Plurality and Contemporary Infant Mortality Risks

描述（由申请人提供）：2002年，美国有超过132，000名多胎妊娠婴儿出生，这是有史以来最高的数字。自1980年以来，这一比率急剧上升，主要原因是不孕症治疗以及生育年龄偏大的趋势。使用辅助生殖技术有30-50%的风险导致多胎妊娠，这取决于所使用的药物和技术。高龄产妇需要更积极的治疗来实现怀孕，包括转移更多的胚胎。影响围产期死亡率的两个最重要的因素是胎龄和相对出生体重;每增加一个胎儿，这两个因素都会受到影响。与单胎相比，多胎妊娠的婴儿更有可能早产和出生体重极低，这是导致其发病率和死亡率过高的重要因素。我们没有当代的，具有全国代表性的，基于人口的估计与多胎妊娠相关的婴儿死亡风险增加。这项拟议研究的目的是确定多胎妊娠婴儿的婴儿死亡风险，控制重要的母体和胎儿因素，包括年龄、种族和民族、产次、吸烟状况、婴儿性别、出生体重和胎龄，以及多胎妊娠特有的因素（例如，体重不一致、性别混合、兄弟姐妹的胎儿死亡）。这一建议的核心假设是，多胎妊娠婴儿的死亡风险高于单胎妊娠，而且其中一些风险已从新生儿推迟到新生儿后期。这项研究的数据是1995-2000年出生/婴儿死亡数据集和多胎出生数据集。由此产生的多特异性围产期，新生儿，新生儿后和整体婴儿死亡率风险将有助于从业者咨询接受不孕症治疗和考虑多胎妊娠教育的患者，并更有效地管理多胎妊娠婴儿的产前和产后健康。

DESCRIPTION (provided by applicant): In 2002 there were more than 132,000 infants born from multiple pregnancies in the US, the highest number ever recorded. Since 1980 this rate has risen dramatically, due primarily to infertility treatments in combination with the trend of childbearing at older ages. The use of assisted reproductive technologies carries a 30-50% risk of resulting in a multiple pregnancy, depending on the medications and techniques used. Older maternal age requires more aggressive therapies to achieve a pregnancy, including transferring more embryos. The two most important factors affecting perinatal mortality are gestational age and relative birth weight; with each additional fetus, both of these factors are compromised. Compared to singletons, infants of multiple pregnancies are much more likely to be born early preterm and very low birth weight, important factors contributing to their excess morbidity and mortality. We do not have contemporary, nationally representative, population-based estimates of the increased infant mortality risk associated with multiple pregnancies. The purpose of this proposed study is to determine the infant mortality risks for infants of multiple pregnancies, controlling for important maternal and fetal factors, including age, race and ethnicity, parity, smoking status, infant gender, birth weight, and gestational age, as well as factors unique to multiple pregnancies (e.g., weight discordance, gender mix, fetal death of a sibling). The central hypothesis of this proposal is that mortality risk is higher for infants of multiple pregnancies compared to singletons, and that some of this risk has been postponed from the neonatal to the post-neonatal period. The data for this study are the 1995-2000 Linked Birth/Infant Death Data Sets and the Matched Multiple Birth Data Sets. The resulting plurality-specific perinatal, neonatal, post-neonatal, and overall infant mortality risks will help practitioners counsel patients undergoing infertility treatments and considering multi-fetal pregnancy education, and more effectively manage the pre- and postnatal health of infants of multiple pregnancy.