Women In Mainland China Research Articles

Effects of pre-pregnancy body mass index on pregnancy outcomes

To explore the effects of pre-pregnancy body mass index (BMI) upon adverse pregnancy outcomes. We selected a population-based cohort of 48 867 nulliparous women in mainland China with singleton and full-term deliveries in 2011. The cohort was categorized in accordance with pre-pregnancy BMI as follows: underweight <18.5; normal weight = 18.5-23.9; overweight = 24-27.9; obesity ≥ 28. Logistic regression was used to estimate the association between BMI and adverse maternal, peripartum and perinatal outcomes with normal weight as a reference range. (1) Overweight and obese women were more likely to have hypertensive disorders with odds ratios of 2.29 and 6.02, gestational diabetes mellitus 2.27, 4.99; (2)the odds ratios for fetal macrosomia increased among women with higher BMI as follows: 0.59, 1.99 and 3.15, whereas only lean women had significantly increased risk of delivering babies with low birth weight (LBW) 1.62; (3)increased BMI was associated with reduced rates of assisted vaginal delivery and increased rates of caesarean section. As an independent risk factor for adverse maternal and fetal outcomes, pre-pregnancy obesity should be managed properly.

Current overview of pregnancy complications and live-birth outcome of assisted reproductive technology in mainland China

To survey the proportion of births born after assisted reproductive technology (ART) and compare the obstetric and prenatal complications between ART and spontaneous pregnancy in women in mainland China. Retrospective analysis. Thirty-nine hospitals. A total of 112,403 deliveries from 14 provinces and 39 different hospitals composed our retrospective study. A multiprovince, hospital-based survey was performed. The prevalence of obstetric complications, mode of delivery, and prenatal outcomes were compared between ART and spontaneous pregnancy. For each group, data included singleton and twin deliveries. The proportion of infants born as a result of ART in mainland China was about 1.013% in 2011. The incidence of hypertensive disorder in pregnancy (11.0%, odds ratio [OR], 1.27, 95% confidence interval [CI] 1.04-1.60), premature delivery (27.0%, OR, 4.53, 95% CI 3.91-5.25), gestational diabetes mellitus (15.1%, OR 3.05, 95% CI 2.57-3.60), and placenta previa (4.5%, OR 2.18, 95% CI 1.62-2.94) were markedly increased in women who conceived using ART. The cesarean section rate in the ART pregnancy group was 85.3%, which is significantly higher than spontaneous pregnancies (54.0%). Compared with spontaneous pregnancy, ART pregnancy had a significantly increased incidence of low birth weight babies (29.7%) and birth gestational age of less than 37 weeks (30.0%). Infants conceived by ART have increased low 5-minute Apgar and mortality. This population-based survey demonstrates that the proportion of births from ART in mainland China was about 1.013% in 2011. Multiple gestation is significantly increased in ART pregnancies, relative to spontaneous pregnancies. The increasing incidence and risk of maternal complications in ART pregnancies (e.g., premature delivery, placenta previa, gestational diabetes mellitus) are found in singleton and twin gestations in ART. A higher cesarean section rate, low birth weight infants, and higher infant mortality rate were also observed in ART pregnancies. Our survey provides a comprehensive overview of the prevalence of ART and ART-associated complications in mainland China, and provides insight into attitudes toward ART among the mainland Chinese population.

Social support and parenting self-efficacy among Chinese women in the perinatal period

Objectiveto examine the changes in and relationship between perceived social support and parenting self-efficacy in the perinatal period among pregnant women in mainland China. Design and settingthis was a secondary analysis with data from part of an experimental study of the effects of an interpersonal-psychotherapy-oriented childbirth psychoeducation programme on maternal adaptation. A longitudinal design was employed in the present study. The study was carried out from July 2008 to May 2009 in one general hospital in Guangzhou, China. Participantsa convenience sample of 68 first-time mothers in mainland China completed measurement of social support and parenting self-efficacy during pregnancy and at six weeks and three months post partum. Findingsperceived social support and parenting self-efficacy declined during early motherhood. Parenting self-efficacy increased from six weeks post partum to three months post partum. Perceived social support positively correlated with parenting self-efficacy. Conclusionculturally competent health-care intervention should be developed during early motherhood to promote perceived social support and parenting self-efficacy for the new mothers.

Psychometric properties of a mainland Chinese version of the Iowa Infant Feeding Attitude Scale among postpartum women in China

Background: The Iowa Infant Feeding Attitude Scale (IIFAS) is used to evaluate maternal infant feeding attitude. The breastfeeding rate has declined but no validated instruments to assess infant feeding attitudes or related studies have been available in mainland China. Aims: The purpose of this study was to assess the reliability and validity of a mainland Chinese version of the IIFAS among postpartum women. Methods: Postpartum women (N = 660) were recruited from three university hospitals in Guangzhou in mainland China. The participants completed an IIFAS questionnaire before being discharged and accepted telephone follow-up sessions at 6 weeks and 3 months postpartum. The reliability of the scale was evaluated using intra-class correlations (ICC) for test–retest reliability, correlated itemtotal correlations and Cronbach’s α. The validity of the scale was evaluated using the content validity index (CVI), construct validity using exploratory factor analysis and predictive validity using independent t–tests. Results: The ICC was 0.861. The correlated item-total correlations ranged from 0.262–0.691. Cronbach’s α was 0.623. The CVI was 0.996. Four factors were extracted using exploratory factor analysis and they contributed to 48.69% of the total variance. Conclusions: The mainland Chinese version of the IIFAS scale can be considered a reliable, valid and predictive scale for assessing infant feeding attitudes among women in mainland China. In-hospital scores on the scale were significant predictors of the infant feeding method and breastfeeding duration at 3 days, 6 weeks and 3 months postpartum. Construct validity was confirmed and showed four factors. However, future studies are required to improve the lower level internal consistency of the IIFAS.

Acupuncture and Clomiphene Citrate for Live Birth in Polycystic Ovary Syndrome: Study Design of a Randomized Controlled Trial

Acupuncture is an alternative therapy to induce ovulation in women with polycystic ovary syndrome (PCOS), but there is no study reporting the live birth rate following ovulation induction by acupuncture or its potential as an adjuvant treatment to clomiphene citrate (CC). We assess the efficacy of acupuncture with or without CC in achieving live births among 1000 PCOS women in Mainland China. This paper reports the methodology of an ongoing multicenter randomized controlled trial. The randomization scheme is coordinated through the central mechanism and stratified by the participating sites. Participants will be randomized into one of the four treatment arms: (A) true acupuncture and CC, (B) control acupuncture and CC, (C) true acupuncture and placebo CC, and (D) control acupuncture and placebo CC. To ensure the quality and integrity of the trial we have developed a unique multinational team of investigators and Data and Safety Monitoring Board. Up to the end of April 2013, 326 subjects were recruited. In conclusion, the success of this trial will allow us to evaluate the additional benefit of acupuncture beyond the first line medicine for fertility treatment in PCOS women in an unbiased manner.

A Chinese beauty story: how college women in China negotiate beauty, body image, and mass media

This study examines how young Chinese women negotiate beauty and body image in context with mass media, paying particular attention to the relationship between ongoing sociocultural change in contemporary Chinese society and the attitudes and behaviors among young women towards beauty. Qualitative in nature, this study explores the “beauty stories” of 13 college women in mainland China through in-depth interviews. Several distinctive themes were found: (1) These women believed the ideal beautiful Chinese woman should have a tall and thin body, big eyes, a watermelon seed-shaped face, fair skin, and qi zhi (inner beauty); (2) Body image issues were centralized in these women's everyday experiences, and they were under significant cultural, societal, familial, and peer pressure to pursue physical beauty; (3) Cultural and media influences on their perceptions of beauty were complex and multi-layered; and (4) The women were hopeful of both potential positive social change and the liberation of Chinese women, and they were concerned about the superficiality and extreme beauty standards advocated in the media. The findings suggest that the contemporary Chinese beauty story is essentially different from the Western one, extending the existing literature on beauty and body image to include an Eastern and Chinese perspective.

Retrospective Study of the Incidence of HFMD and Seroepidemiology of Antibodies against EV71 and CoxA16 in Prenatal Women and Their Infants

BackgroundHand, foot, and mouth disease (HFMD) has been emerging as an important public problem over the past few decades, especially in Asian and Pacific regions. A national program on EV71 vaccine development against HFMD was initiated in China, in 2008, which called for a need for seroepidemiological study for the target population.Methodology/Principal FindingsThis was a retrospective study conducted in Jiangsu Province, in October, 2010. We measured the neutralizing antibodies against EV71 and CoxA16 in a cohort of infants aged of 2, 7, 12, and 27–38 months and their mothers just before delivery. Series sera samples from 975 infants and 555 mothers were collected and analyzed. Questionnaires on the history of HFMD were completed in the survey. A total of 143 HFMD cases were collected, but only 11.2% were reported to the National Infectious Disease Information Management System. The level of maternal antibody titers decreased dramatically during the first 7 month and remained at a relatively low level thereafter. But it increased significantly from month 12 to months 27–38. The accumulate incidence density of HFMD demonstrated a significant increase after 14 months of age, resulting in a accumulate incidence density of 50.8/1000 person-years in survey period. Seropositivity of EV71 antibody in infants at the age of 2 months seems to demonstrate a protective effect against HFMD.Conclusions and SignificanceHigh seropositive rate of EV71 and CoxA16 antibody was found in prenatal women in mainland China, and there is a need to enhance the HFMD case management and the current surveillance system. We suggest that infants aged between 6 to 14 months should have the first priority to receive EV71 vaccine.

Impact of genital warts on health related quality of life in men and women in mainland China: a multicenter hospital-based cross-sectional study

BackgroundInformation on the health-related quality of life (HRQoL) of patients with genital warts (GW) in populations in mainland China is still limited. The aim of the study was to use a generic instrument to measure the impact of genital warts on HRQoL in men and women in this setting.MethodsA multi-centre hospital-based cross-sectional study across 18 centers in China was conducted to interview patients using the European quality of life-5 dimension (EQ-5D) instrument; respondents' demographic and clinical data were also collected.ResultsA total of 1,358 GW patients (612 men, 746 women) were included in the analysis, with a mean age of 32.0 ± 10.6 years. 56.4% of the patients reported some problems in the dimension of Anxiety/Depression (highest), followed by Pain/Discomfort (24.7%) and Mobility (3.5%). The overall visual analogue scale (VAS) score of the study population was found to be 65.2 ± 22.0, and the EQ-5D index score was found to be 0.843 ± 0.129 using Japanese preference weights (the Chinese preference was unavailable yet). Patients with lower VAS means and EQ-5D index scores were more often female, living in urban area, and suffering multiple GW (all p values < 0.05), but the values did not differ notably by age (p values > 0.05).ConclusionsThe HRQoL of patients with GW was substantially lower, compared to a national representative general population in China (VAS = ~80); the findings of different subgroups are informative for future GW prevention and control efforts.

Health-Related Quality of Life Among Pregnant Women With and Without Depression in Hubei, China

The role of prenatal depression on physical and mental health among women in mainland China has not been previously investigated. The aim of this research was to (a) calculate the prevalence of depression during pregnancy, (b) explore the relationship between depression sample characteristics and quality of life and (c) identify predictors of physical and mental health among pregnant women. This study was designed as a cross-sectional and exploratory survey. A total of 454 pregnant women participated in the study between December 2009 and June 2010 in central China. The data was collected using the Medical Outcomes Study short form 36 v2 and the Edinburgh Postnatal Depression Scale. Participants were recruited at outpatient departments of obstetrics and gynecology. Findings show that almost 40% of pregnant women experience prenatal depression. Depression was significantly associated with physical and mental health-related quality of life (HRQoL). Depression, increased age, higher gestational age, being employed and married were significant predictors of lower physical HRQoL. Depression, lower BMI and having an unintended pregnancy were significant predictors of lower mental HRQoL. Prenatal depression is very common in women from mainland China. Depressed women suffer from impaired physical and mental health; prenatal depression has a negative impact on women's HRQoL. We recommend that antenatal services integrate screening for depression into routine antenatal care.

Impact of Human Papillomavirus-Related Lesions on Quality of Life: A Multicenter Hospital-Based Study of Women in Mainland China

To date, few studies using a human papillomavirus (HPV)-specific questionnaire have focused on the impact of quality of life (QoL) among women with HPV-related lesions in developing countries. A multicenter, hospital-based survey was conducted from 2007 to 2008. Women 18 to 65 years old who had HPV-related lesions or underwent HPV-related screening interventions during the past 3 months were recruited and divided into 6 groups based on different diagnoses: (1) normal Papanicolaou (Pap) test result, (2) abnormal Pap test result without HPV test, (3) external genital warts (GWs), (4) precancerous cervical lesions (confirmed by histological diagnoses), (5) HPV positive (HPV+) after abnormal Pap test result, and (6) HPV negative (HPV-) after abnormal Pap test result. Psychosocial burdens were assessed by the HPV impact profile (HIP). The HIP contains 7 domains and 29 questions, and its scores reversely relates to the subjects' QoL. A total of 2605 eligible women were enrolled. Women with GWs had the highest mean HIP scores (52.2), followed by the group with precancerous cervical lesions (48.6), HPV+ after abnormal Pap (45.8), abnormal Pap test result without HPV test (44.1), HPV- after abnormal Pap (43.1), and women with normal Pap endured the least (33.1). "Sexual impact," "self-image," and "control/life impact" were the 3 QoL-related domains that affected women the most. The psychosocial burden of urban residents was heavier than that of rural women. Women with GWs and precancerous cervical lesions had the worst psychological burden, and sexual-related concern was the primary cause of burdens regarding HPV-related diseases for Chinese women. In addition to basic medical treatments, psychosocial support systems should be established, and consultation services should be generalized to help alleviate these burdens.

How Sexual History and Knowledge of Cervical Cancer and Screening Influence Chinese Women's Screening Behavior in Mainland China

Accurate information and knowledge about cervical cancer and screening importantly influence women's cervical screening participation. Sexual behavior plays a crucial role in human papillomavirus transmission and the subsequent development of cervical cancer. Indeed, the uptake of cervical screening among Chinese women is relatively low compared with other populations. To understand women's attendance pattern of cervical screening, knowledge about cervical cancer and screening, and factors influencing their utilization of cervical screening in mainland China. A cross-sectional survey was conducted to collect women's participation pattern for cervical screening, knowledge about cervical cancer and screening, sociodemographic information and sexual history, and barriers to participating in cervical screening. Married women and women who had had their first intercourse after the age of 21 years were significantly more likely to participate in screening. Screened women demonstrated a higher level of knowledge about the cervical screening procedure compared with nonscreened women (P = .002). Also, the scores of individual items such as women's knowledge of cervical screening and risk factors were significantly different between the 2 groups. The current system of free physical examinations for women in mainland China is a major motivator for women's utilization of cervical screening services. Chinese women's marital status and sexual history influence their screening behavior. Unmarried women who have ever had sex should be encouraged to have cervical screening, and consistent and appropriate information about the preventive nature of cervical screening and risk factors associated with cervical cancer should be provided to the general public.

Validation of the short form of the chinese childbirth self‐efficacy inventory in Mainland China

Self-efficacy increasingly has been reported as an important outcome measure in childbirth care. The purpose of this study was to evaluate the psychometrics of the short form of the Chinese Childbirth Self-Efficacy Inventory (CBSEI-C32) in mainland China. A convenience sample of 297 pregnant Chinese women who were attending the out-patient clinic of the study hospital in Guangzhou participated in the study. The participants were asked to complete the CBSEI-C32, the Chinese Self-Rating Anxiety Scale (CSAS), the Chinese Self-Efficacy Scale (CSE) and the socio-demographic questionnaire. A subgroup of 75 pregnant women was selected randomly from the total sample using a table of random numbers for test-retest reliability assessment. The findings demonstrate high internal consistency (Cronbach's α = .96) and test-retest reliability (intraclass correlation coefficient = .88) for the CBSEI-C32. Confirmatory factor analysis showed some support for a two-factor structure of the CBSEI-C32, and construct validity was further supported by a significant relationship with CSAS. The CBSEI-C32 has the potential to be used as a clinical and research instrument for measuring childbirth self-efficacy in women in mainland China.

Determination of median levels of the free β subunit of human chorionic gonadotropin in women from mainland China using a new time-resolved fluoroimmunoassay

The free beta subunit of human chorionic gonadotropin (free beta-hCG) is an important serum marker for biochemical screening. Its weekly median value varies with ethnicity. Most of the fluorometers for lanthanide chelates are designed for the detection of signals from europium (Eu(3+)) chelates only. We developed a two-site, one-step assay using two monoclonal antibodies (MAbs) against free beta subunit and beta subunit with Eu(3+) chelates as labels. Using the present assay, we evaluated 24,634 normal serum samples in Chinese pregnant women during 8-20 weeks of gestation. The detection limit using this assay was <0.05 ng/mL. The within-run and between-run imprecision was <6.0% and 7.0% using control material. Free beta-hCG concentrations measured using the current assay in 999 maternal serum samples correlated well with those obtained by samarium (Sm(3+))-labeled DELFIA free hCGbeta assay (r=0.987). The medians for 8-20 weeks for maternal serum free beta-hCG were higher in the women from mainland China compared to reports from other countries. The present assay is suitable for use in biochemical screening of women in mainland China. Our study on the median concentrations of free beta-hCG will help establish reference values that are specific for ethnic populations from the Chinese mainland. These will be useful for studying the importance of ethnic factors in biochemical screening.

Parsing the ageing Asian woman: Symptom results from the China Study of Midlife Women

Objectives It has become popular to assert that Asian women in general have low midlife rates of reporting a wide variety of symptoms and that these rates are much lower than those found among women in western countries. Comparable data from mainland China remains sparse, however. This study aimed to uncover the symptom reporting frequency for a general population sample of women in mainland China and to compare these results with rates from similar studies conducted in Japan and North America. Methods The author conducted a community-based survey of over 400 Chinese women aged 40–65 years living in a rural village and an urban neighborhood in northern China. The cross-cultural analysis was conducted on the 156 Chinese women within that sample who were between the ages of 45 and 55 years. Their rates of reporting 16 core symptoms in the previous 2 weeks were compared with those of women in the same age range in studies conducted in Japan [Lock M. Encounters with aging: mythologies of menopause in Japan and North America. Berkeley: University of California Press; 1993], Canada [Kaufert P, Lock M, McKinlay S, et al. Menopause research: the Korpilampi workshop. Soc Sci Med 1986;22(11):1285–9], and the U.S. [McKinlay SM, McKinlay JB. Research note: aging in a ‘healthy’ population. Soc Sci Med 1986;23(5):531–5]. Results The Chinese women had a low to moderate rate (below 50%) of reporting each of the 16 core symptoms. On most symptoms, the Chinese rates were higher than the Japanese and more similar to the North American. The only exceptions were hot flashes and headaches. Conclusions Data from the China Study of Midlife Women showed that women's rates of midlife core symptom reporting in mainland China differ from the extremely low levels found in Japan. It is important to avoid generalizations about East Asian women relative to North American women in this regard.

Relationship of body surface area with bone density and its risk of osteoporosis at various skeletal regions in women of mainland China.

The aim of this study was to investigate the relationship between body surface area (BS) and bone mineral density (BMD) and the associated osteoporosis risk at various skeletal regions in women from mainland China. BMD was measured at the posteroanterior (PA) spine (L1-L4), supine lateral spine (L2-L4) including volumetric BMD (vBMD), hip including femoral neck, trochanter and total hip, and forearm, including radius + ulna ultradistal (R + UUD), 1/3 site (R + U1/3) and total region (R + UT) using a dual-energy X-ray absorptiometry (DXA) fan-beam bone densitometer (Hologic QDR 4500A) in 3418 females aged from 18 to 75 years. Data analysis revealed a positive correlation between BS and BMD at the various skeletal regions (r = 0.114-0.373, all P = 0.000), but no correlation with vBMD (r = 0.000, P = 0.934). Using the stepwise regression model, BMDs at various skeletal regions were dependent variables while height, weight, body mass index (BMI), BS and projective bone area (BA) were independent variables; BS was determined to be the most important variable that affected the PA spine, hip and forearm BMDs. Subjects were divided into three groups according to size: large BS group (LBSG), intermediate BS group (IBSG) and small BS group (SBSG). The BMD at different skeletal regions of subjects between groups exhibited a significant gradient difference, with LBSG > IBSG > SBSG, but this was not seen for vBMD. On the fitting curves where BMD varied with age at the PA spine, femoral neck, total hip and R + UUD, BMDs of LBSG were 6.93-9.29% higher than those of IBSG and 12.1-16.9 % higher than those of SBSG, whereas those of SBSG were 6.12-9.59% lower than those of IBSG at various skeletal regions, respectively. The prevalence rates and risks of osteoporosis of LBSG were significantly lower than those of SBSG and IBSG, whereas those of IBSG were obviously lower than those of SBSG at various skeletal regions, respectively, presenting a gradient difference among the three study groups, LBSG < IBSG < SBSG. Our study shows that the relationship between BS and BMD exceeds that between BMD and height or weight in women in mainland China. When areal BMD is employed, those with a larger BS have higher areal BMD and lower risks of osteoporosis while, conversely, those with a smaller BS have lower areal BMD, and therefore higher risk for osteoporosis. However, when vBMD is used, these differences diminish or even disappear.

The Past is another Country: Hong Kong Women in Transition

Women in both Hong Kong and China have inherited the legacy of traditional values that severely discriminated against women compared to men. In terms of legal protections, women in mainland China enjoy an advantage. In real terms, Hong Kong women do better, as is shown in relation to education and work. Relocation of factories to Guangdong has created unemployment among older, less educated women in Hong Kong and has created opportunities for younger women in China—at some risk to their safety, as overseas Chinese businessmen ignore industrial safety regulations. There has been little renegotiation in family responsibilities, although many Hong Kong women work. Increasingly, families are employing a Filipina domestic helper, but this has only reinforced the concept of the traditional female domestic role. Relocation of Hong Kong businesses over the border has placed additional strains on marriage, as Hong Kong men establish second families in China.