Conception Failure and Pregnancy Loss in the U.S.

美国关于怀孕和妊娠丢失的新证据。 摘要 受孕失败和怀孕失败阻碍了数百万美国夫妇成为父母 年。尽管是可以改变的和常见的--怀孕损失的发生率是婴儿死亡率的50倍-- 流产是人口健康或人口动态研究最少的方面之一。我们知道 关于造成这些损失的原因很少，从小的研究产生的估计的概括性 招募的样本，包括流产的风险如何在不同的时间、地点或亚人群中不同。 这些巨大的差距是因为研究人类活产的途径是多么困难，需要 一个足够大和多样化的“先入为主的群体”。到目前为止，没有代表性的小群体做出了贡献 我们所知道的关于早孕的大部分。但有限的样本量、变异性和覆盖率排除了 对社会和生态因素的研究--贫困、伴侣健康、环境暴露--这些因素现在很普遍 被理解为影响以后年龄的死亡率：例如，死产、婴儿和儿童死亡率。这些遗漏是 重要的是。受孕失败和流产会带来巨大的情感和经济代价。尽管 怀孕失败很可能在人群中分布不均，这种不同负担的大小是 未知。我们没有证据表明政策对预防这些结果的潜在影响。 我们的研究结合了数据科学和社会科学的工具，将前概念设计扩展到 在美国，这是一个庞大的、多样化的群体。在数字设备上跟踪月经和怀孕现在很常见 处于生育年龄的女性。我们使用了400万女性每日月经周期记录的数据， 排卵、怀孕以及所报告的社会和经济特征。这些数据使我们能够 测量报告和检测到的受孕和妊娠丢失。我们将数据与地理配准相结合 关于妇女及其伴侣所处的物质、社会、经济和政策环境的信息 活着。样本是多样的：用户来自美国99%以上的县；超过100万用户使用医疗补助。 我们使用这些非同寻常的数据来提供对#年大规模人口变异性的第一次估计 活产的途径并记录影响这一途径的因素。目标1开发新的估计 受孕和怀孕损失，包括与教育、收入、种族认同、 以及邻里贫困。目标2估计男性伴侣特征对受孕和 怀孕损失，根据报告的有关伴侣的详细数据。目标3使用准实验设计来 提供对多个环境、社会、经济领域未充分研究的风险暴露的第一次估计 关于受孕和妊娠丢失。这项研究揭示了一种普遍存在的、大量未被研究的 公共卫生问题，对改善早孕结局有直接影响。通过这样做， 这项研究还产生了一些估计，这些估计是支持在多个领域取得进展所急需的投入， 社会、健康和生物医学科学的相关研究领域。

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.