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

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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.

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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.

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Authors and Affiliations

  1. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Laura A. Schieve, Cynthia Ferre, Meredith A. Reynolds, Gary Jeng, Maurizio Macaluso & Victoria C. Wright

  2. Massachusetts Department of Public Health, Boston, MA, USA

    Bruce Cohen, Angela Nannini & Zi Zhang

  3. Northeastern University, Boston, MA, USA

    Angela Nannini

  4. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Mailstop E-86, 1600 Clifton Road, Atlanta, GA, 30333, USA

    Laura A. Schieve

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  1. Laura A. Schieve
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  2. Bruce Cohen
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  3. Angela Nannini
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  4. Cynthia Ferre
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  5. Meredith A. Reynolds
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  6. Zi Zhang
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  7. Gary Jeng
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  8. Maurizio Macaluso
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  9. Victoria C. Wright
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Consortia

Massachusetts Consortium for Assisted Reproductive Technology Epidemiologic Research (MCARTER)

Corresponding author

Correspondence to Laura A. Schieve.

Additional information

The member clinics of MCARTER are listed in the Acknowledgments.

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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Schieve, L.A., Cohen, B., Nannini, A. et al. A Population-Based Study of Maternal and Perinatal Outcomes Associated with Assisted Reproductive Technology in Massachusetts. Matern Child Health J 11, 517–525 (2007). https://doi.org/10.1007/s10995-007-0202-7

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  • DOI: https://doi.org/10.1007/s10995-007-0202-7

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