Spatiotemporal Patterns of Adverse Pregnancy Outcomes in Rural Areas of Henan, China

The spatial patterns of adverse pregnancy outcomes (APOs) are complex, vary by place, and remain not entirely clear. This study investigated spatiotemporal patterns of APOs in rural areas of Henan, China. We used data from 1,315,327 singleton pregnancies during 2013-2016 in rural areas of Henan, China, from the National Free Pre-pregnancy Checkup Program (NFPCP). A spatiotemporal analysis of APOs was conducted based on the time of conception and current address. Results of seasonality decomposed showed a slight decline in the incidence rate of APOs (12.93% to 11.27% in the compound trend) among the participants from 2013 to 2016 and also variation in annual periodicity (peaking in autumn at 12.66% and hitting bottom in spring at 11.16%). Spatial clusters of APOs were concentrated in an intersection band of northwestern to southeastern Henan Province (with a relative risk ratio ranging from 3.66 to 1.20), the northwestern and northern portion for temporal variation (having a trend in the cluster ranged from -6.25% to 83.93). This study provides an overall picture of APOs that presented downward trends over time, seasonal fluctuation, and clustered patterns across space and over time in Henan Province-the most populated province in China. The findings of this study warrant future studies to investigate underlying influential factors of spatial variation of APOs.