Mode of First Delivery and Subsequent Child-Bearing

描述(申请人提供)：之前在美国和其他国家进行的研究发现，通过剖腹产生下第一个孩子的女性比通过阴道生下第一个孩子的女性更不可能生育后续孩子。然而，几乎所有这些研究都是对现有数据集的回顾分析，或者是对第一次分娩后数年的妇女的调查。因此，尚不清楚通过剖腹产分娩第一个孩子的妇女是否与第一次分娩前经阴道分娩的妇女不同，这两种方式都使她们倾向于要求通过剖腹产分娩，并不太可能想要或能够怀孕和生育一个或多个后续孩子，或者剖腹产本身是否存在影响妇女怀孕或生育后续孩子的愿望或能力的因素。鉴于最近美国和世界各国剖腹产率的上升，至关重要的是，必须进行精心设计、仔细进行、具有足够统计能力的前瞻性纵向研究，以提高科学知识，了解剖腹产在多大程度上会增加妇女随后不孕的风险，如果是这样的话，原因是什么。这项关于生育模式与第一次分娩方式之间关系的前瞻性纵向研究，既调查了增加妇女通过剖腹产分娩第一个孩子的风险的因素，也调查了初次剖腹产对重要结局的影响，包括随后的生育。这项研究的具体目的是：1)2.通过对2790名孕妇的不同抽样调查，评估可解释剖腹产后生育缺陷的产前因素，以衡量首次分娩前的生育意愿和意向。测量这2790名妇女的医院医疗记录中与分娩和分娩相关的因素，这些因素可以解释剖宫产后继发生育的缺陷，以及3。为了确定初次剖宫产对再次分娩的影响，对2790名妇女进行了为期3年的前瞻性纵向研究，在第一次分娩后1、6、12、18、24、30和36个月进行评估，将剖宫产和阴道分娩的产妇进行比较，考虑到产前访谈和医院医疗记录中测量的因素。与公共健康相关：在过去的十年里，美国的剖腹产率急剧上升，每年有100多万妇女通过剖腹产分娩。这项研究将调查剖腹产在多大程度上增加了妇女随后不孕的风险，并将极大地提高目前对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.