Antenatal care for women in their second pregnancies in China
Authors: Fangfan Ye, Jia Huang
Journal: The Lancet Global Health (2016)

In The Lancet Global Health, Jun Zhu and colleagues1Zhu J Liang J Mu Y et al.Sociodemographic and obstetric characteristics of stillbirths in China: a census of nearly 4 million health facility births between 2012 and 2014.Lancet Glob Health. 2016; 4: e109-e118Summary Full Text Full Text PDF Scopus (53) Google Scholar provide stillbirth rates retrieved from China's National Maternal Near Miss Surveillance System between 2012 and 2014. The authors found the stillbirth rate was particularly high in young women (aged <15 years). However, this study1Zhu J Liang J Mu Y et al.Sociodemographic and obstetric characteristics of stillbirths in China: a census of nearly 4 million health facility births between 2012 and 2014.Lancet Glob Health. 2016; 4: e109-e118Summary Full Text Full Text PDF Scopus (53) Google Scholar overlooks the demographic impact of China's population policy shift at present. With the implementation of the two-child policy in 2016, we presume that the age group of women at high risk of stillbirth might shift to older women. Data from WHO2Lumbiganon P Laopaiboon M Gulmezoglu AM et al.Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007–08.Lancet. 2010; 375: 490-499Summary Full Text Full Text PDF PubMed Scopus (690) Google Scholar, 3Feng XL Xu L Guo Y Ronsmans C Factors influencing rising caesarean section rates in China between 1988 and 2008.Bull World Health Organ. 2012; 90: 30-39Crossref PubMed Scopus (179) Google Scholar indicated that the prevalence of cesarean sections in the past 10 years in China was significantly higher than WHO's recommended proportion. The one-child policy might have contributed indirectly to this increase. Parents who can have only one child might opt for what is perceived to be the safest delivery option.3Feng XL Xu L Guo Y Ronsmans C Factors influencing rising caesarean section rates in China between 1988 and 2008.Bull World Health Organ. 2012; 90: 30-39Crossref PubMed Scopus (179) Google Scholar In 2015, however, the Communist Party of China Central Committee has substantially relaxed its one-child policy and has shifted to a two-child policy to balance population growth and offset the burden of an ageing population. Some women who had their first child with caesarean section during the one-child policy period stand a good chance to choose to have their second child now, as they are more mature mentally and economically than before. However, those women with their growing age (>35 years) might have higher risk of stillbirth during pregnancy. Indeed, several population-based studies showed that in women with previous caesarean delivery, the risk of unexplained antepartum stillbirth at or after 39 weeks' gestation was about double the risk of stillbirth or neonatal death from intrapartum uterine rupture.4Smith GC Pell JP Dobbie R Caesarean section and risk of unexplained stillbirth in subsequent pregnancy.Lancet. 2003; 362: 1779-1784Summary Full Text Full Text PDF PubMed Scopus (302) Google Scholar Therefore, the Government in China need to pay more attention to enhance the quality of antenatal care for pregnant women who had one previous caesarean delivery, particularly for older parturient women among them. We declare no competing interests.