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Conception Failure and Pregnancy Loss in the U.S.

美国的受孕失败和流产

基本信息

批准号：
10613363
负责人：
JENNA E. NOBLES
金额：
$ 28.97万
依托单位：
UNIVERSITY OF WISCONSIN-MADISON
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-04-15 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10613363
关键词：
Address Affect Age Behavior Biological Markers Characteristics Child Mortality Clinic Communities Conceptions County Couples Data Data Reporting Data Science Devices Disparate Disparity Economic Conditions Economics Education Emotional Environment Environmental Exposure Environmental Risk Factor Event Failure Family Fertility Fertility Study Health Health Policy Health Status Health behavior Human Implant Income Individual Infant Mortality Inflammation Live Birth Maternal Health Measures Medicaid Menstrual cycle Neighborhoods Obesity Outcome Ovulation Pathway interactions Policies Policy Analysis Population Population Dynamics Poverty Pregnancy Pregnancy Outcome Pregnancy loss Prevention Probability Process Public Health Quasi-experiment Race Reporting Research Risk Risk Reduction Rural Community Sample Size Sampling Science Shapes Smoking Social Conditions Social Sciences Spontaneous abortion Statutes and Laws Stratification Time Translations Validation Variant Weight Woman Women&apos s Health clinical practice cohort data tools design digital early pregnancy economic cost experience field study health disparity improved machine learning prediction algorithm male men mortality population health pregnancy failure pregnancy health pregnant prepregnancy programs recruit reproductive social social factors spatiotemporal stillbirth stress reactivity success tribal lands trying to conceive

项目摘要

NEW EVIDENCE ON CONCEPTION AND PREGNANCY LOSS IN THE U.S. ABSTRACT Conception failure and pregnancy loss impede the pathway to parenthood for millions of US couples each year. Despite being modifiable and common—pregnancy loss occurs fifty times as often as infant mortality— miscarriage is among the least well-studied aspects of population health or population dynamics. We know little about what causes these losses, the generalizability of estimates generated from the study of small recruited samples, including how the risk of miscarriage differs across time, place, or subpopulation. These enormous gaps are driven by how difficult it is to study the pathway to live birth in humans, requiring a sufficiently large and diverse “preconception cohort.” To date small, nonrepresentative cohorts contribute most of what we know about early pregnancy. But limited sample size, variation, and coverage preclude the study of social and ecological factors—poverty, partner health, environmental exposures—that are now widely understood to shape mortality at later ages: e.g., stillbirth, infant, and child mortality. Such omissions are consequential. Conception failures and pregnancy loss have significant emotional and economic costs. Though pregnancy failures are likely distributed unevenly across populations, the size of this disparate burden is unknown. We do not have evidence about the potential impact of policies on the prevention of these outcomes. Our research combines the tools of data science and social science to scale the preconception design to a large, diverse cohort in the US. Period and pregnancy “tracking” on digital devices is now common among reproductive-age women. We use data on 4 million women’s day-to-day recording of menstrual cycles, ovulation, and pregnancy, as well as reported social and economic characteristics. The data allow us to measure both reported and detected conception and pregnancy loss. We combine the data with georeferenced information about the physical, social, economic, and policy environments in which women and their partners live. The sample is diverse: users come from over 99% of U.S. counties; over 1 million users are on Medicaid. We use these extraordinary data to provide the first estimates of large-scale population variability in the pathway to live birth and to document factors that affect this pathway. Aim 1 develops new estimates of conception and pregnancy loss, including disparities associated with education, income, racial identification, and neighborhood poverty. Aim 2 estimates the contribution of male partner characteristics to conception and pregnancy loss, drawing on detailed data reported about partners. Aim 3 uses quasi-experimental designs to provide the first estimates of understudied exposures from multiple environmental, social, economic domains on conception and pregnancy loss. The research sheds new light on a pervasive and massively understudied public health concern, with direct implications for the improvement of early pregnancy outcomes. In so doing, the research also generates estimates that are much-needed inputs to support advancement in multiple, connected fields of study in the social, health, and biomedical sciences.

美国关于受孕和流产的新证据