IMPACT OF COVID-19 EXPOSURE ON U.S. BIRTH OUTCOMES

接触 COVID-19 对美国出生结果的影响

• 批准号: 10466859
• 负责人: JENNA E. NOBLES
• 金额: $ 19.39万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-10 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10466859
• 关键词: Address; Alabama; American; Area; Arizona; Behavioral; Birth; Birth Records; Birth Weight; COVID-19; COVID-19 impact; COVID-19 pandemic; Characteristics; Color; Communities; Data; Dimensions; Disadvantaged; Economic Conditions; Economically Deprived Population; Economics; Education; Ethnic Origin; Event; Exposure to; Family; Fertility; Fetal Growth Retardation; Florida; Geography; Hawaii; Health; Healthcare; Heterogeneity; Home; Hospitalization; Individual; Inequality; Infant Health; Infection; Infrastructure; Level of Evidence; Life; Link; Location; Longevity; Maternal Age; Maternal Health; Measurement; Modeling; New Jersey; Outcome; Policies; Policy Making; Population; Pregnancy; Premature Birth; Prenatal care; Psychological Stress; Race; Research; SARS-CoV-2 exposure; Sampling; Shapes; Social Distance; Source; Stress; Subgroup; Techniques; Testing; Time; Translational Research; Variant; Vital Statistics; Vulnerable Populations; Wisconsin; Woman; clinical translation; coronavirus disease; delivery complications; development policy; health care availability; health economics; healthy pregnancy; infection risk; lower income families; maternal outcome; mortality; neonatal health; next generation; pandemic disease; pregnancy health; prenatal exposure; response; rural area; social group; socioeconomic disadvantage; socioeconomics; urban area; welfare

THE IMPACT OF COVID-19 ON U.S. BIRTH OUTCOMES ABSTRACT The COVID-19 pandemic will shape most domains of life in the US. Among the most enduring will be effects on the health of the next generation of Americans. Over 4 million pregnancies are currently in progress in the US. Between 1-3 million pregnancies will be initiated over the next six months. Prenatal exposure to large- scale health and economic events have serious implications for birth outcomes, including delivery conditions, pregnancy duration, and birthweight. These outcomes, in turn, predict welfare throughout life—education, earnings, and even lifespan. Pandemic effects on pregnancy will have implications that last decades. Currently we have little systematic population-level evidence on newborn health with which to make policy decisions about COVID management. Evidence is urgently needed because COVID-19 has shaped well-established predictors of pregnancy health, including infection exposure, stress, economic precarity, and health care access. These individual-level factors are shaped by community-level dynamics like infection spread, distancing policies, and economic decline. Because these factors differ across the U.S., the impact of COVID-19 on birth outcomes is likely stronger among vulnerable groups defined by location, race, ethnicity, and socioeconomic disadvantage, potentially exacerbating inequality in infant health. This research estimates the effects of COVID-19 on birth outcomes at the population level, over time, and across groups defined by different sources of disadvantage. To provide the earliest possible evidence, we use birth records obtained at the state level with early release. We focus on six states that provide large and diverse samples in areas in which the pandemic unfolded with significant variation: Alabama, Arizona, Florida, Hawaii, New Jersey, and Wisconsin. The analysis uses causal inference techniques and explicitly incorporates changes to fertility and the composition of pregnancies. Aim 1 estimates the effect of local-level exposure to COVID-19 on birth outcomes, including intrauterine growth restriction, birthweight, and delivery complications. Aim 2 tests for differences in COVID-19 effects on birth outcomes by maternal age, race, nativity, economic disadvantage, and pre-pandemic, local-level economic conditions and health care infrastructure. Establishing across-group differences is critical for understanding how the pandemic will shape early-life inequality. Aim 3 addresses a serious form of bias in prenatal exposure estimates—selection into birth—by modeling the change in the number and composition of women giving birth as a result of COVID-19 exposure. We use this information to adjust estimates of COVID-19 effects on infant health, while also providing the earliest evidence of COVID effects on population fertility. The research provides a rapid, comprehensive assessment of the impact on birth outcomes across localities in which the pandemic unfolded with significant variation, while adjusting for critical sources of selectivity. The research identifies communities and subpopulations in which the pandemic has had the largest impact, and in which lasting effects for the next generation may unfold.

新冠肺炎对美国新生儿出生结局的影响 摘要 新冠肺炎大流行将塑造美国生活的大部分领域。其中最持久的将是影响 关于下一代美国人的健康。目前有400多万例怀孕正在进行中。 我们。在接下来的六个月里，将有100-300万人怀孕。产前暴露于大剂量的- 大规模的健康和经济事件对分娩结果有严重影响，包括分娩条件， 孕期和出生体重。这些结果反过来又预示着终身教育的福利， 收入，甚至寿命。大流行对怀孕的影响将持续数十年。 目前，我们几乎没有关于新生儿健康的系统的人口水平的证据可供参考 关于COVID管理的政策决定。迫切需要证据，因为新冠肺炎已经形成 成熟的妊娠健康预测因素，包括感染暴露、压力、经济早熟和 医疗保健服务。这些个人层面的因素是由社区层面的动态形成的，比如感染 扩散、疏远政策和经济衰退。由于这些因素在美国各地都不同，因此 新冠肺炎对出生结局的预测在按地区、种族、民族、 和社会经济劣势，有可能加剧婴儿健康方面的不平等。 这项研究估计了新冠肺炎在人群水平上，随着时间的推移，对出生结局的影响 由不同的劣势来源定义的跨群体。为了提供尽可能早的证据，我们使用 提前公布在州一级获得的出生记录。我们重点关注六个州，这些州提供了 在大流行以显著差异展开的地区的不同样本：阿拉巴马州，亚利桑那州，佛罗里达州， 夏威夷、新泽西和威斯康星州。分析使用了因果推理技术，并明确地结合了 生育力和怀孕构成的变化。目标1估计地方一级暴露于 新冠肺炎对分娩结局的影响，包括宫内生长受限、出生体重和分娩并发症。 目标2检验不同母亲年龄、种族、出生地、经济状况对生育结局的新冠肺炎影响的差异 不利因素，以及大流行前地方一级的经济状况和卫生保健基础设施。建立 跨群体的差异对于理解大流行将如何塑造早期生命不平等至关重要。目标3 通过对变化进行建模，解决了产前暴露评估中的一种严重形式的偏差-选择出生 因新冠肺炎接触而生育的女性的数量和构成。我们用这个 调整新冠肺炎对婴儿健康影响的估计的信息，同时也提供最早的证据 冠状病毒对人口生育力的影响。这项研究提供了一个快速、全面的评估 在大流行以显著差异展开的地区对分娩结局的影响，而 针对关键的选择性来源进行调整。这项研究确定了其中的社区和亚群体 这场大流行的影响最大，可能会对下一代产生持久的影响。