{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:22:47Z","timestamp":1787008967290,"version":"build-2736575974"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82474335"],"award-info":[{"award-number":["82474335"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82225049"],"award-info":[{"award-number":["82225049"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018542","name":"Natural Science Foundation of Sichuan Province","doi-asserted-by":"publisher","award":["2024NSFSC1668"],"award-info":[{"award-number":["2024NSFSC1668"]}],"id":[{"id":"10.13039\/501100018542","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018542","name":"Natural Science Foundation of Sichuan Province","doi-asserted-by":"publisher","award":["2024YFFK0152"],"award-info":[{"award-number":["2024YFFK0152"]}],"id":[{"id":"10.13039\/501100018542","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013365","name":"West China Hospital, Sichuan University","doi-asserted-by":"publisher","award":["ZYYC24010"],"award-info":[{"award-number":["ZYYC24010"]}],"id":[{"id":"10.13039\/501100013365","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>After over three decades of the one-child policy (OCP), China introduced the partial two-child policy (PTCP) in 2013 and the universal two-child policy (UTCP) in 2015. However, their potential impacts on maternal and neonatal health remain unclear. This study aimed to examine temporal changes in maternal characteristics and neonatal outcomes across different policy periods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used data from a population-based pregnancy registry in Ximen, China. Maternal characteristics and neonatal outcomes were compared across the three periods: OCP (2012\u20132014), PTCP (2014\u20132016), and UTCP (2016\u20132021). Joinpoint regression and interrupted time series (ITS) model were applied to evaluate temporal trends and quantify the effect of policy implementation on trends over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 491\u00a0895 pregnancies, the proportion of advanced maternal age and multiparity rose significantly after policy shifts. Maternal obesity, hypertensive disorders of pregnancy, and gestational diabetes showed steady increases. Monthly births peaked in 2016, then declined below the pre-PTCP baseline level by 2020. Compared to OCP, the prevalence of birth defects (BDs) increased by 62% during PTCP and 204% during UTCP. Preterm birth and low Apgar scores also rose. ITS indicated a significant post-UTCP acceleration in BDs (\u03b23 = 2.57), largely driven by circulatory system BDs, with maternal age acting as a partial mediator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>China\u2019s TCP implementation was associated with notable shifts in maternal risk profiles and increased adverse neonatal outcomes, underscoring the need for continuous maternal-child health monitoring during fertility policy transitions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ije\/dyaf222","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T13:08:33Z","timestamp":1765458513000},"source":"Crossref","is-referenced-by-count":1,"title":["Impact of evolving fertility policies on maternal and neonatal outcomes in southeastern China: a 10-year population-based cohort study"],"prefix":"10.1093","volume":"55","author":[{"given":"Yiquan","family":"Xiong","sequence":"first","affiliation":[{"name":"General Practice Medical Center, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University , Chengdu,","place":["China"]},{"name":"NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan , Chengdu,","place":["China"]},{"name":"Sichuan Center of Technology Innovation for Real World Data , Chengdu,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Zhao","sequence":"additional","affiliation":[{"name":"General Practice Medical Center, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University , Chengdu,","place":["China"]},{"name":"NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan , Chengdu,","place":["China"]},{"name":"Sichuan Center of Technology Innovation for Real World Data , Chengdu,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunrong","family":"Liu","sequence":"additional","affiliation":[{"name":"General Practice Medical Center, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University , Chengdu,","place":["China"]},{"name":"NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan , Chengdu,","place":["China"]},{"name":"Sichuan Center of Technology Innovation for Real World Data , Chengdu,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0355-9734","authenticated-orcid":false,"given":"Lehana","family":"Thabane","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University , Hamilton, ON,","place":["Canada"]},{"name":"Biostatistics Unit, St Joseph\u2019s Healthcare Hamilton , Hamilton, ON,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingyu","family":"Liao","sequence":"additional","affiliation":[{"name":"General Practice Medical Center, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University , Chengdu,","place":["China"]},{"name":"NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan , Chengdu,","place":["China"]},{"name":"Sichuan Center of Technology Innovation for Real World Data , Chengdu,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Guo","sequence":"additional","affiliation":[{"name":"General Practice Medical Center, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University , Chengdu,","place":["China"]},{"name":"NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan , Chengdu,","place":["China"]},{"name":"Sichuan Center of Technology Innovation for Real World Data , Chengdu,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanqiang","family":"Wei","sequence":"additional","affiliation":[{"name":"General Practice Medical Center, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University , Chengdu,","place":["China"]},{"name":"NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan , Chengdu,","place":["China"]},{"name":"Sichuan Center of Technology Innovation for Real World Data , Chengdu,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingwen","family":"Chen","sequence":"additional","affiliation":[{"name":"General Practice Medical Center, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University , Chengdu,","place":["China"]},{"name":"NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan , Chengdu,","place":["China"]},{"name":"Sichuan Center of Technology Innovation for Real World Data , Chengdu,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Ren","sequence":"additional","affiliation":[{"name":"General Practice Medical Center, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University , Chengdu,","place":["China"]},{"name":"NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan , Chengdu,","place":["China"]},{"name":"Sichuan Center of Technology Innovation for Real World Data , Chengdu,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guanhua","family":"Yao","sequence":"additional","affiliation":[{"name":"Xiamen Health Commission , Xiamen,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongyao","family":"Qian","sequence":"additional","affiliation":[{"name":"Xiamen Health Commission , Xiamen,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biao","family":"Rong","sequence":"additional","affiliation":[{"name":"Xiamen Health and Medical Big Data Center , Xiamen,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moliang","family":"Chen","sequence":"additional","affiliation":[{"name":"Xiamen Health and Medical Big Data Center , Xiamen,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3777-1813","authenticated-orcid":false,"given":"Min","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University , Chengdu,","place":["China"]},{"name":"Faculty of Health, Design and Art, Swinburne University of Technology , Hawthorn, VIC,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6554-7088","authenticated-orcid":false,"given":"Xin","family":"Sun","sequence":"additional","affiliation":[{"name":"General Practice Medical Center, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University , Chengdu,","place":["China"]},{"name":"NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan , Chengdu,","place":["China"]},{"name":"Sichuan Center of Technology Innovation for Real World Data , Chengdu,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Tan","sequence":"additional","affiliation":[{"name":"General Practice Medical Center, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University , Chengdu,","place":["China"]},{"name":"NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan , Chengdu,","place":["China"]},{"name":"Sichuan Center of Technology Innovation for Real World Data , Chengdu,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"2026010509244427000_dyaf222-B1","doi-asserted-by":"publisher","first-page":"2619","DOI":"10.1001\/jama.2015.16279","article-title":"The end of the one-child policy: lasting implications for China","volume":"314","author":"Hesketh","year":"2015","journal-title":"JAMA"},{"key":"2026010509244427000_dyaf222-B2","doi-asserted-by":"publisher","first-page":"1930","DOI":"10.1016\/S0140-6736","article-title":"The effects of China\u2019s universal two-child policy","volume":"388","author":"Zeng","year":"2016","journal-title":"Lancet"},{"key":"2026010509244427000_dyaf222-B3","doi-asserted-by":"publisher","first-page":"2238","DOI":"10.1016\/S0140-6736(21)01295-2","article-title":"China\u2019s three-child policy","volume":"397","author":"Tatum","year":"2021","journal-title":"Lancet"},{"key":"2026010509244427000_dyaf222-B4","doi-asserted-by":"publisher","first-page":"l4680","DOI":"10.1136\/bmj.l4680","article-title":"Association of China\u2019s universal two child policy with changes in births and birth related health factors: national, descriptive comparative study","volume":"366","author":"Li","year":"2019","journal-title":"BMJ"},{"key":"2026010509244427000_dyaf222-B5","doi-asserted-by":"publisher","first-page":"e1003047","DOI":"10.1371\/journal.pmed.1003047","article-title":"Changes in maternal age and prevalence of congenital anomalies during the enactment of China\u2019s universal two-child policy (2013-2017) in Zhejiang Province, China: an observational study","volume":"17","author":"Zhang","year":"2020","journal-title":"PLoS Med"},{"key":"2026010509244427000_dyaf222-B6","doi-asserted-by":"publisher","first-page":"k817","DOI":"10.1136\/bmj.k817","article-title":"Relaxation of the one child policy and trends in caesarean section rates and birth outcomes in China between 2012 and 2016: observational study of nearly seven million health facility births","volume":"360","author":"Liang","year":"2018","journal-title":"BMJ"},{"key":"2026010509244427000_dyaf222-B7","doi-asserted-by":"publisher","first-page":"2226","DOI":"10.1186\/s12889-023-16583-x","article-title":"The effect of China\u2019s many-child policy on the number of births and the prevalence of serious teratogenic and disabling defects in Hunan Province","volume":"23","author":"Xie","year":"2023","journal-title":"BMC Public Health"},{"key":"2026010509244427000_dyaf222-B8","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deac107.689","article-title":"P-744 Fertility intention for a second or third child among childbearing couple in Shanghai, China","volume":"37","author":"Zhu","year":"2022","journal-title":"Hum Reprod"},{"key":"2026010509244427000_dyaf222-B9","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1186\/s12884-021-03897-0","article-title":"Maternal mortality ratio in Jiangsu Province, China: recent trends and associated factors","volume":"21","author":"Li","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026010509244427000_dyaf222-B10","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1186\/s12884-023-05552-2","article-title":"The effect of 2016 Chinese second-child policy and different maternal age on pregnancy outcomes in Hebei Province, China","volume":"23","author":"Tian","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026010509244427000_dyaf222-B11","doi-asserted-by":"publisher","first-page":"2497","DOI":"10.1016\/S0140-6736(20)32708-2","article-title":"A Lancet Commission on 70 years of women\u2019s reproductive, maternal, newborn, child, and adolescent health in China","volume":"397","author":"Qiao","year":"2021","journal-title":"Lancet"},{"key":"2026010509244427000_dyaf222-B12","doi-asserted-by":"publisher","first-page":"e059208","DOI":"10.1136\/bmjopen-2021-059208","article-title":"Changes in caesarean section rates in China during the period of transition from the one-child to two-child policy era: cross-sectional National Household Health Services Surveys","volume":"12","author":"Long","year":"2022","journal-title":"BMJ Open"},{"key":"2026010509244427000_dyaf222-B13","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1186\/s12889-024-17810-9","article-title":"Changes in the characteristics and outcomes of high-risk pregnant women who delivered prior to and after China\u2019s universal two-child policy: a real-world retrospective study, 2010-2021","volume":"24","author":"Zhu","year":"2024","journal-title":"BMC Public Health"},{"key":"2026010509244427000_dyaf222-B14","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1093\/ije\/dyaa161","article-title":"Data resource profile: Xiamen Registry of Pregnant Women and Offspring (REPRESENT): a population-based, long-term follow-up database linking four major healthcare data platforms","volume":"50","author":"Tan","year":"2021","journal-title":"Int J Epidemiol"},{"key":"2026010509244427000_dyaf222-B15","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"2026010509244427000_dyaf222-B16","author":"Surveillance Research Program, NCI","year":"2025"},{"key":"2026010509244427000_dyaf222-B17","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1186\/s12874-018-0519-5","article-title":"Comparing performance between log-binomial and robust Poisson regression models for estimating risk ratios under model misspecification","volume":"18","author":"Chen","year":"2018","journal-title":"BMC Med Res Methodol"},{"key":"2026010509244427000_dyaf222-B18","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1093\/aje\/kwh090","article-title":"A modified Poisson regression approach to prospective studies with binary data","volume":"159","author":"Zou","year":"2004","journal-title":"Am J Epidemiol"},{"key":"2026010509244427000_dyaf222-B19","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1177\/1536867x1501500208","article-title":"Conducting interrupted time-series analysis for single- and multiple-group comparisons","volume":"15","author":"Linden","year":"2015","journal-title":"Stata J"},{"key":"2026010509244427000_dyaf222-B20","doi-asserted-by":"publisher","first-page":"1414","DOI":"10.1093\/ije\/dyaa118","article-title":"Corrigendum to: interrupted time series regression for the evaluation of public health interventions: a tutorial","volume":"49","author":"Bernal","year":"2020","journal-title":"Int J Epidemiol"},{"key":"2026010509244427000_dyaf222-B21","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.jclinepi.2018.05.026","article-title":"A methodological framework for model selection in interrupted time series studies","volume":"103","author":"Lopez Bernal","year":"2018","journal-title":"J Clin Epidemiol"},{"key":"2026010509244427000_dyaf222-B22","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1186\/s12874-021-01426-3","article-title":"Mediation analysis methods used in observational research: a scoping review and recommendations","volume":"21","author":"Rijnhart","year":"2021","journal-title":"BMC Med Res Methodol"},{"key":"2026010509244427000_dyaf222-B23","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1037\/hea0001299","article-title":"Tutorial on causal mediation analysis with binary variables: an application to health psychology research","volume":"42","author":"Xu","year":"2023","journal-title":"Health Psychol"},{"key":"2026010509244427000_dyaf222-B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v076.i11","article-title":"medflex: an R package for flexible mediation analysis using natural effect models","volume":"76","author":"Steen","year":"2017","journal-title":"J Stat Soft"},{"key":"2026010509244427000_dyaf222-B25","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1186\/s12889-022-12839-0","article-title":"Association of China\u2019s two-child policy with changes in number of births and birth defects rate, 2008-2017","volume":"22","author":"Chen","year":"2022","journal-title":"BMC Public Health"},{"key":"2026010509244427000_dyaf222-B26","doi-asserted-by":"publisher","first-page":"04134","DOI":"10.7189\/jogh.14.04134","article-title":"Burden of multiple high-risk factors in pregnancy before and after the universal two-child policy in Chinese women: an observational study","volume":"14","author":"Zhang","year":"2024","journal-title":"J Glob Health"},{"key":"2026010509244427000_dyaf222-B27","doi-asserted-by":"publisher","first-page":"e1226","DOI":"10.1016\/S2214-109X","article-title":"Preterm births in China between 2012 and 2018: an observational study of more than 9 million women","volume":"9","author":"Deng","year":"2021","journal-title":"Lancet Glob Health"},{"key":"2026010509244427000_dyaf222-B28","doi-asserted-by":"publisher","first-page":"37","DOI":"10.4103\/0366-6999.221268","article-title":"Analysis of the characteristics of pregnancy and delivery before and after implementation of the two-child policy","volume":"131","author":"Zhang","year":"2018","journal-title":"Chin Med J"},{"key":"2026010509244427000_dyaf222-B29","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1186\/s12889-020-08799-y","article-title":"How does the two-child policy affect the sex ratio at birth in China? A cross-sectional study","volume":"20","author":"Fan","year":"2020","journal-title":"BMC Public Health"},{"key":"2026010509244427000_dyaf222-B30","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1186\/s12884-021-03740-6","article-title":"Socio-demographic characteristics and outcomes of pregnant women who delivered prior to and after the termination of the one-child policy in China: a comparative study","volume":"21","author":"Zhang","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026010509244427000_dyaf222-B31","doi-asserted-by":"publisher","first-page":"960877","DOI":"10.3389\/fendo.2022.960877","article-title":"The prevalence of gestational diabetes mellitus before and after the implementation of the universal two-child policy in China","volume":"13","author":"Zhu","year":"2022","journal-title":"Front Endocrinol"},{"key":"2026010509244427000_dyaf222-B32","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1186\/s12916-020-01714-7","article-title":"The trend of caesarean birth rate changes in China after \u2018universal two-child policy\u2019 era: a population-based study in 2013-2018","volume":"18","author":"Yan","year":"2020","journal-title":"BMC Med"},{"key":"2026010509244427000_dyaf222-B33","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1186\/s12884-021-03811-8","article-title":"The incidence, risk factors and maternal and foetal outcomes of uterine rupture during different birth policy periods: an observational study in China","volume":"21","author":"Zhou","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026010509244427000_dyaf222-B34","doi-asserted-by":"publisher","first-page":"04069","DOI":"10.7189\/jogh.14.04069","article-title":"Trajectories tracking of maternal and neonatal health in eastern China from 2010 to 2021: a multicentre cross-sectional study","volume":"14","author":"Zhu","year":"2024","journal-title":"J Glob Health"},{"key":"2026010509244427000_dyaf222-B35","doi-asserted-by":"publisher","first-page":"378","DOI":"10.3389\/fpubh.2020.00378","article-title":"Birth defects data from population-based birth defects surveillance system in a district of Southern Jiangsu, China, 2014-2018","volume":"8","author":"Zhou","year":"2020","journal-title":"Front Public Health"},{"key":"2026010509244427000_dyaf222-B36","doi-asserted-by":"publisher","first-page":"e0147280","DOI":"10.1371\/journal.pone.0147280","article-title":"Epidemiology of birth defects based on a birth defect surveillance system from 2005 to 2014 in Hunan Province, China","volume":"11","author":"Xie","year":"2016","journal-title":"PLoS One"},{"key":"2026010509244427000_dyaf222-B37","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1186\/s12889-018-5947-y","article-title":"Epidemiology of birth defects based on surveillance data from 2011-2015 in Guangxi, China: comparison across five major ethnic groups","volume":"18","author":"Chen","year":"2018","journal-title":"BMC Public Health"},{"key":"2026010509244427000_dyaf222-B38","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1007\/s10654-020-00653-0","article-title":"Birth prevalence of congenital heart disease in China, 1980-2019: a systematic review and meta-analysis of 617 studies","volume":"35","author":"Zhao","year":"2020","journal-title":"Eur J Epidemiol"},{"key":"2026010509244427000_dyaf222-B39","doi-asserted-by":"publisher","first-page":"1219091","DOI":"10.3389\/fped.2023.1219091","article-title":"The current state and potential innovation of fetal cardiac MRI","volume":"11","author":"Udine","year":"2023","journal-title":"Front Pediatr"},{"key":"2026010509244427000_dyaf222-B40","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1186\/s12889-023-15235-4","article-title":"Age-specific effects on adverse pregnancy outcomes vary by maternal characteristics: a population-based retrospective study in Xiamen, China","volume":"23","author":"Huang","year":"2023","journal-title":"BMC Public Health"},{"key":"2026010509244427000_dyaf222-B41","doi-asserted-by":"publisher","first-page":"2250894","DOI":"10.1080\/14767058.2023.2250894","article-title":"The role of maternal age on adverse pregnancy outcomes among primiparous women with singleton birth: a retrospective cohort study in urban areas of China","volume":"36","author":"Li","year":"2023","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2026010509244427000_dyaf222-B42","doi-asserted-by":"crossref","first-page":"2292","DOI":"10.1001\/jama.1979.03300210018013","article-title":"Reducing birth defect risk in advanced maternal age","volume":"242","author":"Goldberg","year":"1979","journal-title":"JAMA"},{"key":"2026010509244427000_dyaf222-B43","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1097\/aog.0000000000002504","article-title":"Risk of adverse pregnancy outcomes at advanced maternal age","volume":"131","author":"Frederiksen","year":"2018","journal-title":"Obstet Gynecol"},{"key":"2026010509244427000_dyaf222-B44","doi-asserted-by":"publisher","first-page":"j2563","DOI":"10.1136\/bmj.j2563","article-title":"Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons","volume":"357","author":"Persson","year":"2017","journal-title":"BMJ"},{"key":"2026010509244427000_dyaf222-B45","doi-asserted-by":"publisher","first-page":"5048","DOI":"10.1038\/s41598-022-08396-6","article-title":"Changes in adverse pregnancy outcomes in women with advanced maternal age (AMA) after the enactment of China\u2019s universal two-child policy","volume":"12","author":"Li","year":"2022","journal-title":"Sci Rep"},{"key":"2026010509244427000_dyaf222-B46","first-page":"4","article-title":"Notice of the General Office of the National Health Commission on Printing and Distributing the Birth Defects Prevention and Treatment Capacity Improvement Plan (2023-2027)","volume":"08","author":"National Health Commission of the People\u2019s Republic of China","year":"2023","journal-title":"Gazette of the National Health Commission of the People\u2019s Republic of China"},{"key":"2026010509244427000_dyaf222-B47","first-page":"17","article-title":"Notice of the National Health Commission on Printing and Distributing the Maternal and Child Safety Action Improvement Plan (2021-2025)","volume":"10","author":"National Health Commission of the People\u2019s Republic of China","year":"2021","journal-title":"Gazette of the National Health Commission of the People\u2019s Republic of China"}],"container-title":["International Journal of Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ije\/article-pdf\/55\/1\/dyaf222\/66263478\/dyaf222.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ije\/article-pdf\/55\/1\/dyaf222\/66263478\/dyaf222.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T14:24:56Z","timestamp":1767623096000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ije\/article\/doi\/10.1093\/ije\/dyaf222\/8414018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,2]]},"references-count":47,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ije\/dyaf222","relation":{},"ISSN":["0300-5771","1464-3685"],"issn-type":[{"value":"0300-5771","type":"print"},{"value":"1464-3685","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2026,1,2]]},"article-number":"dyaf222"}}