence among Chinese women remain inadequately characterized. This study analyzed health examination data from 231 prefecture-level cities across all 31 provincial-level administrative divisions in China, encompassing 16,700,713 women examined in 2019 (n=7,822,489) and 2024 (n=8,878,224). Standardized prevalence estimates with 95% confidence intervals (CIs) were calculated by adjusting for provincial population structures. Temporal changes were quantified using prevalence differences with corresponding 95% CIs. Multivariable logistic regression models incorporating time-by-covariate interaction terms were employed to identify factors associated with anemia and moderate-to-severe anemia and to assess time-varying associations. Between 2019 and 2024, the overall prevalence of anemia among urban women and women of reproductive age in China declined from 13.7% (95% CI: 13.0, 14.4) and 17.0% (95% CI: 16.3, 17.8) to 13.2% (95% CI: 12.7, 13.8) and 16.7% (95% CI: 16.1, 17.3), respectively, while moderate-to-severe anemia prevalence remained essentially unchanged. Among women aged 40–49 years, anemia prevalence increased modestly, with a statistically significant rise in moderate-to-severe anemia of 0.32 percentage points (95% CI: 0.06, 0.57). Substantial regional disparities persisted: anemia prevalence decreased in 18 provincial units but increased in the remaining 13 units. Among women of reproductive age, anemia prevalence rose in 14 provincial units, with three provinces reaching or exceeding the 20% threshold indicative of moderate public health burden. Although China has achieved modest progress in reducing anemia among women, the overall disease burden remains substantial, with persistently elevated or increasing prevalence observed in specific subpopulations. These findings underscore the urgent need for targeted, risk-stratified public health interventions that prioritize women aged 40–49 years and provinces where anemia prevalence has increased or exceeds 20%.

城市女性贫血患病率与严重程度的变迁 — 中国，2019–2024年

刘晓曦^1,&；邢雅馨^2,&；满塞丽麦^3,4,5,6,&；包鹤龄¹；祖一宁³；余灿清^4,5,6,7；吕筠^4,5,6,7；王临虹⁸；王波^3,4,7,#；李立明^4,5,6,7,#；刘辉^1,#

1. 医学信息研究所，中国医学科学院，北京，中国

2. 北京协和医学院，北京，中国

3. 美年健康产业研究院，北京，中国

4. 美年公众健康研究院，医学部，北京大学，北京，中国

5. 流行病学与生物统计学系，公共卫生学院，北京大学，北京，中国

6. 重大疾病流行病学教育部重点实验室（北京大学），北京，中国

7. 北京大学公众健康与重大疫情防控战略研究中心，北京，中国

8. 慢性非传染性疾病预防控制中心，中国疾病预防控制中心（中国预防医学科学院），北京，中国。

^& 共同第一作者。

^# 通信作者：刘辉, liuhui@pumc.edu.cn；李立明，lmlee@bjmu.edu.cn；王波，paul@meinianresearch.com。

贫血是女性面临的主要健康负担，也是实现2030年全球降低育龄女性贫血患病率及消除营养不良目标的关键挑战。然而，中国女性贫血患病率的时间变化尚不明确。本研究分析了来自中国31个省份231个地级市的体检数据，共纳入16,700,713名女性，其中2019年7,822,489名，2024年8,878,224名。通过考虑省级人口结构，计算了标化患病率估计值及95%置信区间（CI）。采用患病率差及95% CI评估时间变化。应用多变量logistic回归模型识别贫血及中重度贫血的影响因素，并纳入时间与协变量的交互项以评估随时间变化的关联性。2019-2024年间，中国城市女性和育龄女性总体贫血患病率分别从13.7%（95% CI: 13.0–14.4）和17.0%（95% CI: 16.3–17.8）降至13.2%（95% CI: 12.7–13.8）和16.7%（95% CI: 16.1–17.3），中重度贫血变化不大。40-49岁女性贫血患病率略有上升，其中中重度贫血显著增加0.32%（95% CI: 0.06–0.57）。地区差异持续存在，18个省份的贫血患病率略有下降，其余省份则有所上升。在育龄女性中，14个省的贫血患病率上升，其中3个省份达到或超过20%。中国在妇女贫血防控方面取得了一定进展，但总体贫血负担仍然较重，部分亚群患病率持续偏高或呈上升趋势，需要采取有针对性的风险分层公共卫生干预措施，重点关注40-49岁女性以及贫血患病率上升或超过20%的省份。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2026.046

Menstrual Characteristics and the Risk of Spontaneous Abortion — 9 PLADs, China, 2013–2024

Tsomo Tenzin^1,2,3,&, Yumei Wei^4,&, Yiyao Jin^1,2,3, Jiaxin Li^1,2,3, Xiaowei Wang^1,2, Shenfengxiang Feng^1,2, Xinyi Lyu^1,2,3, Yuanyuan Xiong^1,2, Hanbin Wu^1,2, Jueming Lei^1,2, Jihong Xu^1,2, Yuan He^1,2, Yuanyuan Wang^1,2, Ya Zhang^1,2, Hongguang Zhang^1,2, Ying Yang^1,2,3,#, Xu Ma^1,2,#

1. National Research Institute for Family Planning, Chinese Academy of Medical Sciences, Beijing, China.

2 National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China.

3 Peking Union Medical College, Beijing, China.

4 Peking University First Hospital, Beijing, China.

^& Joint first authors

^# Corresponding authors: Ying Yang, yangying@nrifp.org.cn; Xu Ma, maxu_ky@nrifp.org.cn.

Menstrual irregularity is a hallmark clinical feature of polycystic ovary syndrome (PCOS), a well-established risk factor for spontaneous abortion (SA). However, robust population-level evidence directly linking specific menstrual patterns to SA risk remains lacking, as prior studies have been limited by small sample sizes and single-center designs. We analyzed data from 3.9 million women across nine Chinese provinces who participated in the National Free Preconception Care Project (NFPCP) between 2013 and 2024. Logistic regression was used to examine associations between menstrual characteristics and SA risk. Multilevel models, restricted cubic splines, and subgroup analyses were employed as extended analytical approaches to confirm the robustness of findings. Irregular menstrual cycles [adjusted odds ration (aOR)=1.11, 95% confidence interval (CI): 1.05, 1.17] and irregular periods (aOR=1.23, 95% CI: 1.15, 1.32) were independently associated with SA. The combination of long cycles (38, 53 days) and prolonged periods (>7 days) conferred the highest risk (aOR=1.82, 95% CI: 1.33, 2.49). Dose-response relationships and subgroup analyses yielded patterns consistent with the primary analysis. These findings support the utility of menstrual characteristic assessment as an effective tool for spontaneous abortion (SA) risk stratification before and during pregnancy. Greater clinical attention should be directed toward women with abnormal menstrual cycles and/or periods, who warrant targeted monitoring and intervention—measures that offer meaningful benefit even for those who have already achieved conception.

月经特征与自然流产风险的相关性分析 — 九省份，中国，2013–2024年

旦增措姆^1,2,3,&, 魏玉梅^4,&, 靳艺瑶^1,2,3, 李佳鑫^1,2,3, 王笑伟^1,2, 冯申凤翔 ^1,2, 吕心怡^1,2,3, 熊圆圆^1,2, 吴汉彬^1,2, 雷珏鸣^1,2, 徐继红^1,2, 贺媛^1,2, 王媛媛^1,2, 张亚^1,2, 张宏光^1,2, 杨英^1,2,3,#, 马旭^1,2,#

1. 国家卫生健康委科学技术研究所，中国医学科学院，北京，中国；

2. 国家人类遗传资源中心，北京，中国；

3. 北京协和医学院研究生院，北京，中国；

4. 北京大学第一医院，北京，中国。

^& 共同第一作者。

^# 通信作者：杨英, yangying@nrifp.org.cn; 马旭, maxu_ky@nrifp.org.cn。

多囊卵巢综合征（PCOS）是公认的自然流产危险因素，而月经不规律作为其核心临床特征，其具体表现模式——包括月经周期长度与经期持续时间——能否作为自然流产的早期预警信号，亟待在人群层面加以验证。本研究为回顾性队列研究，数据来源于2013–2024年国家免费孕前优生健康检查项目，覆盖中国东、中、西部九省，共纳入390万20–49岁育龄女性。采用逻辑回归分析月经特征与自然流产的关联，运用限制性立方样条探索剂量-反应关系，并进行亚组分析验证稳健性。月经不规律（aOR=1.11，95% CI：1.05, 1.17）和经期异常（aOR=1.23，95% CI：1.15, 1.32）均与自然流产风险独立相关。长周期（38–53天）合并经期延长（>7天）者的风险最高（aOR=1.82，95% CI：1.33, 2.49）。限制性立方样条分析显示周期长度呈J型、经期持续时间呈U型剂量-反应关系，亚组分析结果与主要分析一致。月经特征评估可作为孕前及孕期自然流产风险识别的潜在有效工具。临床应加强对月经周期或经期异常女性的关注，实施针对性监测与干预——即使对于已成功受孕者，此类措施亦具有重要临床价值。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2026.045

Association Between Longitudinal Serum Ferritin and Gestational Diabetes Mellitus — Beijing, Shanxi, and Shandong PLADs, China, 2021–2024

Xueyin Wang¹, Xiaosong Zhang¹, Juan Juan¹, Di Gao¹, Meihua Zhang², Yue Teng³, Qiuhong Yang⁴, Huixia Yang^1,#

1. Department of Obstetrics and Gynecology and Reproductive Medicine, Peking University First Hospital, Beijing, China;

2. Department of Obstetrics and Gynecology, Taiyuan Maternity and Child Health Hospital, Taiyuan City, Shanxi Province, China;

3. Department of Nutrition, Haidian District Maternal and Child Health Care Hospital, Beijing, China;

4. Department of Obstetrics, Jinan Maternity and Child Care Hospital, Jinan City, Shandong Province, China.

^# Corresponding author: Huixia Yang, yanghuixia@bjmu.edu.cn.

The influence of serum ferritin on gestational diabetes mellitus (GDM) development remains unclear. This study evaluated associations between longitudinal serum ferritin measurements in the first and second trimesters and GDM risk. This multicenter, prospective cohort study enrolled participants from four hospitals across Beijing Municipality, and Shanxi and Shandong provinces in China between July 2021 and June 2024. Participants were stratified into tertiles based on serum ferritin concentrations measured at 11–13, 16–19, and 24–27 weeks' gestation. Poisson regression and restricted cubic spline models were employed to examine associations between serum ferritin and GDM. Among 6,614 participants, 1,427 (21.6%) developed GDM. At 11–13 weeks' gestation, a U-shaped relationship between serum ferritin and GDM was identified (P for non-linearity=0.008), demonstrating that both the lowest (RR: 1.31; 95% CI: 1.05, 1.63) and highest tertiles (RR: 1.33; 95% CI: 1.07, 1.66) were associated with elevated GDM risk after adjusting for demographic, socioeconomic, and clinical confounders. Women in the highest tertile of serum ferritin at 16–19 weeks' (RR: 1.28; 95% CI: 1.03, 1.58) and 24–27 weeks' gestation (RR: 1.18; 95% CI: 1.03, 1.35) had significantly greater GDM risk compared with the medium tertile. Serum ferritin concentrations in the first and second trimesters were independently associated with GDM risk. Enhanced strategies are needed to improve understanding and clinical utility of serum ferritin measurements for early identification and prevention of GDM.

血清铁蛋白与妊娠期糖尿病的关联 — 北京、山西、山东省，中国，2021-2024年

王雪茵¹；张小松¹；隽娟¹；高迪¹；张眉花²；滕越³；杨秋红⁴；杨慧霞^1,#

1. 妇产生殖医学中心，北京大学第一医院，北京，中国；

2. 妇产科，太原市妇幼保健院，太原市，山西省，中国；

3. 营养科，北京市海淀区妇幼保健院，北京，中国；

4. 产科，济南市妇幼保健院，济南市，山东省，中国。

^# 通信作者：杨慧霞，yanghuixia@bjmu.edu.cn。

血清铁蛋白对妊娠期糖尿病（GDM）发生的影响尚不明确。本研究旨在评估孕早期和孕中期纵向测量的血清铁蛋白水平与GDM的关联。本研究为多中心、前瞻性队列研究，于2021年7月至2024年6月在中国北京市、山西省和山东省的四家医院开展。根据孕11–13周、16–19周和24–27周血清铁蛋白的三分位数，将血清铁蛋白水平分别分为三组。采用泊松回归和限制性立方样条模型分析血清铁蛋白与GDM之间的关联。在6614名孕妇中，1427名（21.6%）诊断为GDM。孕11–13周血清铁蛋白与GDM之间存在U型关系（非线性检验P=0.008）；校正潜在混杂因素后，血清铁蛋白最低三分位数组（RR: 1.31; 95% CI: 1.05, 1.63）和最高三分位数组（RR: 1.33; 95% CI: 1.07, 1.66）发生GDM的风险显著增加。与中等水平组相比，孕16–19周（RR: 1.28; 95% CI: 1.03, 1.58）和孕24–27周（RR: 1.18; 95% CI: 1.03, 1.35）血清铁蛋白最高三分位数组发生GDM的风险显著升高。需进一步探索和认识血清铁蛋白在识别与预防GDM中的作用，并推动相关防控策略的制定。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2026.044