Assuntos
Prole de Múltiplos Nascimentos , Humanos , Feminino , Gravidez , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Técnicas de Reprodução Assistida/estatística & dados numéricos , Recém-Nascido , Fatores de Confusão Epidemiológicos , Gravidez Múltipla/estatística & dados numéricosRESUMO
RESEARCH QUESTION: What are the trends in patient characteristics, effectiveness and safety of assisted reproductive technology (ART) performed in Latin America over the past three decades, as well as the detailed outcomes of procedures initiated in 2018? DESIGN: Retrospective collection of multinational data including epidemiology and outcomes of ART performed between 1990 and 2018. RESULTS: Over these 30 years we report 955,117 initiated cycles, 191,191 deliveries and 238,045 live births. In 1990, 66.5% of women were ≤34 years and 8.7% ≥40 years; in 2018, 26.4% of women were ≤34 years and 32.0% were ≥40 years. In 1990, 60.4% of transfers included ≥3 embryos, falling to 13.5% in 2018, and single embryo transfer (SET) increased from 13.8% to 30.4% between 1990 and 2018. Delivery rate per fresh transfer increased from approximately 17% in the 1990s to 25% in 2018, with a meaningful drop in high-order multiples, from 5-9% in the 1990s to 0.4% in 2018. This drop is associated with increasing use of frozen embryo transfer (FET) (57% in 2018) compared with 10% in 2000. In 2018, delivery rate in FET was 28.3%, reaching 31.2% in freeze-all cycles; and the cumulative live birth rate (freshâ¯+â¯FET) was 41.9%. Elective SET also increased, from 0.9% in 2010 to 10% in 2018. The delivery rate in elective SET (31.7%) was only 5.4% lower than elective double embryo transfer (DET) (37.1%); however, multiple births increased from 2.1% to 25.5% twins and 0.4% triplets in elective DET. CONCLUSION: The Latin American Registry of Assisted Reproduction (RLA) celebrates 30 years of voluntary reporting from a total of nearly 200 centres in 15 countries. This South-South Cooperation network has proven to be an efficient and safe system for technological transfer and regional growth.
Assuntos
Resultado da Gravidez/epidemiologia , Técnicas de Reprodução Assistida/história , Técnicas de Reprodução Assistida/tendências , Adulto , Feminino , História do Século XX , História do Século XXI , Humanos , Recém-Nascido , Infertilidade/epidemiologia , Infertilidade/terapia , América Latina/epidemiologia , Nascido Vivo/epidemiologia , Masculino , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Gravidez , Gravidez Múltipla/estatística & dados numéricos , Sistema de Registros , Técnicas de Reprodução Assistida/estatística & dados numéricos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Objectives-This report presents 2019 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods-Descriptive tabulations of data reported on the birth certificates of the 3.75 million births that occurred in 2019 are presented. Data are presented for maternal age, livebirth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age are also shown. Trend data for 2010 through 2019 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016-2019. Results-A total of 3,747,540 births were registered in the United States in 2019, down 1% from 2018. The general fertility rate declined from 2018 to 58.3 births per 1,000 women aged 15-44 in 2019. The birth rate for females aged 15-19 fell 4% between 2018 and 2019. Birth rates declined for women aged 20-34 and increased for women aged 35-44 for 2018-2019. The total fertility rate declined to 1,706.0 births per 1,000 women in 2019. Birth rates declined for both married and unmarried women from 2018 to 2019. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.6% in 2019; the percentage of all women who smoked during pregnancy declined to 6.0%. The cesarean delivery rate decreased to 31.7% in 2019 (Figure 1). Medicaid was the source of payment for 42.1% of all births in 2019. The preterm birth rate rose for the fifth straight year to 10.23% in 2019; the rate of low birthweight was essentially unchanged from 2018 at 8.31%. Twin and triplet and higher-order multiple birth rates both declined in 2019 compared with 2018.
Assuntos
Coeficiente de Natalidade/tendências , Adolescente , Adulto , Declaração de Nascimento , Ordem de Nascimento , Coeficiente de Natalidade/etnologia , Peso ao Nascer , Parto Obstétrico/economia , Parto Obstétrico/métodos , Feminino , Idade Gestacional , Hispânico ou Latino/estatística & dados numéricos , Humanos , Recém-Nascido , Masculino , Estado Civil/etnologia , Estado Civil/estatística & dados numéricos , Idade Materna , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Grupos Raciais/estatística & dados numéricos , Uso de Tabaco/epidemiologia , Uso de Tabaco/etnologia , Estados Unidos/epidemiologia , Adulto JovemAssuntos
Cardiopatias Congênitas/epidemiologia , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Gêmeos Unidos , Aorta Torácica/anormalidades , Dupla Via de Saída do Ventrículo Direito/epidemiologia , Defeitos dos Septos Cardíacos/epidemiologia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/epidemiologia , Recém-Nascido , Prevalência , Atresia Pulmonar/epidemiologia , Estudos Retrospectivos , Síndrome de Cimitarra/epidemiologia , Tetralogia de Fallot/epidemiologia , Transposição dos Grandes Vasos/epidemiologia , Atresia Tricúspide/epidemiologia , Persistência do Tronco Arterial/epidemiologia , Estados UnidosRESUMO
OBJECTIVE: To determine whether outcomes among infants with very low birth weight (VLBW) vary according to the birthplace (Japan or California) controlling for maternal ethnicity. STUDY DESIGN: Severe intraventricular hemorrhage (IVH) and mortality were ascertained for infants with VLBW born at 24-29 weeks of gestation during 2008-2017 and retrospectively analyzed by the country of birth for mothers and infants (Japan or California). RESULTS: Rates of severe IVH, mortality, or combined IVH/mortality were lower in the 24 095 infants born in Japan (5.1%, 5.0%, 8.8% respectively) compared with infants born in California either to 157 mothers with Japanese ethnicity (12.5%, 9.7%, 17.8%) or to a comparison group of 6173 non-Hispanic white mothers (8.4%, 8.8%, 14.6%). ORs for adverse outcomes were increased for infants born in California to mothers with Japanese ethnicity compared with infants born in Japan for severe IVH (OR, 3.31; 95% CI, 1.93-5.68), mortality (3.73; 95% CI, 2.03-6.86), and the combined outcome (3.26; 95% CI, 2.02-5.27). The odds of these outcomes also were increased for infants born in California to non-Hispanic white mothers compared with infants born in Japan. Outcomes of infants born in California did not differ by Japanese or non-Hispanic white maternal ethnicity. CONCLUSIONS: Low rates of severe IVH and mortality for infants with VLBW born in Japan were not seen in infants born in California to mothers with Japanese ethnicity. Differences in systems of regional perinatal care, social environment, and the quality of perinatal care may partially account for these differences in outcomes.
Assuntos
Entorno do Parto , Hemorragia Cerebral Intraventricular/epidemiologia , Mortalidade Infantil , Recém-Nascido de muito Baixo Peso , Adolescente , Adulto , Índice de Apgar , Povo Asiático , California/epidemiologia , Cesárea/estatística & dados numéricos , Corioamnionite/epidemiologia , Estudos de Coortes , Diabetes Mellitus/epidemiologia , Feminino , Idade Gestacional , Glucocorticoides/uso terapêutico , Humanos , Hipertensão/epidemiologia , Lactente , Recém-Nascido , Japão/epidemiologia , Idade Materna , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Obesidade Materna , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos , População Branca , Adulto JovemRESUMO
Multiple births (twins or higher order multiples) are increasing in developed countries and may present higher risk for cerebral palsy (CP). However, few studies can reliably investigate trends over time because these outcomes are relatively rare. OBJECTIVE: We pooled data from European CP registers to investigate CP birth prevalence and its trends among single and multiple births born between 1990 and 2008. DESIGN: Population cohort study. SETTING: 12 population-based registers from the Surveillance of Cerebral Palsy in Europe collaboration. PARTICIPANTS: 4 446 125 single and multiple live births, of whom 8416 (0.19%) had CP of prenatal or perinatal origin. MAIN OUTCOMES: CP diagnosis ascertained in childhood using harmonised methods; CP subtype; Motor impairment severity among CP cases. RESULTS: The rate of multiple births increased from 1990. Multiples displayed higher risk for CP (RR=4.27, 95% CI 4.00 to 4.57). For singletons and multiples alike, risk for CP was higher among births of lower gestational age (GA) or birth weight (BW). However, CP birth prevalence declined significantly among very preterm (<32 weeks) and very low BW (<1500 g) multiples. Singletons and multiples with CP displayed similar severity of motor impairment. CONCLUSIONS: Between 1990 and 2008, CP birth prevalence decreased steadily among multiples with low GA or BW. Furthermore, multiples with CP display similar profiles of severe motor impairment compared with CP singletons. Improvements in management of preterm birth since the 1990s may also have been responsible for providing better prospects for multiples.
Assuntos
Paralisia Cerebral/epidemiologia , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Peso ao Nascer , Europa (Continente)/epidemiologia , Idade Gestacional , Humanos , Nascimento Prematuro/epidemiologia , Prevalência , Regressão PsicológicaRESUMO
BACKGROUND: There are limited data available on the survival and early complications of preterm infants with less than 500 g birthweight. To estimate the outcomes for these infants, it is important for caregivers to be aware of perinatal factors that may affect survival. OBJECTIVES: We assessed the mortality and certain early complications of preterm infants born with less than 500 g in Hungary between 2006 and 2015. METHODS: We reviewed data of 486 infants from the database of the Hungarian Central Statistical Office and in parallel of 407 infants from the "NICU database." The study period was divided into two epochs: 2006-2010 and 2011-2015. RESULTS: The survival was 27.1% in the first epoch and 39.1% in the second epoch, and the incidence of early complications was slightly higher in the second epoch. In the surviving group (first and second epoch combined), gestational age (25.1 vs 23.7 weeks), birthweight (458 vs 447 g) antenatal steroid treatment (66.3% vs 52.3%), surfactant therapy (95.1% vs 84.3%), median Apgar scores (6 vs 3 and 8 vs 5 at 1 and 5 minutes, respectively) and proportion of caesarean delivery (89.3% versus 68.5%) were higher than in the non-surviving group (first and second epoch combined). The proportion of multiple births was lower in the surviving group (15.7% vs 33.4%). CONCLUSIONS: Survival of infants with less than 500 g improved between 2006-2010 and 2011-2015 in Hungary. The slightly higher occurrence of early complications might be associated with improving survival.
Assuntos
Cesárea/estatística & dados numéricos , Glucocorticoides/uso terapêutico , Surfactantes Pulmonares/uso terapêutico , Taxa de Sobrevida/tendências , Adulto , Índice de Apgar , Displasia Broncopulmonar/epidemiologia , Hemorragia Cerebral Intraventricular/epidemiologia , Enterocolite Necrosante/epidemiologia , Feminino , Humanos , Hungria/epidemiologia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido , Leucomalácia Periventricular/epidemiologia , Mortalidade/tendências , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal , Retinopatia da Prematuridade/epidemiologiaRESUMO
The new West Japan Twins and Higher Order Multiple Births Registry was established by recruiting young twins and multiple births and by referrals from public health centers in the 1990s. The participants included in the survey comprised over 7800 twins and 4241 higher order multiples, and their families. Specifically, the present registry contains one of the largest triplet samples in the world. For these twins and multiples, data on year of delivery, mode of delivery, gestational age, intrapartum complications, longitudinal physical measures, motor milestones, cerebral palsy and feeding methods were obtained from records in the Maternal and Child Health Handbooks and schools. Participating mothers were asked to indicate family structure, parental educational history, maternal sleeping time, maternal health condition, maternal and paternal age at multiple delivery, complications during pregnancy, handedness of multiples and age at menarche of multiples. However, the zygosity differed among the various collaborating public health centers according to factors such as the time of investigation. Follow-up questionnaires have been mailed out every 3-4 years for longitudinal studies. This article describes the goals of this registry, recruitment of multiples and the focus of the study. The goals of this registry are not only to conduct research on human genetics and maternal and child health, but also to contribute to providing appropriate information for families with multiples.
Assuntos
Doenças em Gêmeos/epidemiologia , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Gravidez Múltipla/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Gêmeos/estatística & dados numéricos , Criança , Pré-Escolar , Doenças em Gêmeos/genética , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Japão/epidemiologia , Masculino , Prole de Múltiplos Nascimentos/genética , Gravidez , Resultado da Gravidez , Inquéritos e Questionários , Gêmeos/genéticaRESUMO
It is desirable for twin researchers to be aware of the needs and concerns of families of multiples and provide participants with appropriate and useful feedback and advice based on scientific evidence. Our most recent database on families with twins throughout Japan is based on a questionnaire survey conducted in 2016. Mailed questionnaires, consisting of over 500 items, were used to collect the basic data. The response rate was 38% (566/1478). This is part of a nationwide study designed to assess the long-term effect of perinatal conditions on mothers of multiples. Its aim was to study the growth and development of multiples in childhood, and for the creation of a multifetal mother and child health handbook, and to conduct a genetic epidemiologic study to test the developmental origin of health and disease hypothesis. One of the ultimate aims of this research was to provide evidence-based information on parenting of multiples for families with multiples.
Assuntos
Bases de Dados Factuais/estatística & dados numéricos , Doenças em Gêmeos/epidemiologia , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Gêmeos/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Gerenciamento de Dados , Doenças em Gêmeos/genética , Família , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prole de Múltiplos Nascimentos/genética , Inquéritos e Questionários , Gêmeos/genética , Adulto JovemRESUMO
BACKGROUND: Brazil experienced important progress in maternal and child health in recent decades. We aimed at describing secular trends as well as socioeconomic and ethnic inequalities in reproductive history indicators (birth spacing, previous adverse perinatal outcome, parity and multiple births) over a 33-year span. METHODS: Four population-based birth cohort studies included all hospital births in 1982, 1993, 2004 and 2015 in Pelotas, Southern Brazil. Information on reproductive history was collected through interviews. Indicators were stratified by family income quintiles and skin colour. Absolute and relative measures of inequality were calculated. RESULTS: From 1982 to 2015, the proportion of primiparae increased from 39.2% to 49.6%, and median birth interval increased by 23.2 months. Poor women were more likely to report short intervals and higher parity, although reductions were observed in all income and ethnic groups. History of previous low birthweight was inversely related to income and increased by 7.7% points (pp) over time-more rapidly in the richest (12.1 pp) than in the poorest quintile (0.4 pp). Multiple births increased from 1.7% to 2.7%, with the highest increase observed among the richest quintile and for white women (220% and 70% increase, respectively). Absolute and relative income and ethnic-related inequalities for short birth intervals increased, whereas inequalities for previous low birthweight decreased over time. CONCLUSIONS: In this 33-year period there were increases in birth intervals, multiple births and reports of previous low-birthweight infants. These trends may be explained by increased family planning coverage, assisted reproduction and a rise in preterm births, respectively. Our results show that socioeconomic and ethnic inequalities in health are dynamic and vary over time, within the same location.
Assuntos
Intervalo entre Nascimentos/estatística & dados numéricos , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Trabalho de Parto Prematuro/epidemiologia , Resultado da Gravidez/epidemiologia , Saúde Reprodutiva/tendências , Brasil/epidemiologia , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Modelos Logísticos , Paridade , Vigilância da População , Gravidez , Fatores SocioeconômicosAssuntos
Lactente Extremamente Prematuro , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Inglaterra , Idade Gestacional , Humanos , Recém-Nascido , Terapia Intensiva Neonatal/estatística & dados numéricosRESUMO
INTRODUCTION: Multiple pregnancy has increased in prevalence in the last few years, which could lead to more foetal and maternal morbidity issues. The aim of this study is to describe the trend of multiple pregnancy deliveries in Castilla y León during the last 13years and the subsequent impact on foetal and maternal health. MATERIAL AND METHODS: Data was collected from the hospital discharge reports registered in the Regional Health-care database (SACYL: Health care in Castilla y León) between 2001 and 2013. A cross sectional descriptive study was conducted, including trend analysis with log-linear joint point model, a rhythm metric study, as well as a risk assessment with multivariate analysis. RESULTS: A pronounced upward trend was observed in the proportion of multiple deliveries in this time period, compared to single ones, with an annual percentage change of 3.4% (95% CI: 2.5-4.4). Multiple pregnancy was significantly correlated with advanced maternal age, abnormal glucose tolerance, dystocia and caesarean section delivery, premature birth, foetal malposition, foetal macrosomia, stillbirth, in vitro fertilisation, and hypertensive episodes of pregnancy. In vitro fertilization showed a 9.3 fold increased risk in multiple pregnancy (95% CI: 7.4-11.5), with maternal age increasing the risk up to 5% per year of age (OR: 1.05: 95%CI: 1.04-1.05). No seasonal rhythm was observed in multiple deliveries compared with single ones. CONCLUSION: Multiple pregnancy has experienced a continuous increase, with no seasonal trend, and is associated with the increase in assisted reproductive technology and advanced maternal age. This involves more problems regarding foetal and maternal morbidity and mortality.
Assuntos
Prole de Múltiplos Nascimentos/estatística & dados numéricos , Gravidez Múltipla/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Espanha/epidemiologia , Fatores de TempoRESUMO
Objectives-This report presents 2018 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods-Descriptive tabulations of data reported on the birth certificates of the 3.79 million births that occurred in 2018 are presented. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age also are shown. Trend data for 2010 through 2018 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016-2018. Results-3,791,712 births were registered in the United States in 2018, down 2% from 2017. Compared with rates in 2017, the general fertility rate declined to 59.1 births per 1,000 women aged 15-44. The birth rate for females aged 15-19 fell 7% in 2018. Birth rates declined for women aged 20-34 and increased for women aged 35-44. The total fertility rate declined to 1,729.5 births per 1,000 women in 2018. Birth rates for both married and unmarried women declined from 2017 to 2018. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.5% in 2018; the percentage of all women who smoked during pregnancy declined to 6.5%. The cesarean delivery rate decreased to 31.9% in 2018 following an increase in 2017. Medicaid was the source of payment for 42.3% of all 2018 births, down 2% from 2017. The preterm birth rate rose for the fourth straight year to 10.02% in 2018; the rate of low birthweight was unchanged at 8.28%. Twin and triplet and higher-order multiple birth rates declined in 2018 (Figure 1).
Assuntos
Coeficiente de Natalidade/tendências , Adolescente , Adulto , Declaração de Nascimento , Ordem de Nascimento , Coeficiente de Natalidade/etnologia , Peso ao Nascer , Parto Obstétrico/economia , Parto Obstétrico/métodos , Feminino , Idade Gestacional , Hispânico ou Latino/estatística & dados numéricos , Humanos , Recém-Nascido , Masculino , Estado Civil/etnologia , Estado Civil/estatística & dados numéricos , Idade Materna , Mães/estatística & dados numéricos , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Grupos Raciais/estatística & dados numéricos , Uso de Tabaco/epidemiologia , Uso de Tabaco/etnologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: To establish the annual and cumulative multiyear contribution of delayed childbearing to the national plural birth excess. METHODS: Using publicly available national birth data reported by the National Center for Health Statistics, we estimated the contribution of delayed childbearing to the national plural birth excess through 2016. To this end, the observed as well as the maternal age- and race-adjusted national plural birth rates were assessed before (1949-1966; n=71,570,717) and during (1971-2016; n=166,817,655) the assisted reproduction era. Comparable estimates through 2025 relied on simulated projections. RESULTS: The relative risk estimates of unassisted plural births by maternal age before the assisted reproduction era (1949-1966) proved unimodal and race-dependent. The risk of unassisted plural births in 35- to 39-year-old black women proved 2.75-fold higher than that of 15- to 19-year-old counterparts (39.81/1,000 to 14.48/1,000; 95% CI 2.67-2.83). A 2.47-fold risk increment was noted for comparably aged white women (28.76/1,000 to 11.63/1,000; 95% CI 2.43-2.52). Similar age-dependent risk increments were obtained for twin and higher order births. An increasingly prominent delayed childbearing trend during the assisted reproduction era (1971-2016) gave rise to 255,964 (95% CI 134,746-375,581) and 66,271 (95% CI 34,099-96,197) unassisted plural births by white and black women, respectively. In 2016 alone, delayed childbearing accounted for 24% (95% CI 15-32%) and 38% (95% CI 28-47%) of the national plural birth excess for white and black women, respectively. By 2025, delayed childbearing could account for as much as 46% (95% CI 32-60%) and 40% (95% CI 30-53%) of the national plural birth excess for white and black women, respectively. CONCLUSION: Delayed childbearing, a growing contributor to the national plural birth excess previously solely ascribed to assisted reproduction, warrants greater consideration in future clinical, analytic, and policy deliberations as well as in individual family planning decisions.
Assuntos
Idade Materna , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Gravidez Múltipla/estatística & dados numéricos , Comportamento Reprodutivo/estatística & dados numéricos , Feminino , Humanos , Gravidez , Estados UnidosRESUMO
This report presents 2016 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.Descriptive tabulations of data reported on the birth certificates of the 3.95 million births that occurred in 2016 are presented. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age also are shown. Trend data for 2010-2016 are presented for selected items. A total of 3,945,875 births were registered in the United States in 2016, down 1% from 2015. Compared with rates in 2015, the general fertility rate declined to 62.0 per 1,000 women aged 15-44. The birth rate for females aged 15-19 fell 9% in 2016. Birth rates declined for women in their 20s but increased for women intheir 30s and early 40s. The total fertility rate declined to 1,820.5 births per 1,000 women in 2016. The birth rate for unmarried women declined, while the rate for married women increased. More than three-quarters of women began prenatal care in the firsttrimester of pregnancy (77.1%) in 2016, while 7.2% of all women smoked during pregnancy. The cesarean delivery rate declined for the fourth year in a row. Medicaid was the source of payment for 42.6% of all 2016 births. The preterm birth rate rose for the second straight year, and the rate of low birthweight increased 1%. Twin and triplet and higher-order multiple birth rates declined, although the changes were not statistically significant.
Assuntos
Coeficiente de Natalidade/tendências , Adolescente , Adulto , Declaração de Nascimento , Ordem de Nascimento , Coeficiente de Natalidade/etnologia , Peso ao Nascer , Criança , Parto Obstétrico/economia , Parto Obstétrico/métodos , Etnicidade/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Estado Civil/estatística & dados numéricos , Idade Materna , Pessoa de Meia-Idade , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Gravidez , Gravidez na Adolescência/etnologia , Gravidez na Adolescência/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Uso de Tabaco/epidemiologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Objectives-This report presents 2017 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods-Descriptive tabulations of data reported on the birth certificates of the 3.86 million births that occurred in 2017 are presented. Data are presented for maternal age, livebirth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age also are shown. Trend data for 2010 to 2017 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016 and 2017. Results- A total of 3,855,500 births were registered in the United States in 2017, down 2% from 2016. Compared with rates in 2016, the general fertility rate declined to 60.3 births per 1,000 women aged 15-44. The birth rate for females aged 15-19 fell 7% in 2017. Birth rates declined for women in their 20s and 30s but increased for women in their early 40s. The total fertility rate declined to 1,765.5 births per 1,000 women in 2017. Birth rates for both married and unmarried women declined from 2016 to 2017. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.3% in 2017; the percentage of all women who smoked during pregnancy declined to 6.9%. The cesarean delivery rate increased to 32.0% following 4 years of declines. Medicaid was the source of payment for 43.0% of all births in 2017, up 1% from 2016. The preterm birth rate rose for the third straight year, as did the rate of low birthweight. Twin and triplet and higher-order multiple birth rates were essentially stable in 2017.
Assuntos
Coeficiente de Natalidade/tendências , Adolescente , Adulto , Declaração de Nascimento , Ordem de Nascimento , Coeficiente de Natalidade/etnologia , Peso ao Nascer , Criança , Parto Obstétrico/economia , Parto Obstétrico/métodos , Etnicidade/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Estado Civil/estatística & dados numéricos , Idade Materna , Pessoa de Meia-Idade , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Gravidez , Gravidez na Adolescência/estatística & dados numéricos , Fumar/etnologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
In the 19th century, a series of international statistical congresses began that were important for population studies, including twin research. The introduction of common rules for the national demographic registers enabled scientists to contribute to the genesis of statistical research. The congress in St. Petersburg in 1872, in particular, focused on the movements of the population, and how they should be registered. Among the facts to be recorded were in multiple births, the sex and number of children born alive or still-born, whether legitimate or illegitimate, and the age of the mother at the date of the births. During the history of twin research, Hellin's law has played a central role because it is an approximately correct association between the rates of multiple maternities. It has been mathematically proven that Hellin's law does not hold as a general rule. Analyses show divergences from the law that are difficult to explain and/or eliminate. Varying improvements of this law have been proposed. The majority of all studies of Hellin's law are based on empirical rates of multiple maternities, ignoring random errors. Such studies can never confirm the law, but only identify errors with respect to Hellin's law that are too large to be characterized as random. It is of particular interest to note and explain why the rates of higher multiple maternities are sometimes too high or too low when Hellin's law is used as a benchmark. Studies have shown that there were investigators before Hellin who have contributed substantially to Hellin's law. In this article, we re-examine some old data sets and contributions in which Hellin's law has been evaluated and also analyze recent data.
Assuntos
Congressos como Assunto/história , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Estudos em Gêmeos como Assunto/história , Feminino , História do Século XIX , Humanos , Países Baixos/epidemiologia , Gravidez , Suécia/epidemiologia , Trigêmeos/estatística & dados numéricos , Gêmeos/estatística & dados numéricosRESUMO
AIM: To calculate the birth prevalence of cerebral palsy (CP) after assisted reproductive technology (ART) and compare the clinical outcomes of children with CP after ART or natural conception. METHOD: This cohort study used linked CP and ART register data from live births in Western Australia (1994-2002). Birth prevalence was calculated and data analysed using descriptive statistics and logistic regression. It was adjusted for confounding variables and stratified by plurality and gestational age. RESULTS: In total, 211 660 live births were included; prevalence of CP was increased in children born after ART (7.2/1000 live births compared with naturally conceived births, 2.5/1000). Odds of CP were doubled for singletons; when stratified by gestational age odds were only increased in the under 32-week group. Prevalence of CP was increased in ART (9.9/1000 live births) and naturally conceived twins (8.4/1000 live births). Clinical outcomes were similar between ART and naturally conceived children. INTERPRETATION: The birth prevalence of CP is increased two-fold after ART. After stratification for gestational age and plurality, residual risk remains in singletons born very preterm. Birth prevalence of CP will be tracked over time to identify any impact of changes to clinical practice. WHAT THIS PAPER ADDS: In Western Australia, assisted reproductive technology (ART) increases birth prevalence of cerebral palsy (CP), mediated mostly by preterm and multiple births. Preterm birth alone does not account for the doubled odds of CP for ART singletons born very preterm. Clinical outcomes are similar between ART and naturally conceived children with CP.
Assuntos
Paralisia Cerebral/epidemiologia , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Sistema de Registros/estatística & dados numéricos , Técnicas de Reprodução Assistida/estatística & dados numéricos , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Austrália Ocidental/epidemiologiaRESUMO
BACKGROUND: Congenital cytomegalovirus (cCMV) infection is an important cause of hearing loss and neurodevelopment delay. While data on vertical transmission and neonatal outcome after singleton pregnancy with cCMV are well established, only scarce reports have addressed cCMV in multiple birth pregnancies. Furthermore, no studies have yet compared the outcome after birth and long-term follow-up of children with cCMV born after a singleton versus multiple pregnancies. METHODS: Infant outcome after birth of symptomatic versus asymptomatic infection was compared for infants born with cCMV after multiple (study group) and singleton (control group) pregnancies in a 1:2 ratio. RESULTS: Of 508 infants diagnosed with cCMV, 25 (4.9%) were born after a multiple pregnancy. Children in the study and control groups did not differ in terms of specific prenatal CMV investigations including amniocentesis and brain magnetic resonance imaging studies. However, prematurity rates were significantly higher in the study compared with control group (52% vs. 4%, P < 0.001). There was a higher rate of symptomatic cCMV infection in the study group than in the controls (48% vs. 14%, P < 0.001). Hearing impairment at birth was also more frequent in the study group (32% vs. 8%, P = 0.016). A long-term follow-up demonstrated that children in the study group had higher rates of neurologic sequelae (hearing impairment or neurodevelopmental delay) compared with children in the control group (20% vs. 4%, P = 0.016). CONCLUSIONS: Infants with cCMV born after multiple birth pregnancies are born earlier and have a higher risk of symptomatic disease at birth and worse long-term neurologic outcome than those born after a singleton pregnancy. This important group of children warrants meticulous prenatal and postnatal care.