Advanced Reproductive Technology and Infant Health

描述（由申请人提供）：先进的生殖技术（ART），如体外受精，自20世纪60年代末以来已经得到了根本性的改善，并且变得越来越普遍。广泛使用抗逆转录病毒疗法背后隐含的假设是，通过抗逆转录病毒疗法出生的儿童与其他儿童相似。利用州政府授权保险公司提供的用于支付不孕症治疗费用的变化，本研究将通过估计ART使用的人口统计学和健康影响来验证这一假设。该提案的具体目标是：（1）利用全国家庭增长调查（NSFG）的数据，寻求关于ART使用的普遍程度、使用ART的妇女的特征以及使用与州法律规定保险公司支付不孕症治疗费用的关系的直接证据;（2）调查ART使用和国家强制性不孕症治疗保险对出生人数、产妇出生年龄、和多胞胎的发生率，同时使用NSFG和生命统计出生证明数据;（3）分析国家强制保险的不孕症治疗对出生体重，妊娠和婴儿死亡率的影响，使用生命统计出生证明数据。这最后一个具体目标是这一建议的核心，对人口学和卫生经济学中正在进行的关于出生选择的辩论具有重要意义。抗逆转录病毒疗法及其对人口和健康的影响值得关注。此外，ART产生了一个原型的出生选择问题，改变婴儿的健康分布，而不是通过影响一个固定的婴儿人口的健康，而是通过使一个新的子集的儿童出生。这种出生选择提出了重要的方法和概念问题，本工作将解决这些问题。这项研究面临着进一步的方法学挑战：通过使用抗逆转录病毒疗法出生的婴儿在所有出生婴儿中所占比例很小，因此样本量可能相当小。然而，初步研究表明，ART的影响可以在双胞胎中清楚地看到，特别是在年长母亲所生的双胞胎中。这项研究将扩展这些初步研究，以研究所有出生，并研究其他结果，如婴儿死亡率。

DESCRIPTION (provided by applicant): Advanced reproductive technologies (ART) such as in vitro fertilization have radically improved since the late 1960s and have become increasingly common. The implicit assumption behind widespread use of ART has been that children born through ART use are similar to other children. Using variation provided by state mandates to insurers to cover infertility treatment, this research will test this assumption by estimating the demographic and health effects of ART use. This proposal's specific aims are to: (1) seek direct evidence about how common ART use is, the characteristics of women using ART, and how utilization is related to state laws mandating that insurers cover infertility treatment, using data from the National Survey of Family Growth (NSFG); (2) investigate the impacts of ART use and of state-mandated insurance coverage of infertility treatment on the number of births, maternal age at birth, and the incidence of multiple births, using both the NSFG and Vital Statistics birth certificate data; and (3) analyze the impacts of state-mandated insurance coverage of infertility treatment on birth weight, gestation, and infant mortality using Vital Statistics birth certificate data. This final specific aim is the core of this proposal and has important implications for the ongoing debate about birth selection in demography and health economics. ART and its demographic and health impacts are of interest. Further, ART generates an archetypal birth-selection problem, altering the infant health distribution not by affecting the health of a fixed infant population but by making it possible for a new subset of children to be born. Such birth selection raises important methodological and conceptual issues, which this work will address. This research faces a further methodological challenge: births through use of ART are a tiny share of all births, so sample sizes are likely to be quite small. However, preliminary studies have shown ART impacts can be clearly seen among twin births, especially among twins born to older mothers. This research will extend these preliminary studies to look at all births, and to look at additional outcomes such as infant mortality.