Mode of First Delivery and Subsequent Child-Bearing

描述（由申请人提供）：之前在美国和其他国家进行的研究发现，剖腹产分娩第一个孩子的女性比顺产分娩第一个孩子的女性生育第二个孩子的可能性更小，生育第二个孩子的数量也更少。然而，几乎所有这些研究都是对现有数据集的回顾性分析，或对首次分娩后数年的妇女进行调查。因此,目前还不清楚如果通过剖腹产交付他们的第一个孩子的女性不同于女性交付之前,阴道分娩第一个交付的方式使他们都需要交付通过剖腹产和不太可能愿意或者能够怀孕和承担一个或多个后续的孩子,或者如果有一些关于剖腹产本身会影响女性生育能力的愿望或承担后续的孩子。鉴于最近美国和世界各国剖宫产率的上升，有必要进行精心设计、精心实施、具有足够统计力的前瞻性、纵向研究，以提高对剖宫产增加妇女随后不孕风险程度的科学认识，如果是，原因是什么。这项关于生育模式与首次分娩方式相关的前瞻性、纵向研究调查了增加女性剖宫产分娩第一胎风险的因素，以及初次剖宫产对重要结局（包括随后的生育）的影响。本研究的具体目的是：1.)通过访谈，测量2790名孕妇在分娩前的生育愿望和意图，以评估产前因素，这些因素可以解释剖宫产后的生育缺陷。2 .测量2790名妇女的医院医疗记录中与分娩相关的因素，这些因素可以解释剖宫产后在随后的生育中出现的缺陷。为了确定初次剖宫产对后续生育的影响，通过对这2790名妇女进行为期3年的前瞻性纵向研究，在首次分娩后1、6、12、18、24、30和36个月进行评估，比较剖宫产和顺产的妇女，并考虑到产前访谈和医院医疗记录中测量的因素。公共卫生相关性：在过去十年中，美国剖宫产率急剧上升，每年有超过100万妇女通过剖宫产分娩。这项研究将调查剖宫产在多大程度上增加了妇女随后不孕的风险，并将大大提高目前关于这一问题的科学知识水平。

DESCRIPTION (provided by applicant): Previous studies, conducted both in the US and other countries, have found that women who deliver their first child by cesarean section are less likely to bear subsequent children and bear fewer subsequent children than women who deliver their first child vaginally. However, nearly all of these studies were retrospective analyses of existing data sets, or surveys of women years after their first delivery. Consequently, it is not clear if women who deliver their first child via cesarean section are different from women who deliver vaginally prior to the first delivery in ways that both predispose them to require delivery by cesarean section and to be less likely to want to or be able to conceive and bear one or more subsequent children, or if there is something about the cesarean section itself that affects women's desire or ability to conceive or bear subsequent children. Given the recent increase in the rate of cesarean section in the US and in countries throughout the world, it is essential that well-designed, carefully conducted, prospective, longitudinal studies with adequate statistical power be conducted to improve scientific knowledge of the extent to which cesarean section increases a woman's risk of subsequent infertility, and if so, why. This prospective, longitudinal study of child-bearing patterns in relation to mode of first delivery is an investigation of both factors that increase a woman's risk of delivering her first child by cesarean section, and the effects of primary cesarean delivery on important outcomes, including subsequent child-bearing. The specific aims of this study are: 1.) To measure pre-first delivery child-bearing desires and intentions among a diverse sample of 2790 pregnant women through interviews designed to assess pre-delivery factors that could explain post-cesarean deficits in subsequent child-bearing, 2.) To measure labor and delivery related factors in the hospital medical records of these 2790 women that could explain post-cesarean deficits in subsequent child-bearing, and 3.) To determine the effects of primary cesarean delivery on subsequent childbearing, via a 3-year prospective, longitudinal study of these 2790 women, with assessments at 1, 6, 12, 18, 24, 30 and 36 months post first delivery, comparing those who deliver by cesarean section to those who deliver vaginally, taking into account factors measured in the pre- delivery interview and the hospital medical records. PUBLIC HEALTH RELEVANCE: The rate of cesarean delivery in the US has increased dramatically in the past decade and more than a million women deliver by cesarean section annually. This study will investigate the extent to which cesarean delivery increases a woman's risk of subsequent infertility and will substantially improve the current level of scientific knowledge about this issue.