Mode of First Delivery and Subsequent Child-Bearing

描述（由申请人提供）：先前在美国和其他国家进行的研究发现，通过剖腹产分娩第一个孩子的女性不太可能生育后续孩子，并且比阴道分娩第一个孩子的女性生育后续孩子的数量更少。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的调查。因此，尚不清楚通过剖宫产分娩第一个孩子的妇女是否与在第一次分娩前阴道分娩的妇女不同，因为这两种妇女都倾向于通过剖宫产分娩，并且不太可能想要或能够怀孕并生育一个或多个后续孩子，或者剖腹产本身是否会影响妇女怀孕或生育后代的愿望或能力。鉴于最近在美国和世界各国剖宫产率的增加，必须进行设计良好，仔细进行，前瞻性，纵向研究，具有足够的统计能力，以提高科学知识的程度，剖宫产增加妇女随后不孕的风险，如果是这样，为什么。这项关于首次分娩方式的生育模式的前瞻性纵向研究调查了增加妇女通过剖宫产分娩第一个孩子的风险的因素，以及初次剖宫产对重要结局（包括随后的生育）的影响。本研究的主要目的是：（1）。通过旨在评估可能解释剖宫产后生育缺陷的分娩前因素的访谈，测量2790名孕妇的首次分娩前生育愿望和意图。测量这2790名妇女的医院病历中与分娩和分娩相关的因素，这些因素可以解释剖宫产后在随后的生育中的缺陷。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个月、6个月、12个月、18个月、24个月、30个月和36个月进行评估，比较剖宫产分娩与阴道分娩的妇女，以确定初次剖宫产分娩对随后分娩的影响。考虑到分娩前面谈和医院医疗记录中测量的因素。公共卫生相关性：在过去的十年中，美国的剖宫产率急剧增加，每年有超过一百万的妇女通过剖宫产分娩。这项研究将调查剖腹产增加妇女随后不孕风险的程度，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.