Conception Failure and Pregnancy Loss in the U.S.

美国的受孕失败和流产

• 批准号: 10613363
• 负责人: JENNA E. NOBLES
• 金额: $ 28.97万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10613363
• 关键词: Address; Affect; Age; Behavior; Biological Markers; Characteristics; Child Mortality; Clinic; Communities; Conceptions; County; Couples; Data; Data Reporting; Data Science; Devices; Disparate; Disparity; Economic Conditions; Economics; Education; Emotional; Environment; Environmental Exposure; Environmental Risk Factor; Event; Failure; Family; Fertility; Fertility Study; Health; Health Policy; Health Status; Health behavior; Human; Implant; Income; Individual; Infant Mortality; Inflammation; Live Birth; Maternal Health; Measures; Medicaid; Menstrual cycle; Neighborhoods; Obesity; Outcome; Ovulation; Pathway interactions; Policies; Policy Analysis; Population; Population Dynamics; Poverty; Pregnancy; Pregnancy Outcome; Pregnancy loss; Prevention; Probability; Process; Public Health; Quasi-experiment; Race; Reporting; Research; Risk; Risk Reduction; Rural Community; Sample Size; Sampling; Science; Shapes; Smoking; Social Conditions; Social Sciences; Spontaneous abortion; Statutes and Laws; Stratification; Time; Translations; Validation; Variant; Weight; Woman; Women' s Health; clinical practice; cohort; data tools; design; digital; early pregnancy; economic cost; experience; field study; health disparity; improved; machine learning prediction algorithm; male; men; mortality; population health; pregnancy failure; pregnancy health; pregnant; prepregnancy; programs; recruit; reproductive; social; social factors; spatiotemporal; stillbirth; stress reactivity; success; tribal lands; trying to conceive

NEW EVIDENCE ON CONCEPTION AND PREGNANCY LOSS IN THE U.S. ABSTRACT Conception failure and pregnancy loss impede the pathway to parenthood for millions of US couples each year. Despite being modifiable and common—pregnancy loss occurs fifty times as often as infant mortality— miscarriage is among the least well-studied aspects of population health or population dynamics. We know little about what causes these losses, the generalizability of estimates generated from the study of small recruited samples, including how the risk of miscarriage differs across time, place, or subpopulation. These enormous gaps are driven by how difficult it is to study the pathway to live birth in humans, requiring a sufficiently large and diverse “preconception cohort.” To date small, nonrepresentative cohorts contribute most of what we know about early pregnancy. But limited sample size, variation, and coverage preclude the study of social and ecological factors—poverty, partner health, environmental exposures—that are now widely understood to shape mortality at later ages: e.g., stillbirth, infant, and child mortality. Such omissions are consequential. Conception failures and pregnancy loss have significant emotional and economic costs. Though pregnancy failures are likely distributed unevenly across populations, the size of this disparate burden is unknown. We do not have evidence about the potential impact of policies on the prevention of these outcomes. Our research combines the tools of data science and social science to scale the preconception design to a large, diverse cohort in the US. Period and pregnancy “tracking” on digital devices is now common among reproductive-age women. We use data on 4 million women’s day-to-day recording of menstrual cycles, ovulation, and pregnancy, as well as reported social and economic characteristics. The data allow us to measure both reported and detected conception and pregnancy loss. We combine the data with georeferenced information about the physical, social, economic, and policy environments in which women and their partners live. The sample is diverse: users come from over 99% of U.S. counties; over 1 million users are on Medicaid. We use these extraordinary data to provide the first estimates of large-scale population variability in the pathway to live birth and to document factors that affect this pathway. Aim 1 develops new estimates of conception and pregnancy loss, including disparities associated with education, income, racial identification, and neighborhood poverty. Aim 2 estimates the contribution of male partner characteristics to conception and pregnancy loss, drawing on detailed data reported about partners. Aim 3 uses quasi-experimental designs to provide the first estimates of understudied exposures from multiple environmental, social, economic domains on conception and pregnancy loss. The research sheds new light on a pervasive and massively understudied public health concern, with direct implications for the improvement of early pregnancy outcomes. In so doing, the research also generates estimates that are much-needed inputs to support advancement in multiple, connected fields of study in the social, health, and biomedical sciences.

关于美国受孕和怀孕丧失的新证据 抽象的 受孕失败和怀孕丧失阻碍了数百万夫妇的育儿途径 年。尽管可修改和普遍 - 怀孕损失的发生率是婴儿死亡率的五十倍 - 流产是人口健康或人口动态的最不足的方面之一。我们知道 几乎没有导致这些损失的原因，从小研究产生的估计值的普遍性 招募样本，包括流产的风险在时间，地点或子群中的不同。 这些巨大的差距是由研究人类活出生的途径的困难所驱动的 足够大且差异的“先入为主的队列”。迄今为止，小的，非代表的人群有贡献 我们对早期怀孕的大部分了解。但是有限的样本量，变化和覆盖范围排除了 对社会和生态因素的研究 - 持续性，合作伙伴健康，环境暴露 - 现在广泛 了解以后的年龄塑造死亡率：例如，死产，婴儿和儿童死亡率。这样的遗漏是 结果。受孕失败和怀孕丧失具有巨大的情感和经济成本。尽管 怀孕失败可能在人群中分布不均，这个不同的伯宁的大小是 未知。我们没有证据表明政策对预防这些结果的潜在影响。 我们的研究结合了数据科学和社会科学的工具，以扩展孕前设计 大型潜水员队列在美国。数字设备上的时期和怀孕“跟踪”现在很常见 生殖时代的妇女。我们使用有关400万女性日常录制月经周期的数据， 排卵，怀孕，以及报道的社会和经济特征。数据允许我们 测量报告和检测到的概念和妊娠丧失。我们将数据与地理参与 有关妇女及其伴侣的身体，社会，经济和政策环境的信息 居住。样本是潜水员：用户来自美国99％以上的县；超过100万用户正在使用医疗补助。 我们使用这些非凡数据来提供大规模人口可变性的首次估计 活产的途径和记录影响这一途径的因素。 AIM 1开发新的估计 受孕和怀孕丧失，包括与教育，收入，种族认同相关的分布， 和邻里贫困。目标2估计男性伴侣特征对概念的贡献和 怀孕丧失，借鉴了有关伴侣的详细数据。 AIM 3使用准实验设计 提供对来自多个环境，社会，经济领域的知识暴露的首次估计 关于概念和怀孕丧失。该研究为普遍且广泛理解的新灯提供了新的启示 公共卫生的关注，对改善早期妊娠结局的影响直接影响。这样做， 该研究还产生了急需输入的估计值，以支持多个， 社会，健康和生物医学科学领域的联系领域。