Characteristics and contraceptive practices among Chinese women seeking abortion: a multicentre, descriptive study from 2019 to 2021.

INTRODUCTION: Despite the widespread provision of free contraceptives and post-abortion care (PAC) services, China grapples with a high rate of unintended pregnancies and subsequent abortions. We aimed to study the evolving characteristics of women seeking abortion and their contraceptive practices before and after abortions, to shed light on the optimisation of Chinese PAC services. METHODS: This study utilised data from an abortion cohort between 2019 and 2021. We studied their demographic features, contraception and abortion histories, reasons and choices using chi-square or linear-by-linear tests. We also explored the potential impact of receiving services at PAC facilities on post-abortion contraception use and repeat abortions using logistic regression models. RESULTS: Among the 9005 participants, 43.4% experienced repeat abortion, without a discernible trend over the 3 years. Noteworthy increases were observed in the percentages of college students (from 1.7% to 6.6%, p<0.01) and middle-aged women (from 23.2% to 26.8%, p<0.01) seeking abortions. Surgical abortion was chosen by nearly 90% of participants with a continuously increasing trend (p trend <0.01). Nearly half of the participants experienced unintended pregnancies due to non-use of contraception. Of the remainder, the majority preferred less or the least effective methods both before and after abortion. Women residing in moderate-gross domestic product (GDP) regions faced a higher risk of repeat abortions (OR 1.33, 95% CI 1.16 to 1.54). Despite this, high-quality PAC services may encourage the use of reliable contraceptive methods, with 86.8% of women changing from least effective or no methods to (most) effective methods post-abortion, and prevent repeat abortions (OR 0.65, 95% CI 0.56 to 0.75). CONCLUSIONS: Increased proportions of college students and middle-aged multiparous women seeking abortions were observed, together with inappropriate preferences for less effective contraception and increasing choice of surgical abortions. Future research should extend the focus to cover the entire abortion period, advocate the rational selection of contraceptive methods, and emphasise the specified PAC services tailored to different socioeconomic groups.

Associations between the COVID-19 pandemic and women's fertility intentions: a multi-country, cross-sectional (I-SHARE) study.

INTRODUCTION: The COVID-19 pandemic, together with the subsequent social distancing measures, could lead to shifts in family and fertility planning. This study aimed to explore the associations between the COVID-19 pandemic and changes in fertility intentions among an international sample of reproductive-aged women. METHODS: A multi-country, cross-sectional study based on data from 10 672 women aged 18-49 years who participated in the International Sexual Health And REproductive Health (I-SHARE) study, which organised an international online survey between July 2020 and February 2021. Factors associated with changes in fertility intentions were explored using multinomial probit regression models. Cluster-robust standard errors were used to calculate model parameters. RESULTS: Of 10 672 included reproductive-aged women, 14.4% reported changing their fertility intentions due to the pandemic, with 10.2% postponement and 4.2% acceleration. Women who had ever been isolated/quarantined were more likely to postpone their fertility intentions (adjusted odds ratio (AOR)=1.41; 95% CI 1.18 to 1.69) compared with those who had not; women who lived with a steady partner were more likely to want children sooner (AOR=1.57; 95% CI 1.10 to 2.23) compared with those who did not; and those who reported a higher frequency of getting angry, feeling frustrated, or worrying about their finances were more likely to postpone their fertility intentions. The main findings were robust in the sensitivity analyses. CONCLUSIONS: Most women who changed fertility intentions because of the pandemic have postponed intentions to expand their families. The pandemic-induced exposures were associated with these postponements.

Strategies for Improving Postpartum Contraception Compared With Routine Maternal Care: A Systematic Review and Meta-Analysis.

Objectives: This study aimed to systematically review the effectiveness of service interventions for improving postpartum contraception, including contraceptive use, prevention of repeat pregnancies and induced abortions. Methods: A systematic literature search was conducted in three databases until June 2022 (PROSPERO registration CRD42022328349). Estimates of intervention effects from meta-analyses were represented as odds ratios (OR) with 95% confidence intervals (CI). Results: 16 studies with 14,289 participants were included, with four kinds of interventions recognized. Interventions effect in increasing use of contraceptives and decreasing rates of repeated pregnancy for up to 6 months postpartum (OR = 2.24, 0.06, 95% CI = 1.46-3.44, 0.02-0.22, respectively), with no significant associations with contraceptive use at 12 months postpartum, prevention of postpartum repeat pregnancies and induced abortions during 1 year after childbirth. Conclusion: We concluded that interventions impact the initiation of postpartum contraceptive use and prevention of repeat pregnancy with an overall certainty from low to moderate. These findings highlight the need for additional studies to integrate the beneficial effect of several interventions and then design more feasible strategies, which is important for the maternal and child healthcare systems.

A global systematic review and meta-analysis of prevalence of repeat induced abortion and correlated risk factors.

As a significant public health problem, repeat-induced abortion is a challenge to women's sexual and reproductive health. Despite many studies in this area, they lack consensus regarding risk factors for repeat-induced abortion. A global systematic review was conducted to analyze prevalence of repeat-induced abortion among women worldwide and determine correlated risk factors. Three electronic databases were systematically searched. Data on prevalence of repeat-induced abortion and related factors were extracted and pooled using a meta-analysis and narrative approach. Sixty-five (which were published between 1972 and 2021) of 3,706 articles were included, consisting of a total of 535,308 participants from 25 countries. The overall pooled prevalence of repeat-induced abortion was 31.3 percent (95 percent CI 25.7 percent, 36.9 percent). Of 57 exposures extracted, 33 factors were significantly correlated with repeat induced abortion, comprising 14 individual demographic factors (i.e. age, education, marriage, etc.), three reproductive history-related factors (i.e. parity, age at sexual debut, and time since sexual debut), five contraception-related factors (i.e. contraceptive use at sexual debut, attitude toward contraceptive use, etc.), four abortion-related factors (i.e. age at the index abortion, previous abortion at the index abortion, etc.), and seven sexual partner-related factors (i.e. multiple sexual partners, sexual partner's age, etc.). The study findings highlight the problem of repeat-induced abortion worldwide and suggest the need for government and civil society in each country to increase efforts to reduce the alarming risk of repeat-induced abortion among women and improve their sexual and reproductive health.

Impact of the COVID-19 pandemic on sexual and reproductive health among women with induced abortion.

The coronavirus disease (COVID-19) has already been declared a global pandemic. To our knowledge, there is very little information regarding the effects of COVID-19 on women seeking reproductive health services, specifically abortion. This study was aimed to assess the impact of the COVID-19 pandemic on reproductive and sexual health among women seeking abortion services. We conducted a series of preliminary analyses using data collected from ten maternal and child health hospitals of seven provinces in China before and during the COVID-19 lockdown. The present study showed that a significant decrease was observed in the frequency of sexual intercourse during the COVID-19 pandemic. Moreover, a significant increase in contraceptive use including condom, rhythm method and coitus interruptus whereas a decrease in choosing oral contraceptives were observed during the COVID-19 pandemic. In addition, the pandemic was associated with increased intention of seeking induced abortion due to social factors. Future research should look into the long-term impact of the COVID-19 pandemic on sexual and reproductive health.

Prevalence and risk factors for repeat induced abortion among Chinese women: a systematic review and meta-analysis.

OBJECTIVES: Repeat induced abortion is a significant public health problem in China. International knowledge about repeat induced abortion and its associated risk factors in Chinese women is scarce, and existing studies are hard to access for international scholars because most are published in Chinese. A systematic review was conducted to analyse the prevalence of repeat induced abortion among Chinese women and determine correlated risk factors. METHODS: Seven electronic databases were systematically searched. Data on the prevalence of repeat induced abortion and related factors were extracted and pooled using a meta-analysis and narrative approach. RESULTS: Of 2458 articles retrieved from seven databases, 21 were included in the study. The overall pooled prevalence of repeat induced abortion was 43.1% (95% confidence interval 36.7%, 49.5%). Of 25 exposures extracted, 15 factors were significantly correlated with repeat induced abortion, comprising seven individual demographic factors (i.e., age, education, employment, migrant status, parity, unhealthy lifestyle habits and region of residence), four reproductive health- and contraception-related factors (i.e., age at sexual debut, history of sexual activity, contraceptive knowledge and having a regular sexual life) and four sexual partner-related factors (i.e., multiple sexual partners, age of sexual partner, educational level of sexual partner and cohabitation with sexual partner). CONCLUSION: The study findings highlight the problem of repeat induced abortion in China and suggest the need for government and civil society to increase efforts to reduce the alarming risks of repeat induced abortion in Chinese women and make them and their sexual partners more aware and protective of their sexual and reproductive health.

Prior surgical uterine evacuation of pregnancy and infertility: protocol for systematic review and meta-analysis.

INTRODUCTION: Prior surgical uterine evacuation is associated with an increased risk of infertility. However, findings are inconsistent, highlighting the need for a clear consensus on the effect of prior surgical uterine evacuation on the risk of infertility. Therefore, the aim of this systematic review and meta-analysis is to summarise the available evidence examining the association between prior surgical uterine evacuation and the risk of infertility. METHODS AND ANALYSIS: A systematic search of electronic databases (ie, PubMed, Scopus, ClinicalTrials.gov, EMBASE and ScienceDirect) will be conducted since their inception until October 2019 with no limit for language using a detailed prespecified search strategy. Both the authors will independently screen titles and abstracts and select full-text articles, perform data extraction and appraise the quality of included studies using a bias classification tool. Meta-analyses will be performed to calculate the overall pooled estimates using the generic inverse variance method. This systematic review and meta-analysis will follow the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. ETHICS AND DISSEMINATION: Given that this is a protocol based on published data, there is no requirement for ethics approval. It is anticipated that the dissemination of results will be reported according to the PRISMA statement. The results will be published in peer-reviewed journals and presented at scientific conferences. PROSPERO REGISTRATION NUMBER: CRD42019117266.

Opportunities for linking research to policy: lessons learned from implementation research in sexual and reproductive health within the ANSER network.

BACKGROUND: The uptake of findings from sexual and reproductive health and rights research into policy-making remains a complex and non-linear process. Different models of research utilisation and guidelines to maximise this in policy-making exist, however, challenges still remain for researchers to improve uptake of their research findings and for policy-makers to use research evidence in their work. METHODS: A participatory workshop with researchers was organised in November 2017 by the Academic Network for Sexual and Reproductive Health and Rights Policy (ANSER) to address this gap. ANSER is a consortium of experienced researchers, some of whom have policy-making experience, working on sexual and reproductive health and rights issues across 16 countries and 5 continents. The experiential learning cycle was used to guide the workshop discussions based on case studies and to encourage participants to focus on key lessons learned. Workshop findings were thematically analysed using specific stages from Hanney et al.'s (Health Res Policy Syst 1:2, 2003) framework on the place of policy-making in the stages of assessment of research utilisation and outcomes. RESULTS: The workshop identified key strategies for translating research into policy, including joint agenda-setting between researchers and policy-makers, as well as building trust and partnerships with different stakeholders. These were linked to stages within Hanney et al.'s framework as opportunities for engaging with policy-makers to ensure uptake of research findings. CONCLUSION: The engagement of stakeholders during the research development and implementation phases, especially at strategic moments, has a positive impact on uptake of research findings. The strategies and stages described in this paper can be applied to improve utilisation of research findings into policy development and implementation globally.

Association Between the 4p16 Susceptibility Locus and the Risk of Atrial Septal Defect in Population from Southeast China.

Three single nucleotide polymorphisms (SNPs), rs16835979, rs870142 and rs6824295, located in chromosome 4p16 were associated with the risk of ostium secundum atrial septal defect (ASD) in the European population. The 4p16 susceptibility locus in congenital heart disease was replicated in Chinese populations. Here, we analyzed the associations between these three SNPs and ASD in Chinese population from Fujian Province in southeast China. We conducted a case-control study by genotyping three SNPs in 354 non-syndromic ASD patients and 557 non-CHD control subjects. Logistic regression analyses showed that the genotype and allele frequencies of these three SNPs were significantly different between the cases and controls in Fujian Chinese population. The allele A of rs870142, the allele A of rs16835979 and the allele A of rs6824295 were significantly associated with an increased risk of ASD. According to the analysis of the three SNPs, the haplotype of AAA was associated with a significantly increased risk of ASD. Our study further supports that these three SNPs confer the predisposition to ASD phenotype in Chinese population.

The effects of mifepristone on the expressions of osteopontin, interleukin-6 and leukemia inhibitory factor in the villi of early pregnant women.

BACKGROUND: The autocrine, paracrine and hormonal effects of osteopontin (OPN), leukemia inhibitory factor (LIF) and interleukin-6 (IL-6) suggest that these cytokines may play key roles at the maternal-fetal interface. This study was performed to determine the effects of mifepristone on OPN, LIF and IL-6 mRNA and protein expressions in the villi in early pregnancy. STUDY DESIGN: Twenty-nine healthy women seeking termination of pregnancy up to 40 days' gestation were recruited. The study group (n=14) was given 150 mg mifepristone 24 h before vacuum aspiration. The control group (n=15) was not given any treatment prior to vacuum aspiration. Villi were collected, and immunohistochemical analysis and real-time reverse transcription PCR (RT-PCR) were used to detect the locations and the expression levels of OPN, IL-6 and LIF mRNA. RESULTS: In the study group, the expression level of OPN protein in the villous trophoblast and stoma cells was significantly lower (p<.01), while the expression levels of IL-6 and LIF protein were significantly higher than those in the control group (p<.01, p<.05, respectively). Compared with the control group, the relative expression of OPN mRNA was significantly lower (p=.001) and the IL-6 and LIF mRNA expression levels were significantly higher in the study group (p=.003 and p<.001, respectively). CONCLUSION: OPN, IL-6 and LIF may have critical roles in human pregnancy maintenance. These three factors may be involved in the immunological reaction initiated by mifepristone.

Expressional and epigenetic alterations of placental matrix metalloproteinase 9 in preeclampsia.

Preeclampsia is classically defined by the presence of hypertension and proteinuria after 20 weeks gestation and, thus, affects multiple body systems. The etiology of the disease remains poorly understood but it is known that the expression profile of placental genes is modified, including that of several matrix metalloproteinases (MMPs). The objective of this study was to perform a systematic expression analysis of MMP9 genes in normal and pathological placentas, and to pinpoint epigenetic alterations inside the MMP9 promoter region. Placentas were obtained from 20 patients with preeclampsia and 18 normal pregnancies in the third trimester. The methylation status of the promoter regions of MMP9 was analyzed with methylation-sensitive restriction enzymes, followed by polymerase chain reaction amplification. Our study found significantly higher expression levels of MMP9 in placental sections from preeclampsia tissue and this increased expression was well correlated to promoter demethylation. The percentage of unmethylated -712 sites were higher in preeclampsia patients (90%) compared with controls (44%). In conclusion, this study provides evidence that altered synthesis of MMP9 in preeclampsia placentas may result from epigenetic changes of the methylation status of CpG sites in the promoter region.

Identification and characterization of a novel spermatogenesis related gene LM23 in rat testis.

The aim of this study is to screen the novel gene related to the spermatogenesis. A novel rat testis-specific gene LM23 was identified and characterized by differential display PCR with total RNA from rat type A spermatogonia, pachytene spermatocytes, and round spermatids. LM23 cDNA consists of 1896 base pairs (bp) with a complete open reading frame of 936 bp, and encodes a putative protein including 312 amino acids, which shares no significant homology with any known gene. The sequence of LM23 was submitted to GenBank and the Accession No. was AF492385. Multitissue Northern blot and RT-PCR analysis showed LM23 was specific expression in testis, while its expression was not detected in other tissues. Real-time PCR analysis showed that the expression level of LM23 was highest in spermatocytes and very low in spermatogonia. In situ hybridization revealed strong cytoplasmic positive signal in spermatocytes and weak signal in spermatids and spermatogonia. These results indicated LM23 possessed the testis-specific and stage-specific expression characteristics, and possibly involved in rat spermatogenesis.

Weekly contraception with mifepristone.

OBJECTIVE: The study investigated the contraceptive effect of weekly administration of mifepristone. SUBJECTS AND METHODS: A double-blind, randomized clinical trial with weekly doses of 25 or 50 mg of mifepristone was carried out in three centers in China. Women were assigned to either of two groups. We defined each study cycle as 28 days. All bleeding data were derived from women's menstrual cards. The outcome measures were contraceptive efficacy, changes of menstrual pattern and side effects. RESULTS: Eighty-three women were enrolled and the outcome was known in 76 women: 39 in the 25-mg group and 37 in the 50-mg group. No pregnancy occurred in both groups in 456 women-months of use accumulated. There were no significant differences in mean bleeding days and no bleeding days between the two groups in the first three study cycles. In the fourth, fifth and sixth cycles, mean bleeding days in the 50-mg group (0.86, 1.05 and 0.62, respectively) were significantly less than those in the 25-mg group (3.5, 2.87 and 2.4 respectively); mean no bleeding days in the 50-mg group (26.07, 25.95 and 26.11, respectively) were significantly more than those in the 25-mg group (22.93, 23.23 and 23.51, respectively), and the percentage of women who had no bleeding in a 28-day study cycle in the 50-mg group (22.3%, 25% and 21.1%, respectively) was significantly more than those in the 25-mg group (2.6%, 3.9% and 3.9%, respectively). Side effects, such as nausea and breast distension, were uncommon and mild. CONCLUSION: Once weekly administration with 25-mg mifepristone is a potentially effective method for regular contraception.

[Effect of successive ejaculation on semen analysis parameters in normal men].

OBJECTIVE: To study the effect of successive ejaculation on semen analysis parameters in normal men. METHODS: Eight ejaculates were collected at daily intervals from 8 normal men. The semen parameters were analyzed according to WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. RESULTS: The semen volumes and total sperm counts decreased gradually day by day, significantly lower from the 5th to the 8th day than the 1st (P < 0.01). The sperm densities also declined day by day, but not significantly. The sperm viability and motility (a + b grade) presented an increasing trend, but with no significance except on the 7th day. CONCLUSION: With the increase of the ejaculatory frequency, human semen volumes and the total counts significantly decrease, while sperm viability and motility gradually increase. Successive ejaculation does not affect the quality of human semen.