A method for constructing complete annual U.S. life tables.
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OBJECTIVES: This report describes a method for constructing complete annual U.S. life tables and for extending the age coverage of the life table to age 100. Previously, annual life tables were based on an abridged methodology and were closed with the age category 85 years and over. In the United States, approximately one-third of the population survives beyond age 85 years. This fact, coupled with improvements in age reporting and the availability of higher quality old-age mortality data, recommends that the life table be closed at an older age. METHODS: The method, similar to that used to construct the decennial life tables, uses vital statistics and census data to calculate death rates for ages under 85 years and Medicare data for ages 85 years and over. Previously, the annual life tables were abridged, and used only vital statistics and census data. CONCLUSIONS: The complete life table methodology described in this report produces estimates of life expectancy at ages 100 years and younger that are consistent with previously published life tables. Complete life tables based on 1996 mortality data compared favorably with published 1996 abridged life tables and with the 1989-91 decennial life tables. The methodology was implemented beginning with final mortality data for 1997. (+info)
A randomized, double-blind, placebo-controlled trial of intravenous immunoglobulin in the prevention of recurrent miscarriage: evidence for a therapeutic effect in women with secondary recurrent miscarriage.
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BACKGROUND: Previous trials of intravenous immunoglobulin (IvIg) treatment of women with recurrent miscarriage (RM) have provided diverging results. This may be due to different inclusion criteria and suboptimal treatment protocols in some trials. METHODS: According to a computer-generated list, 58 women with at least four unexplained miscarriages were randomly assigned to receive infusions of high doses of IvIg or placebo starting as soon as the pregnancy test was positive. RESULTS: In the intention-to-treat analysis, a 45% live birth rate was found in both allocation groups. In patients with secondary RM, 50% in the treatment group and 23% in the placebo group had successful pregnancies (P = not significant). When data from the present and a previous placebo-controlled trial of the same treatment were combined, 15/26 (58%) of the patients with secondary RM in the treatment group versus 6/26 (24%) in the placebo group had successful outcomes (P < 0.02). Only 7% of the karyotyped abortuses were abnormal. CONCLUSIONS: IvIg may improve pregnancy outcome in patients with secondary RM. A new placebo-controlled trial focusing on this subgroup should be conducted to confirm the results. (+info)
Births: final data for 2000.
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OBJECTIVES: This report presents 2000 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal characteristics (medical risk factors, weight gain, tobacco and alcohol use); medical care utilization by pregnant women (prenatal care, obstetric procedures, complications of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, abnormal conditions, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's State of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. 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 4.059 million births that occurred in 2000 are presented. RESULTS: The number of births rose 3 percent in 2000; birth and fertility rates rose 1 to 2 percent. The total fertility rate was above "replacement" for the first time in almost 30 years. Teenage birth rates continued to fall while birth rates for women aged 20-24 years rose slightly, and rates for women in their late twenties and thirties rose 3 to 5 percent. Births to women in their forties and early fifties were also up for 2000. The number of births to unmarried women, the birth rate, and the percent of births that were to unmarried women rose 1 to 3 percent, but birth rates for unmarried teenagers declined. Smoking by pregnant women was down again. The cesarean delivery rate rose 4 percent to 22.9, the fourth consecutive increase; the primary cesarean rate was up and the rate of vaginal births after a previous cesarean was down. The number and rate of twin births continued to rise, but the triplet/+ birth rate declined for the second year in a row. For the first year in almost a decade the preterm birth rate declined (to 11.6 percent); the low birthweight rate, however, was unchanged at 7.6 percent. (+info)
Rationale for the study of the human sex ratio in population studies of polluted environments.
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The human secondary sex ratio remains a subject of substantial interest. The possibility has been raised that environmental chemical exposures have played a role in the changes associated with the sex ratio in a number of countries. The possibility that such an effect may be present is supported at least theoretically by the observation that clomiphene citrate, a drug used in the treatment of infertility with powerful estrogenic and anti-estrogenic properties, has profound effects on the sex ratio resulting in significantly fewer males at birth. Using a model of causality based on the clinical identification of adverse drug effect methodology one may improve the objectivity of the assessment of significant environmental exposures on this human reproductive outcome. (+info)
Hospital care utilization of infants born after IVF.
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BACKGROUND: Infants born after IVF are often twins, and singleton IVF babies have an increased risk for preterm birth. Both conditions are likely to increase morbidity. We examined the frequency and duration of hospitalization required by babies born after IVF, and compared this information with all infants born in Sweden during the same time period. METHODS: We used a nationwide registration of IVF pregnancies from 1984 to 1997 and a nationwide register of all in-patient care up to the end of 1998. We identified 9056 live born infants after IVF treatment and compared them with 1 417 166 non-IVF live born infants. RESULTS: The highest odds ratio (OR approximately 3) was seen for neonatal hospitalization, but an increased OR (1.2-1.3) was noted for children up to 6 years of age. The OR for being hospitalized after IVF was 1.8, but when the analysis was restricted to term infants it was 1.3 and this excess was then explainable by maternal subfertility. Statistically significant increased ORs were seen for hospitalization for cerebral palsy (1.7), epilepsy (1.5), congenital malformation (1.8) or tumour (1.6), but also for asthma (1.4) or any infection (1.4). When information from the Swedish Cancer Registry was used, no excess risk for childhood cancer was found. The average number of days spent in hospital by IVF and non-IVF children was 9.5 and 3.6 respectively. CONCLUSIONS: The increased hospitalization of IVF children is, to a large extent, due to the increased incidence of multiple births. Therefore, the increased costs associated with this may be reduced by the use of single embryo transfers, with the savings in health care costs being offset against the increased number of embryo transfer cycles required to maintain the pregnancy rate. (+info)
Cumulative delivery rates after ICSI in women aged >37 years.
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BACKGROUND: Female patients aged >37 years have a poor prognosis after ICSI. To determine the cumulative delivery rates in these women by life-table analysis, 228 patients aged >37 years who had undergone a total of 437 ICSI cycles were analysed retrospectively. METHODS: Only cycles in which fresh ejaculated sperm was used, and in which at least one oocyte was micro-injected, were analysed. The main outcome measure was cumulative rate of deliveries. Any delivery after 25 weeks gestation was included in the study. RESULTS: In women aged 38-39 years, the real cumulative delivery rate after two cycles was 21%, while the expected delivery rate was 26%. In patients aged 40-43 years, the real and expected cumulative delivery rates were 12 and 17% respectively after three cycles, when they reached a plateau. There was only one delivery in the age group >43 years, which consisted of 26 patients with 66 cycles. In women aged >37 years, an expected cumulative delivery rate of 30% may be obtained at the end of the fourth cycle. Women aged >43 years do not have a realistic chance of achieving a delivery with their own oocytes. CONCLUSIONS: This life-table analysis provides a means by which to counsel couples about their chances of achieving a delivery by ICSI at an age >37 years. (+info)
Trends in twin and triplet births: 1980-97.
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This report presents data from U.S. birth certificates on the numbers and rates of twin and triplet and other higher order multiple births for 1980-97. Over the study period, the number of twin births rose 52 percent (from 68,339 to 104,137) and triplet and other higher order multiple births (heretofore referred to as "triplet/+") climbed 404 percent (from 1,337 to 6,737 births). Comparable but less pronounced rises were observed in twin and triplet/+ birth rates. Growth in twin and triplet/+ birth rates was most marked among women aged 30 years and over. Between 1980-82 and 1995-97, the twin rate rose 63 percent for women aged 40-44 years, and soared nearly 1,000 percent for women 45-49 years. (As one result, there were more twins born to women 45-49 years of age in 1997, than during the entire decade of the 1980's.) The triplet/+ birth rate rose nearly 400 percent for women in their thirties and exploded by more than 1,000 percent for women in their forties. The extraordinary rise in multiple births resulted in a shift in age-specific patterns, and the highest twin and triplet/+ birth rates now are for women 45-49 years of age. Historical differences in twinning rates between non-Hispanic white and black mothers have been largely eliminated (28.8 per 1,000 non-Hispanic white compared with 30.0 for black women). Non-Hispanic white women were more than twice as likely as non-Hispanic black or Hispanic women to have a triplet/+ birth. Rates of low birthweight, very low birthweight, and infant mortality were 4 to 33 times higher for twins and triplet/+ compared with singleton births. The risk for these adverse outcomes was lowest for twins and triplet/+ born to women 35-44 years of age. Twin birth rates for Massachusetts and Connecticut were at least 25 percent higher than the U.S. rate; triplet/+ rates for Nebraska and New Jersey were twice the national level. (+info)
The effect on IVF outcome of small intramural fibroids not compressing the uterine cavity as determined by a prospective matched control study.
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BACKGROUND: Several studies have reported that the presence of intramural fibroids affects conception following IVF. We attempted to corroborate or refute the conclusions relating to IVF and leiomyomas of the aforementioned studies. METHODS: Women with small intramural leiomyomata (< or = 5 cm) discovered on initial pelvic sonographic studies performed in preparation for IVF were prospectively matched by age, with the next patient of the same age undergoing IVF who did not demonstrate fibroids (controls). RESULTS: Though no significant differences were found in outcome when comparing these two groups, there was a distinct trend for lower live delivery rates and higher miscarriage rates. CONCLUSIONS: These data support the conclusions of the only other prospective matched control study evaluating similar factors, i.e. that small intramural fibroids can negatively affect IVF outcome. Nevertheless, we think that a multicentre study should be conducted first before evaluating whether myomectomy improves outcome or not. (+info)