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Maternal and Child Health Journal

, Volume 11, Issue 6, pp 517–525 | Cite as

A Population-Based Study of Maternal and Perinatal Outcomes Associated with Assisted Reproductive Technology in Massachusetts

  • Laura A. SchieveEmail author
  • Bruce Cohen
  • Angela Nannini
  • Cynthia Ferre
  • Meredith A. Reynolds
  • Zi Zhang
  • Gary Jeng
  • Maurizio Macaluso
  • Victoria C. Wright
  • Massachusetts Consortium for Assisted Reproductive Technology Epidemiologic Research (MCARTER)
Original Paper

Abstract

Objective: To assess associations between assisted reproductive technology (ART) and adverse maternal and infant outcomes, with an emphasis on singletons. Methods: We linked data from the US ART surveillance system with Massachusetts live birth-infant death records data for resident births in 1997–1998 and compared births conceived with ART (N = 3316) with births not conceived with ART or infertility medications (N = 157,066) on: maternal chronic conditions, pregnancy complications, labor and delivery complications, and perinatal and infant outcomes. Results: Overall, ART was strongly associated with numerous adverse outcomes. The magnitude was reduced for several outcomes when analyses were limited to singletons. After further exclusion of maternal subsets with rare ART births (maternal age <20; education <high school; unmarried, no or public health insurance; no or third trimester prenatal care initiation), and matching ART and non-ART singletons on birth hospital, birth month and year, maternal age, parity, and race/ethnicity, ART remained associated with pre-existing diabetes (Relative Risk [RR] = 2.2 95% confidence interval 1.02–4.9), incompetent cervix (RR = 6.0, [2.3–15.4]), pregnancy-induced hypertension (RR = 1.5, [1.04–2.2]), uterine bleeding (RR = 3.2, [1.5–6.8]), placental abruption (RR = 3.8 [1.6–9.4]), placenta previa (RR = 3.8, [1.6–9.4]), preterm delivery (RR = 2.4, [1.8–3.0]), very preterm delivery (RR = 2.5, [1.2–5.2]), low birth weight (RR = 2.1, [1.5–2.9]), and infant not discharged home (RR = 1.8, [1.2–2.6]). Conclusions: Women who conceive with ART are more likely than women who do not to enter pregnancy with a chronic condition and develop complications during pregnancy and labor and delivery. Additionally, infants born after ART are at increased risk for adverse health outcomes. The mechanisms underlying these associations require further study.

Keywords

Infant Low birth weight Pregnancy complications Premature birth Assisted reproductive technology 

Notes

Acknowledgments

The authors acknowledge the member clinics of the Massachusetts Consortium of Assisted Reproductive Technology Epidemiologic Research (MCARTER) for their support and assistance with data collection for this linkage project. These clinics include Baystate Reproductive Medicine, Boston IVF, Fertility Center of New England, Massachusetts General Hospital, New England Fertility and Endocrinology Associates, Reproductive Science Center, and Women and Infants IVF. The original ART surveillance system data used for this study were collected by the Society for Assisted Reproductive Technology (SART). This system is jointly supported by SART, the American Society for Reproductive Medicine (ASRM), and the CDC.

The listed authors were solely responsible for the study design, data analysis, and writing of this manuscript. The findings and conclusions in this report are those of the listed authors and do not necessarily represent the views of the Centers for Disease Control and Prevention, nor the ART clinics comprising MCARTER.

References

  1. 1.
    Wright VC, Chang JMA, Jeng G, Macaluso M. Assisted reproductive technology surveillance – United States, 2003. In: surveillance summaries, May 26, 2006. MMWR 2006;55(No. SS04):1–22.Google Scholar
  2. 2.
    Kiely JL. What is the population-based risk of preterm birth among twins and other multiples? Clin Obstet Gynecol 1998;41:3–11.PubMedCrossRefGoogle Scholar
  3. 3.
    MacDorman MF, Martin JA, Mathews TJ, Hoyert DL, Ventura SJ. Explaining the 2001–02 infant mortality increase: data from the linked birth/infant death data set. Natl Vital Stat Rep 2005;53(12):1–24.PubMedGoogle Scholar
  4. 4.
    Pharoah PO. Neurological outcome in twins. Semin Neonatol 2002;7:223–30.PubMedCrossRefGoogle Scholar
  5. 5.
    ESHRE Capri Workshop Group. Multiple gestation pregnancy. Hum Reprod 2000;15:1856–64.CrossRefGoogle Scholar
  6. 6.
    Schieve LA, Ferre C, Peterson HB, Macaluso M, Reynolds MA, Wright VC. Perinatal outcome among singleton infants conceived through assisted reproductive technology in the United States. Obstet Gynecol 2004;103:1144–53.PubMedGoogle Scholar
  7. 7.
    Schieve LA, Meikle SF, Ferre C, Peterson HB, Jeng G, Wilcox LS. Low and very low birth weight in infants conceived with use of assisted reproductive technology. N Engl J Med 2002;346:731–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Jackson RA, Gibson KA, Wu YW, Croughan MS. Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol 2004;103:551–63.PubMedGoogle Scholar
  9. 9.
    Helmerhorst FM, Perquin DAM, Donker D, Keirse MJNC. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ 2004;261–65.Google Scholar
  10. 10.
    Klemetti R, Gissler M, Hemminki E. Comparison of perinatal health of children born from IVF in Finland in the early and late 1990s. Hum Reprod 2002;17:2192–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Draper ES, Kurinczuk JJ, Abrams KR, Clarke M. Assessment of separate contributions to perinatal mortality of infertility history and treatment: a case-control analysis. Lancet 1999;353:1746–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Shevell T, Malone FD, Vidaver J, et al. Assisted reproductive technology and pregnancy outcome. Obstet Gynecol 2005;106:1039–49.PubMedGoogle Scholar
  13. 13.
    Daniel Y, Ochshorn Y, Fait G, Geva E, Bar-Am A, Lessing JB. Analysis of 104 twin pregnancies conceived with assisted reproductive technologies and 193 spontaneously conceived twin pregnancies. Fertil Steril 2000;74:683–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Smithers PR, Halliday J, Hale L, Talbot JM, Breheny S, Healy D. High frequency of cesarean section, antepartum hemorrhage, placenta previa, and preterm delivery in in vitro fertilization twin pregnancies. Fertil Steril 2003;80:666–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Perri T, Chen R, Yoeli R, et al. Are singleton assisted reproductive technology pregnancies at risk of prematureity? J Assist Reprod Genet 2001;18:245–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Isaksson R, Gissler M, Tiitinen A. Obstetric outcome among women with unexplained infertility after IVF: a matched case-control study. Hum Reprod 2002;17:1755–61.PubMedCrossRefGoogle Scholar
  17. 17.
    Schieve LA, Wilcox LS, Zeitz J, et al. Assessment of outcomes for assisted reproductive technology: overview of issues and the US experience in establishing a surveillance system. In: Vayena E, Rowe PJ, Griffin PD, editors. Current practices and controversies in assisted reproduction: report of a WHO meeting. Medical, ethical and social aspects of assisted reproduction (2001: Geneva, Switzerland). Geneva, Switzerland: WHO Publications; 2002. p. 363–76.Google Scholar
  18. 18.
    Sunderam S, Schieve LA, Cohen B, et al. Linking birth and infant death records with assisted reproductive technology data: Massachusetts, 1997–1998. Matern Child Health J 2006;10:115–25.Google Scholar
  19. 19.
    Martin JA, Hamilton BE, Sutton PD, et al. Births: final data for 2003. National vital statistics reports; vol 54 no 2. Hyattsville, MD: National Center for Health Statistics; 2005.Google Scholar
  20. 20.
    Kotelchuck M. An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. Am J Public Health 1994;84:1414–20.PubMedCrossRefGoogle Scholar
  21. 21.
    Rothman KJ, Greenland S. Modern epidemiology. 2nd edn. Philadelphia, PA: Lippincott-Raven Publishers; 1998.Google Scholar
  22. 22.
    DiGiuseppe DL, Aron DC, Ranbom L, Harper DL, Rosenthal GE. Reliability of birth certificate data: a multi-hospital comparison to medical records information. Matern Child Health J 2002;6:169–79.PubMedCrossRefGoogle Scholar
  23. 23.
    Roohan PJ, Josberger RE, Acar J, et al. Validation of birth certificate data in New York State. J Community Health 2003;28:335–46.PubMedCrossRefGoogle Scholar
  24. 24.
    Dobie SA, Baldwin LM, Rosenblatt RA, Fordyce MA, Andrilla CHA, Hart LG. How well do birth certificates describe the pregnancies they report? The Washington state experience with low-risk pregnancies. Matern Child Health J 1998;2:145–53.PubMedCrossRefGoogle Scholar
  25. 25.
    Lydon-Rochelle MT, Holt VL, Cardenas V, et al. The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data. Am J Obstet Gynecol 2005;193:125–34.PubMedCrossRefGoogle Scholar
  26. 26.
    Legro RS. Diagnostic criteria in polycystic ovary syndrome. Sem Reprod Med 2003;21:267–75.CrossRefGoogle Scholar
  27. 27.
    Cramer DW, Wise LA. The epidemiology of recurrent pregnancy loss. Sem Reprod Med 2000;18:331–9.CrossRefGoogle Scholar
  28. 28.
    Mitchell AA. Infertility treatment – more risks and challenges. N Engl J Med 2002;346:769–70.PubMedCrossRefGoogle Scholar
  29. 29.
    Olivennes F, Rufat P, Andre B, Pourade A, Quiros MC, Frydman R. The increased risk of complication observed in singleton pregnancies resulting from in-vitro fertilization (IVF) does not seem to be related to the IVF method itself. Hum Reprod 1993;8:1297–300.PubMedGoogle Scholar
  30. 30.
    Wang JX, Norman RJ, Kristiansson PK. The effect of various infertility treatments on the risk of preterm birth. Hum Reprod 2002;17:945–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Sundstrom I, Ildgruben A, Hogberg U. Treatment-related and treatment-independent deliveries among infertile couples, a long-term follow-up. Acta Obstet Gynecol Scand 1997;76:238–43.PubMedGoogle Scholar
  32. 32.
    Henriksen TB, Baird DD, Olsen J, Hedegaard M, Secher NJ, Wilcox AJ. Time to pregnancy and preterm delivery. Obstet Gynecol 1997;89:594–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Williams MA, Goldman MB, Mittendorf R, Monson RR. Subfertility and the risk of low birth weight. Fertil Steril 1991;56:668–71.PubMedGoogle Scholar
  34. 34.
    McElrath TF, Wise PH. Fertility therapy and the risk of very low birth weight. Obstet Gynecol 1997;90(4 Pt 1):600–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Baird DD, Wilcox AJ, Kramer MS. Why might infertile couples have problem pregnancies? Lancet 1999;353:1724–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Daniel Y, Schreiber L, Geva E, et al. Do placentae of term singleton pregnancies obtained by assisted reproductive technologies differ from those of spontaneously conceived pregnancies? Hum Reprod 1999;14:1107–10.PubMedCrossRefGoogle Scholar
  37. 37.
    Jauniaux E, Englert Y, Vanesse M, Hiden M, Wilkin P. Pathologic features of placentas from singleton pregnancies obtained by in vitro fertilization and embryo transfer. Obstet Gynecol 1990;76:61–4.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Laura A. Schieve
    • 1
    • 4
    Email author
  • Bruce Cohen
    • 2
  • Angela Nannini
    • 2
    • 3
  • Cynthia Ferre
    • 1
  • Meredith A. Reynolds
    • 1
  • Zi Zhang
    • 2
  • Gary Jeng
    • 1
  • Maurizio Macaluso
    • 1
  • Victoria C. Wright
    • 1
  • Massachusetts Consortium for Assisted Reproductive Technology Epidemiologic Research (MCARTER)
  1. 1.Division of Reproductive Health, National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Massachusetts Department of Public HealthBostonUSA
  3. 3.Northeastern UniversityBostonUSA
  4. 4.National Center on Birth Defects and Developmental DisabilitiesCenters for Disease Control and PreventionAtlantaUSA

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