{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:37:27Z","timestamp":1788950247955,"version":"build-2803163510"},"reference-count":42,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T00:00:00Z","timestamp":1707350400000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National High Level Hospital","award":["BJ-2021-222"],"award-info":[{"award-number":["BJ-2021-222"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,1,25]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to explore the impacts of the changing national fertility policy on maternal and fetal characteristics, and birth timing patterns and provide a basis for the management of the obstetric and midwifery workforce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Data from medical register of a tertiary referral centre in Beijing, China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>We included 20 334 births with a gestational age more than 28 weeks during January 2013\u2013September 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcomes<\/jats:title>\n                    <jats:p>The main outcomes included birth numbers, maternal age, parity, birth modes, premature rates, neonatal birth weight, and birth timings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The birth rates showed a general rising trend before 2016. Afterwards, the birth rates kept decreasing and reached the bottom level in 2022. The caesarean section rates showed a declining trend, while the assisted birth rates were progressively rising, especially among primiparous women. From 2013 to 2022, the proportions of multiparous women (increasing from 9.3% to 36.6%) and women with advanced maternal age (increasing from 11.4% to 34.5%) were on the rise, together with increasing rates of premature birth (increasing from 5.7% to 8.5%) and neonatal low birth weight (rising from 4.3% to 7.2%) in this population. This study found a significant peak of births between 14:00 and 15:00, which remained unchanged despite shifts in the fertility policy (p&lt;0.001 and\n                      <jats:inline-formula>\n                        <m:math xmlns:m=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" overflow=\"scroll\">\n                          <m:mover accent=\"false\">\n                            <m:mrow>\n                              <m:mi>R<\/m:mi>\n                            <\/m:mrow>\n                            <m:mo>\u00af<\/m:mo>\n                          <\/m:mover>\n                        <\/m:math>\n                      <\/jats:inline-formula>\n                      values close to 1, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The \u2018three-child\u2019 policy did not boost the birth rate further 2 years later after its enactment, and the proportion of multiparous women and women with advanced maternal age were on the rise, accompanied by an increase in rates of premature birth and low birth weight. Targeted training should be offered to healthcare professionals to empower them to deal with possible negative pregnancy outcomes and childbirth complications. Prepregnancy and antepartum education should be parity specific. Adequate midwifery staffing during this 14:00\u201315:00 is vital to promote a safe birth.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-076987","type":"journal-article","created":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T21:41:15Z","timestamp":1707428475000},"page":"e076987","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Fertility policy changes, maternal and foetal characteristics and birth timing patterns at a tertiary referral centre in Beijing: a ten-year retrospective study"],"prefix":"10.1136","volume":"14","author":[{"given":"Dehui","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R.China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R.China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6827-1232","authenticated-orcid":false,"given":"Jing","family":"Huang","sequence":"additional","affiliation":[{"name":"Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,2,8]]},"reference":[{"key":"2025120520522361000_14.2.e076987.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31405-2"},{"key":"2025120520522361000_14.2.e076987.2","doi-asserted-by":"crossref","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":"2025120520522361000_14.2.e076987.3","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2019-002157","article-title":"Reducing maternal mortality in China in the era of the two-child policy","volume":"5","author":"Liu","year":"2020","journal-title":"BMJ Glob Health"},{"key":"2025120520522361000_14.2.e076987.4","unstructured":"NHC of the People\u2019s Republic of China . China health statistics yearbook. Beijing: Peking Union Medical College Press, 2017. Available: www.pumcp.com"},{"key":"2025120520522361000_14.2.e076987.5","doi-asserted-by":"crossref","DOI":"10.1111\/1471-0528.14464","article-title":"Advanced maternal age increases the risk of very preterm birth, irrespective of parity: a population-based register study","volume":"124","author":"Eichelberger","year":"2017","journal-title":"BJOG"},{"key":"2025120520522361000_14.2.e076987.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0191002","article-title":"Effect of maternal age on the risk of preterm birth: A large cohort study","volume":"13","author":"Fuchs","year":"2018","journal-title":"PLoS One"},{"key":"2025120520522361000_14.2.e076987.7","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.bpobgyn.2020.07.005","article-title":"Advanced maternal age and adverse pregnancy outcomes","volume":"70","author":"Frick","year":"2021","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"2025120520522361000_14.2.e076987.8","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajog.2015.01.043","article-title":"Cesarean delivery on maternal request in China: what are the risks and benefits?","volume":"212","author":"Liu","year":"2015","journal-title":"Am J Obstet Gynecol"},{"key":"2025120520522361000_14.2.e076987.9","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S41410"},{"key":"2025120520522361000_14.2.e076987.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-054959","article-title":"Early-term birth and its association with universal two-child policy: A national cross-sectional study in China","volume":"11","author":"Zhang","year":"2021","journal-title":"BMJ Open"},{"key":"2025120520522361000_14.2.e076987.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60789-3"},{"key":"2025120520522361000_14.2.e076987.12","doi-asserted-by":"crossref","first-page":"e24","DOI":"10.1016\/S2214-109X(20)30397-1","article-title":"Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study","volume":"9","author":"Nove","year":"2021","journal-title":"Lancet Glob Health"},{"key":"2025120520522361000_14.2.e076987.13","unstructured":"UNFPA, ICM, WHO . States of world midwifery. New York, 2021."},{"key":"2025120520522361000_14.2.e076987.14","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0198183","article-title":"Timing of singleton births by onset of labour and mode of birth in NHS maternity units in England, 2005-2014: A study of linked birth registration, birth notification, and hospital episode data","volume":"13","author":"Martin","year":"2018","journal-title":"PLoS One"},{"key":"2025120520522361000_14.2.e076987.15","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1002\/ajhb.21228","article-title":"Hour of birth and birth assistance: from a primate to a medicalized pattern?","volume":"24","author":"Bernis","year":"2012","journal-title":"Am J Hum Biol"},{"key":"2025120520522361000_14.2.e076987.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2014.07.013"},{"key":"2025120520522361000_14.2.e076987.17","doi-asserted-by":"crossref","first-page":"63","DOI":"10.36472\/msd.v6i3.218","article-title":"Application of circular statistics to life science data","volume":"6","author":"Demir","year":"2019","journal-title":"Medical Science and Discovery"},{"key":"2025120520522361000_14.2.e076987.18","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0187029","article-title":"Association between birth season and physical development in children under 3 years old residing in low-income counties in western China","volume":"12","author":"Lei","year":"2017","journal-title":"PLoS One"},{"key":"2025120520522361000_14.2.e076987.19","doi-asserted-by":"crossref","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 Preg Childbirth"},{"key":"2025120520522361000_14.2.e076987.20","doi-asserted-by":"crossref","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":"2025120520522361000_14.2.e076987.21","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1007\/s42379-020-00053-7","article-title":"Fertility intention and related factors in China: findings from the 2017 National Fertility Survey","volume":"4","author":"Zhuang","year":"2020","journal-title":"China Popul Dev Stud"},{"key":"2025120520522361000_14.2.e076987.22","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-022-04873-y","article-title":"Fertility intentions among young people in the era of China\u2019s three-child policy: a national survey of university students","volume":"22","author":"Zhang","year":"2022","journal-title":"BMC Preg Childbirth"},{"key":"2025120520522361000_14.2.e076987.23","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1093\/humrep\/deac101","article-title":"Fertility intentions to have a second or third child under China\u2019s three-child policy: a national cross-sectional study","volume":"37","author":"Jing","year":"2022","journal-title":"Hum Reprod"},{"key":"2025120520522361000_14.2.e076987.24","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.13.04072","article-title":"Fertility intentions to have A second or third child among the childbearing-age population in Central China under China\u2019s three-child policy: A cross-sectional study","volume":"13","author":"Chen","year":"2023","journal-title":"J Glob Health"},{"key":"2025120520522361000_14.2.e076987.25","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-023-15719-3","article-title":"Third-child fertility intention and its socioeconomic factors among women aged 20-34 years in China","volume":"23","author":"Yang","year":"2023","journal-title":"BMC Public Health"},{"key":"2025120520522361000_14.2.e076987.26","doi-asserted-by":"crossref","DOI":"10.1186\/s12905-022-02145-7","article-title":"The relationship among pregnancy-related anxiety, perceived social support, family function and resilience in Chinese pregnant women: a structural equation modeling analysis","volume":"22","author":"Huang","year":"2022","journal-title":"BMC Womens Health"},{"key":"2025120520522361000_14.2.e076987.27","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-023-15944-w","article-title":"The impact of COVID-19 on the intention of third-child in China: an empirical analysis based on survey data","volume":"23","author":"Li","year":"2023","journal-title":"BMC Public Health"},{"key":"2025120520522361000_14.2.e076987.28","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1080\/00324728.2022.2134579","article-title":"Sooner, later, or never: Changing fertility intentions due to Covid-19 in China\u2019s Covid-19 epicentre","volume":"77","author":"Zhou","year":"2023","journal-title":"Popul Stud (Camb)"},{"key":"2025120520522361000_14.2.e076987.29","doi-asserted-by":"crossref","DOI":"10.3390\/bs13020184","article-title":"Factors Associated with Fertility Intention among Chinese Married Youth during the COVID-19 Pandemic","volume":"13","author":"Peng","year":"2023","journal-title":"Behav Sci (Basel)"},{"key":"2025120520522361000_14.2.e076987.30","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2022.903183","article-title":"Fertility intention among Chinese reproductive couples during the COVID-19 outbreak: a cross-sectional study","volume":"10","author":"Chu","year":"2022","journal-title":"Front Public Health"},{"key":"2025120520522361000_14.2.e076987.31","doi-asserted-by":"crossref","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 Preg Childbirth"},{"key":"2025120520522361000_14.2.e076987.32","doi-asserted-by":"crossref","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":"2025120520522361000_14.2.e076987.33","doi-asserted-by":"crossref","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":"2025120520522361000_14.2.e076987.34","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.puhe.2022.02.015","article-title":"Trends in maternal age and the relationship between advanced age and adverse pregnancy outcomes: a population-based register study in Wuhan, China, 2010-2017","volume":"206","author":"Cao","year":"2022","journal-title":"Public Health"},{"key":"2025120520522361000_14.2.e076987.35","doi-asserted-by":"crossref","DOI":"10.1016\/j.midw.2022.103260","article-title":"The effect of the two-child policy on cesarean section in China: Identification using difference-in-differences techniques","volume":"107","author":"Tang","year":"2022","journal-title":"Midwifery"},{"key":"2025120520522361000_14.2.e076987.36","doi-asserted-by":"crossref","first-page":"476","DOI":"10.2105\/AJPH.2018.304868","article-title":"The Rates and Medical Necessity of Cesarean Delivery in the Era of the Two-Child Policy in Hubei and Gansu Provinces, China","volume":"109","author":"Liao","year":"2019","journal-title":"Am J Public Health"},{"key":"2025120520522361000_14.2.e076987.37","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-018823","article-title":"Effect of second child intent on delivery mode after Chinese two child policy implementation: A cross sectional and prospective observational study of nulliparous women in Chongqing","volume":"7","author":"Zhao","year":"2017","journal-title":"BMJ Open"},{"key":"2025120520522361000_14.2.e076987.38","doi-asserted-by":"crossref","first-page":"4733","DOI":"10.1111\/jocn.15514","article-title":"Comparison of midwives\u2019 self-perceived essential competencies between low and high maternal mortality ratio provinces in China","volume":"29","author":"Huang","year":"2020","journal-title":"J Clin Nurs"},{"key":"2025120520522361000_14.2.e076987.39","doi-asserted-by":"crossref","first-page":"e1226","DOI":"10.1016\/S2214-109X(21)00298-9","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":"2025120520522361000_14.2.e076987.40","doi-asserted-by":"crossref","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":"2025120520522361000_14.2.e076987.41","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1093\/ije\/dyac211","article-title":"Maternal age and the risk of low birthweight and pre-term delivery: A pan-Nordic comparison","volume":"52","author":"Aradhya","year":"2023","journal-title":"Int J Epidemiol"},{"key":"2025120520522361000_14.2.e076987.42","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0278856","article-title":"The natural pattern of birth timing and gestational age in the U.S. compared to England, and the Netherlands","volume":"18","author":"Declercq","year":"2023","journal-title":"PLoS One"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-076987","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T04:52:38Z","timestamp":1764996758000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-076987"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2]]},"references-count":42,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2,8]]},"published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1136\/bmjopen-2023-076987"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-076987","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2]]}}}