{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T03:44:41Z","timestamp":1770349481156,"version":"3.49.0"},"reference-count":43,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"unspecified","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Noncommunicable Chronic Diseases -National Science and Technology Major Project of China","award":["2023ZD0519300"],"award-info":[{"award-number":["2023ZD0519300"]}]},{"DOI":"10.13039\/501100010229","name":"Natural Science Foundation of Tianjin Municipal Science and Technology Commission","doi-asserted-by":"publisher","award":["24JCQNJC00610"],"award-info":[{"award-number":["24JCQNJC00610"]}],"id":[{"id":"10.13039\/501100010229","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,1,12]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In China, the increase in high-risk pregnancies along with rising maternal age and complications has underscored the need for the development of maternal and newborn risk management programmes. The Chinese National Maternal and Newborn Safety Action Plan (CNMNSAP) was initiated in 2017. Given that neonatal mortality is a key indicator of healthcare quality, we evaluate the real-world effects of CNMNSAP against neonatal mortality among pregnant women with high-risk conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective, matched, population-based cohort study, we collected information on all pregnant women with clinically diagnosed conditions from electronic medical records in Chengdu, China, between July 2014 and December 2019. Individual-level data, covering all healthcare services and testing records in public hospitals, were obtained and categorised into two groups based on the timing of CNMNSAP implementation (pre-CNMNSAP vs post-CNMNSAP). After 1:1 propensity score matching, we calculated the annual percentage change (APC) of neonatal mortality within 7\u2009days post-delivery and compared outcomes between two groups of pregnant women with conditions. We then employed multivariate log-binomial regression models to examine the association between the CNMNSAP implementation and temporal changes in neonatal mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the 5-year study period, a total of 241\u2009343\u2009women with high-risk conditions delivered prior to CNMNSAP and 163\u2009367 after its implementation. After 1:1 propensity score matching, 299\u2009190 mothers were included for analysis. We estimated that the APC changed from 10.0% (95% CI \u22120.4% to 21.5%) prior to the maternal risk management programme to \u221228.5% (95% CI \u201344.2% to \u20138.4%) after its implementation, with an attributed risk reduction of 1.29 neonatal deaths per 1000 deliveries annually. In subgroup analysis, we found a significant reduction in neonatal mortality after policy implementation among mothers aged 18\u201334 years, those with a normal body mass index and those having a history of abortion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The CNMNSAP was found to be associated with a significant annual reduction in early neonatal mortality risk among pregnant women with high-risk conditions in Chengdu, China. The maternal risk management programme effectively improved outcomes for high-risk pregnancies, highlighting the importance of maternal risk classification and management throughout pregnancy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-003629","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T13:50:23Z","timestamp":1770299423000},"page":"e003629","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world evaluation of Chinese National Maternal and Newborn Safety Action Plan for reducing neonatal mortality among pregnant women with conditions: a retrospective, matched, population-based cohort study"],"prefix":"10.1136","volume":"4","author":[{"given":"Nan","family":"Zhang","sequence":"first","affiliation":[{"name":"School of Public Health, Tianjin Medical University, Tianjin, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunrong","family":"Li","sequence":"additional","affiliation":[{"name":"Sichuan Provincial Women\u2019s and Children\u2019s Hospital, The Affiliated Women\u2019s and Children\u2019s Hospital of Chengdu Medical College, Chengdu, Sichuan, China"},{"name":"Jintang County Chinese Medical Hospital, Chengdu, Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zihao","family":"Guo","sequence":"additional","affiliation":[{"name":"Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorothy Yingxuan","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Public Health, Tianjin Medical University, Tianjin, China"},{"name":"Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Du","sequence":"additional","affiliation":[{"name":"School of Public Health, Tianjin Medical University, Tianjin, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, Xinjiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiaoge","family":"Chi","sequence":"additional","affiliation":[{"name":"Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5610-1298","authenticated-orcid":false,"given":"Ka-Chun","family":"Chong","sequence":"additional","affiliation":[{"name":"Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mu","family":"He","sequence":"additional","affiliation":[{"name":"School of Mathematics and Physics, Xi\u2019an Jiaotong-Liverpool University, Suzhou, Jiangsu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shengzhi","family":"Sun","sequence":"additional","affiliation":[{"name":"School of Public Health, Capital Medical University, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Ge","sequence":"additional","affiliation":[{"name":"School of Health Professions, University of Southern Mississippi, Hattiesburg, Mississippi, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Song","sequence":"additional","affiliation":[{"name":"Health Commission of Chengdu, Chengdu, Sichuan, 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