{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T02:46:02Z","timestamp":1790736362609,"version":"4.1.0"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>China\u2019s evolving fertility policies (one-child to three-child) have shaped maternal and neonatal outcomes, but specific gaps in stillbirth epidemiology during policy transitions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study analyzed 721,860 singleton pregnancies in 2011\u20132023, from 18 maternal near-miss surveillance hospitals in Hunan. Stillbirth rates were assessed across four policy periods: one-child (2011\u20132013), partial two-child (2013\u20132015), universal two-child (2016\u20132020), and three-child (2021\u20132023). Multivariable logistic regression identified risk factors, adjusting for fertility policy period, maternal demographics and maternal comorbidities. Trends over time were analyzed using segmented regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The overall stillbirth rate was 7.02\u2030 (95% confidence interval [CI]: 6.82\u20137.21), declining significantly from 9.62\u2030 during the one-child policy to 5.73\u2030 (95%CI: 5.25\u20136.23) under the three-child policy (<jats:italic>t<\/jats:italic> =\u202f\u22124.22, <jats:italic>p<\/jats:italic> &amp;lt;\u202f0.01). Key risk factors included maternal age &amp;lt; 24\u202fyears (adjusted odds ratio [aOR]\u202f=\u202f1.77, 95%CI:1.63\u20131.92), multiparity (aOR\u202f=\u202f1.27\u20132.82. <jats:italic>p<\/jats:italic> &amp;lt;\u202f0.01), non-rural hospital delivery (aOR\u202f=\u202f4.00\u201311.13, <jats:italic>p<\/jats:italic> &amp;lt;\u202f0.01), education \u22649\u202fyears (aOR\u202f=\u202f1.51\u20132.20, <jats:italic>p<\/jats:italic> &amp;lt;\u202f0.01), not being married (aOR\u202f=\u202f2.92\u20135.60, <jats:italic>p<\/jats:italic> &amp;lt;\u202f0.01), and comorbidities: severe preeclampsia (aOR\u202f=\u202f3.80, 95%CI: 3.36\u20134.29), chronic hypertension (aOR\u202f=\u202f2.67, 95%CI: 2.09\u20133.37), placental abruption (aOR\u202f=\u202f5.06, 95%CI: 4.11\u20136.16), and placenta previa (aOR\u202f=\u202f1.55, 95%CI: 1.29\u20131.84). Paradoxically, prenatal diabetes was associated with reduced stillbirth risk (aOR\u202f=\u202f0.86, 95%CI: 0.77\u20130.95). Temporal shifts revealed elevated stillbirth rates among advanced-age mothers pre-2016 versus rising rates in women &amp;lt;24\u202fyears post-policy liberalization. Only the partial two-child policy period (aOR\u202f=\u202f1.15, 95%CI: 1.05\u20131.25) was associated with the risk of stillbirth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>China\u2019s fertility policy transitions correlate with dynamic stillbirth epidemiology, emphasizing age- and parity-specific vulnerabilities. Targeted interventions for high-risk subgroups, especially younger, less well-educated, multiparous women, and those with hypertensive or placental disorders, are critical amid ongoing implementation of the three-child policy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1635120","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T05:35:56Z","timestamp":1759815356000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The incidence, characteristics, and complications of pregnant women who delivered stillbirths under different child policies in central China"],"prefix":"10.3389","volume":"13","author":[{"given":"Lili","family":"Xiong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donghua","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingyun","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junqun","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"key":"ref1","article-title":"A Neglected Tragedy: the Global Burden of Stillbirths. 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