Feasibility analysis of China's medical insurance coverage of assisted reproductive technology.

There are millions of patients experiencing infertility in China, but assisted reproductive technology (ART) is performed at the patient's expense and is difficult to afford. With the sharp decline in China's birth rate, there is a growing controversy over the inclusion of ART in medical insurance (MI). This study aims to explore the feasibility of ART coverage by MI for the first time. We obtained basic data such as the prevalence of infertility, the cost of ART, and the success rate in China with the method of meta-analysis and consulting the government bulletin. Then, we calculated the number of infertile couples in China and the total financial expenditure of MI covering ART. Finally, we discussed the feasibility of coverage, and analyzed the population growth and economic benefits after coverage. According to our research results, it was estimated that there were 4.102-11.792 million infertile couples in China, with an annual increase of 1.189-1.867 million. If MI covered ART, the fund would pay 72.313-207.878 billion yuan, accounting for 2-6% of the current fund balance, and the subsequent annual payment would be 20.961-32.913 billion yuan, accounting for 4-7% of the annual fund balance. This was assuming that all infertile couples would undergo ART, and the actual cost would be lower. The financial input‒output ratio would be 13.022. Benefiting from the inclusion of ART in MI coverage, there would be 3.348-9.624 million new live infants, and 8-13% newborns would be born every year thereafter, which means that by 2050, 37-65 million people would be born. Due to its affordable cost, high cost-effectiveness and favourable population growth, it may be feasible to include ART in MI.

Relationship between maternal ABO blood groups and pregnancy outcomes: a retrospective cohort study in Dongguan, China.

The purpose of this study was to study the relationship between maternal ABO blood groups and pregnancy outcomes. A total of 29,658 couples in Dongguan were selected as the research subjects. We obtained data on ABO blood groups and pregnancy outcomes and explored the relationship between them through log binomial regression and survival analysis. Compared to mothers with type B blood, the RR of foetal stillbirth in mothers with type A blood was 2.87 (95% CI: 1.70, 4.85), and compared to mothers with type O blood, the RR was 1.72 (95% CI: 1.16, 2.55). Compared with foetuses of other three blood type mothers, foetuses of A blood type mothers have a higher median birth weight (P = 0.011). Other pregnancy outcomes, including preterm birth, macrosomia, caesarean section, multiple births, birth defects, low birth weight, foetal sex, gestational days, birth length, and APGAR score, were not significantly different. The relationship between maternal ABO blood type and pregnancy outcomes was not affected by paternal blood type. More studies are needed to confirm these results.

What is already known on this subject? The relationship between blood type and disease is being increasingly studied. With regard to the relationship between maternal blood type and pregnancy outcomes, some studies have focused on people undergoing in vitro fertilisation. There are few reports on healthy women.What do the results of this study add? Compared to mothers with type B blood, the RR of foetal stillbirth in mothers with type A blood was 2.87 (95% CI: 1.70, 4.85), and compared to mothers with type O blood, the RR was 1.72 (95% CI: 1.16, 2.55). Compared with foetuses of other three blood type mothers, foetuses of A blood type mothers have a higher median birth weight (P = 0.011).What are the implications of these findings for clinical practice and/or further research? This study is the first to explore the relationship between blood type and pregnancy outcomes in healthy women.These results can provide some clues for the study of the mechanism of pregnancy outcomes.

History of induced abortion and the risk of preterm birth: a retrospective cohort study.

OBJECTIVES: To explore the relationship between a history of induced abortion and follow-up preterm birth. METHODS: We performed a retrospective cohort study of 27,176 women aged 19 to 48 years old in the city of Dongguan. Participants were divided into two groups according to the history of induced abortion. We used log-binomial regression to estimate adjusted risk ratios of preterm birth (gestation at less than 37 weeks) and early preterm birth (gestation at less than 34 weeks) for women with a history of induced abortion. Four models adjusted for different baseline data were used to verify the stability of the results. We also performed a subgroup analysis and mediation effect analysis to control for the influence of confounding factors and analyzed the relationship between the number of abortions and subsequent preterm birth. RESULTS: Our study included 2,985 women who had undergone a prior induced abortion. Women who reported having a prior induced abortion were more likely to have preterm births before 37 weeks and 34 weeks, with risk ratios of 1.18 (95% CI 1.02-1.36) and 1.65 (95% CI 1.23-2.21), respectively. The above associations were stable in all models. We also found that a history of induced abortion was independently associated with a higher risk of preterm birth and early preterm birth in the subgroups. After controlling for the indirect effect of demographic data, the direct effect of abortion history on follow-up preterm delivery was still significantly different. The higher the number of abortions, the greater the risk of subsequent preterm birth. CONCLUSIONS: This study suggests that induced abortion increases the risk of subsequent preterm birth.

History of IUD utilization and the risk of preterm birth: a cohort study.

OBJECTIVE: To explore whether a history of IUD use could increase the risk of subsequent preterm birth. METHODS: We performed a cohort study of 24,496 multipara aged 19-48 years in Dongguan City. Each subject was followed up for 1 year, and 12,508 women obtained pregnancy outcomes. They were divided into 2 groups: 2130 subjects with IUD use history (exposure group), and 10,378 subjects without IUD use history (control group). The exposure group will remove the IUD before pregnancy. The primary outcomes were preterm birth (less than 37 weeks of gestation) and early preterm birth (less than 34 weeks of gestation). We used log-binomial regression to estimate adjusted risk ratios (aRR) of preterm birth and early preterm birth for women with a history of IUD. According to the different adjusted baseline data, three regression models were established, and the propensity matching score method was also used to verify the stability of the results. RESULTS: The delivery rate of women with IUD history was 51.24%, and that of women without IUD was 51.03% (2 = 0.063, P = 0.802). Six hundred and eighty-five women had preterm birth (5.48%, 95% CI 5.08-5.88) and 133 women had early preterm birth (1.06%, 95% CI 0.83-1.24). Compared with the control group, the incidence of preterm birth and early preterm birth in the exposure group were significantly lower. The results are stable in all four models. Subgroup analysis also supported the result. This study also found that the longer the women used IUD before pregnancy, the younger the age of first using IUD, and the shorter the time from condom removal to pregnancy, the lower the incidence of premature birth. CONCLUSION: The women with a history of IUD use are less likely to have premature birth after the IUD is removed. More prospective studies are needed to confirm it.

Elevated serum neurofilament light chain in children autism spectrum disorder: A case control study.

OBJECTIVE: We aimed to assess serum neurofilament light chain (sNfL) levels in autism spectrum disorder (ASD) and to investigate whether they are related to the severity of disease. METHODS: The cohorts consisted of 166 children aged 3-8 (83 children diagnosed with ASD and 83 children with typically-developing). sNfL were analyzed using Single Molecule Array (Simoa) technology. ASD symptom severity was assessed according to the Chinese version of the Childhood Autism Rating Scale (CARS) score. RESULTS: The mean age of those included ASD was 5.1 years (standard deviations [S.D.]: 1.7) and 78.3 % were boys. The mean (SD) sNfL concentrations were significantly (P < 0.001) higher in ASD than in TP children (10.2[5.0] pg/mL and 7.1[3.2]pg/mL). For each 1 pg/mL increase of sNfL, the risk of ASD would increase by 19 % (with the OR unadjusted of 1.19 [95 % CI 1.10-1.29], P < 0.001) and 11 % (with the OR adjusted of 1.11 [1.03-1.23], P < 0.001), respectively. sNfL concentrations in children with severe ASD were higher than in those children with mild-to-moderate ASD (12.4[5.1] pg/mL vs. 8.3[4.2]pg/mL; P < 0.001). Among ASD cases, each 1 pg/mL increase of sNfL is associated with 20 % higher unadjusted or 11 % higher adjusted odds, respectively, of severe (vs. mild-to-moderate) ASD. CONCLUSIONS: The data showed that sNfL was elevated in ASD and related to symptom severity, suggesting that sNfL may play a role in ASD progression.