Determinants of second pregnancy among pregnant women: a hospital-based cross-sectional survey in China

Xu, Xianglong; Zuo, Hanxiao; Shi, Zumin; Rao, Yunshuang; Wang, LianLian; Zeng, Huan; Zhang, Lei; Sharma, Manoj; Reis, Cesar; Zhao, Yong

doi:10.1136/bmjopen-2016-014544

Cited by 11 publications

(11 citation statements)

References 22 publications

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“…In fact, those who had or preferred a son as the first child more often wanted a daughter as their second child. This echoes the findings of Xu et al (2017) who showed that only 2.5% of their participants entered a second pregnancy because of gender preference. Most barriers to childbearing were related to socioeconomic factors.…”

Section: Discussionsupporting

confidence: 84%

“…A possible explanation for this might be that infertile women are more aware of their diminished fecundity and related health problems because they were planning for a second child. As expected, this study, which was conducted in gynecology outpatient clinics, reveals a much higher percentage of participants wanting a second child than previous studies conducted in the general public or in general medical practice (Ding and Hesketh, 2006; Xu et al , 2017). Thus, healthcare professionals should be aware of the increased demand for services associated with second pregnancies from this women who are seeking gynecologic care (Cheng and Duan, 2016).…”

Section: Discussionsupporting

confidence: 80%

“…The decision to have a second child in China has been found to be determined by factors such as education, urban residency, income, employment, benefits for the first child and love of children (Luo and Mao, 2014; Xiu et al , 2016; Xu et al , 2016, 2017). In our study, around two-thirds of the women were interested in having a second child under the new policy, with infertile women having a living child reporting the highest intention.…”

Section: Discussionmentioning

confidence: 99%

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Intention of having a second child among infertile and fertile women attending outpatient gynecology clinics in three major cities in China: a cross-sectional study

Lau

Huo

Wang

et al. 2018

Human Reproduction Open

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STUDY QUESTION What is the intention to have a second child among women attending outpatient gynecology clinics in three major cities in China? SUMMARY ANSWER In total, 69.3% of the participants expressed the intention to have a second child and this was related to infertility status, pronatalist attitudes, and sociodemographic factors. WHAT IS KNOWN ALREADY In 2016, the new universal two-child policy was introduced in China enabling all Chinese couples to have a second child. A government-led national survey revealed that the majority of women included under the policy would be 35 years old and older and thus would be at higher risk of infertility. Previous studies found that fertility intention differs by infertility status. STUDY DESIGN, SIZE, DURATION A cross-sectional survey was performed to examine the intention of having a second child and its associated factors among infertile and fertile women attending gynecology outpatient clinics in three major cities in China. Clinical nurses approached eligible women in person while waiting for their consultations. Recruitment and data collection were conducted from April to August 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS The survey involved four gynecology outpatient clinics in Beijing, Shenzhen, and Hohhot. Married women aged 20–45 years who were seeking outpatient gynecology care for non-malignant problems were invited to participate. MAIN RESULTS AND THE ROLE OF CHANCE Data from 974 women were included in the analysis. A total of 69.3% of the women expressed the intention to have a second child, and infertile women were more likely to want a second child compared to fertile women (76.6% vs 61.9%, respectively; P < 0.001). Greater ideal parity facilitated the intention for a second child in both groups, while pronatalist attitudes (meaning that they preferred to have their first childbirth at a younger age and attached greater significance to traditional childbearing beliefs), unexplained infertility, presence of a living child and religious affiliation were associated with greater intention among infertile women. In contrast, in the fertile group, older age, full-time work and lower confidence in achieving parity goals diminished the intention for a second child. Although infertile women displayed greater agreement with pronatalist attitudes and desired a higher ideal parity, they had less confidence in achieving their parity goals than their fertile counterparts. LIMITATIONS REASONS FOR CAUTION In addition to self-report and self-selection bias, our participants were recruited from urbanized areas and were more educated than the general population. Owing to the extremely busy environment in the clinics, difficulties were encountered in keeping track of the number of women whom the nurses approached, and the response rate wa...

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Intention of having a second child among infertile and fertile women attending outpatient gynecology clinics in three major cities in China: a cross-sectional study

Lau

Huo

Wang

et al. 2018

Human Reproduction Open

View full text Add to dashboard Cite

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“…In the multivariate analysis for factors that affect smoking among pregnant women, employment status was categorized as non-manual (individual business/civil servants/senior manager and middle-level manager in large and medium enterprise/private entrepreneur/professionals/clerk/students), manual (rural migrant workers/industrial workers of non-agricultural registered permanent residence/business services staff), unemployed, and others [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

Smoking in pregnancy: a cross-sectional study in China

Xu¹,

Rao²,

Wang³

et al. 2017

Tob. Induced Dis.

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BackgroundFindings on smoking among pregnant women were mostly from high income countries and were rarely from China. This study aimed to estimate the prevalence of smoking and its influencing factors among pregnant women living in China.MethodsA cross-sectional analysis was conducted in this study. Data from pregnant women were collected in this study from June to August 2015 from 5 provinces of mainland China. A total of 2345 pregnant women were included in this study, the mean age of the participants was 28.12 years (SD 4.13).ResultsAbout 82.9% of smoking women quit smoking after they were pregnant. The prevalence of smoking among pregnant women was 3.8%. Among the participants, 40.0, 30.7, 1.8, 29.9, 0.8, 31.4, 31.2, and 26.7% had husbands, fathers-in-law, mothers-in-law, fathers, mothers, colleagues, friends, and relatives, respectively, who were smokers. Compared with pregnant women of basic education level (junior middle school or below), those of the higher education level (undergraduate or above) were at higher risk of smoking (OR, 5.17; 95% CI, 2.00–13.39). Compared with pregnant women from rural areas, urban pregnant women were less likely to be current smokers (OR, 0.55; 95% CI, 0.32–0.94). Compared with pregnant women whose mothers-in-law did not smoke, those whose mothers-in-law smoked were at higher risk of smoking (OR, 4.67; 95% CI, 1.87–11.70). However, compared with pregnant women whose husband did not smoke, those whose husband smoked were not significantly at higher risk of smoking (OR, 1.12; 95% CI, 0.73–1.73).ConclusionsMost of smoking women quit smoking after they became pregnant. Tailored intervention programs to reduce smoking in pregnant women should focus on those with higher education level, from rural areas, and pregnant women whose mothers-in-law smoke.

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“…It is also important to note that during 2016, mid-way through the period of data collection for Lotus II, the two-child policy was implemented in China [3]. While initial data on the demographics of women having a second child in China are beginning to emerge [37], it is difficult to assess the impact that this may have had on the study outcomes, if any.…”

Section: Discussionmentioning

confidence: 99%

A Phase III randomized controlled trial of oral dydrogesterone versus intravaginal progesterone gel for luteal phase support in in vitro fertilization (Lotus II): results from the Chinese mainland subpopulation

Yang

Griesinger

Wang

et al. 2019

Gynecological Endocrinology

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Lotus II, a randomized, open-label, multicenter, international study compared the efficacy and safety of oral dydrogesterone versus micronized vaginal progesterone (MVP) gel for luteal support in IVF. A prespecified subgroup analysis was performed on 239 Chinese mainland subjects from the overall study population (n ¼ 1034), who were randomized to oral dydrogesterone 30 mg or 8% MVP gel 90 mg daily from the day of oocyte retrieval until 12 weeks of gestation. The aim was to demonstrate non-inferiority of oral dydrogesterone to MVP gel, assessed by the presence of a fetal heartbeat at 12 weeks of gestation. In the Chinese mainland subpopulation, there was a numerical difference of 9.4% in favor of oral dydrogesterone, with ongoing pregnancy rates at 12 weeks of gestation of 61.4% and 51.9% in the oral dydrogesterone and MVP gel groups, respectively (adjusted difference, 9.4%; 95% CI: À3.4 to 22.1); in the overall population, these were 38.7% and 35%, respectively (adjusted difference, 3.7%; 95% CI: À2.3 to 9.7). In both the Chinese mainland subpopulation and the overall population, dydrogesterone had similar efficacy and safety to MVP gel. With convenient oral administration, dydrogesterone has potential to transform luteal support treatment.

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Determinants of second pregnancy among pregnant women: a hospital-based cross-sectional survey in China

Cited by 11 publications

References 22 publications

Intention of having a second child among infertile and fertile women attending outpatient gynecology clinics in three major cities in China: a cross-sectional study

Intention of having a second child among infertile and fertile women attending outpatient gynecology clinics in three major cities in China: a cross-sectional study

Smoking in pregnancy: a cross-sectional study in China

A Phase III randomized controlled trial of oral dydrogesterone versus intravaginal progesterone gel for luteal phase support in in vitro fertilization (Lotus II): results from the Chinese mainland subpopulation

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