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1.
J Perinat Neonatal Nurs ; 35(4): 313-319, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34726647

RESUMO

Cesarean births have increased in the United States, accounting for approximately one-third of all births. There is concern that cesarean birth is overused, due to the wide variation in rates geographically and at different institutions within the same region. Despite the rising rate, there has not been an improvement in maternal or neonatal outcomes. Consequently, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine published recommendations aimed at the safe prevention of primary cesarean births in 2014. The purpose of this project was to identify the term singleton vertex cesarean birth rates in the Military Health System's hospitals; to compare the Military Health System's rate of term singleton vertex cesarean birth to published benchmarks; and to compare term singleton vertex cesarean birth rates over time and among facilities within the Military Health System to determine whether variation existed. This was a retrospective review of aggregate data reported by the National Perinatal Information Center. Data were analyzed over 9 years at 2-year intervals from 2011 through 2019 inclusively. The Military Health System exceeded national benchmarks for term singleton vertex cesarean birth rates and had less variation over time and among facilities.


Assuntos
Coeficiente de Natalidade , Serviços de Saúde Militar , Cesárea , Feminino , Hospitais , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos , Estados Unidos/epidemiologia
2.
Ann Palliat Med ; 10(9): 9984-9992, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628922

RESUMO

BACKGROUND: The long protocol has been recognized as the gold standard in controlled ovarian hyperstimulation (COH). However, the full dose of gonadotropin-releasing hormone agonist (GnRH-a) under the prolonged protocol has become increasingly popular in China. This study sought to compare pregnancy outcomes among the following 3 groups: a long protocol group, and 2 types of improved prolonged protocol groups. METHODS: A retrospective cohort study was conducted of 550 patients undergoing fresh embryo transfer (ET). Patients were treated either with the improved prolonged protocol in the follicular phase (Group 1; n=288) or the mid-luteal phase (Group 2; n=143), or the long protocol (Group 3; n=119). The clinical and laboratory outcomes of the 3 groups were compared. RESULTS: The general characteristics of the women in the 3 groups were comparable. On the day on which gonadotropin (Gn) was first administered and on the day on which human chorionic gonadotropin (hCG) was administered, the luteinizing hormone (LH) levels of patients in both Groups 1 and 2 were lower than those of patients in Group 3. The number of oocytes retrieved, fertilized, and cleaved, and the number of high-quality embryos in the 3 procedures were similar. However, the number of transferred embryos, the rate of blastocyst progression, and the rate of implantation differed. The clinical pregnancy rates (CPRs)were significantly higher in the prolonged protocol groups (62.5% and 61.5%) than the long protocol group (48.7%). Further, statistically significant differences in the live-birth rates (LBRs) (56.9% vs. 57.3% vs. 42.9%) were observed. However, no differences in early abortion rates were found. CONCLUSIONS: As a result of pituitary downregulation with GnRH-a, the prolonged groups had better CPRs and LBRs than the long protocol group. The prolonged protocol in the mid-luteal phase was equally effective as that in the early follicular phase in fresh in-vitro fertilization (IVF)/intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycles. High LH levels on the day of hCG may be a predictor of adverse clinical outcomes.


Assuntos
Coeficiente de Natalidade , Indução da Ovulação , Regulação para Baixo , Feminino , Hormônio Liberador de Gonadotropina , Humanos , Gravidez , Estudos Retrospectivos
3.
Artigo em Russo | MEDLINE | ID: mdl-34665545

RESUMO

The purpose of the study is to systematize theoretical models of demographic family policy approved in publications included into database SCOPUS in 2019-2020 and developed using empirical data obtained by analysis of methods and practices of increasing natality in certain countries of EU, BRICS and the New World. The France, Sweden, Great Britain, Norway and Denmark are oriented to expand measures of social support of citizen and regulation of occupation of women with children with purpose to increase natality. In the countries of South-Western Asia and North Africa the measures are targeted to decreasing level of natality and to implement family planning policy.


Assuntos
Política de Planejamento Familiar , Coeficiente de Natalidade , Criança , Demografia , Países em Desenvolvimento , Serviços de Planejamento Familiar , Fertilidade , Planejamento em Saúde , Humanos , Dinâmica Populacional , Política Pública , Reprodução , Fatores Socioeconômicos
4.
Front Public Health ; 9: 729795, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34595149

RESUMO

This paper aims to evaluate the performance of multiple non-linear regression techniques, such as support-vector regression (SVR), k-nearest neighbor (KNN), Random Forest Regressor, Gradient Boosting, and XGBOOST for COVID-19 reproduction rate prediction and to study the impact of feature selection algorithms and hyperparameter tuning on prediction. Sixteen features (for example, Total_cases_per_million and Total_deaths_per_million) related to significant factors, such as testing, death, positivity rate, active cases, stringency index, and population density are considered for the COVID-19 reproduction rate prediction. These 16 features are ranked using Random Forest, Gradient Boosting, and XGBOOST feature selection algorithms. Seven features are selected from the 16 features according to the ranks assigned by most of the above mentioned feature-selection algorithms. Predictions by historical statistical models are based solely on the predicted feature and the assumption that future instances resemble past occurrences. However, techniques, such as Random Forest, XGBOOST, Gradient Boosting, KNN, and SVR considered the influence of other significant features for predicting the result. The performance of reproduction rate prediction is measured by mean absolute error (MAE), mean squared error (MSE), root mean squared error (RMSE), R-Squared, relative absolute error (RAE), and root relative squared error (RRSE) metrics. The performances of algorithms with and without feature selection are similar, but a remarkable difference is seen with hyperparameter tuning. The results suggest that the reproduction rate is highly dependent on many features, and the prediction should not be based solely upon past values. In the case without hyperparameter tuning, the minimum value of RAE is 0.117315935 with feature selection and 0.0968989 without feature selection, respectively. The KNN attains a low MAE value of 0.0008 and performs well without feature selection and with hyperparameter tuning. The results show that predictions performed using all features and hyperparameter tuning is more accurate than predictions performed using selected features.


Assuntos
COVID-19 , Coeficiente de Natalidade , Análise por Conglomerados , Humanos , Reprodução , SARS-CoV-2
6.
Rev Assoc Med Bras (1992) ; 67(5): 759-765, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34550269

RESUMO

OBJECTIVE: The aim of this study was to evaluate the frequency of teenage pregnancy in all Brazilian regions and states in the period of 2000-2019 among two age groups, namely, 10-14 and 15-19 years old, and correlate it with the human development index. METHODS: A cross-sectional study was performed by using the data from the Live Birth Info System from the National Health System's database. RESULTS: The percentage of live births from teenage mothers (age 10-19 years) in Brazil decreased by 37.2% (i.e., 23.4 in 2000 to 14.7% in 2019) in all regions. Amazonas and Maranhão were the only states to show increased fertility rates for teens in the age group of 10-14 years. The fertility index decreased from 80.9-48% in all states among mothers aged 15-19 years. Only the Southeast and South regions showed levels below the Brazilian average (i.e., 38.2 and 39%, respectively). The proportion of live birth showed an inversely proportional trend to the human development index score. CONCLUSIONS: Brazil shows a decline in the percentage of live birth among adolescent mothers and the fertility rate. Live birth is inversely proportional to the human development index score. However, the teenage pregnancy numbers are still high, with great regional inequality in the country.


Assuntos
Gravidez na Adolescência , Adolescente , Adulto , Coeficiente de Natalidade , Brasil/epidemiologia , Criança , Estudos Transversais , Feminino , Fertilidade , Humanos , Gravidez , Estados Unidos , Adulto Jovem
8.
Artigo em Russo | MEDLINE | ID: mdl-34486853

RESUMO

The formation of code of normative legal documents ensuring activities of perinatal service is one of the most important, basic organizational technologies that determine activities of obstetrics and childhood services, contributing to increasing of natality, decreasing of maternal and infant morbidity, and maternal and childhood health care in general. The article presents analysis of formation of normative legal base that regulates functioning of perinatal service in the Russian Federation in 2000-2020. Actually, there is no objective prerequisites for fundamental alterations in the three-level system of medical care of women during pregnancy, labor, postpartum period and newborns. However, the regulatory adjustment of the system, improvement and refinement of models of profile patients' routing, development of medical care of pregnant women, parturient women and puerpera will proceed.


Assuntos
Obstetrícia , Coeficiente de Natalidade , Criança , Feminino , Humanos , Recém-Nascido , Organizações , Assistência ao Paciente , Gravidez , Federação Russa
9.
Hum Reprod ; 36(11): 2891-2903, 2021 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-34550368

RESUMO

STUDY QUESTION: What are couples' preferences for fresh embryo transfer versus freezing of all embryos followed by frozen embryo transfer and the associated clinical outcomes that may differentiate them? SUMMARY ANSWER: Couples' preferences are driven by anticipated chances of live birth, miscarriage, neonatal complications, and costs but not by the differences in the treatment process (including delay of embryo transfer linked to frozen embryo transfer and risk of ovarian hyperstimulation syndrome (OHSS) associated with fresh embryo transfer). WHAT IS KNOWN ALREADY: A policy of freezing all embryos followed by transfer of frozen embryos results in livebirth rates which are similar to or higher than those following the transfer of fresh embryos while reducing the risk of OHSS and small for gestational age babies: it can, however, increase the risk of pre-eclampsia and large for gestational age offspring. Hence, the controversy continues over whether to do fresh embryo transfer or freeze all embryos followed by frozen embryo transfer. STUDY DESIGN, SIZE, DURATION: We used a discrete choice experiment (DCE) technique to survey infertile couples between August 2018 and January 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS: We asked IVF naïve couples attending a tertiary referral centre to independently complete a questionnaire with nine hypothetical choice tasks between fresh and frozen embryo transfer. The alternatives varied across the choice occurrences on several attributes including efficacy (live birth rate), safety (miscarriage rate, neonatal complication rate), and cost of treatment. We assumed that a freeze-all strategy prolonged treatment but reduced the risk of OHSS. An error components mixed logit model was used to estimate the relative value (utility) that couples placed on the alternative treatment approaches and the attributes used to describe them. Willingness to pay and marginal rates of substitution between the non-cost attributes were calculated. A total of 360 individual questionnaires were given to 180 couples who fulfilled the inclusion criteria, of which 212 were completed and returned Our study population included 3 same sex couples (2 females and 1 male) and 101 heterosexual couples. Four questionnaires were filled by one partner only. The response rate was 58.8%. MAIN RESULTS AND THE ROLE OF CHANCE: Couples preferred both fresh and frozen embryo transfer (odds ratio 27.93 and 28.06, respectively) compared with no IVF treatment, with no strong preference for fresh over frozen. Couples strongly preferred any IVF technique that offered an increase in live birth rates by 5% (P = 0.006) and 15% (P < 0.0001), reduced miscarriage by 18% (P < 0.0001) and diminished neonatal complications by 10% (P < 0.0001). Respondents were willing to pay an additional £2451 (95% CI 604 - 4299) and £761 (95% CI 5056-9265) for a 5 and 15% increase in the chance of live birth, respectively, regardless of whether this involved fresh or frozen embryos. They required compensation of £5230 (95% CI 3320 - 7141) and £13 245 (95% CI 10 110-16 380) to accept a 10 and 25% increase in the risk of neonatal complications, respectively (P < 0.001). Results indicated that couples would be willing to accept a 1.26% (95% CI 1.001 - 1.706) reduction in the live birth rate for a 1% reduction in the risk of neonatal complications per live birth. Older couples appeared to place less emphasis on the risk of neonatal complications than younger couples. LIMITATIONS, REASONS FOR CAUTION: DCEs can elicit intentions which may not reflect actual behaviour. The external validity of this study is limited by the fact that it was conducted in a single centre with generous public funding for IVF. We cannot rule out the potential for selection or responder bias. WIDER IMPLICATIONS OF THE FINDINGS: If a strategy of freeze all was to be implemented it would appear to be acceptable to patients, if either success rates can be improved or neonatal complications reduced. Live birth rates, neonatal complication rates, miscarriage rates, and cost are more likely to drive their preferences than a slight delay in the treatment process. The results of this study have important implications for future economic evaluations of IVF, as they suggest that the appropriate balance needs to be struck between success and safety. A holistic approach incorporating patient preferences for expected clinical outcomes and risks should be taken into consideration for individualized care. STUDY FUNDING/COMPETING INTEREST(S): No external funding was sought for this study. A.M. is the chief investigator of the randomized controlled trial 'Freeze all'. S.B. is an Editor in Chief of Human Reproduction Open. The other co-authors have no conflicts of interest to declare. Graham Scotland reports non-financial support from Merck KGaA, Darmstadt, Germany, outside the submitted work. TRIAL REGISTRATION NUMBER: N/A.


Assuntos
Fertilização In Vitro , Síndrome de Hiperestimulação Ovariana , Coeficiente de Natalidade , Transferência Embrionária , Feminino , Humanos , Nascido Vivo , Masculino , Síndrome de Hiperestimulação Ovariana/epidemiologia , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
10.
Reprod Biomed Online ; 43(4): 765-767, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34474979

RESUMO

RESEARCH QUESTION: What effects did the early phase of the COVID-19 pandemic have on natural and assisted reproductive technology (ART)-mediated birth rates? DESIGN: Regional registries were consulted with permission from the Health Authorities of Lombardy Region, Northern Italy, an area particularly affected by the early phase of the epidemic. Deliveries occurring in the area between 1 January 2019 and 31 December 2020 from women beneficiaries of the National Health System and resident in Lombardy were identified. Comparisons mainly focused on December 2020, when women who conceived after 8 March (the start of the stringent lockdown imposed by the authorities) were expected to deliver. RESULTS: When comparing the periods January to November in 2019 and 2020, a 5.1% reduction of monthly general birth rate (from 5732 in 2019 to 5438 in 2020) was observed. The contribution of ART births was similar in 2019 and 2020, being 4.4% and 4.5%, respectively. In December 2020, a notable drop in natural (-17.8%), ART-mediated (-86.6%) and overall (-21.0%) births was observed compared with December 2019. After adjusting for the expected 5.1% reduction, the inferred effect of the COVID-19 crisis corresponded to a 16.7% reduction in birth rate, of which 76% was related to natural (707 births) and 24% to ART (218 births) conceptions. CONCLUSIONS: This is the first study providing population-based evidence on the effects of COVID-19 and its related stringent restrictions on birth rates. The birth rate was dramatically reduced following the critical period, and the closure of ART centres played only a marginal role (24%) in the overall detrimental effect.


Assuntos
COVID-19/epidemiologia , Gravidez Múltipla/estatística & dados numéricos , Técnicas de Reprodução Assistida/estatística & dados numéricos , Coeficiente de Natalidade , Controle de Doenças Transmissíveis , Feminino , Humanos , Itália/epidemiologia , Gravidez , Resultado da Gravidez , Sistema de Registros
11.
NCHS Data Brief ; (418): 1-8, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34582330

RESUMO

This report presents selected highlights from 2020 final birth data on key demographic, health care utilization, and infant health indicators. General fertility rates (births per 1,000 women aged 15-44), age-specific birth rates (births per 1,000 women in specified age group), low-risk (nulliparous, term, singleton, cephalic births) cesarean delivery, and preterm (less than 37 weeks of gestation) birth rates are presented. All indicators are compared between 2019 and 2020 and shown for all births. General fertility rates (GFRs), lowrisk cesarean and preterm birth rates are shown for the three largest race and Hispanic-origin groups: non-Hispanic white, non-Hispanic black, and Hispanic. Fertility rates are shown by age of mother.


Assuntos
Nascimento Prematuro , Coeficiente de Natalidade , Cesárea , Feminino , Hispano-Americanos , Humanos , Lactente , Recém-Nascido , Parto , Gravidez , Nascimento Prematuro/epidemiologia , Estados Unidos/epidemiologia
12.
PLoS One ; 16(9): e0257570, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34550992

RESUMO

In this study, we seek to perform macro analysis of fertility in a panel of 6 selected Pacific Island Countries (PICs, hereafter). The macro analysis with secondary data, mostly obtained from World Bank database, stretched over the period 1990-2019 was stacked randomly in a balanced panel set-up, within which the most preferred fixed effect model is used for multivariate analysis. Pooled OLS and Random effect estimation techniques were applied for comparing results. Categories such as women's empowerment, health, connectivity and cost of living were used to classify proxy variables as regressors for fertility determination. The results indicate variables such as contraceptive prevalence rate, female labour force participation rate and consumer price index (inflation) are negatively correlated with fertility at 1% level, while urbanisation is negatively correlated with fertility rate only at 10% significance level. Real GDP has negative relationship with fertility, however it is not statistically significant. Variables that are positively correlated with fertility but hold limited to no significance effects are female secondary enrolment, female population, mobile subscription and infant mortality rate. It is implied that those variables that are negatively associated with fertility, as well as Real GDP will be the major drivers for achieving replacement level fertility in the long run.


Assuntos
Coeficiente de Natalidade , Fatores Socioeconômicos , Comportamento Contraceptivo , Bases de Dados Factuais , Demografia , Economia , Emprego , Empoderamento , Produto Interno Bruto , Nível de Saúde , Humanos , Análise Multivariada , Ilhas do Pacífico , Urbanização
13.
Am J Obstet Gynecol MFM ; 3(6): 100476, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34478877

RESUMO

OBJECTIVE: Recent analyses have suggested that the number of births in the United States may decrease substantially in the wake of the COVID-19 pandemic.1 Some of this decline may be attributable to economic disruptions that are often linked to lowered birth rates.1 However to the best of our knowledge, empirical data to validate these projections and to look more specifically at the consequences of "lockdowns," have not yet been published. The objective of our study was to compare the birth rates in New York City and Long Island hospitals during the 9 months after the lockdown, to the birth rates during the same time frames in previous years. STUDY DESIGN: This was a multicenter, retrospective study of live births from hospitals in the New York City Maternal-Fetal Medicine Research Consortium, an ongoing collaboration at several hospitals in New York City and Long Island. This consortium captures approximately one-third of the births in New York City (eg, of the 117,013 births recorded in 2017, 42,680 [36.6%] were from this consortium). To evaluate whether the lockdown in New York City (the first in the United States) between March 2020 and June 2020 resulted in a change in the number of births after the lockdown, we calculated the total live births 9 months after the lockdown (between December 2020 and February 2021) and compared the number with the total in the same 3 months during the previous 4 years. Fourteen hospitals with a total of greater than 55,000 annualized live births were included. Time series regression was performed to test the birth trends and to determine whether any change was a part of an ongoing trend. RESULTS: Figure 1 shows the total live births in the different time frames. There were 12,099 live births that occurred between December 2020 and February 2021. This is 2994 (19.8%) less live births than the previous year. In addition, the average number of live births in the 4 years before the study period was 15,101 births. This decrease was seen in all the hospitals included in the cohort. The hospitals located within New York City (N=10) had a larger drop in birth rate in the last 2 years (-1947, 18.9%) than in the hospitals located in Long Island (N=4) (-581, 13.4%). Figure 2 represents the total live births by individual hospitals in the different time frames. Among the entire cohort, the largest drop in birth rate in the previous years was only 4.9%. In addition, there was no significant trend in the number of births in the previous years (P=.586). Furthermore, no significant trend was identified in the hospitals located in New York City or Long Island (P=.831 and P=.178, respectively). Hospitals with large numbers of Medicaid-funded births showed the same trend as hospitals with smaller numbers of such births. CONCLUSION: Nine months after the lockdown was implemented, we observed a nearly 20% decrease in live births than the previous year. Although these data demonstrate a decline that is even greater than previously projected by analysts,1 there are several issues that should be considered. Firstly, the relationship between lockdowns and preterm birth is unclear, because we did not evaluate the birth outcomes, and thus, we cannot comment on preterm birth. However, most data do not suggest a major effect in the direction of more preterm births.2-4 We are unable to comment on the outmigration of pregnant women to other hospitals, the 3 accredited free-standing birth centers in New York City, or other geographic areas. However, the estimates on the outmigration data were less than the decrease we found. Using anonymized smartphone location data of approximately 140,000 New York City residents, a company specializing in geospatial analysis found that approximately 5% of New York City residents left New York City between March and May, with the majority moving to surrounding locations in the Northeast and to South Florida.5 The steeper decrease in live births in hospitals located in New York City than in those located in Long Island may be related to the population density and the recommended social distancing practices. The population density is higher in New York City than in Long Island (27,000 people per square mile vs 2360 people per square mile). Thus, the lockdown may have had a reduced effect on the number of live births in areas with a lower population density. In addition, most of the New York City residents outmigrated to surrounding locations including Long Island, which may have diminished the decrease in live births. Our data clearly demonstrate that there were significant changes in the number of births in the 9 months after the nation's first lockdown. Although we cannot definitively determine the contributions of migration, family choice, or other factors to those changes, these preliminary findings should provide direction to future studies. That work should consider zip codes, parities, and other factors that might exaggerate or mitigate the trends we report here.


Assuntos
COVID-19 , Nascimento Prematuro , Coeficiente de Natalidade , Controle de Doenças Transmissíveis , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Cidade de Nova Iorque/epidemiologia , Pandemias , Vigilância da População , Gravidez , Resultado da Gravidez , Gravidez Múltipla , Nascimento Prematuro/epidemiologia , Técnicas de Reprodução Assistida , Estudos Retrospectivos , SARS-CoV-2 , Estados Unidos
14.
Cells ; 10(9)2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34571932

RESUMO

Approximately one million in vitro produced (IVP) cattle embryos are transferred worldwide each year as a way to improve the rates of genetic gain. The most advanced programmes also apply genomic selection at the embryonic stage by SNP genotyping and the calculation of genomic estimated breeding values (GEBVs). However, a high proportion of cattle embryos fail to establish a pregnancy. Here, we demonstrate that further interrogation of the SNP data collected for GEBVs can effectively remove aneuploid embryos from the pool, improving live births per embryo transfer (ET). Using three preimplantation genetic testing for aneuploidy (PGT-A) approaches, we assessed 1713 cattle blastocysts in a blind, retrospective analysis. Our findings indicate aneuploid embryos have a 5.8% chance of establishing a pregnancy and a 5.0% chance of given rise to a live birth. This compares to 59.6% and 46.7% for euploid embryos (p < 0.0001). PGT-A improved overall pregnancy and live birth rates by 7.5% and 5.8%, respectively (p < 0.0001). More detailed analyses revealed donor, chromosome, stage, grade, and sex-specific rates of error. Notably, we discovered a significantly higher incidence of aneuploidy in XY embryos and, as in humans, detected a preponderance of maternal meiosis I errors. Our data strongly support the use of PGT-A in cattle IVP programmes.


Assuntos
Aneuploidia , Coeficiente de Natalidade/tendências , Testes Genéticos/métodos , Nascido Vivo , Diagnóstico Pré-Implantação/métodos , Animais , Blastocisto/citologia , Blastocisto/metabolismo , Bovinos , Feminino , Fertilização In Vitro/métodos , Gravidez , Estudos Retrospectivos
15.
Proc Natl Acad Sci U S A ; 118(36)2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34462356

RESUMO

Drawing on past pandemics, scholars have suggested that the COVID-19 pandemic will bring about fertility decline. Evidence from actual birth data has so far been scarce. This brief report uses data on vital statistics from a selection of high-income countries, including the United States. The pandemic has been accompanied by a significant drop in crude birth rates beyond that predicted by past trends in 7 out of the 22 countries considered, with particularly strong declines in southern Europe: Italy (-9.1%), Spain (-8.4%), and Portugal (-6.6%). Substantial heterogeneities are, however, observed.


Assuntos
Coeficiente de Natalidade , Pandemias/estatística & dados numéricos , COVID-19/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pandemias/economia , Crescimento Demográfico , Gravidez , Estados Unidos/epidemiologia
16.
Public Health ; 198: 35-36, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34352613

RESUMO

OBJECTIVES: The COVID-19 pandemic has led to major changes in the lives of people worldwide, including changes in personal and social habits. Faced with this global health emergency, governments have imposed strict mitigation measures. Within this context, and considering data from previous epidemics, it has been proposed that birth rates may have been negatively impacted. This study aimed to assess the trends in birth rates in three main industrial cities in Northern Italy during the COVID-19 pandemic. STUDY DESIGN: This was a retrospective and observational study. METHODS: Data on birth rates were collected and compared for the cities of Milan, Genoa and Turin from November 2019 to January 2020 (i.e. before the COVID-19 pandemic) and during the same period of the following year (i.e. during the COVID-19 pandemic). RESULTS: Birth rates in the cities of Milan, Genoa and Turin decreased by 55%, 12% and 33%, respectively. CONCLUSIONS: The decrease in birth rates during the COVID-19 pandemic in these three industrialised cities is in line with the demographic effects of previous pandemics. The negative impact of COVID-19 on conception may be a result of various underlying factors. Further studies are required to verify how social and demographic factors may influence birth rates during pandemics.


Assuntos
COVID-19 , Pandemias , Coeficiente de Natalidade , Cidades , Humanos , Itália/epidemiologia , Estudos Retrospectivos , SARS-CoV-2
17.
BMJ Glob Health ; 6(8)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34385161

RESUMO

OBJECTIVE: Preterm birth is the leading cause of child morbidity and mortality globally. We aimed to determine the impact of the COVID-19 mitigation measures implemented in China on 23 January 2020 on the incidence of preterm birth in our institution. DESIGN: Logistic regression analysis was used to investigate the association between the national COVID-19 mitigation measures implemented in China and the incidence of preterm birth. SETTING: Shanghai First Maternity and Infant Hospital, Shanghai China. PARTICIPANTS: All singleton deliveries abstracted from electronic medical record between 1 January 2014 to 31 December 2020. MAIN OUTCOME MEASURES: Preterm birth rate. RESULTS: Data on 164 107 singleton deliveries were available. COVID-19 mitigation measures were consistently associated with significant reductions in preterm birth in the 2-month, 3-month, 4-month, 5-month time windows after implementation (+2 months, OR 0.80, 95% CI 0.69 to 0.94; +3 months, OR 0.83, 95% CI 0.73 to 0.94; +4 months, OR 0.82, 95% CI 0.73 to 0.92; +5 months, OR 0.84, 95% CI 0.76 to 0.93). These reductions in preterm birth were obvious across various degrees of prematurity, but were statistically significant only in moderate-to-late preterm birth (32 complete weeks to 36 weeks and 6 days) subgroup. The preterm birth difference disappeared gradually after various restrictions were removed (7th-12th month of 2020, OR 1.02, 95% CI 0.94 to 1.11). There was no difference in stillbirth rate across the study time window. CONCLUSION: Substantial decreases in preterm birth rates were observed following implementation of the national COVID-19 mitigation measures in China. Further study is warranted to explore the underlying mechanisms associated with this observation.


Assuntos
COVID-19 , Nascimento Prematuro , Coeficiente de Natalidade , Criança , China/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle , SARS-CoV-2
18.
FASEB J ; 35(9): e21812, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34411354

RESUMO

Blastocysts hatch from the zona pellucida (ZP) to enable implantation into the uterine endometrial epithelium, but little is known regarding the effect of hatching sites on pregnancy outcomes. Murine hatching embryos were categorized into five groups based on initial trophectoderm projection (TEP)/ZP position corresponding to the inner cell mass center. In blastocysts (3.5 dpc) post-12 hours in vitro culture, TEP rates of A-site (44.4%) and B-site (38.6%) embryos were higher than those of C-site (12.5%) and D-site (3.1%) embryos, while the O-site (1.4%) was the lowest (P < .05). Post-ET A-site (55.6%) and B-site (65.6%) birth rates were higher than those of C-site embryos (21.3%) and controls (P < .05). Furthermore, live birth rate of B-site embryos remained higher than C-site embryos (68.8% vs 31.3%; P < .05) when both were transferred into the same recipients. Different TEP site blastocysts exhibited different implantation competences: the implantation rate of C-site embryos was lower than that of both A- and B-site groups (67.7% vs 84.3% and 83.2%, respectively; P < .05) at 2 days post-ET. C-site embryos also had a distinctly higher ratio of developmental defects (47.5%) than A- and B-site embryos (22.5% and 14.6%, respectively), with implantation failure mainly associated with poor birth rate, a finding corroborated by differential gene expression analysis such as LIF, LIFR, and S100a9. Surprisingly, acidified Tyrode's solution (AAH)-treated B-site blastocysts had a significantly increased birth rate (77.1%) than C-site (55.3%) and controls (43.4%). Site specificity and differential gene expression during embryo hatching can be applied in ART screening. More importantly, assisted hatching by AAH is effective and feasible for improving pregnancy and term development, particularly at the B-site, for humans and in animal husbandry.


Assuntos
Coeficiente de Natalidade , Blastocisto/citologia , Implantação do Embrião , Trofoblastos/citologia , Zona Pelúcida/metabolismo , Animais , Transferência Embrionária , Feminino , Fertilização In Vitro , Regulação da Expressão Gênica no Desenvolvimento , Masculino , Camundongos , Gravidez , Resultado da Gravidez , Útero/citologia
19.
Hum Reprod ; 36(10): 2687-2696, 2021 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-34447994

RESUMO

STUDY QUESTION: Is there an association between serum LH levels prior to progesterone administration and live birth rate (LBR) in artificial frozen-thawed embryo transfer (FET) cycles? SUMMARY ANSWER: : Low serum LH levels on the day before progesterone initiation in artificial frozen-thawed blastocyst transfer cycles of ovulatory women are associated with a lower LBR. WHAT IS KNOWN ALREADY: In artificial FET cycles, exogenous oestrogen and progesterone are administered sequentially to mimic the serum hormone pattern similar to the natural cycle. In oestrogen-only phase, the supplemental oestrogen causes thickening of the endometrium and is sometimes accompanied by a rise in serum LH. However, whether the endogenous LH level in artificial FET cycles is related to clinical outcomes remains unclear. STUDY DESIGN, SIZE, DURATION: A retrospective cohort study including 3469 artificial frozen-thawed blastocyst transfer cycles was conducted at a tertiary-care academic medical centre between February 2014 and January 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 3469 frozen blastocyst transfer cycles were stratified into four groups based on the quartiles of serum LH level before progesterone initiation: <25th percentile (LH < 8.79 mIU/ml), 25-50th percentile (8.79 ≤ LH ≤ 13.91 mIU/ml), 51-75th percentile (13.91 < LH ≤ 20.75 mIU/ml) and >75th percentile (LH > 20.75 mIU/ml). The serum LH level >75th percentile group was considered as the reference group. Patients with polycystic ovarian syndrome or other ovulatory disorders were excluded from the study. We also excluded cycles with an endometrial thickness <7 mm before progesterone initiation and patients with intrauterine adhesions and uterine abnormalities. In order to avoid the interference of BMI, all patients were divided into two categories based on the overweight threshold: BMI <25 kg/m2 and ≥25 kg/m2, and the impacts of serum LH levels on LBR were investigated separately. Univariable and multivariable logistic regression analysis were performed to adjust for potential confounders. EmpowerStats software and R-project were used to build smooth curve fitting models. MAIN RESULTS AND THE ROLE OF CHANCE: Compared with the reference group, the implantation rate significantly decreased with low LH levels (<25th percentile) on the day before progesterone initiation (odds ratio [OR] = 0.74; 95% CI, 0.64-0.86; P = 0.001). Accounting for major covariates, low LH levels were associated with a relatively lower LBR (adjusted OR = 0.649; 95% CI, 0.531-0.794; P < 0.001), mainly due to a lower implantation rate, lower clinical pregnancy rate and higher pregnancy loss rate. Moreover, in the patients with BMI <25 kg/m2, low LH was associated with a lower LBR (P < 0.001); while in the overweight subgroup, LBR and LH were not correlated (P = 0.823). LIMITATIONS, REASONS FOR CAUTION: The main limitation of this study is its retrospective design. Owing to the relatively small number in the overweight group, the results of the overweight subgroup should be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS: The evidence provided in this study shows the importance of serum LH levels on the day before progesterone initiation in patients undergoing artificial FET cycles. Hypothalamic dysfunction may be one of the important causes of a relatively low LH, which is related to impaired pregnancy outcomes. Serum LH levels may be used as one of the clinical indicators to predict pregnancy outcomes. STUDY FUNDING/COMPETING INTEREST(S): No funding and no competing interest were involved in this study. TRIAL REGISTRATION NUMBER: NA.


Assuntos
Coeficiente de Natalidade , Progesterona , Transferência Embrionária , Feminino , Humanos , Nascido Vivo , Indução da Ovulação , Gravidez , Estudos Retrospectivos
20.
Twin Res Hum Genet ; 24(3): 163-167, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34247687

RESUMO

Over the previous decades, twinning rates worldwide have increased remarkably. This study aimed to describe changes in multiple birth rates and related demographic characteristics, such as maternal age and the level of education of parents in South Korea from 1981 to 2019. This study analyzed birth data obtained from the Korean Statistical Information Service. From 1981 to 2019, the total twinning rate increased from 5 to 22.5 pairs per 1000 births. This rapid increase was due to an increase in dizygotic twin births, which mainly occurred in mothers aged between 30 and 39 years. The average maternal age of multiples increased from 26.06 years in 1981 to 33.98 years in 2019, suggesting that a delay in childbearing contributed to the increase in the twinning rate. The percentage of mothers of multiples who completed a college or higher degree (CHD) increased by 1000% from 1981 to 2019, indicating that a sharp increase in the level of education of females in part explains the delay in childbearing. The percentages of individuals who completed a CHD were higher among parents of multiples than among those of singletons in recent years when public funding arrangements for fertility treatments were available. This result suggested that completion of higher education may be associated with increased use of assisted reproductive technology (ART) independent of the financial status of couples. Taken together, the analysis suggested that increased maternal age, ART and the increased number of females who completed CHD may be responsible for the remarkable increase in the rates of multiple births in South Korea in the last four decades.


Assuntos
Recém-Nascido de Baixo Peso , Nascimento Prematuro , Adulto , Coeficiente de Natalidade , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Idade Materna , Mães , Vigilância da População , Gravidez , Resultado da Gravidez , Técnicas de Reprodução Assistida , República da Coreia/epidemiologia , Gêmeos Dizigóticos
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