一、机构介绍

妇幼保健学专科是全市妇幼保健网顶部门，承担全市12个区级妇幼保健机构、152家助产机构、197家家社区卫生服务中心/镇卫生院产科、儿科及妇幼保健业务指导、技术培训及督导质控工作。在广州市卫生和计划生育委员会和天博体育的领导下，通过监测和调研，分析全市妇女儿童健康状况，评估妇幼保健服务供需存在的问题，为政府决策提供科学依据，并落实相关措施，持续改进工作，带领全市妇幼保健机构实现广州市妇女发展纲要和儿童发展纲要健康领域相关指标。

二、主要事迹

（一）深入调研，为科学决策提供准确的参考依据。通过开展广州市控制和降低孕产妇、婴儿死亡率及服务需求调研等，为全市妇幼卫生决策提供依据。

（二）科学管理，不断提高妇幼卫生工作效果。从2012年起，以实施广州市母婴安康行动计划为契机，构建新的区域危重孕产妇和儿童救治体系，有效提高救治成功率，全市孕产妇死亡率、婴儿死亡率分别由2010年的15.2/10万、4.04‰下降到2014年的7.34/10万、3.30‰；以百日帮扶、骨干培训等方式，指导基层助产机构标准化建设，夯实产儿科服务基础。

（三）夯实基层工作，忠实守护妇女儿童健康。大力推进公共卫生服务下沉到基层，指导社区卫生服务中心/镇卫生院每年为7万余农村妇女提供免费宫颈癌和乳腺癌筛查；为10万余孕产妇提供规范的围产保健和产后访视服务，为80多万 7岁以下儿童提供系统保健服务。

（四）开拓进取，快速提高团队工作能力。通过科研推动学科发展，团队坚持每天早交班学习#!新进展，2011年至今获省级科研立项6项，市科信局重大项目7项，累计获科研资助超1300万；接受基层医疗机构进修及中山大学、南方医科大学等本科生实习70余人。5年来累计举办妇幼保健培训班37类、235期，培训2万余人次。完成国家、省级继续教育项目26项，市级16项，为推动妇幼保健专业发展做出贡献。

三、获取荣誉

2012年分别获“2006-2010年广东省实施妇女儿童发展规划先进集体”和 “2001-2010年广州市实施妇女儿童发展规划先进集体”；2012年获得广东省 “十二五”医学重点学科荣誉；2014年获广州市“巾帼文明岗”及广东省“巾帼文明岗”称号。

Study Protocol for Analysis on Prevalence and Related Factors for Adverse Birth Outcomes in Guangzhou， China

Background

Maternal and children health in China have been improved dramaticallyduring last several decades， especially in Guangzhou that experiencing rapid economic development and social transition。 The maternal and infant mortality rates have fallen significantly in Guangzhou following a series of strengthened maternal and child health programs。 As one of theimportant indicators of prenatal and postnatal health，small for gestational age （SGA） or large for gestational age （LGA） means a higher risk of infant mortality and morbidity in later life。 The surveillance for changing of birth weight and trends in SGA or LGA births in Guangzhou is important。

On the other hand， China’s family planning policy has also changed from one-child for one couple in the late1970s to conditionaltwo-child policy， and to a general two-child policy in 2015.Problems caused by this policy adjustment may emerge soon after a boom of the second child， such as upward inter-pregnancy intervals （IPIs） and maternal age， which may have adverse effects on maternal and newborns’ health including preterm birth， low birth weight， SGAand perinatal death。 Littlewas known about the effects of policy adjustment on perinatal outcomes in Chinese population。

Objectives

A retrospective cohort study was conducted to examine the trends in birth weight z- score， prevalence of SGA and LGA among singleton births from 2001to 2015 based on the INTERGROWTH-21st birth weight standard， and to investigate the effects of policy adjustment on preterm birth， SGA and LGA during the period of 2000-2015in Guangzhou， China， and to determine maternal age and the optimal IPIs among Chinese pregnant women。

Data source

The delivery information was abstracted from the Guangzhou Perinatal Health Care and Delivery Surveillance System （GPHCDSS）， which in brief is the electronic database that covers over 97% of deliveries in Guangzhou from 2000。 GPHCDSS routinely collected data on maternal characteristic， conditions during pregnancy and birth characteristics。 All of these information was approved of usage after application according to corresponding standard procedure。

Within this surveillance system， 2，419，184 babies were born in Guangzhou between 2000 and 2015。 There were 2，329，389 were singleton live birth during this period， among which 227，352 women were multiple pregnancies。

Statistical strategies

We applied the international standard for newborn weight， proposed by theInternational Fetal and Newborn Growth Consortium forthe 21st Century （INTERGROWTH-21st） to define small-for-gestational-age（SGA） and large-for-gestational-age（LGA） infants and calculate birth weight z-score。 As regard to preterm delivery， it is defined as gestational age less than 37 completed weeks。 Preterm birth （PTB） was further subdivided into early PTB （24 to 31 weeks），middle PTB （32 to 33 weeks） and late PTB（34 to 36 weeks）.The inter-pregnancy intervals（IPI） were calculated from the records as the time in months between the first delivery date and date of conception for the second pregnancy。

Thisinternational standard of INTERGROWTH-21stproject provides an opportunity for the comparisons in different time periods or among different populations.We first attempt to examine trends in birth weight z-score， prevalence of SGA and LGA among singleton births form 2001 to 2015 based on the INTERGROWTH-21st birth weight standard。 Then we will further explore these trends by maternal characteristics to identify subgroups that need more attentions。

Next， we will ascertain the effect of inter-pregnancy intervals （IPI） on perinatal outcomes， like SGA， LGA and preterm birth as mentioned above。 Stratified analysis by maternal age at second pregnancy was also explored。

Expectations of results

（1） As the dramatic improvement in women and children’s health care service in China during the last decade， we expected to find that the prevalence of SGA and LGA would decline。

（2） On the base of physiology， the relationship between IPI and perinatal outcomes should U-shaped， with both shorter and longer IPI associated with increased risk of SGA， AGA and preterm birth。