Advanced Reproductive Technology and Infant Health

先进的生殖技术和婴儿健康

• 批准号: 6756869
• 负责人: Marianne P Bitler
• 金额: $ 8.69万
• 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 2006-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6756869
• 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(申请人提供)：自20世纪60年代末以来，体外受精等先进生殖技术(ART)已得到根本改进，并变得越来越普遍。广泛使用艺术背后的隐含假设是，通过使用艺术而出生的孩子与其他孩子相似。这项研究利用国家强制保险公司为不孕不育治疗提供的差异，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。这项建议的具体目的是：(1)利用全国家庭增长调查(NSFG)的数据，寻找直接证据，说明使用ART的情况有多普遍，使用ART的妇女的特征，以及ART的使用与要求保险公司承保不孕不育治疗的州法律之间的关系；(2)使用NSFG和生命统计出生证明数据，调查ART使用和国家规定的不孕不育治疗保险覆盖范围对出生人数、产妇出生年龄和多胎发生率的影响；以及(3)使用《生命统计》出生证明数据分析国家强制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。这一最终的具体目标是这项提案的核心，并对人口学和卫生经济学中正在进行的关于生育选择的辩论具有重要影响。抗逆转录病毒疗法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生育选择问题，改变了婴儿的健康分布，不是通过影响固定婴儿人口的健康，而是通过使新的子集儿童出生成为可能。这样的出生选择提出了重要的方法和概念问题，这项工作将解决这些问题。这项研究面临着另一个方法论上的挑战：通过ART技术出生的婴儿在所有出生中所占比例很小，因此样本量可能很小。然而，初步研究表明，在双胞胎生育中可以清楚地看到ART的影响，特别是在大龄母亲所生的双胞胎中。这项研究将扩展这些初步研究，以观察所有出生的婴儿，并观察其他结果，如婴儿死亡率。