Advanced Reproductive Technology and Infant Health

先进的生殖技术和婴儿健康

• 批准号: 6856494
• 负责人: Marianne P Bitler
• 金额: $ 9.2万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-03-01 至 2008-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6856494
• 关键词: age at pregnancy; assistive reproductive technique; clinical research; epidemiology; family planning; fertility; gestational age; health; health care service availability; health care service utilization; health economics; health related legal; human birth weight; human data; human population study; human therapy evaluation; infant human (0-1 year); infant mortality; outcomes research; parity; twin /multiplet

DESCRIPTION (provided by applicant): Advanced reproductive technologies (ART) such as in vitro fertilization have radically improved since the late 1960s and have become increasingly common. The implicit assumption behind widespread use of ART has been that children born through ART use are similar to other children. Using variation provided by state mandates to insurers to cover infertility treatment, this research will test this assumption by estimating the demographic and health effects of ART use. This proposal's specific aims are to: (1) seek direct evidence about how common ART use is, the characteristics of women using ART, and how utilization is related to state laws mandating that insurers cover infertility treatment, using data from the National Survey of Family Growth (NSFG); (2) investigate the impacts of ART use and of state-mandated insurance coverage of infertility treatment on the number of births, maternal age at birth, and the incidence of multiple births, using both the NSFG and Vital Statistics birth certificate data; and (3) analyze the impacts of state-mandated insurance coverage of infertility treatment on birth weight, gestation, and infant mortality using Vital Statistics birth certificate data. This final specific aim is the core of this proposal and has important implications for the ongoing debate about birth selection in demography and health economics. ART and its demographic and health impacts are of interest. Further, ART generates an archetypal birth-selection problem, altering the infant health distribution not by affecting the health of a fixed infant population but by making it possible for a new subset of children to be born. Such birth selection raises important methodological and conceptual issues, which this work will address. This research faces a further methodological challenge: births through use of ART are a tiny share of all births, so sample sizes are likely to be quite small. However, preliminary studies have shown ART impacts can be clearly seen among twin births, especially among twins born to older mothers. This research will extend these preliminary studies to look at all births, and to look at additional outcomes such as infant mortality.

描述（由申请人提供）：先进的生殖技术（ART），如体外受精，自20世纪60年代末以来得到了根本性的改善，并变得越来越普遍。广泛使用抗逆转录病毒治疗背后的隐含假设是，通过抗逆转录病毒治疗出生的儿童与其他儿童相似。利用各州要求保险公司承保不孕症治疗的规定，本研究将通过估计抗逆转录病毒治疗对人口和健康的影响来检验这一假设。该提案的具体目标是：(1)利用国家家庭增长调查（NSFG）的数据，寻求有关ART使用的普遍程度、使用ART的妇女的特征以及使用与要求保险公司支付不孕症治疗的州法律之间的关系的直接证据；(2)利用NSFG和Vital Statistics出生证明数据，调查抗逆转录病毒治疗的使用和国家规定的不孕症治疗保险覆盖对出生人数、产妇出生年龄和多胎发生率的影响；(3)利用Vital Statistics出生证明数据分析国家规定的不孕症治疗保险覆盖范围对出生体重、妊娠和婴儿死亡率的影响。这一最后的具体目标是本建议的核心，对正在进行的关于人口统计学和卫生经济学中出生选择的辩论具有重要意义。抗逆转录病毒治疗及其对人口和健康的影响令人感兴趣。此外，抗逆转录病毒治疗产生了一个典型的出生选择问题，它不是通过影响固定婴儿人口的健康，而是通过使新的儿童子集出生成为可能，从而改变婴儿健康分布。这种出生选择提出了重要的方法和概念问题，这一工作将解决。这项研究面临着进一步的方法学挑战：通过使用抗逆转录病毒治疗出生的婴儿只占所有出生婴儿的一小部分，因此样本量可能相当小。然而，初步研究表明，抗逆转录病毒治疗对双胞胎的影响可以清楚地看到，特别是对大龄母亲所生的双胞胎。这项研究将把这些初步研究扩展到所有的出生，并研究婴儿死亡率等其他结果。