IMPACT OF COVID-19 EXPOSURE ON U.S. BIRTH OUTCOMES

COVID-19对美国生育结果的影响 摘要 COVID-19大流行将影响美国生活的大部分领域。其中最持久的将是影响 下一代美国人的健康。目前，有400多万人正在怀孕， 我们在未来六个月内，将有100万至300万人怀孕。产前暴露于大- 大规模的健康和经济事件对生育结果，包括分娩条件， 怀孕时间和出生体重。反过来，这些结果又预测了一生的福利--教育， 收入甚至寿命流行病对怀孕的影响将持续数十年。 目前，我们几乎没有关于新生儿健康的系统性人口水平证据， 有关COVID管理的政策决定。迫切需要证据，因为COVID-19已经形成了 妊娠健康的公认预测因素，包括感染暴露、压力、经济不稳定性， 获得保健服务。这些个人层面的因素是由社区层面的动力学（如感染）塑造的 传播、疏远政策和经济衰退。由于这些因素在美国各地不同，的影响 COVID-19对出生结果的影响在按地点、种族、民族定义的弱势群体中可能更大， 和社会经济劣势，可能加剧婴儿健康方面的不平等。 这项研究估计了COVID-19对人口水平出生结果的影响，随着时间的推移， 不同的弱势群体之间的差异。为了提供最早的证据，我们使用 在州一级获得出生记录并提前释放。我们重点关注六个州，这些州提供大量的 在大流行发生显著变化的地区，有不同的样本：亚拉巴马、亚利桑那、佛罗里达， 夏威夷，新泽西和威斯康星州。分析使用因果推理技术，并明确纳入 生育能力和怀孕构成的变化。目标1估计了地方一级接触对 COVID-19对出生结局的影响，包括宫内生长受限、出生体重和分娩并发症。 目的2检验COVID-19对孕产妇年龄、种族、出生地、经济状况和出生率对出生结果影响的差异 不利条件以及流行病前的地方经济条件和保健基础设施。建立 群体间的差异对于理解这一流行病如何影响幼年不平等至关重要。目标3 通过对变化进行建模，解决了产前暴露估计中的一种严重形式的偏差--选择出生 因COVID-19暴露而分娩的妇女人数和组成。我们用这个 调整COVID-19对婴儿健康影响的估计，同时提供最早的证据 COVID对人口生育率的影响。这项研究提供了一个快速，全面的评估， 对各地区出生结果的影响，在这些地区，大流行病的发展存在显著差异， 调整选择性的关键来源。该研究确定了社区和亚群， 这一大流行病的影响最大，可能对下一代产生持久影响。

THE IMPACT OF COVID-19 ON U.S. BIRTH OUTCOMES ABSTRACT The COVID-19 pandemic will shape most domains of life in the US. Among the most enduring will be effects on the health of the next generation of Americans. Over 4 million pregnancies are currently in progress in the US. Between 1-3 million pregnancies will be initiated over the next six months. Prenatal exposure to large- scale health and economic events have serious implications for birth outcomes, including delivery conditions, pregnancy duration, and birthweight. These outcomes, in turn, predict welfare throughout life—education, earnings, and even lifespan. Pandemic effects on pregnancy will have implications that last decades. Currently we have little systematic population-level evidence on newborn health with which to make policy decisions about COVID management. Evidence is urgently needed because COVID-19 has shaped well-established predictors of pregnancy health, including infection exposure, stress, economic precarity, and health care access. These individual-level factors are shaped by community-level dynamics like infection spread, distancing policies, and economic decline. Because these factors differ across the U.S., the impact of COVID-19 on birth outcomes is likely stronger among vulnerable groups defined by location, race, ethnicity, and socioeconomic disadvantage, potentially exacerbating inequality in infant health. This research estimates the effects of COVID-19 on birth outcomes at the population level, over time, and across groups defined by different sources of disadvantage. To provide the earliest possible evidence, we use birth records obtained at the state level with early release. We focus on six states that provide large and diverse samples in areas in which the pandemic unfolded with significant variation: Alabama, Arizona, Florida, Hawaii, New Jersey, and Wisconsin. The analysis uses causal inference techniques and explicitly incorporates changes to fertility and the composition of pregnancies. Aim 1 estimates the effect of local-level exposure to COVID-19 on birth outcomes, including intrauterine growth restriction, birthweight, and delivery complications. Aim 2 tests for differences in COVID-19 effects on birth outcomes by maternal age, race, nativity, economic disadvantage, and pre-pandemic, local-level economic conditions and health care infrastructure. Establishing across-group differences is critical for understanding how the pandemic will shape early-life inequality. Aim 3 addresses a serious form of bias in prenatal exposure estimates—selection into birth—by modeling the change in the number and composition of women giving birth as a result of COVID-19 exposure. We use this information to adjust estimates of COVID-19 effects on infant health, while also providing the earliest evidence of COVID effects on population fertility. The research provides a rapid, comprehensive assessment of the impact on birth outcomes across localities in which the pandemic unfolded with significant variation, while adjusting for critical sources of selectivity. The research identifies communities and subpopulations in which the pandemic has had the largest impact, and in which lasting effects for the next generation may unfold.